FSH Test: All You Need To Know [Male & Female]

FSH test is a hormone test and is important in sexual and reproductive health. The test is more commonly performed in women. However, there are many indications for FSH testing in both men and women.

Hormones are the chemical messengers in our body, which regulate various bodily functions. The sex hormones in our body are testosterone and estrogen. FSH is a reproductive hormone which controls the level of these sex hormones.

FSH test full form is Follicle Stimulating Hormone (FSH). In our body, the anterior pituitary gland produces FSH hormone. It is released under the influence of the gonadotropin-releasing hormone (or GnRH) from the hypothalamus.

FSH is a glycopeptide hormone in nature. It regulates pubertal and sex organ or gonadal development in both males and females.  

In females, the egg develops in ovarian follicles. FSH helps in follicle maturation. It works in close harmony with the other hormone known as luteinizing hormone (LH).

In males, it also helps in spermatogenesis (sperm development). FSH, along with LH controls the overall growth and development of the reproductive system.

Any disorder that affects the reproductive system may require an FSH Test.

Why do we test for FSH?

As per earlier discussion, the FSH test is important for understanding sexual health. In women, FSH works alongside LH at the ovarian follicles for the release of female hormones like estrogen and progesterone.

Women

FSH test helps in assessing problems concerning the menstrual cycle like irregular periods or heavy bleeding, including menopause. FSH test also ensures proper stimulation of the ovaries for egg (ovum) development. It may even aid in the diagnosis of conditions affecting the pituitary gland which is the master gland that controls most of the endocrine organs including the ovaries.

FSH level has also been linked to ovarian reserve in a woman. Studies have shown that elevated base level FSH can indicate poor ovarian reserve & result in poor IVF treatment outcome.

Men

For men, on the other hand, FSH helps in sperm production and in particular for the proliferation of Sertoli cells. These cells are very important in the development of sperms.

Thus, a deficiency of FSH may lead to testicular failure and infertility secondary to a low sperm count. Thus, an FSH test can help in identifying the hormonal problem in men.

Children

In pubertal issues with children, FSH Test may help in understanding an early (precocious) or delay in puberty. This is characterized by an early maturation or under maturation of the sex organs and secondary sexual characters.

FSH Test Cost & Price In India

FSH is a simple blood test thus it is not a costly test. In general, most of the good labs with proper certifications charges between Rs 400 to Rs 700. However, the actual cost of the FSH test depends on City, location & diagnostic center.

Keeping in view so many factors, we are preparing a detailed article on FSH test cost in India.

What is the procedure for FSH Test?

A follicle stimulating hormone test is basically a blood test and the sample collected from you is tested in the laboratory for the levels of FSH.

You would have come across a usual blood sampling technique a couple of times before. The procedure for FSH testing is similar & as follows:

1. A technician will counsel you about the procedure, and he/she may collect some information regarding any bleeding disorders, medications or previous complications.
2. Any arm or vein preference is ensured, following which a tourniquet is tied in the arm above the site.
3. The phlebotomist (a technician who collect the blood sample) will look for an engorged vein and when a vein is visible, they sterilize the site using antiseptic solution.
4. You will be warned once he/she is ready to introduce the needle. It may feel like a sharp scratch as the needle is introduced into the vein by a skin prick.
5. The blood is then collected in a labelled container and the needle is withdrawn. A cotton ball or gauze is used to apply direct pressure onto the site
6. In a short time, we will remove the compress and place a bandage and you are done.
7. The sample is then sent to the laboratory for testing and may take one or two days for the results.

Alternatively, urine tests to assess FSH levels are also available but will be performed based on the indication for which your doctor suggested the FSH test, as the blood tests are more reliable.

FSH Levels, Normal range & Interpretations

Disclaimer: The content here is general medical information and not personalized advice. Your FSH test results must always be interpreted by your consulting doctor.

FSH test results may vary normally on a day to day basis, with your menstrual cycle or periods. The normal levels of FSH test also depend on your gender and age factor.

FSH is usually measured in mIU/mL (milli international units per milliliter). Furthermore, the normal reference range for FSH test can vary depending on the test method used in the laboratory.

Furthermore, the FSH levels depend on the laboratory where you have performed your test, as they may use different reference ranges depending on the method of testing used.

FSH Levels in Females

Below Age of 18 Years

REFERENCE GROUP	REFERENCE RANGE IN mIU/mL
Tanner Stage 1( < 9.2 yrs)	1.00-4.20
Tanner Stage 2 ( 9.2 – 13.7 yrs)	1.00-10.80
Tanner Stage 3 ( 10-14.4 yrs)	1.50-12.80
Tanner Stage 4 ( 10.7-15.6 yrs)	1.50-11.70
Tanner Stage5 (11.8-18.6 yrs)	1.00-9.20

Adult Females above 18 Years

STAGES IN MENSURAL CYCLE	REFERENCE RANGE IN mIU/mL
Follicular	2.50 – 10.20
Mid Cycle Peak	3.40 – 33.40
Luteal Phase	1.50 – 9.10
Post Menopausal	23.00 – 116.30
Pregnant	Less than 0.3

FSH Levels in Male

REFERENCE GROUP	REFERENCE RANGE IN mIU/mL
Tanner Stage 1( < 9.8 yrs)	0.26-3.00
Tanner Stage 2 ( 9.8 – 14.5 yrs)	1.80-3.20
Tanner Stage 3 ( 10.7-15.4 yrs)	1.20-5.80
Tanner Stage 4 ( 11.8-16.2 yrs)	2.00-9.20
Tanner Stage5 (12.8-17.3 yrs)	2.60-11.00
Male above 18 yrs	1.40-18.10

See the list of references below for sample report & source of FSH levels. Above ranges are for CLIA test method.

There are other factors that may influence your test results. It includes

• Use of any over the counter supplements
• Hormonal contraceptives like birth control pills
• Intrauterine devices (Mirena coil)
• Hormone replacement therapy.

Any medical illnesses related to your reproductive health or endocrine (hormone) system, may also influence the test results.

How to understand your FSH Test results?

The values obtained for the FSH test may be high or low. This may indicate a few possibilities of disease. Your doctor might have to test for other hormone levels in blood like luteinizing hormone (LH), testosterone, progesterone, and estrogen in order to arrive at a conclusion. As such, FSH test results do not have a positive or negative type of binary results.

Low FSH Level

This can be due to a primary pathology at the level of the pituitary gland or secondary to some ovarian tumors

• Hypothalamic or Pituitary problem: where FSH release or production is impaired, as in the case of tumors of the ovary.
• An ovarian problem in women: No ovum or egg production
• A testicular problem in men: Impaired sperm development.
• Liver disease: In chronic liver disease, there can be normal to inappropriately low levels of FSH, as the metabolic function of the liver gets impaired

High or Elevated FSH Levels

High or elevated FSH levels: This may be seen in response to poor ovarian function in general.

• Ovarian failure: As the ovaries do not function adequately to maintain the female hormone levels, it will result in a feedback increase in FSH levels to stimulate the ovaries
• Menopause: In menopause, the ovary becomes atrophic and non-functional and hence the FSH levels can increase. The rise may be seen from 36 years of age (pre-menopause) but within the normal range. It is followed by an intermittent and persistent rise during perimenopause to a fully established menopause.
• Polycystic ovarian syndrome (PCOS): It is a disorder characterized by multiple cysts within the ovaries without any ovulation. Commonly, these people may present with infertility or irregular menstrual cycles (irregular bleeding). In order to stimulate follicular maturation, FSH hormone goes high in these patients.
• Turner’s syndrome: It is a chromosomal anomaly with a single X chromosome, making the patient sterile for life. However, secondary sexual characters may develop as usual, but the ovaries may not be adequately developed. This leads to ovarian failure and subsequent rise in FSH.

What is the importance of testing for LH with FSH?

FSH and LH are the two gonadotrophic hormones produced in our body. Thus, the effect of these hormones synergistically brings about growth and development of the reproductive system. Hence, testing for FSH is usually accompanied by testing for LH, in order to get a clear idea to the problem with the patient.

LH is an important indicator of ovulation and rises to a maximum during mid-cycle. This leads to release of an ovum or egg, from the ovary. The estimation of LH levels will thus, help in understanding any problem associated with ovulation. If LH tests are normal, then a secondary cause for infertility needs to be assessed for.

FSH Test timing: When and how to prepare for the test?

The test as such doesn’t need any special preparation, but it is preferable to be done in the earlier days of the menstrual cycle. The menstrual cycle has four phases- proliferative (follicular), ovulatory, secretory (luteal) and menstrual phases.

FSH test results in females changes depending on the stages in the menstrual cycle.

FSH Testing in special conditions

In general, FSH levels on the rise may represent a decrease in the quality of the gametes produced by the individual. A decline, on the other hand, is indicative of decreased production or feedback inhibition.

FSH Test in men

High FSH levels in men may indicate poor sexual health because it has a direct influence in the maturation of sperms in adult males. The rise in hormone levels may suggest a defective response of sperm development to the normal FSH levels. The symptoms associated may be reflected as a loss of libido (interest in sex), erectile dysfunction, depression, fatigue, and infertility. The commonest causes for these include:

• Klinefelter’s syndrome: It is a chromosomal defect where an extra X chromosome is found in a male, creating an XXY configuration. The affected males may show a tall habitus, with gynecomastia (breast development in males). Fertility is also impaired in these individuals due to primary gonadal failure(testicular failure)
• Hypogonadism: Poorly functioning testes can lead to decreased testosterone levels and thereby impair male sexual development.
• Testicular agenesis or atrophy: An absent testes by birth or non-functional testes can contribute to a rise in FSH levels
• Testicular damage secondary to a tumor, radiation, drugs, alcohol or trauma, may also lead to a rise in FSH levels.

FSH Test during pregnancy

The levels of FSH may be high around the initial stages around ovulation. However, throughout pregnancy, negative feedback from the pregnancy hormones produced by the ovaries, cause feedback inhibition to the production of both LH and FSH, making them undetectable.

Critical Illness

In prolonged critical illnesses, the levels of sex hormones and gonadotropins (LH & FSH) will be low (hypogonadotropic hypogonadism)

Children

Higher levels of FSH in children reflect the onset of puberty. However, at an earlier age this may indicate precocious pubertal onset. It will require testing for other steroidal hormones in the body.

Why is FSH important?

It is indeed a hormone that controls the sex hormones in our body and has its importance in understanding the several sexual disorders that has been discussed. Moreover, it is a cost-effective and simple blood investigation, which helps in understanding associated disease processes.

So why wait? Contact us today and we will be more than happy to assist you.

References:

1)      Oxford Handbook of Endocrinology and Diabetes, 3^rd edition (2014), OUP

2)   https://emedicine.medscape.com/article/2089048-overview

3)   https://www.merckmanuals.com/professional/gynecology-and-obstetrics/female-reproductive-endocrinology/female-reproductive-endocrinology