PCOS (Now PMOS) Blood Test Results, Explained: What Each Number Means

You got the blood draw. Days later a PDF lands in your patient portal with a dozen acronyms, a column of numbers, and a few "H" and "L" flags — and no explanation of which ones actually matter for PCOS. So you do what everyone does: paste "high LH" into a search bar and hope.

This page is the plain-English key. It walks through the markers that show up on a PCOS panel, what a high or low value tends to point to, and — just as important — what each number can't tell you on its own. It is not a way to diagnose yourself from a lab report. It's here so you walk into your next appointment understanding your own results instead of nodding along.

PCOS is now PMOS — Polyendocrine Metabolic Ovarian Syndrome, after the Lancet consensus renamed it in May 2026. Both names still appear on lab requisitions and in guidelines, so both appear here.

First: no single number diagnoses PCOS

This is the part most lab-result explainers bury, so we'll lead with it. PCOS is a pattern diagnosis, not a single-value one. Under the 2023 International Evidence-based Guideline — the standard most US and international clinicians follow — an adult diagnosis needs two of three features: signs of high androgens (clinical or on bloodwork), irregular or absent ovulation, and polycystic ovaries on ultrasound or an elevated AMH.

Two consequences fall out of that, and they shape how you should read everything below:

• A "normal" panel does not rule PCOS out. If you have irregular cycles plus physical signs of high androgens (acne, unwanted hair growth, scalp thinning), the guideline says that combination is enough — no imaging and no perfect lab number required.
• A single flagged value does not rule it in. One high reading, drawn on the wrong cycle day or while your body was doing something else, is a prompt to look closer, not a verdict.

Which markers matter also depends on who you are: in adolescents, the same guideline says AMH and ultrasound shouldn't be used to diagnose PCOS at all, because both overlap too much with normal teenage physiology. Keep that in mind if the results in front of you belong to someone under about 18.

Androgens: testosterone, free testosterone, SHBG, and FAI

This cluster is the biochemical heart of a PCOS workup, and it's the one people misread most — because the number that matters usually isn't the one they look at first.

• Total testosterone is the headline figure, but it can sit inside the "normal" range while you still have too much active androgen. That's why it's rarely read alone.
• SHBG (sex hormone-binding globulin) is the protein that mops up testosterone and keeps it inactive. In PCOS, SHBG is often low — and low SHBG means more free, biologically active testosterone even when the total looks unremarkable.
• Free testosterone and the Free Androgen Index (FAI) — FAI is total testosterone divided by SHBG, times 100 — are the values that actually capture that active fraction. High FAI or high free testosterone alongside low SHBG is the classic PCOS signature, and it's why a report can read "high FAI" while total testosterone shows no flag at all.

Reference cutoffs vary by lab and assay — an FAI around 5 or above is commonly treated as elevated, but the exact threshold your report uses is set by the lab that ran it. The takeaway isn't a magic number; it's the shape: high free androgens, low SHBG. If your total testosterone is flagged very high (well above the typical PCOS range), that's a reason for your clinician to check for other causes rather than assume PCOS.

LH and FSH: what the ratio does and doesn't tell you

For years the "LH:FSH ratio above 2:1" was treated as a PCOS hallmark. It shows up in roughly 60% of people with PCOS — which is exactly why it's no longer part of the diagnostic criteria. A marker that's absent in 40% of cases can't confirm or exclude anything.

So if your ratio is elevated, it's consistent with PCOS but not proof; if it's normal, that changes nothing about whether you have it. LH and FSH are still worth drawing — they help your doctor rule out other reasons for missed periods (like ovarian or pituitary problems) — but read them as context, not as the answer. For accuracy these are ideally measured early in the cycle, around days 2–5.

AMH: the newest marker on the panel

Anti-Müllerian hormone reflects how many small follicles your ovaries carry, so it tends to run high in PCOS. The 2023 guideline's notable change: in adults, an elevated AMH can now stand in for an ovarian ultrasound as evidence of polycystic ovaries — useful if imaging is hard to access.

Two honest caveats. First, there is no single universal AMH cutoff for PCOS; values commonly considered elevated fall in a broad band (roughly 3.5–5.0 ng/mL and up), but the meaningful threshold shifts with your age and the specific assay, and it's higher in your twenties than your thirties. Second — and again — AMH is not used this way in adolescents. A high AMH supports the picture; it doesn't seal it.

Insulin and glucose: the metabolic layer

PCOS is a metabolic condition as much as a reproductive one, so many panels include fasting insulin, fasting glucose, or a HOMA-IR score (a calculation from the two). Fasting insulin above roughly 10 mU/L, or HOMA-IR above about 2.0, is often read as a sign of insulin resistance.

Here's the nuance the number alone won't give you: insulin resistance is not a diagnostic criterion for PCOS, and the guideline doesn't recommend using insulin levels to make the diagnosis — the assays aren't standardized enough between labs. What these markers do is guide treatment. Evidence of insulin resistance is often what tips a clinician toward metformin or inositol, and it's a reason to watch long-term metabolic risk. So read this layer as a "how do we manage it" signal, not a "do I have it" one.

What if my results are 'normal' but I have symptoms?

This is the most common — and most frustrating — scenario, and it usually has an explanation rather than a dead end. A few things quietly distort a panel:

• Timing. Cycle-dependent hormones read differently depending on the day drawn. If bloods were taken at the wrong point, the numbers can look reassuringly flat.
• The pill. Combined hormonal contraception suppresses your own androgens and raises SHBG, so testosterone and FAI can look normal even when your underlying physiology isn't. Guidelines generally advise being off it for at least three months before androgen testing for diagnosis.
• The pattern, not the point. Because PCOS is diagnosed on a combination of features, symptoms plus one supportive finding can matter more than any single "normal" value.

None of this means you should self-diagnose in either direction. It means a clean-looking report and real symptoms is a conversation to keep having — ideally with the timing and pill status of the draw on the table.

If you want a structured way to organize your symptoms, cycle history, and questions before that appointment — so the visit is about your specific pattern instead of starting from scratch — you can work through Oestra's assessment. And if you're trying to make sense of which version of PCOS your results point toward, our guide on the different types of PCOS breaks down the driver-based picture.

Your lab report is a set of clues, not a diagnosis. Understanding what each clue means is what lets you and your clinician read them together — which is the only place the diagnosis actually gets made.

Sources

• Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 International Evidence-Based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Monash University; endorsed by ESHRE and ASRM, 2023. — The source for the diagnostic framework used throughout: the two-of-three criteria; AMH as an adult alternative to ovarian ultrasound and its exclusion in adolescents; the removal of the LH:FSH ratio from the diagnostic criteria; insulin and HOMA-IR as management rather than diagnostic markers; and the recommendation to be off hormonal contraception for at least three months before androgen testing for diagnosis.
• Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril / Hum Reprod, 2004. — The basis for calculated free androgens (Free Androgen Index = total testosterone ÷ SHBG × 100) and the role of SHBG in defining biochemical hyperandrogenism.

A note on the numbers: the specific cutoffs mentioned (FAI, fasting insulin, HOMA-IR, AMH) are commonly used, assay- and lab-dependent thresholds — not universal values. As the 2023 guideline itself stresses, there is no single fixed cutoff for several of these markers; always read your result against the reference range your own lab prints.