How To Get Your Hormone Levels Checked And What To Expect

Getting hormone levels checked starts with a blood test ordered through a healthcare provider or a direct-pay telehealth provider like Marek Diagnostics. For men concerned about testosterone, the American Urological Association (AUA) and Endocrine Society both recommend a specific sequence: a fasting, early-morning total testosterone draw on a reliable assay, repeated on a separate morning, interpreted alongside symptoms and a clinical evaluation (Mulhall et al., 2018; Bhasin et al., 2018). A single number on a lab report is not a diagnosis. Two confirmed low values plus symptoms, after reversible causes have been excluded, form the basis for a clinical diagnosis.

A hormone level test measures the concentration of specific hormones in the blood through a venous draw analyzed at a certified laboratory. For testosterone, clinical guidelines recommend two separate early-morning draws that return consistently low results, with the Endocrine Society additionally recommending a fasting sample, combined with signs or symptoms of deficiency, before a diagnosis is made.

The sections below cover what the test measures, how to prepare, which hormones belong on a panel, and what the results mean.

What Does a Hormone Level Test Measure?

A hormone level test quantifies how much of a given hormone circulates in the blood at the time of the draw. The most common method is a venous blood sample sent to a laboratory for analysis, though some hormones can be measured through saliva or urine under certain circumstances.

What Do Hormones Do in the Body?

Hormones are chemical messengers produced by endocrine glands. They travel through the bloodstream and bind to receptors on target cells, carrying instructions that regulate growth, metabolism, mood, reproduction, and stress response.

Each hormone has a specific job. Melatonin, made by the pineal gland, signals the body to sleep. Insulin, released by the pancreas, responds to blood sugar. Testosterone, produced primarily in the testes, plays a central role in male sexual development and influences muscle mass, bone density, and red blood cell production. These messengers don't work in isolation. A shift in one hormone often changes the behavior of others, which is why a single-hormone test can miss the full picture.

Which Hormones Are Included in a Standard Panel?

The answer depends on the reason for testing and the patient's sex. A men's hormone panel centered on testosterone deficiency typically includes the markers listed below.

Women's panels follow different priorities and typically measure FSH, LH, estradiol, progesterone, and thyroid hormones. The right panel depends on symptoms, age, and reproductive status.

Marek Diagnostics offers testosterone-focused panels that include the markers above, built around the testing protocols described in AUA and Endocrine Society guidelines.

How a Hormone Imbalance Affects the Body

A hormone imbalance occurs when one or more hormones are produced at levels too high or too low for normal function. The effects depend on which hormone is involved and how far the level deviates from the reference range.

Testosterone deficiency in men is associated with reduced libido, fatigue, loss of muscle mass, increased body fat, depressed mood, poor concentration, and erectile dysfunction (Bhasin et al., 2018). Thyroid imbalances can drive unexplained weight changes, heart rate shifts, and temperature sensitivity. Cortisol dysregulation affects sleep, blood pressure, and the immune response.

Hormones operate as a network. An imbalance in one often disrupts others. That interconnection is why a well-selected panel tests multiple hormones at once, not just the one a patient suspects.

How to Get Hormone Levels Checked

The testing process follows a practical sequence. A healthcare provider orders the panel, the patient goes to a laboratory or certified draw site for a venous blood sample, and results are returned (often within a few business days) for clinical interpretation.

For testosterone, both the AUA and Endocrine Society specify that the draw must happen in the early morning (Mulhall et al., 2018; Bhasin et al., 2018). The Endocrine Society recommends a fasting morning draw. Clinical practice typically targets 8 to 10 a.m., when testosterone is at its daily peak. An afternoon draw can sit well below the morning value in men who still have a normal daily rhythm, enough to push a result below the 300 ng/dL line and trigger a false classification.

Three options exist for ordering the test. A primary care physician can write the lab order. A specialist (endocrinologist or urologist) can do the same. Or a direct-pay telehealth provider can order the panel without an insurance referral. Marek Diagnostics follows this last model: patients choose a lab panel, complete the draw at a local laboratory, and receive results for review with a provider.

Preparation matters. Fasting is recommended, water is fine, and prepping for blood work ahead of the draw helps produce accurate results. Acute illness, recent intense exercise, sleep deprivation, and certain medications can all suppress testosterone temporarily. Testing during those states can generate misleading values.

Why Does the Testing Method Matter?

Not all testosterone assays produce the same number from the same blood sample. Immunoassays and liquid chromatography-tandem mass spectrometry (LC-MS/MS) can disagree at low concentrations near diagnostic thresholds, where the gap between methods matters most.

The CDC runs the Hormone Standardization Program (HoSt), which certifies total testosterone assays to within plus or minus 6.4% mean bias versus the CDC reference method (CDC, 2026). Labs using a certified assay produce more consistent results than those using uncertified immunoassays, and the Endocrine Society recommends accurate, reliable assays as a condition for diagnosis (Bhasin et al., 2018).

This distinction matters in practice. A man whose total testosterone comes back at 310 ng/dL on one method might register at 280 ng/dL on another. That difference crosses the AUA's 300 ng/dL cut-off and changes whether the result is flagged. The guideline-level advice: repeat the test on the same assay, at the same laboratory, on a different morning. A mass spectrometry test provides the accuracy benchmark used in modern clinical research, including the NHANES sex-steroid analyses.

At-home fingerstick kits and saliva tests are not the diagnostic standard in AUA or Endocrine Society guidelines. A low result from a consumer kit is a reason to schedule a proper venous draw, not a reason to start a Schedule III medication.

What Causes Hormone Levels to Shift?

Hormone levels change in response to aging, illness, weight, stress, medications, sleep patterns, and genetic factors. Some shifts are expected; others signal a problem that testing can identify.

Testosterone declines an estimated 1.6% per year after age 40 in longitudinal population data, though cross-sectional estimates are lower and individual trajectories vary considerably (Feldman et al., 2002). But age alone doesn't explain every low result. Obesity lowers SHBG and can drop total testosterone without the same change in free testosterone. Opioid medications, chronic corticosteroids, and certain anticonvulsants suppress the pituitary signals that drive testosterone production. Pituitary tumors, testicular injury, and genetic conditions like Klinefelter syndrome cause deficiency at any age.

Signs of a Hormone Imbalance

Symptoms vary by which hormone is affected. For testosterone deficiency, clinically associated signs may include reduced libido, erectile dysfunction, fatigue, loss of muscle mass, increased body fat, depressed mood, reduced motivation, poor concentration, and impaired memory (Bhasin et al., 2018). These symptoms overlap with other conditions and are not specific to testosterone deficiency.

Thyroid imbalances can produce overlapping symptoms: fatigue, weight changes, hair loss, heart rate shifts, and temperature sensitivity. Cortisol dysregulation adds anxiety, sleep disruption, and digestive changes. Because symptoms overlap across hormone types, blood testing is the primary way to determine which hormone is involved.

The presence of symptoms alone doesn't confirm a deficiency. The AUA and Endocrine Society both recommend documented low levels on repeated blood draws plus clinical signs before a diagnosis is made.

How Men and Women Experience Imbalances Differently

Men and women share some hormones (testosterone, estrogen, cortisol, thyroid hormones) but at different concentrations and with different clinical effects.

In women, hormonal changes tied to the menstrual cycle, pregnancy, and menopause produce symptoms that don't have a male equivalent: irregular periods, hot flashes, vaginal dryness, and shifts in reproductive hormone ratios. Testing in women often centers on FSH, LH, estradiol, progesterone, and thyroid markers.

In men, testosterone deficiency is the most commonly tested hormonal problem. The diagnostic pathway is specific: two early-morning fasting total testosterone values below 300 ng/dL (AUA cut-off), with symptoms, confirmed on a reliable assay, plus LH to determine the cause (Mulhall et al., 2018). Guidelines also recommend hematocrit, PSA (if over 40), and a fertility conversation before any testosterone prescription. When the initial total testosterone result is borderline, a total and free testosterone panel measured by equilibrium dialysis can clarify whether free testosterone is also low.

A sex hormone panel can cover multiple markers in a single draw, reducing the need for repeat visits.

Hormone Changes in Adolescence and Early Adulthood

Hormonal shifts are expected during puberty, when sex hormones are first produced in meaningful quantities. In boys, testosterone drives voice deepening, muscle development, and body hair growth. In girls, estrogen and progesterone drive breast development, menstruation, and growth spurts.

When these changes don't happen on a typical timeline, hypogonadism may be the cause. In boys, this can mean delayed puberty, underdeveloped sex organs, or breast tissue growth. In girls, absent menstruation or lack of breast development can signal the same condition.

Hypogonadism in younger patients may originate in the gonads themselves (primary) or in the pituitary gland and hypothalamus (secondary). Testing follows the same principles: morning blood draws, repeat confirmation, and a workup that includes LH and FSH to locate the problem. A pediatric endocrinologist is typically the appropriate specialist, though the referral may depend on the clinical presentation.

Why Cortisol Testing May Be Part of the Workup

Cortisol is a steroid hormone produced by the adrenal glands in response to stress. It regulates blood pressure, blood sugar, immune function, and the sleep-wake cycle. When a patient reports persistent fatigue, unexplained weight changes, or chronic stress alongside other hormonal symptoms, cortisol testing may be ordered alongside testosterone and thyroid markers.

What Happens When Cortisol Stays Too High or Too Low

When the stress response system works normally, cortisol rises in response to a threat, triggers a burst of energy and alertness by increasing heart rate, blood pressure, and blood glucose, and then falls back to baseline once the situation passes.

Chronic stress can alter that cycle. In some individuals, the result is prolonged cortisol elevation; in others, a flattened daily rhythm. Either pattern may contribute to anxiety, weight gain around the midsection, sleep disruption, digestive problems, and impaired concentration. Over time, altered cortisol patterns are associated with cardiovascular strain and immune suppression.

High cortisol can result from chronic psychological stress, pituitary gland abnormalities (including tumors that produce excess ACTH), adrenal gland tumors, or long-term use of corticosteroid medications.

Low cortisol creates a different set of problems: chronic fatigue, muscle weakness, weight loss, low blood pressure, hypoglycemia, irritability, and abdominal pain. Addison's disease (primary adrenal insufficiency) is the most recognized cause. It occurs when the adrenal glands are damaged, most often by autoimmune activity, and can no longer produce adequate cortisol. Secondary adrenal insufficiency, where the pituitary fails to release enough ACTH, can follow head trauma, pituitary tumors, or prolonged steroid use.

Neither extreme is something to self-diagnose. Testing confirms the level, and a clinical evaluation identifies the cause.

How Cortisol Levels Are Tested

Cortisol is measured through blood draws, saliva samples, or 24-hour urine collection. Blood draws are typically done in the early morning, when cortisol is at its daily peak, and repeated in the afternoon to capture the daily decline. Saliva testing is sometimes used for late-night cortisol, which helps screen for Cushing's syndrome.

ACTH (adrenocorticotropic hormone) is often tested alongside cortisol to determine whether the adrenal or pituitary gland is the source of the problem. If results fall outside normal ranges, follow-up imaging or stimulation testing may be needed to identify the underlying cause.

The pattern is the same across all hormone testing: a single out-of-range result is a starting point, not a conclusion. Repeat testing, clinical context, and provider interpretation separate a real condition from a lab fluctuation.

Getting hormone levels checked is a structured process, not a guessing game. A repeated morning fasting blood draw, analyzed on a certified assay and interpreted alongside a clinical evaluation, helps distinguish a clinically meaningful deficiency from a lab fluctuation. Marek Diagnostics offers panels built around the testing protocols described in AUA and Endocrine Society guidelines, including a pre-TRT panel that covers the baseline labs both guidelines call for.

Disclaimer: This blog post is intended for informational purposes only and should not be considered medical advice. Always consult a healthcare professional before making changes to your health routine.

FAQs

Do I need two blood tests to check my testosterone levels? 

Yes. The AUA recommends two early-morning total testosterone measurements on separate days before a diagnosis of low testosterone is made (Mulhall et al., 2018). This is a Strong Recommendation based on Grade A evidence. A single low result could reflect a temporary dip from illness, poor sleep, or an afternoon draw. Repeating the test on a different morning confirms whether the low value is consistent.

What time of day should I get hormone levels checked? 

Early morning, between 8 and 10 a.m. Testosterone follows a daily rhythm and peaks in the morning hours. An afternoon draw can return a value well below the morning level in men with a normal daily cycle. The Endocrine Society specifies a fasting morning draw as the initial diagnostic test (Bhasin et al., 2018).

What is considered a low testosterone level? 

The AUA uses total testosterone below 300 ng/dL as a reasonable diagnostic cut-off, combined with symptoms (Mulhall et al., 2018). The Endocrine Society defines it as "unequivocally and consistently low" on an accurate assay rather than naming a single number (Bhasin et al., 2018). A lab's reference range flag is not the same as a clinical decision. Borderline results (near 300 ng/dL) may require free testosterone testing to clarify the picture.

Can I use an at-home test to check hormone levels? 

At-home fingerstick and saliva kits are not the diagnostic standard in AUA or Endocrine Society guidelines (Mulhall et al., 2018; Bhasin et al., 2018). These tests can provide a general indication, but they don't meet the accuracy requirements for diagnosing a deficiency or starting a controlled medication. A low at-home result is a reason to schedule a proper venous blood draw, not a basis for treatment decisions.

Should I test free testosterone or total testosterone? 

Start with total testosterone. Free testosterone should be added when total testosterone is near the lower limit of normal or when a condition alters SHBG. Obesity lowers SHBG and can make total testosterone appear low while free testosterone remains adequate. Aging and hyperthyroidism raise SHBG and can mask a free testosterone deficit behind a normal total number. The Endocrine Society recommends free testosterone measurement by equilibrium dialysis or a validated calculation formula (Bhasin et al., 2018).

What other hormones should be tested alongside testosterone? 

At minimum: LH (to determine whether low testosterone originates in the testes or the pituitary), prolactin (if LH is low or low-normal), hematocrit (recommended before any testosterone prescription per AUA guidelines), and PSA in men over 40 (Mulhall et al., 2018). SHBG and free testosterone are added when indicated. A metabolic panel (fasting glucose, lipids) provides context on why testosterone may be low and whether therapy carries additional risk.

Can hormone levels be tested through telehealth? 

Yes, under specific conditions. As of this writing, the DEA's Fourth Temporary Extension (effective January 1, 2026 through December 31, 2026) allows licensed practitioners to prescribe Schedule III medications via audio-video telemedicine without a prior in-person visit, when all other legal conditions are met. These rules carry defined expiration dates, so providers and patients should confirm current federal and state policy at the time of care. State law can be stricter than the federal rule. A telehealth evaluation still requires lab confirmation and a documented medical purpose. Online access to testing does not mean access without bloodwork or evaluation.

References

• J Urol. 2018;200(2):423-432

• JCEM. 2018;103(5):1715-1744

• JCEM. 2002;87(2):589-598

• CDC. Hormone Standardization (HoSt). Updated 2026