PCOS blood tests: androgens, insulin and metabolic health
The hormonal and metabolic markers Australian doctors assess together when PCOS is the question, in one fasting collection, with the result explained rather than emailed.
About this stage
This stage covers the two halves of PCOS that often get separated: the hormones and the metabolism. On the hormone side, testosterone with SHBG and the free androgen index, DHEA-S, LH, FSH, prolactin and TSH, the last three there mainly to check what else could be causing the same picture. On the metabolic side, fasting glucose, HbA1c and a lipid profile, because insulin resistance travels with PCOS at any body size.
The questions are familiar to anyone who has spent years being told to come back when they want a baby. What are the actual signs of PCOS. What blood tests are done for it, and are there three markers or twenty. Can a blood test diagnose it. Why do I have to fast. My periods are fine but my skin and hair are not, could it still be PCOS. I already have the diagnosis, so what should be re-checked, and how often.
Testing fits as one of three legs. In Australia and internationally, PCOS is diagnosed from two of three features: irregular ovulation, clinical or biochemical signs of high androgens, and polycystic ovaries on ultrasound, with AMH accepted in place of the scan for adults in the current guideline. Bloods supply the biochemical androgen leg and rule out the conditions that mimic it, particularly thyroid disease and raised prolactin. The metabolic markers do a different job: they describe long-term risk, which is the part of PCOS care that gets neglected.
Weight that will not shift, cravings and energy crashes belong here as well, whether or not PCOS is confirmed. The same metabolic markers answer that question, read alongside thyroid function, with a morning cortisol as a rough baseline only, so what is happening is measured rather than assumed.
Honestly, a panel cannot diagnose PCOS by itself, and a completely normal androgen result does not rule it out, because signs on examination count too. Fasting matters for insulin and lipids, morning collection matters for androgens, and cycle day two to five matters if you still have cycles. Self-pay, not Medicare-rebated. Abnormal results are always followed up by a doctor, and your report is written so your own GP can use it.
PCOS diagnosis in Australia
The criteria, the blood tests, and what the results actually show.
PCOS and your hormones
What a blood test can and cannot show, and where the panel fits.
PCOS blood test: what to expect
Fasting, cycle day, contraception, and what happens afterwards.
Insulin resistance in women
The signs, the tests that check it, and what HbA1c means.
Testosterone, SHBG and DHEA-S in women
How the androgen tests are read, and why SHBG matters so much.
Choose your test
Pick the panel that matches your question. Each test page lists every marker, the fasting rules, the cycle timing and the price before you order.
A doctor requests it
Upload a request your own GP or specialist has signed, or answer a short questionnaire and have a KnowLuna women's health doctor review it and request the panel.
Collect and understand
Give your sample at an accredited collection centre near you, or choose a home kit or a nurse visit where the test allows it. Plain-English results land in your account, with a doctor to talk them through.
Common questions
What blood tests are done for PCOS?
Total testosterone with SHBG so the free androgen index can be calculated, DHEA-S, LH and FSH, prolactin and TSH to check for other causes, and the metabolic group of fasting glucose, HbA1c and lipids. In adults a doctor can add AMH, which the current guideline accepts in place of an ultrasound; it is not part of the standard panel. Where blood sugar is the question, the guideline names a 75 g oral glucose tolerance test as the most accurate check, with fasting glucose or HbA1c as alternatives; it recommends against fasting insulin and HOMA-IR for assessing an individual, so they are not in the panel.
Can a blood test diagnose PCOS?
No. PCOS is a clinical diagnosis your doctor makes from two of three features: irregular ovulation, signs of high androgens on examination or on bloods, and polycystic ovaries on ultrasound. A panel supplies one of those legs and rules other conditions in or out. It supports the assessment rather than replacing it.
Do I have to fast, and does the time of day matter?
Yes to both. Fasting glucose and the lipid profile need eight to twelve hours without food, water only. Androgens are highest in the morning, so an early collection is easier to interpret. If you still have cycles, day two to five is preferred for LH and FSH. We send the exact instructions with your request.
I already have PCOS. What is worth re-checking?
Most ongoing PCOS care is metabolic rather than hormonal. Doctors commonly re-check HbA1c, fasting glucose and lipids periodically, and blood pressure and weight at the same time, because long-term risk is the part that quietly builds. How often depends on your results and history, and your doctor will suggest an interval.
Sources and further reading
- Monash University: International Evidence-based Guideline for the Assessment and Management of PCOS 2023
- Teede HJ et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS. J Clin Endocrinol Metab 2023
- Jean Hailes for Women's Health: polycystic ovary syndrome (PCOS)
- Healthdirect: polycystic ovarian syndrome (PCOS)
General information only, not medical advice. A blood test is one input to a doctor's assessment, not a diagnosis on its own. If your symptoms are severe or sudden, see a doctor promptly. Read our medical disclaimer.
Check both.