PCOS Hormones: What Your Levels Reveal

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders that affects women in the reproductive age group worldwide. The number of PCOS cases in India has also seen a dramatic rise in recent years, now affecting at least one in five women. While several high-profile celebrities, including Shruti Haasan and Masaba Gupta, have been speaking out to raise awareness and end the stigma around the condition, we still have a long way to go. Understanding the link between PCOS and hormone levels is an essential step in this direction, as hormonal changes define the condition and how it progresses. 

The link between PCOS and hormonal imbalance

PCOS is often described as a hormonal disorder because dysregulation of hormones is one of its main characteristics. This means that your body’s production and response to certain hormones is disrupted, which can result in a wide range of PCOS symptoms and long-term health complications.

Typically, levels of ‘male’ hormones, such as testosterone, are elevated, while levels of oestrogen, progesterone, luteinizing hormone (LH), and follicle‑stimulating hormone (FSH) are disrupted. In roughly a third of all women with PCOS, there is also an increase in insulin resistance, which forces your body to produce more insulin. This, in turn, causes irregularities in the production of other hormones, having a cascading effect.

All of these changes can occur due to a variety of reasons that we are still unravelling, but it is clear that the link between PCOS and hormone levels is not one-directional. Instead, PCOS both arises from and further perpetuates hormonal dysregulation.

Hormones commonly tested in PCOS diagnosis

A diagnosis of PCOS is not reached solely through testing hormonal levels, as it is a multi-faceted condition that can present a variety of symptoms. However, a PCOS hormone levels test may include hormones of interest such as:

• Total and free testosterone (usually elevated)

• Dehydroepiandrosterone-sulfate (DHEA-S) (adrenal androgen is often raised)

• LH and FSH (a high LH: FSH ratio is common in PCOS)

• Prolactin (to rule out prolactinoma or other causes of menstrual irregularities)

• Thyroid-stimulating hormone (TSH) (to rule out thyroid disorders)

• Fasting insulin and glucose (to evaluate insulin resistance)

All of these levels can be detected with easily available blood tests that your doctor will recommend if necessary.

PCOS hormone levels (Typical ranges)

If you're monitoring hormone levels for PCOS, it can be helpful to understand how your results compare to typical reference ranges. However, it's important to note that normal values may vary slightly between laboratories, and all results should be interpreted with guidance from your doctor.

Total testosterone levels normally fall between 6 and 86 ng/dL, with higher levels potentially suggesting PCOS. Free testosterone, which is the biologically active form, usually ranges from 0.7 to 3.6 pg/mL—again, elevated levels may be linked to PCOS. Oestrogen levels tend to range widely, from 30 to 400 pg/mL, and while these can fluctuate significantly in women with PCOS, they may still fall within the standard range.

Progesterone levels, which typically vary from 0.1 to 25 ng/mL, are often found to be lower in women with PCOS, especially when ovulation is irregular or absent. DHEA-S (dehydroepiandrosterone sulphate), a hormone produced by the adrenal glands, generally falls between 35 and 430 μg/dL; levels above 200 μg/dL may indicate PCOS or other androgen-related conditions.

The LH to FSH ratio is also a common indicator. While a typical balance is around 1:1 or 1:2, women with PCOS may show a 2:1 or 3:1 ratio, which can signal hormonal disruption. Additionally, prolactin levels should usually be below 25 ng/mL, elevated levels could suggest other underlying issues, such as pituitary disorders. Finally, TSH (thyroid-stimulating hormone) is assessed to rule out thyroid involvement, with a typical reference range of 0.4 to 4.0 mIU/L; abnormalities here may indicate thyroid dysfunction, which can sometimes mimic or worsen PCOS symptoms.

Always speak to your healthcare provider to understand what your test results mean in the context of your symptoms and health history.

What if you have PCOS with ‘normal’ hormone levels?

Contrary to what you might expect, PCOS is not always diagnosed from abnormalities in the levels of hormones. Because of the variation in what is the normal range of many hormones, some women can have PCOS with normal hormone levels. However, they may still be experiencing PCOS symptoms and could meet other clinical criteria, as subtle shifts within this range can also disrupt normal ovulation and the menstrual cycle.

How to balance hormones in PCOS naturally

PCOS is closely linked to hormonal imbalances, particularly involving insulin, androgens, and progesterone. 

Here are evidence-based ways to help balance hormones naturally with PCOS:

• Follow a Mediterranean-style diet

Prioritise vegetables, fruits, whole grains, legumes, healthy fats (like olive oil), and lean proteins. This helps stabilise blood sugar and reduce inflammation.

• Reduce ultra-processed foods

Cut back on refined sugars, sugary drinks, fried foods, and packaged snacks. These can worsen insulin resistance and disrupt hormone levels.

• Choose low-glycaemic index (GI) carbohydrates

Opt for foods that release energy slowly, such as oats, quinoa, lentils, and sweet potatoes to support balanced blood sugar and reduce insulin spikes.

• Exercise regularly

Engage in a mix of aerobic activities (like brisk walking or cycling) and strength training. Regular movement improves insulin sensitivity and reduces excess androgen levels.

When to see a doctor

Early diagnosis and proper management of PCOS are essential to prevent or lower the risk of serious complications, including diabetes, cardiovascular disease, and infertility. If you notice any of the following symptoms, make it a point to consult your doctor:

• Irregularities or absence of monthly periods

• Increased and excessive hair growth, such as on the face or body

• Difficulty getting pregnant 

• Increased weight gain and difficulty losing weight

• Mood swings and depression, or anxiety

Frequently Asked Questions

1. Can PCOS be diagnosed with hormone level tests?

PCOS hormone level tests can help with a diagnosis, but they are not used in isolation as PCOS is a complex condition involving other physiological changes and symptoms. This requires a combination of diagnostic tools to reach a conclusive diagnosis. 

2. Can hormone levels be normal with PCOS?

Yes, hormonal disruptions that occur in PCOS can be subtle, while the normal range of hormone levels is large. As a result, PCOS-related fluctuations may still show within the normal range. 

3. Is it possible to restore PCOS hormone balance naturally?

Yes, hormonal balance can often be restored with lifestyle interventions, including diet and exercise. Although this is the main approach, severe cases or those with complications will require additional measures.