The Hormonal and Reproductive Biomarkers That Matter Most

Women are significantly more likely to develop thyroid disorders, are consistently diagnosed later than men across diseases, and are routinely under-tested for the hormonal markers that matter most. The WHOOP Women’s Health Panel looks at 81 biomarkers that cover reproductive, thyroid, metabolic, and nutrient markers alongside the foundational health data that puts them in context. Dial deeper into what’s driving your hormones, energy, and symptoms across every stage of your cycle and life.

Standard hormone testing checks TSH and sometimes estradiol. If both fall within range, the conversation ends. The markers that explain what’s happening with your cycle, your fertility, and your hormonal transitions are often left out of standard testing. Anti-Mullerian Hormone, thyroid autoimmune antibodies, progesterone, free thyroid hormones only get tested once something has gone wrong. By then, the window for proactive decisions has narrowed.

Women wait longer for those answers. A population-wide analysis of 6.9 million people found that women were diagnosed later than men across diseases, including cancer (2.5 years later on average) and metabolic diseases (4.5 years later), and the gap is especially wide for hormonal and autoimmune conditions, where early information changes the most.

Perimenopause is a clear example. Women experiencing symptoms like fatigue, mood shifts, and weight changes are frequently evaluated for depression or anxiety before hormonal shifts are considered. 

Standard testing wasn’t designed to catch what’s actually changing. The Women's Health Panel fills that gap.

What matters at each life stage

Hormonal health changes over time. The markers that matter in your 20s might differ from the ones that matter in your 40s, and different again in your 60s. This panel accounts for that progression.

20s and 30s: fertility clarity

This is when ovarian reserve is highest and starts to decline. AMH (Anti-Müllerian Hormone) is one of the most commonly used markers of that reserve. AMH levels peak in the mid-20s, well before many women start thinking about fertility timelines, and declines steadily in the 30s.

AMH doesn’t predict whether you’ll get pregnant. It tells you something about your timeline. That’s a distinction worth having, especially given ACOG’s 2025 update acknowledging AMH as “a useful, albeit imperfect, predictor of ovarian reserve” for women planning to delay childbearing.

Progesterone matters here too. It drives the second half of your cycle (the luteal phase) and confirms that ovulation actually occurred. Prolactin, a hormone most people associate with breastfeeding, plays a quieter role: elevated levels (hyperprolactinemia) are present in 15-20% of women evaluated for infertility, and 80-90% of those cases are treatable with medication. But, in order to find it, you need to test for it.

40s: the perimenopausal shift

Menopause typically occurs between ages 46 and 55, with vasomotor symptoms most pronounced in the first four to seven years. Perimenopause is a multi-year hormonal transition where the sequence of changes matters as much as any individual number.

At first you might see an inhibin B decline. FSH rises, often years before the final menstrual period. Estradiol actually increases by 20-30% during this window before eventually dropping, which is why perimenopause feels like volatility, not a steady fade. Up to 80% of women experience vasomotor symptoms. 37% report sleep disruption.

Standard testing doesn’t help much here. FSH is unreliable during perimenopause because of high day-to-day variability. ACOG doesn’t recommend routine hormone testing for diagnosis; it’s considered clinical (age + symptoms + menstrual changes). Women in their early-to-mid 40s with fatigue, mood shifts, and irregular cycles are often told their labs look normal.

Thyroid autoimmunity also peaks during this decade. Hashimoto’s thyroiditis has a 7:1 to 10:1 female-to-male ratio with onset typically between ages 45-55. Standard TSH screening may not pick up these changes until thyroid function is already shifting. The antibodies that cause it can be present years earlier.

50s and beyond: metabolic and bone health

After menopause (defined as 12 consecutive months without a period, median age 51-52), estradiol drops to low levels and FSH remains elevated. The hormonal picture stabilizes, but the health priorities shift.

Cardiovascular risk increases post-menopause. Metabolic markers become more relevant, including leptin, which provides context for why body composition and weight regulation change during this transition. Leptin signals energy availability and fat mass status, and when leptin patterns are disrupted, they can affect metabolic adaptation, recovery, and thyroid signaling. Bone density monitoring takes priority, and magnesium is central to that conversation. 84% of postmenopausal women with osteoporosis are magnesium-deficient, and higher intake is associated with increased bone mineral density.

The markers your doctor isn’t testing

Four markers stand out for the gap between their clinical value and how often they’re actually ordered.

AMH (Anti-Mullerian Hormone)

What it measures: Ovarian reserve: the pool of developing follicles available for ovulation. AMH is produced by the cells surrounding each follicle and reflects the remaining follicle pool, declining steadily with age.

Why it matters: AMH provides information about ovarian reserve and reproductive aging. A level of 0.5 ng/mL carries an odds ratio of 23 for early menopause compared to a level of 2.0 ng/mL. By age 40-44, the median drops to 0.52 ng/mL. That data point can shape fertility planning, egg freezing decisions, and conversations with specialists.

Why it’s not standard: ACOG has historically cautioned against AMH testing for women without diagnosed infertility, citing limited predictive value for natural fertility and the lack of international assay standardization. In practice, most women don’t learn their AMH until they’re already working with a fertility clinic.

TPOAb (Thyroid Peroxidase Antibodies)

What it measures: Whether your immune system is producing antibodies against your thyroid. TPOAb is the primary marker for Hashimoto’s thyroiditis, the most common autoimmune thyroid condition.

Why it matters: 12-26% of women with normal thyroid function are TPOAb-positive. While their TSH can look fine, their thyroid might be under attack. Those antibodies precede a clinical Hashimoto’s diagnosis by 7 or more years, with a 2.1% annual progression rate to hypothyroidism.

TPOAb status also has reproductive implications. TPOAb-positive women may face elevated risk of adverse reproductive outcomes, even when thyroid hormone levels appear normal, one reason testing before conception is valuable.

Why it’s not standard: Standard thyroid screening tests TSH. If TSH is normal, the thyroid is considered healthy. Antibody testing adds cost and complexity, and guidelines don’t recommend it for the general population, even though 80% of autoimmune disease patients are women.

Progesterone

What it measures: The hormone that governs the second half of your menstrual cycle (luteal phase) and confirms that ovulation occurred.

Why it matters: During perimenopause, cycles can appear regular while ovulation stops. Women and clinicians “should not rely on cycle length in the perimenopause as a benchmark for identifying whether or not a cycle is ovulatory.” A woman can have predictable periods but anovulatory cycles, meaning progesterone is low and symptoms like mood changes, sleep disruption, and irregular bleeding may have a hormonal explanation that never gets tested.

Why it’s not standard: Progesterone fluctuates dramatically across the cycle, making single blood draws harder to interpret. ACOG considers perimenopause a clinical diagnosis (age + symptoms) and doesn’t recommend routine hormone testing. In most clinical settings, the marker is ordered only when a woman is under 45 with significant menstrual changes or under 40 with suspected premature menopause.

Free T3 and Free T4

What they measure: T4 is the precursor thyroid hormone; T3 is the active form that cells actually use. The ratio between them reveals whether your body is converting thyroid hormone effectively.

Why they matter: Some hypothyroid patients on levothyroxine report persistent symptoms (fatigue, weight gain, cold intolerance, brain fog) despite normal TSH. Research in the Lancet Diabetes & Endocrinology found that 15.2% of patients on levothyroxine with normal TSH had low Free T3. Their screening test reads normal, but the active thyroid hormone is below range. Testing Free T3 and Free T4 can identify why symptoms persist when TSH looks fine.

Free T4 is also important for women on hormonal birth control, since estrogens affect total T4/T3 readings. Free hormone levels give a more accurate picture regardless of medication status.

Why they’re not standard: TSH is the accepted first-line thyroid screen. If it’s normal, most clinicians don’t order further testing. Free T3 and Free T4 add layers of interpretation that the standard screening model doesn’t require, but for women with persistent symptoms despite “normal” thyroid results, these markers can explain why.

Nutrients and metabolic markers that connect everything

Hormonal health doesn’t exist in isolation. The building blocks behind hormone production, bone density, and energy metabolism are nutrients, and deficiency rates among women are higher than most people realize.

Iron: 22.6% of US women aged 12-49 are iron-deficient, with significant racial disparities (31.4% of Black women vs. 8.3% of White women). Iron deficiency affects energy, concentration, and mood well before it progresses to anemia.

Folate: Mandatory fortification after 1998 reduced folate deficiency significantly, but 19% of female adolescents and 17% of women aged 19-30 still don’t meet requirements even with supplements. The MTHFR 677C>T polymorphism, which affects roughly 10-25% of the population depending on ethnicity, impairs folate metabolism, meaning adequate intake doesn’t guarantee adequate levels. Folate is also a critical cofactor for red blood cell production and DNA synthesis.

Vitamin B12: Beyond its role in energy and neurological function, B12 status is especially important for women planning conception, adequate levels before and during early development support healthy outcomes. About 3.6% of US adults are B12-deficient, and another 12.5% are insufficient.

Magnesium: 48% of Americans consume less than recommended. Women’s intake is about one-third below current recommendations. For postmenopausal women, the stakes are direct: 84% of those with osteoporosis are magnesium-deficient, and a study of 88,375 female nurses found the highest intake quartile had a 37% lower risk of sudden cardiac death.

Phosphorus: Works alongside calcium and magnesium in bone health. Often overlooked in standard panels despite its role in energy metabolism and cellular function.

Leptin: A hormone produced by fat tissue that signals energy availability to the brain. Leptin helps explain why weight regulation changes during hormonal transitions. Disrupted leptin patterns can affect metabolic adaptation, appetite signaling, and recovery. When interpreted alongside thyroid hormones and reproductive markers, leptin provides context for body composition changes that standard testing misses.

When cofactors are depleted, hormone levels can look more concerning than the underlying biology warrants. Testing them together provides a more complete picture. The Women’s Health Panel includes all six nutrient markers alongside your hormonal and thyroid results, connecting the building blocks to the hormones they support.

What the WHOOP Women’s Health Panel includes

The Women’s Health Panel tests 81 biomarkers. Eleven markers are not typically available in a standard blood draw. Those unique markers include:

• Fertility and hormonal markers: AMH, Progesterone, Prolactin
• Thyroid depth: TPOAb (autoimmune), Free T3, Free T4
• Metabolic context: Leptin
• Nutrients: Vitamin B12, Folate, Magnesium, Phosphorus

The remaining biomarkers cover the foundations that matter for women’s health, including FSH, LH, estradiol, and testosterone (the hormonal baseline that AMH, progesterone, and prolactin build on), TSH (the thyroid screen that Free T3/T4/TPOAb deepen), ferritin and iron studies (the blood health foundation that B12 and folate extend), Vitamin D and calcium (the bone health foundation that magnesium and phosphorus strengthen), plus CBC, full metabolic panel, lipid panel, and inflammation markers. You get the baseline covered and the depth added in one test.

Every result is reviewed by a licensed clinician. The panel’s biomarker selection was developed with WHOOP’s Medical Advisory Board, and all testing is exclusively powered by Quest® Diagnostics, with 2,000+ US locations. Key reference ranges adjust for age, sex, and hormonal status, so your results reflect your biology, not a generic average.

$299. No subscription required. No baseline test required. FSA/HSA eligible. Schedule a test at 2,000+ Quest® locations nationwide, right in the WHOOP app.

Frequently asked questions

When should I get tested? Anytime you want a baseline or have questions about your hormonal health; for women tracking fertility, testing earlier provides more useful data than testing after issues arise. For women in their 40s experiencing symptoms, a panel can provide context for conversations with your doctor.

How do results change across my cycle? Some markers, especially progesterone and estradiol, fluctuate depending on cycle phase. Your results are interpreted in the context of when your blood was drawn and where you are in your cycle.

Can I use FSA/HSA funds? Yes. The Women’s Health Panel is FSA/HSA eligible.

How does my menstrual cycle affect my training and recovery? Your cycle directly influences recovery capacity, energy availability, and performance. Estradiol and progesterone shift across cycle phases, affecting sleep quality, inflammation, and how your body responds to training stress. Blood testing can reveal whether these patterns are driven by normal hormonal fluctuation, a progesterone issue, thyroid autoimmunity, or nutrient deficiency, context that cycle tracking alone can’t provide.

What blood tests should women get for hormonal health? Standard panels typically test only TSH and sometimes estradiol. A targeted women’s health panel adds AMH (ovarian reserve), progesterone (ovulation confirmation), prolactin, TPOAb (thyroid autoimmunity), Free T3 and Free T4 (thyroid hormone availability), leptin, and key nutrients (B12, folate, magnesium, phosphorus), alongside the full hormonal foundation of FSH, LH, estradiol, and testosterone.

What is AMH and why does it matter? Anti-Mullerian Hormone (AMH) reflects your ovarian reserve: the pool of developing follicles available for ovulation. AMH levels peak in the mid-20s and decline steadily with age, providing information about ovarian reserve and reproductive aging. AMH is relevant for fertility planning at any age, but it is rarely tested outside of fertility clinics.

How is this different from the Women’s Hormonal Insights article? The Women’s Hormonal Insights article covers WHOOP Menstrual Cycle Insights, the wearable side of cycle tracking. This article covers the blood testing side. The two complement each other: MCI tracks daily patterns, blood testing reveals the hormonal biology behind those patterns.

Want to understand what standard bloodwork misses across all five health domains? Read: What Your Doctor’s Bloodwork Misses.

WHOOP Advanced Labs includes Specialized Panels, the Comprehensive Health Panel for ongoing longitudinal tracking, and free blood work uploads. Choose the path that fits you. Explore Advanced Labs.

This data is not diagnostic and does not identify individuals; individual results vary.