PMOS lab interpretation focuses on 14 tests across 4 categories: androgens (testosterone, free testosterone, SHBG, DHEA-S, androstenedione, 17-hydroxyprogesterone), reproductive hormones (LH, FSH, prolactin, oestradiol, AMH), metabolic (HbA1c, fasting insulin, fasting glucose, lipid panel, ALT/AST), and rule-outs (TSH, free T4, cortisol). Optimal ranges are often tighter than standard lab ranges; PMOS-informed clinicians typically target free testosterone in the lower third of the female range, fasting insulin below 8 mIU/L, HbA1c below 5.5 percent, vitamin D 40 to 60 ng/mL, and SHBG above 50 nmol/L. A normal-range result is not always an optimal result. PMOS is the new name for PCOS as of 12 May 2026; lab interpretation is unchanged under both names.
The 14 PMOS lab tests, what they mean, and what to do about each
Androgens (the "is my body making too much male hormone" panel)
| Test | Standard lab range | PMOS-relevant interpretation |
|---|---|---|
| Total testosterone | 15-70 ng/dL (women) | Above 50 ng/dL is borderline. Above 200 ng/dL warrants imaging to rule out androgen-secreting tumor. |
| Free testosterone | 0.1-6.4 pg/mL | The biologically active form. Often elevated even when total is normal due to low SHBG. Target lower third of range. |
| SHBG | 20-120 nmol/L | Often low in PMOS (linked to insulin resistance). Below 30 nmol/L raises free testosterone. Target above 50 nmol/L. |
| DHEA-S | 35-430 mcg/dL (varies by age) | Adrenal-source androgen. Elevated in adrenal-phenotype PMOS. Above 700 mcg/dL warrants imaging. |
| Androstenedione | 0.4-2.7 ng/mL | Less commonly elevated. Useful when total/free testosterone are equivocal. |
| 17-hydroxyprogesterone (8am) | Below 200 ng/dL follicular phase | Above 200 ng/dL suggests non-classical congenital adrenal hyperplasia (NCCAH), a PMOS mimic. |
Reproductive hormones (the "is the cycle machinery working" panel)
| Test | Standard lab range | PMOS interpretation |
|---|---|---|
| LH (luteinizing hormone) | 2-12 IU/L (follicular) | Often elevated in PMOS, particularly relative to FSH. LH/FSH ratio above 2 supports PMOS. |
| FSH (follicle stimulating hormone) | 3-10 IU/L (follicular) | Typically normal in PMOS. High FSH (above 25) suggests premature ovarian insufficiency. |
| Prolactin | 5-25 ng/mL | Mild elevation common in PMOS. Above 50 ng/mL warrants pituitary imaging. |
| Oestradiol | 30-400 pg/mL (cycle-dependent) | Often normal in PMOS. Very low oestradiol with low LH/FSH suggests hypothalamic amenorrhea. |
| AMH (anti-Mullerian hormone) | 1-5 ng/mL (varies by age) | Often elevated in PMOS due to high follicle count. AMH alone is not diagnostic. Above 7 ng/mL supports PCOM. |
Metabolic (the "is insulin resistance present" panel)
| Test | Standard lab range | PMOS interpretation |
|---|---|---|
| HbA1c | Below 5.7% normal | 5.7-6.4% pre-diabetes. PMOS-informed target: below 5.5% for optimal. |
| Fasting insulin | Below 25 mIU/L | The lab range is very wide. Insulin above 10 mIU/L on its own suggests insulin resistance. Target below 8. |
| Fasting glucose | 3.9-5.6 mmol/L (70-100 mg/dL) | Above 5.6 mmol/L = pre-diabetes. Target 4.4-5.0 mmol/L (80-90 mg/dL) for optimal. |
| HOMA-IR (calculated) | Below 2.0 | Above 2.0 suggests insulin resistance. Calculate: (fasting insulin x fasting glucose) / 22.5 for mmol/L. Or divide by 405 for mg/dL. |
| Lipid panel | HDL above 50, triglycerides below 150 | Low HDL and high triglycerides common in PMOS. Triglycerides/HDL ratio above 3 strongly suggests insulin resistance. |
| ALT and AST | Below 35 U/L | Elevated ALT (above 30 in women) suggests non-alcoholic fatty liver disease, present in around 60 percent of women with PMOS. |
| Vitamin D (25-OH) | 30-100 ng/mL | 67-85% of women with PMOS are deficient (below 30 ng/mL). PMOS-informed target: 40-60 ng/mL. |
Thyroid and cortisol (the rule-outs)
| Test | Standard lab range | PMOS interpretation |
|---|---|---|
| TSH | 0.4-4.5 mIU/L | PMOS-informed clinicians often target below 2.5 mIU/L for symptom resolution. |
| Free T4 | 0.8-1.8 ng/dL | Should be tested alongside TSH for full thyroid picture. |
| Free T3 | 2.3-4.2 pg/mL | Useful for full thyroid function picture, especially in conversion issues. |
| TPO antibodies, TgAb | Negative | Positive suggests Hashimotos thyroiditis (3x higher rate in PMOS). |
| Morning cortisol | 5-25 mcg/dL (8am) | Pattern matters more than single value. Useful in adrenal-phenotype PMOS. |
How to read your PMOS labs as a pattern, not single numbers
The most useful PMOS lab interpretation looks at patterns across multiple results, not at single numbers in isolation.
The classic insulin-resistant PMOS pattern
- Free testosterone in the upper third or above range
- SHBG below 30 nmol/L (low)
- Fasting insulin above 10 mIU/L
- HOMA-IR above 2.0
- HbA1c 5.5-5.7%
- Triglycerides/HDL ratio above 3
- ALT slightly elevated (NAFLD)
- Often: AMH above 5, LH/FSH above 2
The classic adrenal-phenotype PMOS pattern
- DHEA-S in the upper third or above range
- Total and free testosterone often normal
- Fasting insulin normal
- LH/FSH ratio less elevated
- Often: cortisol patterns disrupted (high morning, low evening, or flat)
The classic post-pill PMOS pattern
- Recently off hormonal contraceptive (within 6-12 months)
- SHBG falling, free testosterone rising
- LH/FSH normalising over months
- AMH may be temporarily low immediately after stopping
- Tendency for the pattern to stabilise toward insulin-resistant or adrenal over 12-18 months
What if my labs are "normal" but I have PMOS symptoms?
This is common and frustrating. Several reasons it can happen:
- The standard lab ranges are too wide. Many PMOS-relevant tests (insulin, vitamin D, TSH) have lab ranges that include levels that are technically "normal" but contribute to symptoms.
- Single-time-point testing misses cycle variation. Hormones change across the cycle. A day 21 reading is different from a day 3 reading. Most reproductive hormones should be tested on cycle day 2-5.
- The PCOS to PMOS framing was being missed. The condition can be present without classical lab abnormalities. Phenotype D PMOS (polycystic ovaries on ultrasound without androgen excess or oligo-ovulation) has minimal lab findings.
- You may have NCCAH or another mimic. Get 17-hydroxyprogesterone, a full thyroid panel, and prolactin to rule out look-alikes.
- Symptoms can precede lab abnormalities. Insulin resistance often shows up in symptoms (cravings, energy crashes, weight at the waist) before HbA1c or fasting insulin reach lab cutoffs.
The PMOS lab testing schedule
| Test | Optimal cycle day | How often to re-test |
|---|---|---|
| Testosterone, free testosterone, SHBG, DHEA-S | Day 2-5 if cycling, any day if amenorrhoeic | Every 6-12 months while treating, then annually |
| LH, FSH, oestradiol | Day 2-5 | Every 6-12 months |
| HbA1c, fasting insulin, fasting glucose, lipid panel | Any day, fasted | Every 6-12 months. Every 3-6 months if on metformin or treating IR |
| Vitamin D, B12, ferritin | Any day | Every 6-12 months |
| Thyroid panel | Any day | Annually unless on thyroid medication |
| 17-OH-progesterone | Morning, day 2-5 | Once unless borderline |
| AMH | Any day | Every 1-3 years for fertility tracking |
What to ask for if your doctor only orders the basics
Many doctors order TSH, testosterone, and a basic metabolic panel and call it done. To get the full PMOS picture, ask specifically for:
- Free testosterone and SHBG (not just total testosterone).
- DHEA-S (for adrenal contribution).
- 17-OH-progesterone (rules out NCCAH).
- Fasting insulin alongside fasting glucose (lets you calculate HOMA-IR).
- HbA1c.
- Full lipid panel including triglycerides.
- ALT and AST (fatty liver screen).
- 25-OH vitamin D.
- Full thyroid panel: TSH, free T4, free T3, TPO antibodies, TgAb.
- Ferritin alongside basic iron studies (often missed).
- Prolactin.
Frequently asked questions
What blood tests are done for PMOS?
The standard PMOS workup includes 14 tests across androgens (testosterone, free testosterone, SHBG, DHEA-S, 17-OH-progesterone), reproductive hormones (LH, FSH, prolactin, oestradiol, AMH), metabolic (HbA1c, fasting insulin, fasting glucose, lipid panel, ALT/AST), vitamins (vitamin D, ferritin, B12), and thyroid (TSH, free T4, free T3, antibodies).
What is a normal testosterone level for PMOS?
The standard lab range for total testosterone in women is 15-70 ng/dL. In PMOS, total testosterone is often within range but free testosterone (the biologically active form) is elevated due to low SHBG. PMOS-informed clinicians target free testosterone in the lower third of the female range for symptom resolution.
What is a normal insulin level for PMOS?
Standard lab range is below 25 mIU/L, which is very wide. Fasting insulin above 10 mIU/L alone suggests insulin resistance even without an elevated HOMA-IR. PMOS-informed target: below 8 mIU/L. HOMA-IR above 2.0 confirms insulin resistance.
What does low SHBG mean in PMOS?
Low SHBG (below 30 nmol/L) is a marker of insulin resistance. SHBG binds testosterone in the blood; less SHBG means more free testosterone reaches tissues, producing more acne, hirsutism, and hair loss. Raising SHBG (via dietary changes, inositol, weight loss, or combined oral contraceptives) reduces free testosterone without changing total testosterone.
What does high AMH mean in PMOS?
AMH (anti-Mullerian hormone) is produced by small developing follicles in the ovary. Women with PMOS often have many small follicles, producing AMH levels above 5 ng/mL (often 7-15+). High AMH supports PCOM (polycystic ovarian morphology) but is not diagnostic on its own. Low AMH suggests low ovarian reserve regardless of PMOS.
What is a normal HbA1c for PMOS?
Standard lab range: below 5.7% normal, 5.7-6.4% pre-diabetes, 6.5%+ diabetes. PMOS-informed target: below 5.5% for optimal symptom and long-term outcomes. Around 30 percent of women with PMOS have HbA1c in the pre-diabetes range by age 40.
Do I need fasting insulin if my HbA1c is normal?
Yes, especially in PMOS. HbA1c reflects average glucose over 3 months but misses early insulin resistance where insulin is elevated to keep glucose normal. Fasting insulin and HOMA-IR catch this earlier stage. A normal HbA1c with elevated fasting insulin (above 10) is a common PMOS pattern.
Why are my PMOS labs normal but I have symptoms?
Common reasons: lab ranges are wider than optimal ranges, hormones vary by cycle day (test on day 2-5), phenotype D PMOS has minimal lab findings, symptoms can precede lab abnormalities, and PMOS mimics (thyroid, prolactin, NCCAH) need to be excluded. Symptom-driven treatment is appropriate even with technically normal labs.
Build a PMOS plan based on your actual results
Lab numbers point to which phenotype you fit.
Insulin-resistant patterns need different food and supplement choices than adrenal patterns. Take the free phenotype quiz to match your labs and symptoms to a tailored PMOS plan.
What to read next
- How PMOS is diagnosed
- PMOS symptoms complete list
- PMOS diet: full food list
- Best PMOS supplements
- PCOS is now PMOS: full renaming explainer
How this article was researched
Sources include the 2023 International Evidence-based Guideline for the Assessment and Management of PCOS, the 2003 Rotterdam diagnostic criteria, the AE-PCOS Society lab recommendations, the 2020 meta-analysis of vitamin D and PCOS (11,000 patients), and the 2022 Endocrine Reviews update on thyroid dysfunction in PCOS. PCOS was renamed PMOS on 12 May 2026; lab tests and interpretation are unchanged under both names. This article is informational and not medical advice. Always interpret lab results with a qualified healthcare provider. See our editorial standards.
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