Hormone Testing in NYC: What the Best Panels Actually Measure
When a patient comes to Regen Health Physicians NYC (RHPNY) with fatigue, mood changes, weight gain, or declining vitality and shows their prior bloodwork — typically a TSH and a total testosterone — Dr. Ajit Dhaliwal often sees the same problem: the testing was inadequate to answer the clinical question. Hormone optimization starts with comprehensive, accurate measurement. Here's what that actually involves.
The Problem With Standard Hormone Testing
Standard primary care hormone testing typically includes:
- TSH only (misses free T3, free T4, reverse T3, and thyroid antibodies)
- Total testosterone only (misses free testosterone, SHBG, LH, FSH)
- Estradiol (without progesterone, DHEA-S, or full cycle context)
- Random cortisol (insensitive to diurnal pattern dysregulation)
These are screening tests designed to rule out frank pathology — hypothyroidism, hypogonadism, Addison's disease. They are not designed to optimize hormonal function in the 90% of patients who fall within "normal" reference ranges yet experience significant symptoms.
The reference ranges themselves are population-derived, not optimized. A 55-year-old man with total testosterone of 320 ng/dL is "in range" — but placing in the 10th percentile of a range including 18-year-olds means very different things for his quality of life, cognition, and body composition.
What a Comprehensive Hormone Evaluation Looks Like
At RHPNY, Dr. Dhaliwal uses a structured panel architecture:
Thyroid (Full Panel)
- TSH
- Free T4
- Free T3
- Reverse T3 (rT3)
- TPO antibodies (thyroid peroxidase)
- Thyroglobulin antibodies
- rT3/Free T3 ratio
This panel distinguishes conversion issues (elevated rT3, low free T3 despite normal TSH), autoimmune thyroid disease (Hashimoto's before TSH becomes abnormal), and cellular resistance patterns that TSH alone cannot capture.
Male Hormones
- Total testosterone
- Free testosterone (calculated or equilibrium dialysis)
- SHBG (sex hormone binding globulin)
- LH and FSH (distinguish primary vs. secondary hypogonadism)
- Estradiol (sensitive assay)
- DHT (dihydrotestosterone)
- DHEA-S
- Prolactin
Female Hormones
- Estradiol (day 3 and day 21 of cycle, or multiple timepoints in perimenopause)
- Progesterone (luteal phase)
- Free and total testosterone
- DHEA-S
- LH and FSH
- SHBG
- Prolactin
- AMH (ovarian reserve, relevant in perimenopause)
Adrenal / HPA Axis
- 4-point salivary cortisol (morning, midday, afternoon, evening)
- DHEA (AM)
- DHEA-S
- 24-hour urinary free cortisol (when indicated)
- DUTCH (Dried Urine Test for Comprehensive Hormones) — maps cortisol metabolites, sex hormone metabolites, and melatonin/serotonin metabolites across the full day
Metabolic Context
Because hormonal function cannot be interpreted without metabolic context:
- Fasting insulin + glucose + HbA1c
- Lipid panel (advanced, with particle sizes when indicated)
- Inflammatory markers (hsCRP, homocysteine, fibrinogen)
- Vitamin D (25-OH)
- Magnesium RBC
- B12 and folate
Understanding DUTCH Testing
The DUTCH (Dried Urine Test for Comprehensive Hormones) panel from Precision Analytical deserves special mention. Unlike serum testing, DUTCH measures:
- Hormone metabolites — revealing how the body processes and clears hormones (important for estrogen metabolism patterns linked to cancer risk)
- Diurnal cortisol curve — cortisol awakening response plus daytime pattern
- Melatonin and oxidative stress markers
- B12 functional markers (methylmalonic acid)
- Neurotransmitter metabolites
For patients on hormone therapy, DUTCH is particularly valuable for monitoring estrogen metabolism pathways — the 2-OH, 4-OH, and 16-OH estrogen metabolite ratios, which have implications for cardiovascular and breast tissue health.
From Results to Protocol
Interpreting these panels requires clinical judgment, not just reference ranges. Dr. Dhaliwal evaluates:
- Pattern recognition — hormonal imbalances rarely occur in isolation; the relationships between thyroid, adrenal, and sex hormones matter
- Symptom correlation — labs must align with the clinical picture; treating numbers without symptoms is not the goal
- Individual optimization targets — not population norms
Treatment may include testosterone or hormone replacement therapy, thyroid optimization, adrenal support, or peptide protocols that modulate the hormonal environment.
Book a comprehensive hormone evaluation at RHPNY to get the testing and interpretation your hormonal health deserves.
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This content is for educational purposes only and does not constitute medical advice. All hormone evaluations and treatment protocols at RHPNY are individualized by Dr. Ajit Dhaliwal, MD, following a comprehensive clinical assessment.
