Home›FSH-LH-Prolactin-TSH

Content created by

Written by

BDS, MDS - Oral and Maxillofacial Pathology

Reviewed by

Dr. Ashish Ranjan

MBBS, MD (Pharmacology)

Want to know more?
Read our Editorial Policy

FSH-LH-Prolactin-TSH

FSH-LH-Prolactin-TSH Includes 4 testsView All

This test is for

Male, Female

Test Preparation

Do not eat or drink anything other than water for 8-12 hours before the test
In females, preferred sampling time is day 2 or 3 of menstrual cycle.

Understanding FSH-LH-Prolactin-TSH

What is FSH-LH-Prolactin-TSH?

FSH-LH-Prolactin-TSH is a group of tests which help in evaluating the functioning of reproductive organs in both males & females. It includes four tests: FSH (Follicle stimulating hormone), LH (Luteinizing hormone), Prolactin, and TSH (Thyroid stimulating hormone) test for checking the level of most important hormones in the body. These tests help in finding the cause of erectile dysfunction, delayed puberty, thyroid disorders, irregular menstruation, loss of libido, abnormal breast milk discharge and more.

What is FSH-LH-Prolactin-TSH used for?

To evaluate the function of reproductive organs (ovaries or testicles)
To evaluate infertility issues in females
To evaluate the role of prolactin in case of lactation failure in women after childbirth
To assess the irregular menstrual cycle in women
To investigate the cause of abnormal breast milk discharge (galactorrhea), menstrual irregularities, or infertility in non-pregnant women
To diagnose disorders of the pituitary gland or diseases involving the ovaries in women
To evaluate early or delayed sexual maturation (puberty) in children
To evaluate low sperm count in men
To assess hypogonadism or gonadal failure in men
To assess testicular dysfunction in men
To investigate the cause of erection problems, testicular failure, or abnormal breast discharge in men
To investigate the cause of loss of sex drive (libido) in both men and women
To detect and monitor the progress of prolactinoma (tumor of the pituitary gland which increases the levels of prolactin) in both men and women
To diagnose any suspected thyroid diseases (Hypothyroidism or Hyperthyroidism)
To monitor the effect of treatment in patients with thyroid diseases
To screen for any thyroid diseases during pregnancy
To screen for any thyroid diseases in newborns
To plan treatment for problems in females like irregular periods, weight gain, vaginal discharge, breast secretions, etc.

What does FSH-LH-Prolactin-TSH measure?

Contains 4 tests

FSH, LH, Prolactin, and TSH are the four key reproductive hormones which play an important role in reproduction. These tests are done to analyze any hormonal changes which may cause infertility.

Follicle-stimulating hormone (FSH): This hormone is associated with reproduction and the development of eggs in women and sperm in men. FSH is produced by the pituitary gland, and its production is controlled by a feedback system involving the hypothalamus in the brain, the pituitary gland, and the hormones produced by the ovaries or testicles. The Gonadotropin-releasing hormone (GnRH) from the hypothalamus stimulates the pituitary gland to release FSH and luteinizing hormone (LH; another closely-related hormone also involved in reproduction). FSH affects the growth and maturation of egg follicles in the ovaries during the follicular phase of the menstrual cycle. The menstrual cycle is divided into follicular and luteal phases, each phase lasting for 14 days. During the follicular phase, FSH initiates the production of estradiol by the follicle, and the two hormones work together in the further development of the egg follicle. Near the end of the follicular phase, the production of FSH and luteinizing hormone increases. The release of the egg from the ovary (ovulation) occurs shortly after this increased production of hormones. The hormone inhibin as well as estradiol and progesterone help in controlling the amount of FSH released by the pituitary gland. FSH also facilitates the ability of the ovary to respond to LH. At menopause, ovarian function decreases and eventually stops which results in increased levels of FSH and LH.

In males, the role of FSH is to stimulate the testicles to produce mature sperms and also to promote the production of androgen binding proteins. FSH levels are relatively constant in men after puberty than in women.

In infants and children, FSH levels rise shortly after birth and then fall to very low levels. Generally, in boys, these levels decrease by 6 months and in girls, they take about 1-2 years. These concentrations rise again before the beginning of puberty and the development of secondary sexual characteristics.

Disorders affecting the hypothalamus, pituitary, and/or the ovaries or testicles can cause abnormal production of FSH (too much or too little). This, as a result, can cause conditions such as infertility, abnormal menstrual cycles, or early (precocious) or delayed sexual maturation (puberty).

Luteinizing hormone (LH): This hormone is associated with reproduction and ovulation. In females, it stimulates the release of an egg from the ovary. However, in males, testosterone production is dependent on LH. This test helps in measuring the amount of LH present in the blood.

Just like FSH, LH is produced by the pituitary gland, and its production is controlled by the hypothalamus, pituitary gland, and the hormones produced by the ovaries (in women) or testicles (in men).

In premenopausal women, LH stimulates ovulation and the production of other hormones, namely, estradiol and progesterone. The menstrual cycle is divided into 2 phases, follicular and luteal phases, each of these last for about 14 days. Near the end of the follicular phase, there is a mid-cycle increase in follicle-stimulating hormone (FSH) and LH. This triggers ovulation. During the luteal phase, LH secretion stimulates the corpus luteum to start producing progesterone. At this point, the levels of FSH and LH get reduced, while progesterone and estradiol concentrations rise. If the egg is not fertilized, then the levels of these hormones fall after several days followed by the beginning of the next menstrual cycle. With the onset of menopause ovarian function reduces and eventually discontinues, which results in increased levels of FSH and LH.

In men, LH stimulates Leydig cells in the testicles to produce testosterone. However, the levels of LH remain relatively constant in men after puberty. Due to high levels of testosterone, the pituitary gland and the hypothalamus receives negative feedback which in turn decreases the secretion of LH hormone.

In infants and children, LH levels rise shortly after birth and then fall to very low levels, which is about 6 months in boys and 1-2 years in girls. At about 6-8 years of age, levels again rise before the beginning of puberty and secondary sexual characteristics development.

Prolactin hormone: It is produced by the pituitary gland which is located at the base of the brain. The secretion of this hormone is controlled by the hypothalamus. The primary function of this hormone is to help in the production of milk after childbirth (lactation). Prolactin levels are usually high during pregnancy and after childbirth. During pregnancy, this hormone along with other hormones like estrogen and progesterone stimulates the breasts for milk production. After the childbirth, it helps to maintain breast milk production. Suckling of the breast by the baby is important for the release of prolactin hormone. If a woman stops breastfeeding, the level of prolactin hormone will return to normal.

Abnormally high levels of prolactin are seen in certain disease conditions like prolactinoma (non-cancerous tumor of the pituitary gland) in men and women. Prolactinomas are generally benign (non-cancerous) in nature and are seen more commonly in women. If the tumor is quite large, it can put pressure on the optic nerve and can cause headaches and visual disturbances.

High levels of prolactin are also seen in patients with diseases of the hypothalamus (located in the brain), other pituitary gland disorders and tumors, kidney disease, liver disease, hypothyroidism, polycystic ovary syndrome (PCOD) and conditions like anorexia nervosa (eating disorder).

Low levels of prolactin are seen in patients with pseudohypoparathyroidism, patients taking bromocriptine and in conditions of pituitary deficiency like necrosis or infarction of the pituitary gland.

Thyroid Stimulating Hormone (TSH): TSH is developed in the pituitary gland. There is a feedback system in the body to maintain stable amounts of the thyroid hormones (T3 and T4) in the blood. TSH signals the thyroid gland to make and release thyroid hormones (T3 and T4) into the blood when the level of thyroid hormones is low and can also signal the thyroid gland to lower the production of thyroid hormones when the level of thyroid hormones is very high. So, when the thyroid hormone (T3 and T4) levels decrease, the pituitary gland is stimulated to release TSH and this high TSH levels, in turn, stimulates the thyroid gland to release more thyroid hormone (T3 and T4) from the thyroid gland and the vice-versa happens when the thyroid hormone levels are very high.

In case of hyperthyroidism, the thyroid gland produces very high amounts of thyroid hormones (T3 and T4) and you may experience symptoms of weight loss, rapid heartbeat, tremors, sweating, anxiety, increased sensitivity to heat, etc. In the case of Hypothyroidism, there is a decreased production of thyroid hormones (T3 and T4) which may cause symptoms like weight gain, fatigue, slow heart rate, increased sensitivity to cold, depression, dry and thin hair, etc.

Follicle Stimulating Hormone

Luteinising Hormone

Interpreting FSH-LH-Prolactin-TSH results

Interpretations

Reference range of FSH is age- and gender-specific. As for women, the reference range is menstrual cycle phase-specific.

The reference range for follicle-stimulating hormone (FSH) is as follows (3rd generation immunochemiluminescence assay):

Females

· Age 0-7 years: <6.7 mIU/mL

· Age 8 years to adult:

· Follicular phase: 3.1-7.9 mIU/mL

· Ovulation peak: 2.3-18.5 mIU/mL

· Luteal phase: 1.4-5.5 mIU/mL

· Postmenopausal: 30.6-106.3 mIU/mL

Males

· Age 0-7 years: <6.7 mIU/mL

· Age 8 years-adult:1.3-19.3 mIU/mL

The following values are considered to be normal, LH blood levels measured in international units per liter (IU/L):

Women:

· Follicular phase of the menstrual cycle: 1.9 to 12.5 IU/L

· LH surge: 8.7 to 76.3 IU/L

· Luteal phase of the menstrual cycle: 0.5 to 16.9 IU/L

· Pregnancy: less than 1.5 IU/L

· Post-menopause: 15.9 to 54.0 IU/L

· Women using contraceptives: 0.7 to 5.6 IU/L

Men:

· Age group of 20 and 70 years: 0.7 to 7.9 IU/L

· >70 years of age: 3.1 to 34.0 IU/L

The following values are considered to be normal, prolactin blood levels measured in international units per liter (ng/mL):

Patients (Age) Reference Range(s)

Males ≤ 18 Years
Tanner Stage 1 (< 9.8 Years) Tanner Stage 2 (9.8 - 14.5 Years) Tanner Stage 3 (10.7 - 15.4 Years) Tanner Stage 4 (11.8 - 16.2 Years) Tanner Stage 5 (12.8 - 17.3 Years) Males > 18 Years	< 10 ng/mL < 6.1 ng/mL < 6.1 ng/mL 2.8 - 11.0 ng/mL 2.8 - 11.0 ng/mL 2.10 - 17.70 ng/mL
In Females ≤ 18 Years
Tanner Stage I (< 9.2 Years)	3.6 - 12.0 ng/mL
Tanner Stage 2 (9.2 - 13.7 Years)	2.6 - 18.0 ng/mL
Tanner Stage 3 (10 - 14.4 Years)	2.6 - 18.0 ng/mL
Tanner Stage 4 (10.7 - 15.6 Years)	3.2 - 20.0 ng/mL
Tanner Stage 5 (11.8 - 18.6 Years)	3.2 - 20.0 ng/mL
Adult Females Non Pregnant	2.80 - 29.20 ng/mL
Pregnant Post Menopausal	9.70 - 208.50 ng/mL 1.80 - 20.30 ng/mL

The following values are considered to be normal, TSH blood levels measured in international units per liter (mIU/L):

Patients (Age) Reference Range(s)

Premature Infants (28-36 Weeks)
1st Week of Life	0.20-27.90 mIU/L
Term Infants (>37 Weeks)
Serum or Cord Blood	1.00-39.00 mIU/L
1-2 Days	3.20-34.60 mIU/L
3-4 Days	0.70-15.40 mIU/L
5 Days-4 Weeks	1.70-9.10 mIU/L
1-11 Months	0.80-8.20 mIU/L
1-19 Years	0.50-4.30 mIU/L
≥20 Years	0.40-4.50 mIU/L
Pregnancy
First Trimester	0.26-2.66 mIU/L
Second Trimester	0.55-2.73 mIU/L
Third Trimester	0.43-2.91 mIU/L

Low TSH level than normal reference range indicates hyperthyroidism.

High TSH level than normal reference range indicates hypothyroidism.

Note: TSH levels show circadian variation (fluctuates during the 24-hour cycle), reaching peak levels between 2-4 am and are at a low between 6-10 pm.

Reference range may vary from lab to lab*

Answers to Patient Concerns & Frequently Asked Questions (FAQs) about FSH-LH-Prolactin-TSH

Frequently Asked Questions about FSH-LH-Prolactin-TSH

Q. Are there any foods which can increase the levels of prolactin?

Yes, foods such as barley (jau), fennel (saunf) and fenugreek (methi) seeds, oats, whole wheat, brown rice, and papaya can increase the levels of prolactin. These foods are considered to be helpful in milk production in new mothers.

Q. Are there any foods which can decrease the levels of prolactin?

Yes, foods rich in vitamin B6 like bananas, potatoes, chicken or spinach, foods rich in zinc (e.g., beef, turkey, beans, shellfish) and zinc supplements can decrease the prolactin levels.

Q. Which factors can affect the FSH level?

The levels of FSH can get affected by conditions like uncontrolled thyroid disease, sex-dependent hormone tumors, ovarian cysts, and unusual vaginal bleeding. Moreover, medicines like birth control pills, cimetidine, clomiphene, digitalis, levodopa, phenothiazines as well as medicines used in hormone replacement therapies can also affect the levels. Similarly, medicines used in hormone replacement therapies can also alter the FSH levels. Multivitamins containing biotin or vitamin B7 may also affect the accuracy of the FSH test. It is generally advised that a woman should avoid taking these supplements for at least 12 hours before a test.

Q. What do high levels of FSH indicate?

High levels of FSH can indicate loss of ovarian function or ovarian failure, menopause, polycystic ovarian syndrome, chromosomal abnormalities (e.g., Turner’s syndrome), and reduction in the production of good quality eggs and embryos for fertilization.

Q. What are the causes of high levels of FSH in Men?

High levels of FSH in men may indicate Klinefelter’s syndrome, absence of testicles or impaired functioning of testicles, damage to testicles by a disease such as alcohol dependence, and testicular damage by treatments such as X-rays or chemotherapy.

Q. What are the causes of high levels of FSH in Children?

The start of puberty might be the cause for high levels of FSH in children.

Q. What do low levels of FSH mean?

Low levels of FSH may indicate decreased ovulation in women, reduced sperm count in men, problems at the level of the hypothalamus or pituitary gland, which are the hormone control centers in the brain, and stress.

Q. Can medicines have any effect on the levels of FSH?

There are certain medicines that can affect the levels of FSH. In order to prevent false readings, it is important for the individual to inform the doctor about all the medicines they are taking as they can alter the functioning of hormones. Medicines that could increase FSH levels include cimetidine, clomiphene, digitalis, and levodopa. Whereas, medicines that decrease FSH levels include hormone replacement therapies, oral contraceptives, and phenothiazines. Taking multivitamins that contain biotin or vitamin B7 may also affect the accuracy of the FSH test. Doctors usually recommend that a woman should not take these supplements for at least 12 hours before a test.

Q. Can levels of FSH vary during different days of the menstrual cycle?

Yes, the FSH level can vary during the different phases of the menstrual cycle. Following are the normal range during different phases: Follicular phase: 3.1-7.9 mIU/ML Ovulation phase: 2.3-18.5 mIU/mL Luteal phase: 1.4-5.5 mIU/mL FSH levels can vary not only throughout the menstrual cycle but also from cycle to cycle. You can get a normal test value one month and an abnormal test value the next. Hence, to test basic fertility and to evaluate ovarian reserves, the FSH level is checked on day 3 of the menstrual cycle. The first day of the cycle is the day when the period begins. Reference range may vary from lab to lab* l range during different phases: Follicular phase: 3.1-7.9 mIU/ML Ovulation phase: 2.3-18.5 mIU/mL Luteal phase: 1.4-5.5 mIU/mL FSH levels can vary not only throughout the menstrual cycle but also from cycle to cycle. You can get a normal test value one month and an abnormal test value the next. Hence, to test basic fertility and to evaluate ovarian reserves, the FSH level is checked on day 3 of the menstrual cycle. The first day of the cycle is the day when the period begins. Reference range may vary from lab to lab*

Q. How LH test results are interpreted in women?

In women, there are two types of ovarian failure, primary and secondary. This test helps to analyze LH and FSH levels which can in turn help to differentiate between the two types of ovarian failure. Primary ovarian failure is when the problem is within the ovaries or there is a lack of ovarian development. However, secondary ovarian failure occurs due to disorders of either the pituitary gland or the hypothalamus. Primary ovarian failure: In this, the levels of LH and FSH rise. The following can be some causes of primary ovarian failure: · Developmental defects: Failure to develop ovaries (ovarian agenesis) · Chromosomal abnormality: Turner syndrome · Defect in steroid production by the ovaries such as 17 alpha-hydroxylase deficiency · Premature ovarian failure due to exposure to radiation, chemotherapy, and autoimmune disease · Chronic failure to ovulate (anovulation) due to polycystic ovary syndrome (PCOS), adrenal disease, thyroid disease, and ovarian tumor · Menopause: In this, a woman's ovaries cease to function; thus, it results in increased levels of LH. Secondary ovarian failure: In this, low levels of LH and FSH are observed which indicates a problem with the pituitary gland or hypothalamus. Here, LH response to GnRH can help differentiate between secondary dysfunction and tertiary disorder (a problem involving the hypothalamus). Following baseline level of LH measurement, a dose of GnRH is given by injection. A subsequent increase in LH level shows that the pituitary gland responded to the GnRH and indicates a disorder involving the hypothalamus. However, a reduced level of LH shows that the pituitary gland did not respond to the GnRH and suggests a disease involving the pituitary gland.

Q. How LH test results are interpreted in men?

Primary testicular failure: High levels of LH may indicate primary testicular failure. The following can be the causes: · Developmental defects: Failure to develop gonads (gonadal agenesis) · Chromosomal abnormality such as Klinefelter syndrome · Testicular failure: Viral infection (mumps), Trauma, Exposure to radiation, Chemotherapy, and Autoimmune disease · Germ cell tumor · Testicular injury Secondary failure: Low levels of LH and FSH can be seen in case of secondary failure of the testicles. This may indicate a problem with the pituitary gland or hypothalamus.

Q. How LH test results are interpreted in children?

In young children, high levels of LH and FSH with the development of secondary sexual characteristics at an unusually young age are an indication of precocious puberty. Usually, this premature development is due to impaired functioning of the central nervous system. It can also have a few different underlying causes such as: · Central nervous system tumor · Brain injury, trauma · Inflammation within the central nervous system (e.g., meningitis, encephalitis) · Brain surgery Normal prepubescent levels of LH and FSH in children showing some signs of pubertal changes may indicate a condition called "precocious pseudopuberty". The signs and symptoms are caused by elevated levels of the hormones estrogen or testosterone. This may be caused by: · Hormone-secreting tumors · Adrenal gland tumors · Ovarian tumors or cysts · Testicular tumors However, normal FSH and LH levels with a few signs of puberty can also indicate a benign form of precocious puberty, with no underlying or discernible cause, or may just be a normal variation of puberty. In delayed puberty, LH and FSH levels can be normal or below considerable range. The test for LH response to GnRH in addition to other tests may help to diagnose the reason for the delayed puberty. Some of the underlying causes of delayed puberty can include: · Failure of the ovaries or testicles · Hormone deficiency · Turner syndrome · Klinefelter syndrome · Chronic infections · Cancer · Eating disorder (anorexia nervosa)

Q. How is the blood sample taken?

The healthcare provider takes a blood sample from the arm. The site from where the blood is to be withdrawn is cleaned with a swab of rubbing alcohol. This is then followed by inserting a small needle which has a tube attached to it for collecting blood. Once the sufficient blood for analysis is withdrawn, the needle is removed. The site is then covered with a gauze pad.

Q. Is there any risk associated with the withdrawal of blood sample procedure?

As such there is no risk but in few cases, bruising, bleeding, and infection at the puncture site can be seen. In very few cases, there can be swelling of the vein after the blood is withdrawn.

Q. Is prolactinoma considered a cancerous tumor?

No, prolactinoma is not a form of cancer. It is a benign tumor of the pituitary gland which means it is simply overgrowth of cells in the pituitary gland.

Q. Is prolactin hormone present in men?

Yes, prolactin hormone is present in men. High levels of prolactin have been associated with low sex drive and decreased erectile function.

Q. Does high prolactin levels affect the levels of testosterone?

Yes, high levels of prolactin can cause erectile dysfunction, as the levels of testosterone start to decrease.

Q. How can hyperthyroidism affect pregnant female and her baby?

An untreated hyperthyroidism during pregnancy can lead to miscarriage, premature birth, low birth weight, preeclampsia (a very high rise in blood pressure in late pregnancy), thyroid storm (a sudden, severe worsening of symptoms of hyperthyroidism), and congestive heart failure.

Q. How can hypothyroidism affect pregnant female and her baby?

Untreated hypothyroidism during pregnancy can cause preeclampsia (a very high rise in blood pressure in late pregnancy), anemia, miscarriage, low birth weight, stillbirth (death or loss of a baby before or during delivery), and congestive heart failure, although in rare cases. These problems occur most often with severe hypothyroidism. As the thyroid hormones play an important role in the development of baby’s brain and nervous system, untreated hypothyroidism—especially during the first trimester—can cause low IQ and other problems with normal development.

Q. Which medicines can affect the levels of Prolactin hormone?

Certain drugs can cause a low level of Prolactin such as Dopamine (used in conditions like shock), Levodopa (used for Parkinson’s disease), or Ergot alkaloid derivatives (used for severe headaches). However, certain drugs can cause elevated levels of Prolactin such as CNS depressants, Estrogen, drugs used for the treatment of hypertension (e.g., Reserpine, Verapamil, Methyldopa), and drugs used for treating gastroesophageal reflux like cimetidine.

Q. What is prolactinoma?

Prolactinomas are tumors which are usually benign (non-cancerous) of the pituitary gland in which there is production of high amounts of prolactin. These are more common in women as compared to men. Prolactinomas may cause menstrual irregularities, infertility, and bone loss in women. However, in men it can cause erectile dysfunction, gynecomastia (breast enlargement), decreased muscle mass, and bone loss. If the size of the tumor is quite large, it can cause pressure symptoms like headache and problems of the vision.

Q. What is Hyperthyroidism?

Hyperthyroidism is a condition in which the thyroid gland is overactive and there is an increased production of thyroid hormones by the thyroid gland. Causes of Hyperthyroidism include Graves’ disease, multinodular goiter, thyroid nodules, toxic adenoma, inflammation of the thyroid, eating too much iodine, and too much synthetic thyroid hormone. Diagnosis of this condition can help to relieve the symptoms and prevent long-term complications.

Q. What are the symptoms of Hyperthyroidism?

Symptoms of Hyperthyroidism include: Rapid heartbeat (tachycardia) — commonly more than 100 beats/minute — irregular heartbeat (arrhythmia) or pounding of your heart (palpitations), sudden weight loss, nervousness, anxiety, irritability, tremor (usually a fine trembling in your hands and fingers), changes in menstrual patterns, increased sensitivity towards heat, changes in bowel patterns (especially more frequent bowel movements), an enlarged thyroid gland (goiter) which may appear as a swelling at the base of your neck, increased appetite, sweating, fatigue, muscle weakness, sleep disturbances, skin thinning, fine and brittle hair.

Q. What is Hypothyroidism?

Hypothyroidism, also called underactive thyroid or low thyroid is a condition in which the thyroid gland does not produce enough thyroid hormones. It can be commonly caused by intake of low iodine diet or Hashimoto's thyroiditis (an autoimmune disease). Less common causes include previous treatment with radioactive iodine, injury to the pituitary gland which secretes TSH, intake of certain medicines, previous thyroid surgery, or a lack of a functioning thyroid gland at birth.

Q. What are the symptoms of Hypothyroidism?

Hypothyroidism can cause symptoms such as tiredness (fatigue), hoarseness, constipation, feeling cold, dry skin, dry and thin hair, puffy face, weight gain, and muscle weakness. Along with that, one may experience decreased sweating, depression, slowed heart rate, increased blood cholesterol levels, pain, and stiffness in your joints, impaired memory, problems of infertility or menstrual changes, muscle stiffness, aches, and tenderness.

Q. What are the causes of high TSH in a newborn?

Congenital hypothyroidism is an important cause of elevated thyroid-stimulating hormone (TSH) in newborns. Other causes of an elevated TSH include transient hypothyroidism due to neonatal illness, premature birth, iodine excess or deficiency. High TSH can also be seen in case the mother is taking some medicines that could affect thyroid hormone levels or the mother has some underlying thyroid disease.

+ more

Other tests

Other similar tests

Anti-Mullerian Hormone

Progesterone

Testosterone Total+Free

LH & FSH

Pregnancy Urine Test

Antenatal Profile Comprehensive

5a- Dihydrotestosterone

T3 & T4 Total

17 Alpha Hydroxy Progesterone 19

Sex Hormone Binding Globulin