Health Assessment Report
ExampleFemale hormone panel · 8 biomarkers
Patient details
- Name
- Fleur Jansen
- Gender
- Female
- Age
- 38 years
- Date of birth
- 22-01-1988
Test details
- Test Date
- 09-06-2026
- Report date
- 12-06-2026
- Location
- Utrecht Oost
- Laboratory
- Star-SHL
8
Total Markers
6
In Range
2
Needs Attention
Overall Assessment
This blood was drawn on cycle day 3, and every reference range below is the follicular one that goes with it. Without that cycle day a hormone result cannot be interpreted, so it is stated explicitly throughout.
Six of the eight values are within range. Your AMH is low for your age and your ferritin is low. Neither is worrying, but both are relevant enough to discuss.
Key Findings
AMH low (8.2 pmol/L)
AttentionBelow the 9.0 lower limit. AMH is a measure of ovarian reserve and declines with age. This value says something about the number of eggs, not their quality, and on its own does not predict whether you can conceive.
Ferritin low (16 µg/L)
AttentionBelow the 20 lower limit. In menstruating women this is one of the most common causes of persistent fatigue, even without anaemia.
FSH, LH and estradiol consistent with cycle day 3
GoodFSH 7.1 U/L, LH 5.4 U/L and estradiol 142 pmol/L all sit within the follicular ranges. An FSH under 10 on day 3 is favourable.
Prolactin and thyroid normal
GoodProlactin 412 mU/L and TSH 2.6 mU/L. These are the two values routinely screened for when there are cycle complaints, and both are normal.
Detailed Analysis
Hormones
AttentionYour FSH is 7.1 U/L and your LH 5.4 U/L, both within the follicular range. An FSH under 10 on cycle day 3 indicates normal pituitary signalling to the ovaries.
Your estradiol of 142 pmol/L and progesterone of 1.4 nmol/L fit the early follicular phase — progesterone is supposed to be low at this point and only rises after ovulation.
Your AMH is 8.2 pmol/L, just below the lower limit. AMH reflects the remaining egg reserve. It declines gradually over the years and a value like this is not unusual at 38. Worth knowing: AMH says nothing about egg quality and is not on its own a predictor of the chance of pregnancy.
Thyroid
NormalYour TSH is 2.6 mU/L, within range. Disturbed thyroid function is a common and readily treatable cause of cycle disturbance; it is excluded here.
Minerals
AttentionYour ferritin is 16 µg/L, below the 20 lower limit. Ferritin is the storage form of iron and depletes before hemoglobin falls. In menstruating women, monthly blood loss is the usual explanation.
At a ferritin in this range, fatigue, breathlessness on exertion and hair loss are recognised complaints, even when the blood count is still normal.
Recommendations
Read the AMH in context, not as a standalone number
If you are trying to conceive, discuss this value with a gynaecologist alongside your age, your cycle and any relevant history. A single AMH is one piece of the picture, not a conclusion.
Address the iron stores
Red meat, lentils, tofu and dark leafy greens, combined with vitamin C at the meal. Talk to your GP before taking an iron supplement, and if menstrual blood loss is heavy have your hemoglobin measured too.
Repeat hormone tests on cycle day 3 again
Only measurements taken on the same cycle day are comparable with each other. Schedule any follow-up for day 2 to 5 of the cycle.
Next Steps
Start with the ferritin and have it measured again in three months, together with your hemoglobin.
Contact your GP or gynaecologist if you are trying to conceive, or if symptoms persist. This report does not replace a consultation.
Your Test Results
Hormones
6What It Measures
This test measures the concentration of follicle-stimulating hormone in your blood. FSH is released by the pituitary gland and stimulates the ovaries to produce eggs or the testes to produce sperm. Your healthcare provider may interpret FSH alongside LH and sex hormones for context.
Lifestyle Tips
Maintaining a healthy weight, managing stress, and ensuring adequate nutrition may support healthy pituitary function and FSH regulation. Avoiding excessive exercise that could disrupt hormonal balance is also important. Always discuss concerns about your reproductive health with your healthcare provider.
What It Measures
This test measures the concentration of luteinizing hormone in your blood. LH is produced by the anterior pituitary gland and works together with FSH to regulate the reproductive system, including gonadal steroid production and gamete maturation.
Lifestyle Tips
Maintaining a healthy weight, managing stress, and ensuring adequate sleep may support balanced LH levels. Extreme exercise or very low body fat can sometimes disrupt pituitary hormone production. Consult your healthcare provider for guidance.
What It Measures
This test measures the concentration of estradiol (E2) in your blood. Estradiol is produced primarily by the ovaries in women and in smaller amounts by the testes and adrenal glands in men. Your healthcare provider may use this result alongside other hormone levels.
Lifestyle Tips
Maintaining a healthy weight, regular physical activity, and a balanced diet rich in fibre and cruciferous vegetables may support healthy estrogen metabolism. Limiting alcohol intake and managing stress could also contribute to hormonal balance. Always discuss lifestyle changes with your healthcare provider.
What It Measures
This test measures the concentration of progesterone in your blood. In women, progesterone rises after ovulation during the luteal phase. In men, small amounts are produced by the adrenal glands and testes as part of normal hormone metabolism.
Lifestyle Tips
Maintaining a healthy weight, managing stress, and ensuring adequate sleep may support healthy progesterone levels. Some nutrients such as vitamin B6, zinc, and magnesium are often associated with progesterone support. Consult your healthcare provider for guidance.
What It Measures
AMH is made by the granulosa cells surrounding the small follicles in the ovary: the preantral and early antral follicles that have not yet been selected for ovulation. The more of those small follicles waiting in the queue, the more AMH ends up in the blood. The blood value therefore tracks closely with the antral follicle count measured on ultrasound. That makes AMH a measure of the size of the remaining egg supply, known as the ovarian reserve. It is explicitly a measure of quantity, not of quality. AMH says nothing about the genetic quality of the eggs, and it is that quality which largely determines the chance of a healthy pregnancy. A normal AMH is therefore not a guarantee, and a low AMH is not a verdict. The growth of these small follicles proceeds independently of FSH and LH signalling from the pituitary. AMH is, in other words, gonadotropin-independent. That is why the value barely fluctuates within a cycle, while FSH, LH and estradiol move strongly with the day of the cycle. In the Netherlands the result is usually reported in µg/l. That unit is numerically identical to ng/ml, the unit used in the international literature. If your laboratory reports in pmol/l, 1 µg/l corresponds to roughly 7.1 pmol/l. Men also have AMH in their blood, produced by the Sertoli cells in the testis. In adult men, however, the value is not used to assess fertility; a semen analysis and the gonadotropins are more suitable for that.
When Levels Are Low
A low AMH value causes no symptoms of itself. AMH is a signalling molecule you cannot feel, so there are no symptoms of a low AMH. Anything you do notice belongs to the underlying situation, not to the number. With a clearly diminished ovarian reserve the cycle can shorten, become irregular or eventually stop, and it can take longer for pregnancy to occur. Where the ovaries are depleted early, menopausal symptoms such as hot flushes, night sweats or vaginal dryness can appear, usually alongside a raised FSH. Many women with a low AMH, however, have a perfectly normal cycle and no complaints at all. The value is then found by chance or through a deliberate test. A low result also does not mean that pregnancy is impossible. Always discuss a low value with a doctor, who will assess it together with your age and your cycle.
Lifestyle Tips
Be honest about what can actually be steered: your ovarian reserve is largely laid down, and AMH is not a value you train upwards with lifestyle. There is no supplement, diet or training programme convincingly shown to enlarge the egg supply. Be sceptical of products that promise it. What does make a difference is smoking. Smoking is associated with a lower ovarian reserve and with an earlier menopause; stopping is the most concrete step you can take. If you use combined hormonal contraception, bear in mind that it makes your AMH read lower than your true reserve. If you want the cleanest possible picture, discuss with your doctor whether to measure after a period without contraception. Never stop contraception on your own initiative purely to have a blood value measured. If you follow AMH over time, always have it done at the same laboratory. Because the assays are not standardised, switching laboratories can produce a difference that looks like a real change but is not. And finally: never let an AMH result stand on its own. The value only takes on meaning alongside your age, your cycle, your FSH and the conversation with your doctor.
What It Measures
This test measures the concentration of prolactin in your blood. Prolactin is produced by the anterior pituitary gland and plays a role in breast milk production, reproductive function, and various metabolic and immune processes.
Lifestyle Tips
Stress management, adequate sleep, and avoiding medications known to raise prolactin may help maintain healthy levels. Regular exercise at moderate intensity is often beneficial. Consult your healthcare provider about any medications that may affect prolactin.
Minerals
1What It Measures
Ferritin is a protein that stores iron. Each ferritin molecule can bind and safely store a large number of iron atoms, mainly in the liver, the spleen and the bone marrow. A small fraction of that ferritin leaks into the blood, and that fraction is what the test measures. Your ferritin level is therefore a reflection of how much iron your body has in storage. That makes ferritin different from the other iron values. Serum iron shows how much iron is circulating in your blood at the moment of the draw, a figure that swings considerably across the day and after a meal. Transferrin is the transport protein that carries iron through the blood, and transferrin saturation indicates what share of that transport capacity is actually occupied. Ferritin answers how much iron you hold in reserve, not how much is in transit. Results are reported in micrograms per litre (µg/l). The band below is the reference range of the laboratory that performs our tests. <table><thead><tr><th>Group</th><th>Reference value</th></tr></thead><tbody><tr><td>Men</td><td>30 – 400 µg/l</td></tr><tr><td>Women</td><td>15 – 150 µg/l</td></tr></tbody></table> The lower limit sits lower in women because the reference population it was derived from includes menstruating women, who lose iron structurally. It describes what is common in that group. It is not a statement that a smaller reserve is desirable or healthy in women. Two national bodies, the Dutch society for clinical chemistry and the hereditary haemochromatosis guideline, deliberately decline to publish a universal ferritin reference value. The reason is that the assay differs between laboratories, and the difference is not small: another platform uses 15 to 200 µg/l for men. Both therefore advise using the values of the performing laboratory. Always go by the reference values printed on your own report.
When Levels Are Low
An empty iron store often causes symptoms before anaemia develops. The most commonly reported are persistent fatigue that sleep does not resolve, breathlessness on exertion, dizziness, headache, cold hands and feet, pallor, brittle nails, hair loss and restless legs. Difficulty concentrating and reduced stamina are also described. Each of these complaints is non-specific and can have dozens of other causes, so on their own they prove nothing. They are, however, a good reason to have your iron status measured rather than wait. In men, and in women after the menopause, a low ferritin always requires an explanation, because menstrual blood loss falls away as a cause. Discuss this with your doctor.
Lifestyle Tips
How much iron you absorb from your diet depends more on the form than on the quantity. Haem iron from meat, fish and poultry is absorbed considerably better than non-haem iron from plant sources such as pulses, wholegrain products, nuts and dark green leafy vegetables. Anyone eating little or no meat therefore obtains iron mainly in the less absorbable form, and that is one reason stores can decline slowly without anything unusual being wrong. What you eat alongside it shifts absorption measurably. <strong>Vitamin C</strong> clearly increases the absorption of non-haem iron, so including a source of vitamin C with a plant-based meal is a simple and effective habit. The reverse also exists: the tannins in tea and coffee and the calcium in dairy inhibit absorption when taken with the same meal. Having tea or coffee an hour before or after eating rather than with it is a worthwhile difference for people with limited stores. Do not take iron supplements on your own initiative. Iron accumulates with untargeted intake, and supplementing without a demonstrated deficiency can be harmful. Whether supplementation is needed, in what form and for how long, is a decision for your doctor based on measured values. If your ferritin stays low despite adjustments, or is repeatedly raised, have the cause investigated rather than correcting it yourself.
Thyroid
1What It Measures
A TSH test measures how much thyroid-stimulating hormone circulates in your blood. TSH comes from the pituitary gland, a small gland at the base of the brain. The pituitary makes TSH and uses it to drive the thyroid. The thyroid then produces the hormones T4 and T3. The feedback between the two is log-linear, not proportional. A small fall in free T4 produces a much larger rise in TSH. That is what makes TSH the most sensitive single test for thyroid disease. It also explains something that often confuses people. TSH can sit far outside the reference range while free T4 is still normal. The direction is the opposite of what most people expect. If the thyroid runs slow, the pituitary pulls harder and TSH rises. If the thyroid makes too much hormone, the signal switches off and TSH falls. So a high value points to an underactive thyroid. A low value points to an overactive one. <table><thead><tr><th>TSH</th><th>Free T4</th><th>How this is usually read</th></tr></thead><tbody><tr><td>raised</td><td>normal</td><td>subclinical hypothyroidism</td></tr><tr><td>raised</td><td>low</td><td>overt hypothyroidism</td></tr><tr><td>low</td><td>normal</td><td>subclinical hyperthyroidism</td></tr><tr><td>low</td><td>raised</td><td>overt hyperthyroidism</td></tr><tr><td>normal or low</td><td>low</td><td>points to the pituitary, not the thyroid</td></tr></tbody></table> The sample is an ordinary blood draw from the arm. No fasting is required. The unit appears on reports as mE/L, mU/L or mIU/L. Those are the same unit written three ways. TSH is rarely judged on its own. Free T4 almost always accompanies it, because only the pair completes the picture.
Lifestyle Tips
No diet or supplement reliably steers a TSH level. What you can influence is whether the measurement is accurate. Four points make most of the practical difference. Stop high-dose biotin well before the draw. Biotin is in many hair, skin and nail supplements, often at 5 to 10 milligrams. On many laboratory platforms that falsely lowers TSH and falsely raises free T4 and free T3. The result then mimics an overactive thyroid in a completely healthy one. Stopping 48 to 72 hours beforehand is the usual advice. Very high doses need longer. An ordinary multivitamin with a few micrograms does not cause this. Give blood at roughly the same time of day each time. Because of the daily rhythm that matters more than most people expect. If you take thyroid medication, give blood before that day's tablet. For TSH this is less critical than for free T4, but it keeps measurements comparable. Tell them which medicines you take. Lithium and amiodarone can disturb the thyroid. Proton pump inhibitors, calcium and iron reduce absorption of levothyroxine. That can explain an unexpectedly high value. Never adjust your own dose on the basis of a self-requested test.
Assessed by a BIG-registered doctor
This report was prepared by a BIG-registered doctor. It does not replace a personal medical consultation. Always consult your general practitioner if you have questions.