Thinking About Your Thyroid? How "Standard" Blood Tests Miss the Real Hormone Info

Dr. Angela DeRosa • August 29, 2025

If you read my blogs or have heard me speak, you know that I’m passionate about helping women get the hormones their bodies need to thrive at every age. I’m especially concerned about women getting the testosterone they need as part of their hormone therapy during perimenopause, menopause, and well into their later years of life, because providers often overlook that hormone. In fact, when I teach medical providers about hormone therapy so they can best serve their male and female patients, I always talk about the importance of testosterone for BOTH men and women. 


In addition to being a testosterone advocate for women, I’m also a proponent for thyroid health.
More often than not, well-meaning, but undereducated providers misunderstand the importance of thyroid hormones during perimenopause and menopause. As is often the case with tests that attempt to assess fluctuating estrogen, progesterone, and testosterone levels, thyroid tests often appear to be in the “normal” range for many women. I’ll explain why in a minute. First, let’s look at some surprising statistics:


  • One in eight women experiences a thyroid disorder in her lifetime.


  • Women are five to eight times more likely than men to have thyroid problems.


  • Nearly 60 percent of people with thyroid issues have no idea there's a problem.


  • Undiagnosed thyroid disease may put women at risk for serious conditions, including cardiovascular diseases and osteoporosis.


You have to wonder, why are so many women suffering from thyroid disorders instead of getting the help they need? It could be largely a result of inadequate testing. Standard blood tests often miss the REAL thyroid information.


Why Should You Think About Your Thyroid in Perimenopause and Menopause?


Thyroid hormones play an important role in regulating the female reproductive system. During perimenopause, fluctuating estrogen levels directly impact how your thyroid hormones function. It’s a complex, intricate connection between the thyroid and your hormones. And, to make things even more confusing, symptoms of a thyroid disorder mimic and overlap some of the same symptoms of perimenopause, like hot flashes, anxiety, heart palpitations, and weight gain.


Typically, when a woman in her 40s or 50s conveys these symptoms to her provider, she gets “standard” testing for hormone levels and TSH (thyroid stimulating hormone). But, this is a limited approach, and doesn’t portray the complete picture of your thyroid function. 


To fully understand whether or not your thyroid is underactive (hypothyroidism) or overactive (hyperthyroidism), you need to have a more comprehensive thyroid test – one that evaluates T3, T4, and reverse T3. 


All the T’s of Your Thyroid


When it comes to evaluating your thyroid, there are a lot of T’s involved! Let’s break them down: 

  • TSH is the thyroid stimulating hormone released from the pituitary gland in your brain
  • T4 is thyroxine, an inactive precursor and the main hormone produced in your thyroid gland. It gets converted to T3.
  • T3 is triiodothyronine, the active hormone
  • Reverse T3 (rT3) is an inactive form of the thyroid hormone, after T4 is converted – a “byproduct” so to speak


Your body produces most of your T3 from your T4. T4 needs to be converted to T3 to perform optimally, and how well your body converts T4 into T3 is often a factor in thyroid disorders. T3 affects your heart rate, digestion, and metabolism.


With all these variable T’s in production and conversion, there are three ways your thyroid can run amok and cause symptoms like fatigue, weight gain/weight loss, hair loss, muscle aches, anxiety, and sleep problems. Here’s what typically goes undetected: 


  1. Your thyroid doesn't produce enough T4
  2. Inactive T4 has trouble converting to active T3
  3. Active T3 can't get into the receptors because it's blocked by reverse T3


Request a More Complete Thyroid Picture


Most standard blood tests for thyroid only indicate TSH levels. Reverse T3 can be tested, but your provider needs to request that specific bloodwork. It helps if you have a practitioner who truly understands the thyroid connection to other hormones, including testosterone, estrogen, and progesterone. 


“Unless all of the levels are tested, you can’t properly diagnose thyroid disorders, and hypothyroidism is the one most often missed. Luckily, hypothyroidism is usually not difficult to treat.”

 

– Angela DeRosa, DO, MBA, CPE


As someone who has treated more than 20 thousand patients in the last 30 years, and written about thyroid and hormone therapies, you might find my book,
A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You, a helpful tool in your perimenopause journey and beyond. You can read more about thyroid disorders in Chapter 3.

The Doctor is in!

By Dr. Angela DeRosa July 3, 2025
I recently read an article about how a man in a 27-year marriage to the same woman was contemplating divorce because the woman he married was a “completely different person” now that she was in her 50s and postmenopausal. In the article, this man went on to say their sex life was nonexistent, and his wife was “moody and mean” all the time. In fact, this husband seemed to be blaming his failing marriage wholly on his wife and menopause. Could there be any truth to this? Or is the man just complaining because his wife has gotten older? With little insight into the rest of their relationship, it’s hard to know what else may be a factor in this particular situation. But, what I do know is that when women attempt to ignore symptoms of perimenopause and menopause (or perhaps even be somewhat in denial of how their psyches and bodies have betrayed them in this natural stage of life), it could wreak havoc on any relationship. There’s a physiological reason for all of this, though. These symptoms occur because your hormones – estrogen, progesterone, and testosterone in particular – begin a natural decline sometime in your 30s. Left untreated or ignored, the physical and emotional changes you go through in perimenopause and menopause could potentially have long-term effects on your marriage. In fact, recent research indicates that more couples over the age of 50 are divorcing than ever before. Research also suggests that couples who have a mutually satisfying sex life are happier overall. Whether you’re married, in a relationship, or single, perimenopause and menopause symptoms are real , even if your doctor has told you otherwise. (If that’s the case, find a new provider!) Ignoring the Symptoms of Perimenopause and Menopause Won’t Make Them Go Away In perimenopause – the years leading up to menopause – you may begin to experience miserable symptoms, like hot flashes, low libido, vaginal dryness, and mood swings as a result of declining hormones. Imagine how ignoring these symptoms not only affects your health and well-being in the moment, but also how it affects your significant other. “I honestly believe that many couples break up when women start going through perimenopause and it’s largely due to testosterone deficiency.” – From A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You I mean, can you even slightly ignore a hot flash or night sweats? If you share a bed with your husband, he’s going to notice that you’re no longer snuggling up to him for warmth and intimacy, but now sleeping with the fan on high and the thermostat on 62 in the middle of winter. And, he might also notice that you toss and turn because you aren’t sleeping well. Then he might notice that you struggle to get out of bed in the morning because you’ve barely slept, yet you still have personal and professional obligations to meet. Is it surprising that you’re in a bad mood as you trudge through your day wishing you could remember how great you used to feel when you could sleep for 7-8 hours a night? Beyond all of this, your partner surely will notice when you’re no longer interested in sex because 1) you have ZERO desire or energy, and 2) you’re suffering from vaginal dryness, so sex is now really painful instead of really pleasurable. If you’re having trouble getting through a week of your life during “the change” – the menopausal transition – then I imagine after months or even years of these experiences, it’s bound to put a strain on your relationship! Beyond emotional strain, untreated hormone deficiencies and imbalances can have long-term physical effects on your brain, heart, and bones, too. Let me be clear here: You are the one going through the rollercoaster ride of perimenopause and menopause – not your husband. You owe it first to yourself to address your symptoms with bioidentical hormone replacement therapy (BHRT), not only for the short-term relief, but for the long-term health benefits. And, a bonus “side effect” of you taking care of your own health as you get older is that perhaps your marriage, other relationships, and even your professional life won’t be caught in the middle of it all. Why Choose to Replenish Your Hormones with BHRT? As I mentioned, there are many reasons to replenish your hormones as you get older. The short-term relief of symptoms seems like an obvious one, including getting your libido back and overcoming vaginal dryness so sex isn’t painful. But, the long-term health benefits often go unconsidered, simply because most people aren’t educated about how an estrogen deficiency increases your risk for osteoporosis, high blood pressure, and heart disease. Or, that years of low testosterone can also affect your brain health, and increase insulin resistance, which often leads to pre-diabetes. The bottom line is that, as a woman, you need balanced levels of estrogen, progesterone, and testosterone to keep yourself healthy and your relationships – especially the intimate ones – thriving, too. *** As someone who has treated more than 20 thousand patients in the last 30 years, and written about BHRT, you might find my book, A Woman’s Hormonal Health Survival Guide: How to Prevent Your Doctor from Slowly Killing You , a helpful tool in your perimenopause journey and beyond. You can read about hormone and intimacy success stories in Chapter 10.
By Dr. DeRosa June 23, 2025
Progesterone: Why So Many Providers & Women Don't Fully Understand It
By Dr. DeRosa June 23, 2025
May is Women’s Health Month, and Women’s Health Week is May 11 - 17th.
More Posts