LH Test – Purpose, Levels & Ovulation [Male & Female]

LH test is a reproductive hormone test. It is important for ovulation in females and testosterone production in males.

LH full form is Luteinizing hormone. It plays a vital role in puberty, menstruation & fertility.

What is an LH test?

LH test is blood (serum) or urine test that measures LH levels in our body. It is a simple and cost-effective method for understanding sexual and reproductive health.

LH Test can be done with a blood sample in a laboratory. However, ovulation test kits help to check LH levels in urine at your home.

Why do we do the LH test?

Your doctor may order an LH test due to many reasons. The symptoms that may require an LH evaluation are:

1. Infertility or difficulty in getting pregnant.
2. Ovarian or menstrual problems in women: Irregular or heavy monthly periods.
3. Sexual or testicular problems in men: Loss of interest in sex (loss of libido) and poor sex drive, low sperm count, loss of muscle mass and masculinity (feminization).
4. Problems with sex hormones or pituitary dysfunction (hormonal abnormalities of a small gland at the base of your brain) especially in children.

LH Test cost In India

LH test cost in India ranges from Rs 350 to Rs 700. The actual cost depends on City, Locality & Diagnostic center. To help with the cost, we are preparing a detailed resource.

Luteinizing hormone (LH) and its function

Luteinizing hormone or LH is a glycoprotein hormone produced by the pituitary gland at the base of our brain. 

It is produced in response to Gonadotropin Releasing hormone (GnRH) from the hypothalamus in our brain. GnRH controls the secretion of the two reproductive hormones – LH and FSH. They help with reproductive development in both men and women.

Men

In men, the testicles contain the interstitial cells or Leydig cells. LH stimulates these cells and hence is also known as ICSH (Interstitial Cell Stimulating Hormone). Thus, it produces the male hormone or testosterone.

Women

In women, LH helps in creating a mid-cycle LH surge that leads to ovulation. Thus, an egg is released from a mature ovarian follicle.

Further, LH also converts the remnants of this follicle into a secretory tissue called the corpus luteum which produces the pregnancy hormones. This will occur only if the egg is fertilized by a sperm to cause a pregnancy.

Normal menstrual bleeding occurs in the absence of fertilization. The thickened uterine lining, blood vessels and dead ovum (or egg) are shed with menstrual blood.

Children

In kids, LH levels help in pubertal development. LH increases sex hormone levels in the body. Thus, it helps in sex organ maturation and development of secondary sexual characters.

LH tests in children are important as it may represent a problem along the hormonal axis, which involves the hypothalamus, pituitary gland and sex organs (testes and ovaries).

Early onset of sex organ maturation in children can cause high LH levels. The symptoms include:

1. In girls: early menarche or age of onset of menstruation
2. In boys: an early pubic hair development, growth of testicles and penis

A late onset of sexual maturity in children can also occur due to low sex hormone levels.

Preparation, Procedure & Timing

No special preparation is required. The procedure is as simple as blood sampling. The nurse or technician will counsel you on the procedure and general health.

You will get your results in 24-48 hours. Alternative methods include LH test from a urine sample.

LH Test Timing

LH test timing is important in women. In females, the preferred time is Day 2 / Day 3 of the menstrual cycle.

However, in case the purpose of the test is to predict ovulation, then the best time is around the 11^th day of your menstrual cycle, in a regular 28-day cycle. In irregular menstrual periods, it may be challenging to know the time of ovulation using this method.

Your consulting gynecologist will discuss your menstrual patterns before ordering an LH test.

How does the LH test help in knowing ovulation in infertility?

LH test helps in identifying the time of egg or ovum release. This is done commonly in cases of infertility, or difficulty in getting pregnant.

An ovary in a healthy woman releases an egg with every menstrual cycle. This egg is released due to a peak in LH levels (LH surge). The phase is known as ovulation and occurs during mid-cycle i.e. 14th day in a regular 28-day cycle.

Knowing the probability of ovulation will aid in decision making among couples. Unprotected sex during this fertile time span will help in a successful pregnancy.

LH test kits have popularised easy testing at home similar to pregnancy detection kits.

What is urine LH test kit or ovulation test kit?

LH test kits are simple urine tests, designed for use at home. Multiple testing may be required to know the time of ovulation.

LH testing kits may help in spot tests and detects an LH surge or high LH levels in urine. It is an easy way to test at home to know the most fertile period. A positive test indicates that ovulation will occur in the next two days.

LH urine tests can be a random urine sample test or a 24-hour urine sample test.

LH is produced only intermittently in the body and hence, a random urine LH test may show variations over a day. Your doctor may suggest a 24-hour urine test if required for your condition.

How does pregnancy affect results?

LH levels peak around ovulation to cause egg release. If this egg is fertilized, it results in a pregnancy.

In pregnancy, there is feedback inhibition at the pituitary by the pregnancy hormones which makes both LH and FSH undetectable.

LH & FSH Test

FSH and LH are both gonadotropins i.e. hormones controlling the sex organs. Thus, any sexual or reproductive problem requires testing its companion hormone FSH. Thus, it is common for doctors to prescribe an FSH test along with LH.

LH Levels & Results

Laboratory values of LH test depend on the chemical method used for testing. We are giving an overview with a sample report from one of our renowned laboratories.

LH Levels in Females

Below 18 Years of Age

REFERENCE GROUP	REFERENCE RANGE IN mIU/mL
Tanner Stage 1( < 9.2 yrs)	0.02-0.18
Tanner Stage 2 ( 9.2 – 13.7 yrs)	0.18-4.70
Tanner Stage 3 ( 10-14.4 yrs)	0.10-12.0
Tanner Stage 4 ( 10.7-15.6 yrs)	0.4-11.70
Tanner Stage5 (11.8-18.6 yrs)	0.4-11.70

Adult Female above 18 Years

STAGES IN MENSURAL CYCLE	REFERENCE RANGE IN mIU/mL
Follicular	1.90-12.50
Mid Cycle Peak	8.70-76.30
Luteal Phase	0.50-16.90
Post Menopausal	15.90-54.0
Pregnant	0.10-1.50
Oral Contraceptives	0.70-5.60

LH Levels in Males

REFERENCE GROUP	REFERENCE RANGE IN mIU/mL
Tanner Stage 1( < 9.8 yrs)	0.20-0.30
Tanner Stage 2 ( 9.8 – 14.5 yrs)	0.20-4.90
Tanner Stage 3 ( 10.7-15.4 yrs)	0.20-5.00
Tanner Stage 4 ( 11.8-16.2 yrs)	0.40-7.00
Tanner Stage5 (12.8-17.3 yrs)	0.40-7.00
Male above 18 yrs and Below 70 Yrs	1.50-9.30
Male Above 70 Yrs	3.10 – 34.60

Understanding LH Test results

Disclaimer:  The information published here, is for general awareness. Treatment decisions pertaining to your LH test results should only be made by your consulting doctor.

Many factors like age, gender and day of your monthly cycle and time when the blood sample is drawn can influence your LH test results. Hence, we may categorize the probable interpretations of your results into three subcategories:

Females

LH levels help in understanding a variety of diseases concerning women’s health.

High LH Levels

Primary ovarian failure or loss of reproductive function due to a non-functioning ovary usually causes high LH and FSH values.

1. Absent ovaries (Ovarian agenesis): Absent ovaries from birth can cause low sex hormone levels and a feedback rise in LH and FSH
2. Turner’s syndrome: A chromosomal disorder with an absent X chromosome, causes streak ovaries which are non-functional
3. Ovarian damage: From trauma, chemotherapy or radiotherapy
4. Ovarian tumours and steroid hormone abnormalities may cause anovulatory cycles where an egg is not released in every cycle. Hence, the pituitary produces more LH in order to stimulate the ovary at a higher frequency, as LH surge helps ovulation.
5. Polycystic Ovarian Disease (PCOD) or syndrome (PCOS) is caused by hormonal imbalances which lead to an excess of male hormones in women. Hence, the symptoms include features of masculinization like excessive facial hair growth (hirsutism), acne and irregular periods. It is often associated with excess body weight and high glucose levels or diabetes. LH test results are high because of anovulatory cycles.
6. Other endocrine problems: Adrenal and thyroid gland problems can also give rise to an increased LH level, as the metabolism in the body is affected
7. Menopause: The cessation of monthly periods in a woman, will lead to a persistently raised level of LH and FSH. This occurs due to positive feedback from low levels of oestrogen.

Low LH Level

Secondary ovarian failure or loss of ovarian function secondary to a problem elsewhere in the body. LH response to GnRH injection may aid in proper diagnosis

1. Low pituitary function: A decrease in pituitary production of LH can cause low levels
2. Low hypothalamic function: A decrease in GnRH can cause low LH levels due to decreased stimulation of the pituitary gland.
3. Others: Critical illnesses and liver damage can cause low LH results

Males

In men, LH levels are tested to ensure adequate stimulation of the interstitial cells of Leydig to produce testosterone.

High LH Levels in Males

It shows primary testicular failure. The problem lies within the testicles. Thus, LH levels increase in order to stimulate the testicles adequately.

1. Testicular agenesis (Absent testes): Birth defect where testicles are not developed completely
2. Klinefelter’s syndrome: A chromosomal anomaly with XXY configuration of sex chromosomes. The patient will suffer from infertility, tall habitus and gynecomastia (breast development in men).
3. Testicular damage: This can occur from trauma, radiation, chemotherapeutic agents and viral infections of the testes like mumps can cause mumps orchitis causing testicular failure.

Low LH Test Levels in Males

It occurs due to secondary testicular failure. Both LH and FSH levels will be low in this case. The problem may lie in the pituitary or hypothalamus. LH response to GnRH administration helps in making a diagnosis.

1. Low pituitary function: GnRH injection will not be able to increase LH levels if the pituitary function is impaired
2. Low hypothalamic function: GnRH injection will raise LH levels if the problem is due to decreased functioning of the hypothalamus
3. Others: Chronic infections and prolonged illnesses with impaired liver function can lower LH levels

Children

Pubertal issues and illnesses can alter the LH test reports

1. Precocious puberty (early): LH and FSH test results are high to normal. Affects young girls more than boys. It occurs due to some problems in the brain or pituitary gland, like trauma and brain injury. Childhood meningitis, encephalitis, and intracranial tumours or neurosurgical interventions may also contribute.
2. Delayed puberty (late): LH and FSH test results may be low to normal. LH response to GnRH is necessary for diagnosis. Eating disorders like anorexia nervosa can also lower your LH levels.

Note: Our body has complex reproductive physiology. Many hormones like LH, FSH, oestrogen, progesterone, beta hCG and testosterone are involved. Therefore, diagnosing a condition may need testing for more than one of these hormone levels.

What drugs can interfere with your LH test results?

If you suffer from epilepsy and is on antiepileptic treatment, your LH levels may go high. The drug used in ovulation induction (clomiphene citrate) can also increase your LH levels.

Other medicines like oral contraceptives and hormone replacement therapies can negatively affect your LH levels. Some drugs like digoxin, used in the treatment of atrial fibrillation and heart failure can also lower your LH levels.

We recommend you to speak to your doctor directly, as dose adjustments may be required prior to LH testing.

References

1. Henry’s Clinical Diagnosis and Management by Laboratory methods 22^nd edition, by Richard A. McPherson and Matthew R. Pincus (Saunders, 2011)
2. Oxford Handbook of Endocrinology and Diabetes, 3^rd edition (OUP, 2014)
3. https://medlineplus.gov/ency/article/007062.htm
4. https://www.ncbi.nlm.nih.gov/books/NBK279054/