PCOS Blood Tests: The Full List and What Each One Shows

Short answer: no single blood test diagnoses PCOS. Doctors diagnose it with the Rotterdam criteria, which need two of three features: high androgens, irregular or absent ovulation, and polycystic ovaries on ultrasound (or a high AMH level in adults). Blood tests do most of the work on the first feature and help rule out lookalikes. The core PCOS labs are total and free testosterone, SHBG, the free androgen index and DHEA-S for the androgen side, plus blood sugar and a lipid panel for the metabolic side. Most of the androgen and metabolic picture can be checked at home, and if you're wondering whether PCOS is behind your acne, irregular periods or hair growth, the way to know is to test.

What blood tests diagnose PCOS?

PCOS affects 10% to 13% of women worldwide, according to the 2023 International PCOS Guideline (Teede et al., 2023). The guideline builds on the Rotterdam criteria: you need two of these three features, and other causes have to be ruled out (Teede et al., 2023; Joham et al., 2022):

• High androgens, seen on the body (acne, unwanted hair growth, scalp thinning) or in the blood.
• Irregular or absent ovulation, usually shown by irregular cycles.
• Polycystic ovaries on ultrasound, or a high AMH blood level in adults.

If you have both irregular cycles and high androgens, you don't need an ultrasound or AMH at all. In teens, both of those are required, and ultrasound and AMH aren't recommended (Teede et al., 2023). That makes the androgen blood tests one of the most important pieces of the whole workup.

The full PCOS labs list: what each test shows

Here is every blood test the guideline lists for assessing PCOS, what it shows, and whether BreakoutLabs measures it.

Blood test	What it shows	BreakoutLabs?
Total testosterone	All the testosterone in your blood. A first-line test for high androgens.	Yes, main panel
Free testosterone	The share that's free to act on skin and hair follicles.	Yes, main panel
SHBG	The protein that binds testosterone. Often low in PCOS, especially with high insulin.	Yes, main panel
Free androgen index (FAI)	Total testosterone compared with SHBG. The guideline's way to estimate free testosterone.	Yes, main panel
DHEA-S	An androgen that comes largely from the adrenal glands. Checked if testosterone isn't raised.	Yes, main panel
Androstenedione	Another androgen, also a second-line test.	No, doctor orders it
HbA1c	Average blood sugar over the past 2 to 3 months.	Yes, main panel
Average glucose (eAG)	Your HbA1c translated into an everyday glucose number.	Yes, main panel
Lipid panel	Total cholesterol, HDL, LDL and triglycerides. Recommended for everyone with PCOS.	Yes, main panel
TSH, Free T4, TPO	Thyroid function. Thyroid problems are one of the conditions doctors rule out.	Thyroid add-on ($49)
LH and FSH	Pituitary hormones, used to rule out other causes of missed periods.	No, doctor orders it
AMH	A hormone from the ovaries that can stand in for an ultrasound in adults.	No, doctor orders it
Prolactin	Rules out high prolactin, one of the conditions doctors exclude first.	No, doctor orders it
17-OH progesterone	Rules out non-classic congenital adrenal hyperplasia.	No, doctor orders it
Oral glucose tolerance test, fasting glucose, fasting insulin	How your body handles a sugar load. The OGTT is the most accurate blood sugar test in PCOS.	No, doctor orders it

Sources for the table: Teede et al., 2023, for which tests to use and why; Biernacka-Bartnik et al., 2022, for SHBG and insulin; Wild et al., 2011, for lipids.

The PCOS hormone panel: testing androgens

The guideline is specific here. Doctors should use total and free testosterone to check for high androgens, and free testosterone can be estimated with the free androgen index. If testosterone isn't raised, DHEA-S and androstenedione can be added, though they're less specific (Teede et al., 2023).

SHBG matters because it decides how much testosterone is actually free. Low SHBG is characteristic of PCOS and is linked to high insulin: in a study of 854 women with PCOS, lower SHBG went with a higher chance of insulin resistance (Biernacka-Bartnik et al., 2022). That's why total testosterone alone can look normal while free testosterone and the FAI are high.

These androgens are also what drive PCOS acne. If that's your main question, read PCOS acne: causes, where it shows up and what to test.

PCOS metabolic labs: blood sugar and lipids

PCOS isn't only a hormone condition. Women with PCOS have a higher risk of prediabetes and type 2 diabetes regardless of age and weight, so the guideline says blood sugar should be checked at diagnosis and every 1 to 3 years after (Teede et al., 2023). The OGTT is the most accurate test. HbA1c is a less accurate but far simpler option that gives a useful read on your average blood sugar.

The guideline also says everyone with PCOS should have a lipid profile at diagnosis (Teede et al., 2023). A meta-analysis found women with PCOS had higher triglycerides and LDL and lower HDL than women without it, and LDL stayed higher even when body weight was matched (Wild et al., 2011).

What about fasting insulin? The guideline says insulin resistance is part of PCOS, but routine insulin tests are of limited use and aren't recommended in everyday care (Teede et al., 2023). Low SHBG and rising HbA1c are often more practical clues.

Does regular blood work show PCOS?

Usually not. Routine yearly bloodwork often covers a blood count, basic chemistry and sometimes cholesterol, but androgens and SHBG generally need to be requested specifically. Getting them the usual way means booking an appointment, getting a lab slip, traveling to a draw site for a needle draw and waiting for a follow-up. A third of women in one large survey waited more than 2 years for a PCOS diagnosis, and almost half saw 3 or more health professionals first (Gibson-Helm et al., 2017).

When to test for PCOS, and how birth control skews results

• Early in your cycle. BreakoutLabs asks you to collect on days 3 to 7 of your cycle if you menstruate, in the morning after an 8 to 10 hour fast.
• Know that the pill changes the numbers. Birth control pills raise SHBG and lower androgens, so androgen results on the pill are hard to read. The guideline says that if androgen testing is essential, the pill should be stopped for at least 3 months first, with other contraception in place (Teede et al., 2023). Never stop a medication without talking to your prescriber.

How long do PCOS blood results take?

Through a doctor, it depends on how fast you can get an appointment, a draw and a follow-up visit. With BreakoutLabs, results arrive 5 business days after the lab receives your sample, with a Clear Skin Blueprint that explains what they mean for your skin.

A PCOS diagnosis is made by a doctor using your cycles, symptoms and labs together. BreakoutLabs gives you the androgen and metabolic picture to bring to that visit. If your results point to PCOS, your doctor can order the remaining tests above.

Why test with BreakoutLabs

• At home, with a painless device on your upper arm. No lab slip, no trip to a lab, no appointment.
• 19 biomarkers across hormones, blood sugar, metabolism and nutrients: Free and Total Testosterone, SHBG, DHEA-S, Free Androgen Index and Albumin; HbA1c, average glucose and a full cholesterol and triglyceride panel; ALT, Creatinine and eGFR; and Vitamin D.
• Thyroid add-on, same sample ($49): TSH, Free T4 and TPO antibodies.
• Results in 5 business days after a CLIA-certified lab receives your sample.
• A personalized Clear Skin Blueprint that reads your results through the lens of acne.
• $199, HSA/FSA eligible, and backed by our 30-day money-back guarantee.

For ages 14 and up (14 to 17 with a parent or guardian).

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Frequently asked questions

What blood tests diagnose PCOS?

No single test does. Doctors use total and free testosterone, SHBG and the free androgen index to check for high androgens, add blood sugar and lipid tests, and rule out lookalikes with thyroid, prolactin and 17-OH progesterone tests. The diagnosis combines these with your cycles and symptoms.

Can you test for PCOS at home?

You can check the androgen and metabolic markers at home, which covers most of the PCOS blood work. The diagnosis itself, and tests like LH, FSH, AMH and prolactin, come from a doctor.

Can you have PCOS with normal testosterone?

Yes. You can meet the criteria with irregular cycles and polycystic ovaries, or with visible signs like hair growth. Total testosterone can also look normal while free testosterone is high because SHBG is low, so it's worth checking all of them.

Is fasting insulin part of the PCOS labs?

The guideline doesn't recommend routine insulin tests, because they're of limited clinical use. Blood sugar tests such as an OGTT or HbA1c are preferred.

Ruling out your skincare too? Hormones explain a lot, but not everything. Paste any product into our free pore clogger checker to see which ingredients are likely to clog pores.

Sources

• Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Journal of Clinical Endocrinology and Metabolism. 2023.
• Joham AE, Norman RJ, Stener-Victorin E, et al. Polycystic ovary syndrome. The Lancet Diabetes and Endocrinology. 2022.
• Biernacka-Bartnik A, Kocełak P, Owczarek AJ, et al. Prediction of insulin resistance and impaired fasting glucose based on sex hormone-binding globulin (SHBG) levels in polycystic ovary syndrome. International Journal of Endocrinology. 2022.
• Wild RA, Rizzo M, Clifton S, Carmina E. Lipid levels in polycystic ovary syndrome: systematic review and meta-analysis. Fertility and Sterility. 2011.
• Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism. 2017.

This article is for educational purposes and is not medical advice. Talk to your healthcare provider about testing and treatment.