"Get these done on day 2 of your period," the gynaecologist says, ticking FSH, LH, prolactin and TSH on the slip. Or perhaps a urologist ordered the same FSH and LH tests for your husband after a semen analysis came back low. Either way, the report arrives with two numbers you have probably never thought about, and a quick internet search throws up everything from "PCOS" to "early menopause" to "poor egg quality".
The FSH and LH test is one of the most frequently ordered hormone panels in India's fertility clinics, gynaecology OPDs and endocrinology clinics. With infertility affecting an estimated 10 to 15% of Indian couples, and PCOS, thyroid disorders and early menopause all common, these two pituitary hormones often provide the first clue to what is going on. This guide explains what FSH and LH do, normal FSH and LH levels for Indian women and men, when to test, what high or low results can mean, and how they fit with other tests like AMH and prolactin.
What Are FSH and LH?
Follicle stimulating hormone (FSH) and luteinising hormone (LH) are made by the pituitary gland at the base of the brain. Together they are called gonadotropins because they control the gonads: the ovaries in women and the testes in men. The pituitary releases them in response to a signal from the brain called GnRH, and the ovaries or testes "report back" through oestrogen, progesterone, testosterone and inhibin. It is a feedback loop, which is why FSH and LH are so useful for working out where a problem lies.
In women
- FSH stimulates a group of follicles (fluid-filled sacs containing eggs) in the ovary to grow each month.
- LH rises sharply mid-cycle in the LH surge, which triggers ovulation about 24 to 36 hours later. It then supports the corpus luteum, which produces progesterone.
In men
- LH tells the Leydig cells in the testes to make testosterone.
- FSH, along with testosterone, drives sperm production in the Sertoli cells.
The key principle: feedback
If the ovaries or testes are failing, the brain "shouts louder" and FSH and LH rise. If the problem is in the brain or pituitary, FSH and LH stay low even though the ovaries or testes are under-active. This one idea explains most FSH and LH results.
When and Why the FSH LH Test Is Ordered
Common reasons in women
- Irregular, scanty or absent periods
- Difficulty conceiving, as part of an infertility workup
- Suspected PCOS (polycystic ovary syndrome)
- Hot flushes or missed periods in the 40s, to assess perimenopause
- Periods stopping before 40, to check for premature ovarian insufficiency (POI)
- Before IVF, to plan the dose of fertility injections
Common reasons in men
- Low sperm count or no sperm on a semen analysis
- Low testosterone, low libido or erectile difficulties
- Small or soft testes, or breast enlargement
- Men who have used anabolic steroids or testosterone for bodybuilding and now have fertility problems
In children
- Signs of puberty starting too early (before 8 in girls or 9 in boys)
- Puberty not starting by 13 in girls or 14 in boys
Timing the test
| Situation | When to test |
|---|---|
| Women with regular periods | Day 2 to 5 of the cycle (day 1 = first day of full bleeding), most often day 2 or 3 |
| Women with irregular or absent periods | Any day, or as your doctor advises (sometimes after a medicine-induced bleed) |
| Confirming menopause | Any day; may be repeated after 4 to 6 weeks |
| Men | Any day, preferably in the morning, along with testosterone |
| Tracking ovulation | Urine LH kits at home, daily from a few days before expected ovulation |
No fasting is needed for FSH and LH alone, though your doctor may combine them with tests that do need fasting. Tell your doctor if you take birth control pills, hormone therapy, clomiphene, letrozole or testosterone, as these change the results. High-dose biotin supplements can interfere with some hormone tests too.
FSH and LH Normal Range in India
Reference ranges vary between labs and analysers, so always compare your values with the range printed on your own report. The table below shows typical values used by many Indian labs. All values are in mIU/mL, which is the same as IU/L.
Women
| Phase | FSH (mIU/mL) | LH (mIU/mL) |
|---|---|---|
| Follicular phase (day 2–5) | 3.5 – 12.5 | 2.4 – 12.6 |
| Mid-cycle (ovulation) peak | 4.7 – 21.5 | 14.0 – 95.6 |
| Luteal phase | 1.7 – 7.7 | 1.0 – 11.4 |
| Postmenopausal | 25.8 – 134.8 | 7.7 – 58.5 |
| Pregnancy | Very low | Very low |
Men
| Hormone | Typical normal range (mIU/mL) |
|---|---|
| FSH | 1.5 – 12.4 |
| LH | 1.7 – 8.6 |
Day 3 FSH and fertility
For women trying to conceive, fertility specialists often read a day 2–3 FSH this way. These are general guides, not strict cut-offs.
| Day 2–3 FSH (mIU/mL) | General interpretation |
|---|---|
| Under 10 | Usually consistent with normal ovarian reserve |
| 10 – 15 | Possibly reduced reserve; interpret with AMH and ultrasound |
| Over 15 – 20 | Suggests diminished ovarian reserve |
| Over 25 (on two tests, 4+ weeks apart, under age 40) | Consistent with premature ovarian insufficiency |
One important catch: a day 3 FSH should be read together with oestradiol (E2). A high early-cycle oestradiol can push FSH down and make it look falsely "normal". This is why many clinics order FSH, LH and E2 together.
FSH also varies from cycle to cycle, so a single result is less reliable than the AMH test combined with an ultrasound antral follicle count (AFC). Our AMH test guide explains ovarian reserve testing in detail.
What High or Low FSH and LH Results Mean
Doctors rarely interpret FSH or LH on their own. They look at the pattern of both hormones together with oestradiol or testosterone, prolactin, thyroid tests and your symptoms.
Common patterns
| Pattern | Likely explanation | Usual next step |
|---|---|---|
| High FSH, high LH, low oestradiol (woman over 45) | Menopause or perimenopause | Clinical diagnosis; treat symptoms if needed |
| High FSH, high LH, low oestradiol (woman under 40) | Premature ovarian insufficiency | Repeat test, AMH, karyotype and thyroid antibodies |
| High LH, normal FSH, LH:FSH ratio above 2 | Often seen in PCOS | Ultrasound, testosterone, blood sugar and insulin tests |
| Low or low-normal FSH and LH, low oestradiol, no periods | Hypothalamic amenorrhoea or a pituitary problem | Prolactin, TSH, weight and lifestyle history, sometimes MRI |
| High FSH, high LH, low testosterone (man) | Primary testicular failure | Semen analysis, karyotype, testicular ultrasound |
| Low FSH, low LH, low testosterone (man) | Pituitary or hypothalamic cause, or steroid use | Prolactin, MRI if needed, medication history |
| High FSH, normal LH and testosterone, low sperm count (man) | Problem with sperm production | Urologist or andrologist evaluation |
FSH, LH and PCOS
Many women with PCOS have a raised LH and a normal FSH, giving an LH:FSH ratio above 2:1 or even 3:1. But this ratio is not part of the official diagnostic criteria for PCOS, and a large number of women with PCOS, especially those who are overweight, have a normal ratio. PCOS is diagnosed using the Rotterdam criteria: irregular ovulation, signs of high androgens (acne, excess hair, high testosterone), and polycystic ovaries on ultrasound, with other causes ruled out. Indian studies estimate that PCOS affects roughly one in ten to one in five women of reproductive age, depending on the criteria used. Read our PCOS guide for the full picture.
High FSH: menopause and premature ovarian insufficiency
Indian women reach menopause on average around 46 to 47 years, a few years earlier than women in many Western countries. As the egg supply runs low, the ovaries make less oestrogen and inhibin, and FSH climbs. During perimenopause, FSH can swing wildly from normal to high from month to month, so a single normal FSH does not rule out perimenopause. Doctors usually diagnose menopause after 12 months without a period in a woman over 45, without needing a blood test. See our menopause guide.
When periods stop before 40 and FSH is persistently high, it is called premature ovarian insufficiency. Causes include genetic conditions such as Turner syndrome and fragile X premutation, autoimmune disease, previous chemotherapy or radiation, and ovarian surgery. Often no cause is found. POI needs proper evaluation, because long-term low oestrogen affects bone and heart health.
Low FSH and LH
Low gonadotropins point to the brain or pituitary. Common causes in India include:
- Stress, rapid weight loss, very low body weight or excessive exercise, leading to hypothalamic amenorrhoea
- High prolactin, which suppresses GnRH. Our prolactin test guide covers this.
- Thyroid disorders (see our thyroid function test guide)
- Anabolic steroid or testosterone use: increasingly common among young men in Indian gyms. External testosterone switches off LH and FSH, which can shut down sperm production, sometimes for many months after stopping.
- Pituitary tumours, head injury, or rare conditions such as Kallmann syndrome
- Pregnancy, birth control pills and hormone therapy (expected, not a disease)
FSH, LH and Fertility Treatment in India
Home ovulation kits
Urine LH ovulation kits, sold at most Indian chemists for a few hundred rupees per pack, detect the LH surge. A positive result means ovulation is likely in the next 24 to 36 hours, which helps couples time intercourse. Women with PCOS can get misleading results because their baseline LH is already high.
Ovulation induction and IVF
FSH and LH levels help fertility specialists choose between treatments such as letrozole or clomiphene tablets, and decide the starting dose of injectable FSH (recombinant FSH or HMG preparations) for IUI or IVF. During IVF, oestradiol, LH and ultrasound scans are monitored closely. Our infertility and IVF guide explains these steps.
Cost and where to test
- FSH or LH alone: roughly ₹400 to ₹700 each at major lab chains
- FSH + LH combined: roughly ₹700 to ₹1,200
- Often bundled with prolactin, TSH, AMH and testosterone in "female hormone", "PCOS" or "fertility" panels
- Usually reported the same day or next day; most labs offer home collection
For tests you will repeat, such as day 3 hormones across cycles, use the same lab where possible, since different analysers can give slightly different numbers.
Keeping Track of Your Hormone Reports
A fertility or PCOS journey can involve dozens of hormone reports over months or years: day 3 FSH, LH and oestradiol, AMH, prolactin, TSH, testosterone, blood sugar and semen analyses, often from different labs and clinics. When a new doctor asks, "What was your FSH last year?", the answer is often buried in a WhatsApp chat or an old paper file.
When you upload your reports to MedicalVault, FSH, LH and other hormone values are extracted automatically with their units and reference ranges. MedicalVault's trend analysis helps you and your doctor see whether FSH is creeping up over time, or whether LH has settled after PCOS treatment. Since fertility is a shared journey, the family sharing feature lets both partners keep their reports in one place and bring a complete history to every consultation.
Key Takeaways
- FSH and LH are pituitary hormones that control the ovaries and testes. High levels usually mean the ovaries or testes are under-active; low levels point to the brain or pituitary.
- Women with regular periods should do the FSH LH test on day 2 to 5 of the cycle. Men can test on any day, ideally in the morning with testosterone.
- Typical normal FSH and LH levels in the follicular phase are roughly 3.5–12.5 and 2.4–12.6 mIU/mL, but always use the range on your own report.
- A day 3 FSH above 10–15 mIU/mL may suggest reduced ovarian reserve, but AMH and an antral follicle count are more reliable markers.
- An LH:FSH ratio above 2 is common in PCOS but is not required for diagnosis; many women with PCOS have normal ratios.
- Persistently high FSH before age 40 needs evaluation for premature ovarian insufficiency; low FSH and LH in men can be caused by anabolic steroid use.
- Keep every hormone report in one place with MedicalVault so you and your doctor can follow trends across cycles and clinics.