What this test measures
This panel measures three anterior pituitary hormones in a single draw:
• Follicle Stimulating Hormone (FSH) — drives follicle growth in women and spermatogenesis in men. • Luteinising Hormone (LH) — triggers ovulation in women and supports testosterone production in men. • Prolactin (PRL) — supports lactation but, in excess, suppresses the reproductive axis and causes amenorrhoea, galactorrhoea or low libido.
Together they cover the most important pituitary outputs for reproductive function.
Why it matters
These three hormones are the standard starting panel for almost any reproductive complaint — amenorrhoea or oligomenorrhoea, unexplained subfertility, galactorrhoea, low libido or erectile dysfunction in men, and screening for pituitary tumours. They efficiently triage where the problem sits: at the pituitary (low FSH, low LH or raised prolactin), at the gonad (high FSH, high LH), or downstream.
The panel is also part of the workup of any patient with visual-field defects, headache, or other features suggesting a pituitary tumour. Prolactin is by far the most common pituitary tumour hormone — even modestly raised prolactin (in the absence of pregnancy, breastfeeding or specific medications) deserves a pituitary MRI.
How to prepare
No fasting required. Morning sample preferred. For cycling women in fertility workup, draw on cycle day 2 or 3 (FSH and LH) — prolactin can be drawn any day. Stop biotin for 48–72 hours. Mention all medications, especially antipsychotics (risperidone, haloperidol), antidepressants, domperidone and prokinetics — all can raise prolactin substantially. Avoid significant nipple stimulation and breast examination in the hour before the draw.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| Follicle Stimulating Hormone (FSH) (mIU/mL)[1] | Female follicular: 3.5 – 12.5 · Mid-cycle: 4.7 – 21.5 · Luteal: 1.7 – 7.7 · Postmenopausal: 25.8 – 134.8 · Adult male: 1.5 – 12.4 | Low FSH with low LH and low sex steroids = hypogonadotropic hypogonadism (pituitary or hypothalamic problem). | Raised FSH in a woman with absent periods suggests primary ovarian failure. In a man with low testosterone suggests primary testicular failure. |
| Luteinising Hormone (LH) (mIU/mL)[1] | Female follicular: 2.4 – 12.6 · Mid-cycle peak: 14 – 95 · Luteal: 1.0 – 11.4 · Postmenopausal: 7.7 – 58.5 · Adult male: 1.7 – 8.6 | Low LH with low FSH = pituitary or hypothalamic problem (stress, low BMI, pituitary tumour, Kallmann syndrome). | LH:FSH > 2 in a woman with irregular periods supports PCOS. Very high LH with high FSH = primary ovarian / testicular failure. |
| Prolactin (PRL) (ng/mL)[1] | Adult female (non-pregnant): 4.8 – 23.3 · Adult male: 4.0 – 15.2 | Low prolactin rarely matters in isolation. Can suggest panhypopituitarism in the context of low FSH, LH, TSH and cortisol. | Mildly raised (25–100 ng/mL) — drug effect (antipsychotics, domperidone), stress, breast stimulation, hypothyroidism. 100–200 ng/mL — micro-prolactinoma likely. > 200 ng/mL — macro-prolactinoma likely; arrange pituitary MRI. |
FSH + LH + Prolactin — pattern recognition
| Pattern | FSH | LH | PRL | Likely picture |
|---|---|---|---|---|
| PCOS | Normal/low | High | Normal | LH:FSH > 2; oligomenorrhoea |
| Hyperprolactinaemia | Low/normal | Low/normal | Raised | Drug effect or prolactinoma |
| Premature ovarian insufficiency / menopause | Very high | High | Normal | Ovarian failure |
| Primary testicular failure | High | High | Normal | Klinefelter, post-chemo, orchitis |
| Hypogonadotropic hypogonadism | Low | Low | Normal | Stress, low BMI, pituitary disease |
| Macroprolactinoma | Low | Low | Very high (> 200) | Pituitary tumour — needs MRI |
Frequently asked questions
When in my cycle should this panel be done?
Cycle day 2 or 3 (early follicular) is the standard for FSH and LH in fertility workup. Prolactin can be drawn any day. If you do not have regular periods, your doctor will pick a convenient day.
My prolactin is slightly raised — does that mean I have a tumour?
Not necessarily. Drug-induced hyperprolactinaemia is the commonest cause (antipsychotics, domperidone, anti-emetics, some antidepressants). Hypothyroidism also raises prolactin. If those are excluded and prolactin stays > 100 ng/mL, a pituitary MRI is warranted.
Will breast examination or recent intercourse affect prolactin?
Yes — nipple stimulation can raise prolactin 2–3 fold for several hours. Avoid significant breast stimulation in the hour before the draw.
Why is prolactin checked in male infertility?
Raised prolactin suppresses GnRH, which lowers FSH, LH and testosterone. It is one of the treatable causes of male hypogonadism and erectile dysfunction.
What is "macroprolactin"?
A large, biologically inactive form of prolactin (an antibody-prolactin complex) that can cause a falsely raised reading. If a raised prolactin is asymptomatic, the lab can do a polyethylene glycol precipitation to look for macroprolactin.
Can stress on the day of the test raise prolactin?
Acute stress (a difficult blood draw, anxiety, exercise) can raise prolactin slightly — usually not enough to change interpretation. Sustained moderate raises need workup.
How often should this panel be repeated?
Once for diagnosis, then as your endocrinologist or fertility specialist directs. On dopamine-agonist therapy for prolactinoma, prolactin is checked every 1–3 months until stable, then every 6–12 months.
Related Hormones / Endocrine tests
Tests commonly ordered alongside FSH, LH & Prolactin Panel, or that help interpret an unexpected result.
Sources & references
- Endocrine Society — Hyperprolactinemia Guideline · accessed 2026-05-30T00:00:00.000Z
- Endocrine Society — Female Infertility · accessed 2026-05-30T00:00:00.000Z
- NIH MedlinePlus — FSH Test · accessed 2026-05-30T00:00:00.000Z
- ASRM — Diagnostic Evaluation of the Infertile Female · accessed 2026-05-30T00:00:00.000Z
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