Male Hormones Interpreter

In men: Low testosterone is most commonly caused by aging and excess weight.

Other causes: primary hypogonadism (Klinefelter syndrome, testicular injury, orchitis), secondary hypogonadism (pituitary/hypothalamic dysfunction, hyperprolactinemia), chronic opioid or glucocorticoid use, obstructive sleep apnea, and chronic illness.

In women: menopause, ovarian or adrenal insufficiency, pelvic radiation, hysterectomy or oophorectomy, and several medications, including glucocorticoids, oral contraceptives, and thyroxine.

In men: Exogenous testosterone (TRT, anabolic steroids) is the most common cause of high total testosterone. Endogenous causes include androgen-secreting testicular or adrenal tumors, congenital adrenal hyperplasia, and conditions such as hyperthyroidism that can raise SHBG and increase total testosterone without necessarily increasing free testosterone.

In women: PCOS is the most common cause of androgen excess and may cause elevated testosterone. Other causes include nonclassic or classic congenital adrenal hyperplasia, androgen-secreting ovarian or adrenal tumors, Cushing syndrome, ovarian hyperthecosis, and exogenous androgen use.

Low free testosterone with inappropriately normal total testosterone suggests reduced bioavailable testosterone, most often seen with high SHBG. In men, this pattern may still be consistent with androgen deficiency if symptoms are present.

Low free testosterone with low total testosterone suggests true androgen deficiency / hypogonadism.

In men, low free testosterone is associated with late-onset hypogonadism, chronic opioid use, type 2 diabetes, metabolic syndrome, reduced muscle mass, poorer physical function, and worse self-rated health.

High calculated free testosterone is seen with androgen excess, most commonly PCOS in women and exogenous testosterone / anabolic steroid use in men.

In women, it is associated with hirsutism, acne, ovulatory dysfunction, and metabolic abnormalities. Less common causes include congenital adrenal hyperplasia, ovarian hyperthecosis, Cushing syndrome, and androgen-secreting ovarian or adrenal tumors.

In men, persistent elevation should prompt review of testosterone use or supplement exposure; rarer endogenous causes include testicular or adrenal androgen-secreting tumors.

Low LH usually suggests reduced hypothalamic or pituitary drive, especially when sex steroid levels are also low. Causes include hypothalamic-pituitary disorders, hyperprolactinemia, functional suppression from undernutrition, excessive exercise / low energy availability, severe stress or systemic illness, and suppressive medications or exogenous androgens. In men, low or inappropriately normal LH with low testosterone suggests secondary hypogonadism.

High LH usually reflects reduced gonadal feedback.

In men, it suggests primary testicular dysfunction when testosterone is low, and may indicate compensated / subclinical primary hypogonadism when testosterone is still normal. Causes include Klinefelter syndrome, orchitis, testicular injury, chemotherapy or radiation, and anorchia.

In women, LH must be interpreted in the context of cycle phase and menopausal status: it normally rises around ovulation and is commonly elevated after menopause. Persistently high LH outside the expected physiologic setting may be seen with reduced ovarian function, including primary ovarian insufficiency; PCOS may show relatively increased LH, but LH:FSH ratio is not a diagnostic criterion on its own.

Low FSH usually suggests reduced hypothalamic or pituitary drive.

In men, it may be seen with secondary hypogonadism and can impair spermatogenesis and fertility.

In women, it may be seen with hypothalamic or pituitary dysfunction, caloric deficit, low body weight, excessive exercise, and functional hypothalamic amenorrhea.

High FSH usually reflects reduced gonadal feedback.

In men, it is seen with primary testicular dysfunction or impaired spermatogenesis.

In women, it rises physiologically with perimenopause and menopause, and outside that setting may suggest primary ovarian insufficiency, ovarian failure, or Turner syndrome.

In men: Low estradiol is seen with low testosterone / reduced aromatization, aromatase inhibitor therapy, and androgen deprivation therapy. It may contribute to reduced libido, vasomotor symptoms, and bone loss.

In women: Low estradiol is seen with menopause, primary ovarian insufficiency, functional hypothalamic amenorrhea / low energy availability, hypopituitarism, and aromatase inhibitor therapy. In premenopausal women, results should be interpreted in the context of cycle phase.

In men: High estradiol is seen with obesity / increased aromatization, liver cirrhosis, hyperthyroidism, and estrogen-producing testicular or adrenal tumors. It may be associated with gynecomastia and sexual dysfunction.

In women: High estradiol is seen physiologically in pregnancy and around ovulation, and can also occur with ovulation induction or estrogen therapy, estrogen-secreting ovarian or adrenal tumors, liver disease, and hyperthyroidism.

Low prolactin is uncommon and usually reflects dopamine agonist use (for example cabergoline or bromocriptine) or hypothalamic-pituitary dysfunction / broader anterior pituitary insufficiency.

Very low prolactin has also been associated in observational studies with insulin resistance, metabolic syndrome, and visceral adiposity.

Elevated prolactin is commonly caused by prolactinoma, medications (especially antipsychotics, metoclopramide, antidepressants, opioids, methyldopa, and some calcium-channel blockers), hypothyroidism, and pregnancy/lactation.

Prolactin can also rise transiently with stress, sleep, exercise, sex, nipple stimulation, and chest wall stimulation or injury. Other causes include pituitary stalk lesions, chronic kidney disease, and liver disease.

In men, low TT:E2 is seen in obesity/metabolic syndrome, worse sexual function, more inflammatory and unstable atherosclerotic plaque and worse CVD outcomes.

In men, high TT:E2 is seen in relative estrogen-deficiency states (classically with aromatase inhibition or rare aromatase deficiency), and while sometimes discussed as “favorable” for spermatogenesis in infertility contexts, extremes may trade off against outcomes like bone density and possibly cerebrovascular risk.

Low SHBG is commonly associated with insulin resistance, obesity and smoking.

It is also seen with hypothyroidism, PCOS (in women), Cushing syndrome, and androgen exposure such as anabolic steroids or other exogenous androgens.

High SHBG is associated with aging, hyperthyroidism, liver disease (especially cirrhosis), eating disorders or malnutrition, and estrogen-containing medications.

Higher SHBG lowers the free fraction of testosterone, so some patients may have hypogonadal symptoms despite a normal total testosterone level.

Low albumin is primarily a consequence of illness rather than a cause, and it serves as a late-stage indicator of inflammation. It is frequently observed in chronic or persistent inflammatory states.

Low albumin is also associated with liver disease, kidney disease, diabetes, heart failure, fluid overload, advanced malnutrition (particularly from protein deficiency or malabsorption), severe burns, and occasionally cancer.

Elevated albumin levels occur with dehydration (commonly due to vomiting or diarrhea) and insulin resistance.