Test Detail
Overview
Interpreting Results
FAQ's
Tests Included

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Written by
Dr. Shreya Gupta
BDS, MDS - Oral and Maxillofacial Pathology
Reviewed by
Dr. Ashish Ranjan
MBBS, MD (Pharmacology)
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FSH-LH-Prolactin

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FSH-LH-Prolactin Test Includes 2 testsView All
FSH-LH-Prolactin
You need to provide
Blood
This test is for
Male, Female
Test Preparation
  1. Blood sample should be collected 4 hours after waking.

Overview


What is FSH-LH-Prolactin?

FSH-LH-Prolactin includes three tests:  FSH (Follicle-stimulating hormone), LH (Luetinising hormone), and Prolactin. The FSH test evaluates the levels of Follicle Stimulating Hormone in blood. The LH test detects the levels of luteinising hormone in the blood. The prolactin checks the levels of prolactin hormone in the blood.


Why is FSH-LH-Prolactin done?

  • 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



What does FSH-LH-Prolactin Measure?

FSH, LH, and Prolactin are three 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. This 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 triggers 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 helps 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 which lasts 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.


Interpreting FSH-LH-Prolactin 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


Reference range may vary from lab to lab*


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


Frequently Asked Questions about FSH-LH-Prolactin

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. 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 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 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.
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Tests Included (2 tests)


  • Luteinising Hormone
  • Follicle Stimulating Hormone

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