10 Most Common Functional Medicine Hormone Tests for Men (and What They Reveal)

Men’s hormone health is often reduced to a single marker: testosterone. 

However, the truth is that the male endocrine system is far more complex.  

It’s a conversation. It’s an ongoing exchange between the adrenal, pituitary, thyroid, and gonadal axes that shapes how men think, move, recover, and age. 

Functional medicine looks at how the hormonal systems adapt (or don’t) under pressure. Practitioners want to know how stress, sleep, nutrition, and inflammation quietly rewrite the body’s internal code over time. 

And the shifts start sooner than most men realize. These changes often show up as “just tired,” “just stressed,” or “just getting older,” long before a diagnosis ever appears in the chart. 

Research indicates that testosterone levels naturally decline by approximately one percent per year after the age of 30.  

Meanwhile, studies on adrenal health suggest that changes in DHEA-S and cortisol rhythms can lead to the slow creep of fatigue, stubborn weight gain, and reduced resilience.  

Even small changes or shifts in thyroid function or SHBG can contribute to fatigue, low libido, and weight gain long before an endocrine disorder is diagnosed. 

That’s where functional medicine testing makes a difference.  

Key Takeaways 

• A men’s hormone evaluation should extend beyond total testosterone to include free testosterone, DHEA-S, cortisol patterns, estradiol, SHBG, thyroid markers, prolactin, Vitamin D, and metabolic labs for a more comprehensive clinical picture. 
• Reviewing these markers together helps differentiate primary endocrine disorders from changes driven by stress, sleep disruption, metabolic dysfunction, or medication effects, enabling earlier and more targeted interventions. 
• Comprehensive hormone testing supports more individualized treatment plans aimed at improving energy, body composition, sexual function, cognition, and long-term cardiometabolic risk in male patients. 

Here's what you'll find in this article:

10 Functional Hormone Lab Tests for Men

1. Testosterone (Total and Free) 

Testosterone is often regarded as the benchmark of men’s health, but in functional medicine, it serves as a reflection of how the entire endocrine system communicates.  

Total testosterone measures overall production, while free testosterone represents the unbound, biologically active fraction that drives muscle synthesis, mood, and energy regulation.  

Only about 2–4% of circulating testosterone remains free, with the rest bound to SHBG and albumin. Because SHBG levels fluctuate in relation to thyroid activity, liver function, and insulin sensitivity, total testosterone alone doesn't provide a complete picture. 

Measuring both provides a more comprehensive picture of how effectively hormones are working.  

Functional practitioners determine both the total level and the free-to-total ratio to understand how effectively hormones are functioning at the tissue level.  

Low free testosterone can exist even when total values appear normal, particularly in men with metabolic syndrome or thyroid imbalance. 

Beyond reproduction, reduced free testosterone levels correlate with increased inflammation and cardiovascular risk, highlighting the importance of early functional assessment for long-term health. 

In an Access Live, Dr. Andrew Sun, Director at the Center for Men’s Health, emphasized that declining testosterone is not purely age-related: 

“We used to think this was just an age phenomenon, but much of the decline we see today is tied to lifestyle, poor sleep, obesity, stress, and environmental factors. It’s not just about performance; testosterone plays a critical role in metabolic and cardiovascular health.”  

2. DHEA-S

DHEA-S (dehydroepiandrosterone sulfate) is one of the most abundant circulating hormones in the body and a key marker of adrenal performance.  

Produced primarily in the adrenal cortex, it functions as a precursor to both testosterone and estrogen. It’s a central player in the body’s anabolic and stress-response systems. 

DHEA-S levels provide a window into adrenal reserve and resilience, often shifting before symptoms such as fatigue, mood instability, or decreased exercise tolerance becomes apparent. 

Evaluating DHEA-S in conjunction with cortisol is important to understand the balance between anabolic and catabolic forces.  

Ideally, DHEA-S should rise in proportion to cortisol to support cellular repair, hormone synthesis, and recovery capacity. When DHEA-S levels remain low relative to cortisol, it signals a system under sustained physiological demand, reducing overall adaptability. 

3. Cortisol

Cortisol is the body’s primary stress hormone. It’s produced by the adrenal glands and released in rhythmic pulses that follow the sleep–wake cycle.  

A healthy rhythm peaks shortly after waking and gradually declines across the day, reaching its lowest point at night. Disruptions in this curve can impact energy, blood sugar levels, immune function, and sex hormone production. 

Persistently high cortisol is associated with a catabolic state that suppresses testosterone, disrupts sleep, and promotes central fat accumulation.  

Conversely, low cortisol levels often indicate adrenal exhaustion or burnout, commonly accompanied by fatigue, low mood, and reduced DHEA-S.  

Reviewing the whole curve enables clinicians to determine whether the system is overactivated, underactive, or flat. This informs interventions focused on sleep hygiene, stress management, nutrition, exercise timing, and, when indicated, more targeted endocrine workups. 

4. Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH)

• Low or in-range LH/FSH suggests secondary hypogonadism (hypothalamic or pituitary origin).
• High LH/FSH suggests primary testicular failure. 

These patterns guide next steps, including evaluation of medications, sleep apnea, systemic illness, prior chemotherapy or radiation, testicular injury, or genetic conditions such as Klinefelter syndrome. 

For a complete review of the axis, clinicians often pair LH/FSH with prolactin (to assess for hyperprolactinemia) and thyroid panels, since thyroid status influences SHBG and downstream androgen availability.  

In symptomatic men with borderline total testosterone, LH/FSH testing can clarify whether the issue is production, signaling, or both. 

Integrating LH and FSH with morning total and free testosterone, estradiol, SHBG, prolactin, and thyroid markers supports targeted therapy decisions and appropriate endocrine referral when central pathology is suspected. 

5. Thyroid Panel (TSH, FT3, FT4)

Thyroid dysfunction often shows up looking very similar to low testosterone.  

Men may report fatigue, low libido, weight gain, brain fog, or reduced exercise tolerance, and without thyroid testing, these symptoms are easy to attribute only to androgen deficiency.  

That’s why a thyroid panel is a key partner to hormone testing in male patients with non-specific complaints. 

An in-depth assessment goes beyond TSH alone. Including free T3 and free T4  provides a bigger picture of thyroid hormone production and peripheral activity.  

Studies show that even mild hypothyroidism is linked to changes in body composition, lipid abnormalities, and reduced quality of life, features that overlap closely with low-T presentations.  

Reduced T3 activity can impair testosterone synthesis, change SHBG levels, and affect both total and free testosterone availability. 

For men presenting with fatigue, low libido, or weight changes, thyroid contribution should always be part of the differential, especially when testosterone values are borderline or don’t match the symptom picture.  

Interpret TSH in context with free T3 and free T4, looking for early patterns of underactive thyroid rather than waiting for overt disease.  

Dr. Patrick Flynn, international best-selling author, Founder, and CEO of The Wellness Way, shared during an Access Live webinar, “TSH alone is not a thyroid hormone. It’s just a pituitary signal. You can’t understand thyroid status without seeing the full picture.”  

This reinforces why functional clinicians interpret TSH in the context of free T3 and free T4, rather than relying on a single marker. 

In an Access Live webinar Dr. Mitch Ghen highlighted how updated evidence and individualized assessment are changing the way providers interpret hormone therapy risk and patient suitability, “Current data indicate that when prescribed appropriately and monitored, standard HRT regimens do not appear to significantly increase overall cancer risk for most patients. The key takeaway is the importance of individualized therapy. 

When thyroid and hormone symptoms overlap, a comprehensive baseline assessment like the Wellness Basic Panel from Access Medical Labs can help identify what is driving the symptoms. 

6. Estradiol (E2) 

Estradiol (E2) is often overlooked in men, yet it plays a major role in maintaining bone density, promoting cardiovascular health, enhancing libido, and regulating mood.  

In males, most estradiol is produced through aromatase conversion of testosterone. E2 levels reflect both androgen status and aromatase activity. 

Increased estradiol in men is associated with gynecomastia, erectile dysfunction, increased adiposity, and mood shifts.  

Low estradiol can present as joint pain, low mood, and decreased libido, even when testosterone appears adequate. This is why measuring estradiol alongside testosterone is important in men with sexual dysfunction, body composition changes, or persistent mood symptoms.  

The goal is balance, not suppression. 

Over-aggressive aromatase inhibition can lead to estradiol levels being too low, impairing bone and vascular health.  

Many clinicians monitor the testosterone-to-estradiol (T:E2) ratio, aiming for an approximate range of 10:1 to 15:1 as a functional target, rather than focusing on estradiol alone.  

This ratio-based approach helps determine whether symptoms are driven by excess aromatase activity, inadequate androgen production, or both. 

7. SHBG

Sex hormone–binding globulin (SHBG) is a glycoprotein produced primarily by the liver that binds testosterone and estradiol with high affinity.  

It is a determinant of how much testosterone remains free or bioavailable to tissues. 

High SHBG can “hide” androgen deficiency by keeping total testosterone in the normal range while significantly reducing free testosterone.  

This pattern is typical in men with hyperthyroidism, chronic liver disease, aging, or higher estradiol exposure.  

Low SHBG is frequently associated with insulin resistance, obesity, and metabolic syndrome, often coinciding with lower total testosterone but relatively preserved free testosterone fractions.  

SHBG is both a binding protein and a metabolic signal.  

Increased SHBG may suggest thyroid excess, hepatic changes, or increased estrogen load.  

Depressed SHBG can flag underlying metabolic stress, toxic load, or androgen excess.  

8. Comprehensive Metabolic Panel (CMP)

A Comprehensive Metabolic Panel (CMP) provides the clinical backdrop for interpreting hormone results. It assesses liver and kidney function, glucose handling, and electrolytes.  

Key components include: 

• Liver enzymes (ALT, AST): Inform SHBG synthesis and estrogen metabolism. Impaired liver function can change SHBG production and estrogen clearance, shifting the testosterone–estradiol balance. 
• Glucose and related markers: Help identify insulin resistance, which is closely linked with low testosterone, low SHBG, and increased visceral fat. 
• Kidney markers (BUN, creatinine): Contribute to the overall assessment of systemic stress and suitability for specific therapies. 

Mild abnormalities that sit inside broad reference ranges can still indicate early metabolic or hepatic strain. When reviewed with hormone panels, CMP data help differentiate primary endocrine disease from hormone changes secondary to metabolic, hepatic, or renal stress.

9. Prolactin 

Prolactin is a pituitary-derived hormone that influences the hypothalamic–pituitary–gonadal (HPG) axis. Although best known for its role in lactation, in men, it can impact testosterone production. 

Increased prolactin suppresses gonadotropin-releasing hormone (GnRH), resulting in reduced levels of LH and FSH, and subsequently lower testosterone.  

Men may present with low libido, erectile dysfunction, infertility, and low energy; galactorrhea is less common but clinically significant when present. 

Persistent hyperprolactinemia warrants evaluation for pituitary adenoma, renal impairment, hypothyroidism, or medication effects.  

Transient increases are common with acute stress, intense exercise, and certain drugs such as antipsychotics, SSRIs, and opioids, so timing and context of testing matter. 

Before moving to imaging, clinicians typically rule out reversible causes such as recently started medications or untreated hypothyroidism.  

When prolactin remains elevated together with low LH/FSH and low testosterone, clinicians should arrange pituitary imaging and involve an endocrinologist for further evaluation. 

10. Vitamin D

Vitamin D acts as a secosteroid hormone, playing roles in bone integrity, immune modulation, muscle function, and endocrine balance. In men, low Vitamin D status has been associated with reduced testosterone levels and higher cardiometabolic risk. 

Testing typically focuses on 25-hydroxyvitamin D, the most reliable indicator of Vitamin D stores.  

Low Vitamin D, 25-OH levels are associated with decreased bone mineral density, increased fracture risk, muscle weakness, increased vulnerability of the immune system, and higher all-cause mortality in older adults. 

For men with fatigue, low mood, reduced exercise recovery, or winter symptom flare-ups, Vitamin D testing can help decide whether low levels are contributing to hormonal and metabolic issues. 

Some functional clinicians target Vitamin D, 25-OH concentrations above conventional sufficiency thresholds, aiming to support immune modulation, mitochondrial energy production, and endocrine health. 

You can incorporate Vitamin D testing into broader hormone and wellness panels to provide male patients with a more comprehensive view of how environmental factors, seasons, and endocrine influences interact. 

FAQs About Men’s Hormone Testing

What labs are included in a full hormone panel for males?

A comprehensive male hormone panel typically includes total and free testosterone, DHEA-S, cortisol, LH, FSH, estradiol (E2), SHBG, a thyroid panel (TSH, free T3, free T4), prolactin, and sometimes vitamin D, as well as a metabolic panel for context. 

How often should men check their hormone levels?

For most men, annual testing is reasonable, especially if they have symptoms such as low libido, fatigue, mood changes, weight gain, or performance decline. Men on hormone therapy or with known endocrine conditions may need more frequent monitoring, as directed by their clinician. 

Restoring Hormonal Balance for Long-Term Men’s Health

Hormone testing in men is no longer just about confirming “low T.” It is a structured way to inspect how the brain, adrenals, thyroid, liver, and testes are working together, and where that communication is starting to break down. 

By examining testosterone, estradiol, DHEA-S, cortisol, thyroid markers, SHBG, prolactin, metabolic labs, and vitamin D as an integrated profile, functional medicine clinicians can transition from symptom management to targeted intervention.  

This approach facilitates the earlier detection of imbalance, enables more individualized treatment plans, and provides clearer monitoring of response over time. 

For male patients, the goal is not simply to raise numbers, but to restore energy, mental clarity, metabolic stability, sexual function, and long-term cardiometabolic health. 

Give your male patients a clearer understanding of their hormonal health. Start with the Male Hormone Test from Access Medical Labs.  

Disclaimer: Content on the Access Labs blog is for informational purposes only and reflects the views of individual contributors, not necessarily those of Access Medical Labs. We do not endorse specific treatments, products, or protocols. This content is not a substitute for professional medical advice. Always consult a qualified healthcare provider regarding any medical concerns.

About Access:

Access is the nation’s premier specialty diagnostic lab. We offer a broad menu of testing from blood, saliva, urine & swab samples. We perform all of your tests in our 25,000 sq. ft. ultra-automated facility in Jupiter, Florida & provide results within 24hrs. Since 2003, we continuously strive to innovate, inspire, and improve solutions for physicians by providing an exceptional personalized experience with the most accurate testing.

Feel free to contact our specialist to find out more about prices and services. We are always ready to answer your questions: sales@accessmedlab.com