The Markers Your Standard Panel Leaves Out
The overlooked markers that change the story
These three markers rarely appear on a standard panel, but each adds genuine information that total testosterone or oestrogen alone can miss.
DHEA-S: The Clearest Age-Related Decline in Endocrinology
DHEA (and its more stable, measurable form, DHEA-S) is produced by the adrenal glands and serves as a precursor that the body converts into both testosterone and oestrogen. A landmark study tracking DHEA-S across adulthood found one of the most consistent, steepest age-related hormonal declines in the entire endocrine system — levels in people in their 70s and 80s commonly measuring only 10–20% of levels seen in young adults[9]. Whether supplementing DHEA to counteract this natural decline provides meaningful benefit remains genuinely debated, with mixed trial results — it's a reasonable marker to know your level of, but a less settled case for routine supplementation than most of the interventions covered elsewhere in this guide.
SHBG: The Modifier That Changes What "Normal" Means
Sex Hormone Binding Globulin binds to testosterone and oestrogen in the blood, and only the unbound ("free") fraction is biologically active in tissues. High SHBG means a smaller fraction of your total testosterone is actually available for use — which is precisely why total testosterone alone can be misleading, and why free testosterone (Section 2) is the more clinically informative number when the two disagree. Alcohol and low zinc status both raise SHBG.
Prolactin: The Marker Most People Have Never Heard Of
Prolactin, best known for its role in lactation, also suppresses the reproductive hormone axis when chronically elevated in anyone, regardless of sex — reducing libido and, in men, testosterone. Chronic stress, certain medications (particularly some antipsychotics and antidepressants), and, less commonly, a pituitary growth are the usual causes of elevation. It's rarely tested unless specifically requested, despite being a genuinely useful marker when reproductive-hormone symptoms don't have an obvious explanation from the more commonly tested markers.
Section takeaway
DHEA-S, SHBG, and prolactin are each individually capable of explaining a hormonal picture that total testosterone or oestrogen alone can't — all three are worth specifically requesting when symptoms persist despite normal-looking standard results.