The Tests Every Woman Over 35 Deserves (and What Each One Actually Tells You)

Most standard workups check TSH only, and stop there if it looks normal. But TSH is just the signal from your brain to your thyroid. It does not tell you how much active hormone your body is actually making or using.

A full panel adds Free T4, Free T3, and thyroid antibodies. Here is why that matters. Your thyroid mostly makes T4, which your body then has to convert into T3, the active form your cells use. That conversion can struggle, especially under stress, and TSH alone will not show it. And antibodies can reveal Hashimoto's, an autoimmune process against the thyroid, years before TSH ever moves out of range. The Colorado thyroid prevalence study found that thyroid dysfunction is far more common in women than standard screening suggests, and that many cases are missed ¹.

If you are exhausted, cold, gaining weight, losing hair, or constipated, and your TSH was called normal, a full panel is where I would start.

These three together tell the story of your blood sugar, and they each show a different chapter.

Fasting glucose is your blood sugar at one moment. A1c is your average over about three months. Both are useful, but here is the thing most people never hear: insulin rises first. Your body can pump out extra insulin for years to keep glucose looking normal, so glucose and A1c can look fine while insulin is quietly climbing ². Fasting insulin catches that early chapter, and insulin resistance is deeply connected to weight gain around the middle, energy crashes, cravings, and hormone imbalance.

Researchers have used fasting glucose and insulin together, in a calculation called HOMA-IR, to estimate insulin sensitivity for decades ³. It is simple, inexpensive, and one of the most useful numbers almost nobody gets.

Vitamin D acts more like a hormone than a vitamin, and it touches mood, immune function, bone health, and inflammation. Deficiency is remarkably common, especially in women, especially in winter, and especially if you work indoors ⁴.

Low vitamin D can feel like low mood, achiness, and fatigue, which means it hides in plain sight behind exactly the symptoms midlife women get dismissed for. It is a simple blood test and one of the easiest wins when it comes back low.

Most standard panels check whether you are anemic, and stop there. But you can be nowhere near anemic and still be running on empty, because ferritin, your iron storage, can be depleted long before your red blood cells are affected.

Low ferritin is one of the most underappreciated causes of fatigue and hair shedding in women. In a randomized controlled trial, non anemic women with low ferritin and fatigue felt significantly better when their iron stores were restored ⁵. If your hair is thinning or you are exhausted and nobody has checked your ferritin, ask for it.

If bloating, irregular digestion, food sensitivities, or that pregnant by evening feeling are part of your picture, a comprehensive stool test can be incredibly revealing. It looks at your beneficial bacteria, unfriendly organisms, signs of inflammation, digestion markers, and more.

This matters beyond digestion. Your gut helps regulate estrogen, influences your immune system, and even talks to your brain. IBS and functional gut symptoms are common, real, and worth investigating properly rather than living with ⁶. I do not run this for everyone, but when the gut is involved, it often holds answers nothing else could see.

Last but absolutely not least. If you are over 35 and dealing with mood, sleep, weight, or cycle changes, a proper look at your sex hormones is essential. When women ask me what hormones should be tested, my answer is always more than one, and at the right time. Not a single estrogen draw on a random day, but a comprehensive panel that includes progesterone at the right time of your cycle, estrogen and its metabolites, testosterone, DHEA, and your cortisol rhythm.

This is where tests like the DUTCH come in, because they show not just your hormone levels but what your body is doing with them. Combined with the blood work above, this is how we stop guessing and start building a plan that is actually about you.

You do not need to figure out which of these you need on your own. That is literally what the free consult is for. Bring your symptoms, and I will tell you which of these would actually give you answers.