Who Sets the Guidelines for Hormone Therapy? A Guide to NAMS, ACOG, & the Endocrine Society

Hormone therapy can be transformative when it is used for the right person, for the right reason, at the right dose, and with appropriate medical oversight. But hormones are not supplements you casually add to your routine because an online quiz says you are “low.” They affect everything from your sexual function and body composition to bone health, fertility, cardiovascular risk, and mood.

At Yunique Medical, hormone optimization begins with understanding you as an individual, not forcing you into a generic protocol. Just as importantly, responsible care should be informed by the professional organizations that establish standards for diagnosis, treatment, and follow-up. Below, we break down who actually sets those guidelines, what their recommendations mean, and how testing helps determine whether hormone therapy belongs in your plan.

The medical organizations behind hormone therapy guidelines

There is no single organization that controls hormone therapy in the United States. Different medical societies focus on different populations and clinical questions. That matters because hormone therapy for a woman experiencing menopause is not governed by exactly the same framework as testosterone therapy for a man with confirmed testosterone deficiency.

The Menopause Society (formerly NAMS)

The Menopause Society, formerly known as the North American Menopause Society (NAMS), is one of the most influential organizations focused on menopause and midlife women’s health.

Its position statements address issues like menopausal hormone therapy, vasomotor symptoms like hot flashes and night sweats, genitourinary syndrome of menopause, bone health, timing of treatment, and individualized risk assessment. The Society describes hormone therapy as the most effective treatment for vasomotor symptoms and genitourinary syndrome of menopause.

Its 2022 Hormone Therapy Position Statement was endorsed by more than 20 international organizations, reflecting just how influential these recommendations are globally.

A central principle is individualization. The benefits and risks of hormone therapy can change according to your age, how long it has been since menopause, the hormones being used, the dose, the delivery route, and your medical history. The statement also emphasizes periodic reassessment rather than treating hormone therapy as something you simply start and forget.

For many healthy, symptomatic women younger than 60 or within 10 years of menopause, the Menopause Society considers the benefit-risk profile favorable when no contraindications are present. That does not mean hormone therapy is automatically right for every woman. It means the decision should be made intelligently.

The American College of Obstetricians and Gynecologists (ACOG)

The American College of Obstetricians and Gynecologists, or ACOG, is another major authority on women’s reproductive and gynecologic healthcare. ACOG provides clinical guidance on menopause, estrogen and progestogen therapy, reproductive health, vaginal symptoms, early menopause, and numerous other conditions affecting women throughout life.

Its menopause guidance recognizes hormone therapy as an option for relieving symptoms including hot flashes, night sweats, vaginal dryness, sleep disruption, and other symptoms associated with menopause and perimenopause.

ACOG also emphasizes that you do not necessarily need a panel of hormone tests before receiving treatment for symptoms. That’s because hormone levels can fluctuate considerably during perimenopause, which means a single blood test may not accurately capture what is happening biologically. ACOG therefore states that routine hormone testing is generally not recommended before starting hormone therapy solely for menopausal symptoms.

The Endocrine Society

The Endocrine Society covers a much broader field. Endocrinology deals with the body’s hormone-producing glands and the biological systems influenced by hormones. Its guidelines address disorders involving testosterone, thyroid hormones, adrenal hormones, pituitary function, reproductive endocrinology, diabetes, bone metabolism, and more.

For male testosterone deficiency, the Endocrine Society takes a deliberately careful approach. It recommends diagnosing hypogonadism when a man has both symptoms or signs consistent with testosterone deficiency and consistently low testosterone concentrations.

In other words, feeling tired does not automatically mean you need testosterone.

Low motivation does not automatically mean you need testosterone.

Getting older does not automatically mean you need testosterone.

The Society recommends accurate testosterone testing, confirmation of low results, evaluation of root causes, and appropriate monitoring. It also recommends against indiscriminately screening and treating healthy men when the clinical indication is unclear.

American Urological Association (AUA)

The American Urological Association, or AUA, is particularly influential in the diagnosis and treatment of testosterone deficiency in men. Its testosterone deficiency guideline uses a total testosterone concentration below 300 ng/dL as a reasonable diagnostic cutoff, but the number alone is not sufficient. A clinical diagnosis requires low testosterone alongside relevant signs.

The AUA also recommends confirming the finding with two total testosterone measurements taken on separate occasions in the early morning. From there, additional testing may help determine why testosterone is low and whether treatment is appropriate.

The AUA also addresses issues that matter enormously if you are considering testosterone therapy, including fertility, prostate evaluation, cardiovascular considerations, hematocrit monitoring, and follow-up testosterone measurements.

Hormone optimization should never mean “push the number as high as possible.” The goal is to improve clinically meaningful symptoms while maintaining appropriate physiologic levels and monitoring safety. Optimization without discipline is just excess.

What lab tests confirm a hormone imbalance

Hormone testing can be incredibly useful, but only when the right test is ordered for the right reason and interpreted in context. One isolated result rarely tells the complete story. Age, sex, symptoms, medications, menstrual status, time of day, binding proteins, fertility goals, and other conditions can all change how hormone values should be interpreted. Here are several of the most important labs used when investigating potential hormone imbalance.

Total testosterone

Total testosterone measures testosterone circulating in your bloodstream, including testosterone bound to proteins and a smaller amount circulating freely. For men evaluated for testosterone deficiency, this is generally the primary screening measurement.

The AUA recommends using two early-morning total testosterone measurements on separate days before establishing deficiency. It considers levels below 300 ng/dL a reasonable cutoff supporting the diagnosis when compatible symptoms or signs are also present.

Testing may be considered when symptoms include reduced libido, erectile difficulties, loss of muscle mass, decreased strength, infertility, or other findings associated with low testosterone. The important word here is associated. Fatigue, low motivation, weight gain, and brain fog can have dozens of causes. A sophisticated provider investigates the actual root cause.

Free testosterone

Most testosterone in the bloodstream is attached to proteins, particularly sex hormone-binding globulin and albumin. Only a small proportion circulates as free testosterone, which may provide additional information when total testosterone does not appear to match your symptoms when SHBG levels are unusually high or low. This can occur in several physiological situations.

Free testosterone testing therefore adds an additional layer of context rather than replacing total testosterone altogether. Think of it this way: a lab value becomes powerful only when someone understands what that number actually means inside your body.

Estradiol

Estradiol is one of the primary forms of estrogen. Testing for estradiol can be useful in certain reproductive, endocrine, fertility, menstrual, or hormone-treatment scenarios. In men with testosterone deficiency, the AUA specifically recommends measuring estradiol before testosterone therapy when breast symptoms or gynecomastia are present.

For women experiencing typical perimenopausal symptoms, however, a single estradiol result usually does not “prove” menopause because hormone concentrations fluctuate considerably during the transition. ACOG therefore does not recommend routine hormone testing simply to determine whether menopausal hormone therapy should be started.

Follicle-stimulating hormone (FSH)

FSH is produced by the pituitary gland and communicates with the ovaries or testes.

In women, FSH generally rises as ovarian function declines because the brain increases signaling in an attempt to stimulate the ovaries. It can be useful when evaluating certain cases of ovarian dysfunction, premature ovarian insufficiency, or fertility concerns. However, FSH can also fluctuate during perimenopause, so one measurement is not enough.

In men, FSH may also help clinicians investigate testicular function. The question is never simply, “Is my FSH high?” The better question is, “Why is it high, and what does that mean?”

Luteinizing hormone (LH)

LH is another pituitary hormone involved in reproductive function.

In men, LH stimulates testosterone production by the testes. That makes LH especially helpful after low testosterone has been identified. The AUA recommends measuring LH in men with low testosterone because it can help distinguish between problems arising primarily in the testes and problems involving signaling from the hypothalamus or pituitary gland.

If testosterone is low and LH is unexpectedly low or normal, additional evaluation may be needed. The AUA recommends checking prolactin when low testosterone occurs alongside low or low-normal LH. That is what root-cause medicine looks like: do not stop at the abnormal number. Ask why it is abnormal, investigate, and then treat.

Sex hormone-binding globulin (SHBG)

SHBG is a protein that binds sex hormones, including testosterone and estradiol. Because bound testosterone is not biologically available in exactly the same way as free testosterone, unusually high or low SHBG can change how total testosterone should be interpreted.

For example, two people could have similar total testosterone concentrations while having meaningfully different free testosterone levels. SHBG can therefore be useful when symptoms and total hormone levels do not appear to line up. It helps provide a more complete hormonal picture, especially when evaluating complex cases.

Guidelines are the foundation, not the finish line

Medical guidelines matter because they establish evidence-based guardrails. They help clinicians determine who should be tested, when treatment may be appropriate, what risks deserve attention, and how therapy should be monitored.

But guidelines alone are not personalized treatment plans.

At Yunique Medical, the objective is not to slap a generic prescription onto a lab result. It is to understand your physiology, symptoms, goals, and the factors keeping you from feeling the way you know you can feel. When appropriate, hormone optimization becomes one piece of a broader strategy to help you reconnect with your body and unlock your potential.

Yunique is not for someone looking for a shortcut while refusing to take responsibility for their health. It is for people willing to show up, make changes, and demand more from themselves. If declining energy, sexual function, strength, recovery, mood, or menopausal symptoms make you feel disconnected from who you used to be, stop accepting that as your new normal. Get the right answers. Build the right strategy. Inspire yourself, and start becoming a new you. Schedule a consultation with us today.