Ask most primary care physicians to run a hormonal panel and you'll get a TSH test — a single thyroid marker. If you're lucky, you might get a free T4 alongside it. For most people, that's where hormonal investigation ends.
This is a significant gap. Hormones regulate metabolism, mood, energy, body composition, sleep, cognition, bone density, and cardiovascular risk. They interact with each other in complex ways. And their levels shift meaningfully in the decade between 35 and 45 — often before symptoms become obvious enough to prompt investigation.
What a full hormonal baseline includes
A comprehensive hormonal assessment covers several distinct axes:
The thyroid axis
TSH (thyroid stimulating hormone) is the standard screening marker, but it's a blunt instrument. TSH reflects pituitary signalling, not actual thyroid output. Two people can have identical TSH levels with very different free T3 and free T4 — the active hormones that cells actually use.
Subclinical hypothyroidism (elevated TSH with normal T4) is common and associated with fatigue, weight gain, cognitive fog, and cardiovascular risk. But without free T3, free T4, and — in some cases — thyroid antibodies (anti-TPO, anti-Tg), the picture is incomplete.
The sex hormone axis
For men, the key markers are:
- Total testosterone: the headline number, but not the whole story - Free testosterone: the fraction not bound to SHBG that's actually bioavailable to cells - SHBG (sex hormone binding globulin): when SHBG is high, free testosterone falls even if total testosterone is normal - LH and FSH: signals from the pituitary that indicate whether low testosterone is primary (testicular) or secondary (pituitary/hypothalamic) - Estradiol: men convert testosterone to estrogen; elevated estradiol is common and relevant to body composition, mood, and bone health - DHEA-S: an adrenal androgen that declines with age and acts as a precursor to both testosterone and estrogen
For women, particularly in the perimenopausal transition, the picture is different but equally underinvestigated. FSH, estradiol, and progesterone levels shift considerably across the cycle and across the decade of perimenopause. AMH (anti-Müllerian hormone) reflects ovarian reserve. Testosterone and DHEA-S are relevant for energy and libido in women, not just men.
The adrenal and stress axis
Cortisol — measured in the morning, ideally — reflects adrenal output and the HPA axis stress response. Chronic stress dysregulates cortisol patterns in ways that affect sleep, weight, blood sugar, and immune function. A single fasting morning measurement is imperfect, but it's a starting point.
DHEA-S, produced by the adrenal glands, declines with age and serves as a useful marker of adrenal ageing alongside cortisol.
What "normal" hides
As with other markers, hormonal reference ranges are set from population distributions — not from optimal function. A 50-year-old man with testosterone at the bottom of the reference range is technically "normal." He may also be experiencing fatigue, reduced muscle mass, poor sleep, and declining mood — all attributable to low-normal testosterone.
The question isn't just "are you within range?" It's "where are you relative to where you were, and where is your trajectory going?"
Annual hormonal testing as a trend
Hormonal profiles are best read as trends rather than snapshots. A single cortisol measurement tells you something. The same measurement a year later, after a significant lifestyle change, tells you more.
This is why foreverbetter includes a full hormonal panel — thyroid, sex hormones, adrenal markers — in every annual draw. Not to diagnose hormonal disorders, but to establish a personal baseline and track it over time.