You go to your annual physical. Blood work comes back. Doctor says everything looks “normal.”
And yet.
You’re exhausted. Your body composition is shifting despite doing everything right. Brain fog rolls in by 2pm. Your energy is unpredictable. Your mood feels harder to manage than it used to. You’re training, eating well, trying — and your body is just not responding the way it should.
Your standard yearly labs aren’t lying. But they’re not telling you the whole story either.
There’s a difference between “normal” and optimal. And for women over 40 navigating perimenopause, that gap is often where the answers live.
In addition to your regular annual bloodwork, here are the 9 labs I believe every woman over 40 should have added to her panel.
These are the markers that give you the full picture — and the ones most conventional doctors never order.
1. Full Thyroid Panel
TSH + Free T3 + Free T4 + Reverse T3 + TPO Antibodies
Most doctors order TSH and stop there. That’s like checking if your car has gas and calling the inspection complete.
TSH tells you what your brain is asking your thyroid to do. It doesn’t tell you what your thyroid is actually doing in response.
Free T3 is the hormone your body actually feels. When it’s low, metabolism slows, weight creeps up, energy crashes, and cold intolerance sets in. You can have a perfectly “normal” TSH and still have a Free T3 that’s tanking your quality of life.
Reverse T3 acts like a brake on your thyroid — blocking the active hormone from doing its job even when levels look fine on paper.
TPO Antibodies screen for Hashimoto’s thyroiditis, an autoimmune condition that’s dramatically underdiagnosed in women and often the silent driver behind stubborn weight, fatigue, and mood issues.
One panel. So much your standard bloodwork is missing.
2. hs-CRP
High-Sensitivity C-Reactive Protein
This is your inflammation marker — and elevated inflammation is one of the most underappreciated reasons fat loss stalls in women over 40.
Elevated hs-CRP actively interferes with insulin’s ability to bind in your muscles. When that happens, your cells can’t use glucose efficiently, fat storage increases, and no matter how clean your nutrition is, your body keeps holding on.
It’s also the silent driver behind fatigue, brain fog, joint aches, and the kind of hormonal chaos that feels impossible to pin down.
If your hs-CRP is elevated, we need to address inflammation first — before obsessing over macros or training volume.
3. Fasting Insulin ← Most Doctors Skip This One
This is not the same as fasting blood sugar. This is fasting INSULIN — and they are not interchangeable.
You can have completely normal glucose levels and still have sky-high insulin. And if insulin is elevated, your body is in active fat-storage mode regardless of your calorie intake.
The “normal” range on standard lab reports goes up to 24.9 µU/mL. But optimal for women is under 5 µU/mL — ideally under 3.
That gap between “normal” and optimal is enormous. And it’s exactly where metabolic dysfunction hides in women who are doing everything right and still not seeing results.
If you haven’t had your fasting insulin tested, this is the one to request first.
4. Ferritin
Your Iron Storage Marker
Ferritin is the protein that stores iron in your body. Low ferritin means low iron reserves, even if your hemoglobin looks fine. And low ferritin is one of the most common and most overlooked causes of:
- Persistent fatigue that doesn’t resolve with sleep
- Hair thinning or shedding
- Poor exercise recovery
- Inability to build or maintain muscle
- Brain fog and low motivation
Optimal ferritin for women is generally 70–100 ng/mL or higher. Many women walking around with levels in the 12–20 range are told they’re “normal” — and they feel absolutely terrible.
Heavy training, menstrual cycles, and poor absorption all deplete ferritin. If you’re a high-performing woman in your 40s who trains hard and still feels drained, check ferritin before assuming it’s hormones.
5. Vitamin D3
The Hormone Masquerading as a Vitamin
Vitamin D3 is technically a hormone — and nearly every cell in your body has a receptor for it. When it’s low, the downstream effects touch everything from immune function and mood to muscle strength, bone density, and insulin sensitivity.
Optimal levels for women are generally 60–80 ng/mL. The standard “sufficient” cutoff of 30 ng/mL leaves most women functioning well below their potential.
Living in Canada, working indoors, and wearing sunscreen whenever you’re outside virtually guarantees you’re not getting enough from sun exposure alone. Test first so you know your baseline — then supplement accordingly.
6. Vitamin B12
Your Energy and Nervous System Foundation
B12 is essential for red blood cell production, neurological function, energy metabolism, and DNA synthesis. When it’s low, everything slows down — cognitively and physically.
Symptoms of low B12 read like a perimenopause checklist: fatigue, brain fog, mood instability, poor memory, and low motivation — which means it’s frequently dismissed as “just hormones” when the actual culprit is B12 deficiency.
Optimal is generally above 400 pg/mL — not just within the “normal” range, which starts as low as 180 pg/mL in many labs.
7. SHBG
Sex Hormone Binding Globulin ← The Other One Most Doctors Miss
This protein binds to your sex hormones — estrogen, testosterone, and DHEA — and makes them unavailable to your cells.
When SHBG is too high, even “normal” hormone levels become essentially useless to your body. Your estrogen and testosterone are bound up and inaccessible. This is why so many women feel profoundly hormone-deficient even when their bloodwork looks completely fine.
Without testing SHBG alongside your sex hormones, your results are only telling you half the story.
8. DHEA-S
Your Adrenal and Sex Hormone Precursor
DHEA-S is produced by your adrenal glands and serves as the raw material for both estrogen and testosterone. When it’s low, everything downstream suffers — energy, mood, libido, muscle maintenance, and immune resilience.
Optimal for women is generally 250–350 µg/dL. Most women in perimenopause are significantly depleted here and have no idea — because nobody has ever tested it.
Chronically high stress, poor sleep, and a nervous system that rarely gets a break all deplete DHEA-S over time. The result is a woman who feels fundamentally flat — low energy, low drive, and a general sense that something is just offthat she can’t quite name.
9. Estrogen and Progesterone Ratio
The Relationship Between Your Hormones Matters as Much as the Numbers Themselves
This is the one that changes everything — and almost nobody talks about it.
You can have estrogen and progesterone levels that both fall within “normal” ranges individually, and still be significantly out of balance relative to each other. The ratio between these two hormones is what drives so many of the symptoms women in perimenopause experience: the anxiety, the sleep disruption, the mood instability, the unexplained weight gain, and the body composition shifts that seem to defy logic.
Progesterone is the calming, sleep-supporting, fat-utilising hormone. Estrogen, when dominant relative to progesterone, drives fluid retention, fat storage, mood swings, and breast tenderness.
In perimenopause, progesterone drops first and drops fastest — which means even women with declining estrogen can still be in a state of relative estrogen dominance. Looking at either hormone in isolation misses the entire story.
Ask for both numbers. Then look at the relationship between them. That’s where the answers often are.
What To Do With This Information
Print this list. Take it to your next appointment. Ask your doctor to add these panels specifically — not just the standard CBC and annual bloodwork.
If you get pushback, request them through a functional medicine practitioner or use private lab services to order your own testing.
The goal isn’t to become obsessed with numbers. The goal is to stop guessing and start working with actual data about what your body needs — because “normal” is not the same as optimal, and you deserve to know the difference.
How We Use This at Team Strong Girls
Here’s what separates a real transformation from a generic program: data.
When you work with us, we don’t hand you a cookie-cutter plan and wish you luck. We build your training and nutrition program around what your body is actually telling us. Lab results inform your nutrition strategy, your supplement priorities, your recovery protocols, and your training load — so nothing is guesswork and nothing is wasted.
Your body isn’t failing you. It may just be missing the right support, the right information, and a coach who knows how to put it all together.
Ready to transform your body with a program built around your data? Take the transformation quiz now — and let’s build your strongest chapter yet.
