PCOS blood test panel

The PCOS blood test panel brings together the eleven markers doctors assess when polycystic ovary syndrome is a question: androgens, the cycle hormones, thyroid and prolactin, and the metabolic markers that often travel with PCOS. It costs $169 with your own doctor's request, or $249 with a KnowLuna women's health doctor who requests it and explains your results in a 20-minute video consult. Collect at an accredited Australian centre, or choose a home kit or a nurse visit at checkout (options below).

What it measures

• Testosterone: the main androgen. Raised total testosterone is one of the biochemical signs of PCOS.
• SHBG: the carrier protein for testosterone. It is often low in PCOS, which leaves more active hormone circulating.
• Free androgen index: testosterone divided by SHBG, which estimates the active fraction. Usually the most telling androgen result.
• LH: often runs higher than FSH in PCOS, a supporting pattern rather than a rule.
• FSH: read with LH for the ratio, and to help exclude other causes of irregular cycles.
• Prolactin: raised prolactin can stop periods and needs to be excluded before PCOS is settled on.
• TSH: thyroid problems also cause irregular cycles and weight change, so they are ruled out at the same time.
• DHEA-S: an adrenal androgen. It helps show where excess androgen is coming from.
• Fasting glucose: your blood sugar after an overnight fast, one of the two glycaemic markers the PCOS guideline recommends.
• HbA1c: average blood glucose over about three months; screens for prediabetes and diabetes.
• Lipid profile: cholesterol and triglycerides, part of the longer-term heart health picture.

Who it's for

Anyone with irregular or absent periods together with acne, excess hair growth, scalp hair thinning or weight that will not shift, who wants to know whether PCOS could be part of the picture. It also suits women already diagnosed with PCOS who want to track their metabolic health each year. Adults aged 18 and over. If your cycles are irregular but you have none of the androgen symptoms, the female hormone panel may be the better starting point.

What you'll learn, and what you won't

You'll get a clear read on your androgens, cycle hormones and metabolic markers, each against your laboratory's range, and a doctor to explain how they fit together and what to do next. If the pattern supports PCOS, the doctor explains what that means and what the sensible next steps are. If it does not, you learn that too, and the thyroid and prolactin results often point elsewhere.

What this panel cannot do is confirm PCOS on its own. PCOS is a clinical diagnosis that combines symptoms, blood results and sometimes an ultrasound. A blood test is one input to a doctor's assessment, not a diagnosis on its own.

There is no single PCOS test

Doctors in Australia use the Rotterdam criteria: PCOS is considered when two of three features are present and other causes have been excluded. The three are irregular or absent ovulation (usually seen as irregular cycles), signs of excess androgen (clinical, such as acne or hair growth, or biochemical, on a blood test), and polycystic ovaries on ultrasound. The blood tests here cover the second feature and the exclusions; your cycle history covers the first; an ultrasound, if needed, covers the third. Current international guidance also allows AMH in place of ultrasound in adults, with the cut-off set by the laboratory assay, and not in teenagers. AMH is not part of this panel; a doctor can request it separately where it would stand in for a scan. Read more in how PCOS is diagnosed in Australia.

Reference ranges and what they mean

Typical adult ranges for women, with what each usually shows when PCOS is being considered. Androgen ranges are assay-specific, so your report is what counts.

Marker	Typical adult range	What it usually means for PCOS
Total testosterone	Laboratory-specific; usually under about 2 nmol/L for women	Above range supports biochemical androgen excess. Many women with PCOS have a normal total but a raised free androgen index.
SHBG	Laboratory-specific, wide range	Low SHBG is common in PCOS and with insulin resistance, and it pushes the free androgen index up.
Free androgen index	Laboratory-specific; low single digits typical	Raised is the most useful blood sign of androgen excess.
LH and FSH (day 2 to 5)	Both about 2 to 10 IU/L early in the cycle	LH clearly higher than FSH is a supporting pattern. Normal ratios do not rule PCOS out.
Prolactin	Under about 500 mIU/L	Raised prolactin is an alternative explanation for missing periods, and is excluded first. A raised result is repeated on a separate day, rested, and the laboratory checks for macroprolactin, an inactive form that can give a falsely high reading. Some medicines also raise prolactin, so tell your doctor what you take.
TSH	About 0.4 to 4.0 mIU/L	Out of range points to a thyroid cause of cycle or weight changes.
DHEA-S	Age-dependent	Raised suggests an adrenal contribution to androgen excess.
Fasting glucose	Laboratory reference interval; 7.0 mmol/L or above on two occasions is the diabetes threshold	Read with HbA1c. These are the glycaemic markers the 2023 International PCOS Guideline recommends; it advises against fasting insulin and HOMA-IR for assessing an individual, because the insulin assay is not standardised between laboratories.
HbA1c	6.5% or above is the diabetes threshold	Results just under the threshold flag higher risk and a reason to recheck yearly.
Lipid profile	Laboratory targets vary with overall risk	Raised triglycerides and low HDL are the pattern most often seen alongside insulin resistance.

Ranges vary by laboratory; your report shows the range your lab uses. Typical ranges on this page are drawn from Pathology Tests Explained (RCPA) and the sources listed below.

Free androgen index explained

The free androgen index (FAI) is calculated, not measured directly: total testosterone (nmol/L) divided by SHBG (nmol/L), multiplied by 100. Because SHBG binds most circulating testosterone, two women with the same total testosterone can have very different amounts of active hormone. A low SHBG raises the index even when total testosterone looks normal, which is exactly the situation many women with PCOS are in.

Why glucose and HbA1c are in a PCOS panel

Insulin resistance is part of the biology of PCOS for many women, including those who are not overweight. Higher insulin drives the ovaries to make more androgen and lowers SHBG, which is why the metabolic and hormonal results are read together. HbA1c and lipids matter because women with PCOS have a higher long-term risk of type 2 diabetes and heart disease, so the International PCOS Guideline suggests a baseline at diagnosis and a repeat every one to three years depending on your risk, with blood pressure checked yearly. The most accurate check of blood sugar is a 75 g oral glucose tolerance test, which your doctor arranges when it is needed. Our insulin resistance guide goes deeper.

When to do this test

Fast for 8 to 12 hours. Fasting glucose needs a fasting sample, and lipids are best fasting too because triglycerides rise after a meal, so have nothing to eat or drink except water from the evening before. Book a morning collection, both for the fast and because androgen levels are steadier early in the day. If you have cycles, day 2 to 5 (day 1 is the first day of full bleeding) is ideal for LH and FSH; if your periods are irregular or absent, collect any day and tell us the date of your last period.

Hormonal contraception changes the picture. The combined pill suppresses LH, FSH and ovarian androgen production and raises SHBG, which lowers the free androgen index. On the pill, the androgen results mostly reflect the pill. The metabolic markers, TSH and prolactin remain useful. Androgen testing is most informative after about three months off combined hormonal contraception, where stopping is safe and practical. Tell us what you use; the doctor will advise whether to test now or time it differently. See contraception and hormone tests.

What happens after the result

Your results arrive as a plain-English report, and any result outside the expected range is always reviewed by a doctor. In the consult, the doctor puts the blood picture together with your cycle history and symptoms. If two of the three criteria are already met, the doctor explains what PCOS means for you and what to keep an eye on. If an ultrasound would settle the question, the doctor can write a referral for a pelvic ultrasound, and a referral letter to a specialist if that is the right next step. Read what to expect in the PCOS blood test, step by step.

How it works

• Order online. Either upload the request your own doctor has signed, or a KnowLuna women's health doctor reviews your short questionnaire and requests the panel for you.
• Collect at an accredited centre near you, or choose a home kit or a nurse visit (options below). This panel is fasting, so we'll tell you exactly how to prepare.
• Results are usually ready within a few business days, explained in your account, with a doctor to talk them through.

Choose how you collect

Every option is the same accredited test and the same report. Pick what suits you at checkout; the fee, if any, is added to either pathway price.

Common questions

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
• Pathology Tests Explained (RCPA): testosterone
• Pathology Tests Explained (RCPA): sex hormone binding globulin (SHBG)
• Pathology Tests Explained (RCPA): HbA1c
• Healthdirect: polycystic ovarian syndrome (PCOS)
• Jean Hailes for Women's Health: polycystic ovary syndrome (PCOS)

General information only, not medical advice. A test result is one input to a doctor's assessment, not a diagnosis on its own, and every abnormal result is followed up by a KnowLuna doctor. If your symptoms are severe or sudden, see a doctor promptly. Read our medical disclaimer.

Related

• All PCOS and metabolic tests
• Weight and metabolic check
• Female hormone blood test
• PCOS hormones explained
• Irregular periods: which blood tests your doctor checks