Clinical and Interpretive

Measurement of luteinizing hormone is used as an adjunct in the evaluation of menstrual irregularities, in the evaluation of patients with suspected hypogonadism, in predicting ovulation, in evaluating infertility, and in diagnosing pituitary disorders.

Luteinizing hormone (LH) is a glycoprotein hormone consisting of 2 noncovalently bound subunits (alpha and beta). The alpha subunit of LH, follicle-stimulating hormone (FSH), thyroid stimulating hormone (TSH), and human chorionic gonadotropin (hCG) are identical and contain 92 amino acids. The beta subunits of these hormones vary and confer the hormones’ specificity. LH has a beta subunit of 121 amino acids and is responsible for interaction with the LH receptor. This beta subunit contains the same amino acids in sequence as the beta subunit of hCG and both stimulate the same receptor, however, the hCG beta subunit contains an additional 24 amino acids, and the hormones differ in the composition of their sugar moieties. Gonadotropin-releasing hormone from the hypothalamus controls the secretion of the gonadotropins, FSH and LH, from the anterior pituitary.In both males and females, LH is essential for reproduction. In females, the menstrual cycle is divided by a midcycle surge of both LH and FSH into a follicular phase and a luteal phase. This “LH surge” triggers ovulation thereby not only releasing the egg, but also initiating the conversion of the residual follicle into a corpus luteum that, in turn, produces progesterone to prepare the endometrium for a possible implantation. LH is necessary to maintain luteal function for the first 2 weeks. In case of pregnancy, luteal function will be further maintained by the action of hCG (a hormone very similar to LH) from the newly established pregnancy. LH supports thecal cells in the ovary that provide androgens and hormonal precursors for estradiol production. LH in males acts on testicular interstitial cells of Leydig to cause increased synthesis of testosterone.

In both males and females, primary hypogonadism results in an elevation of basal follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels.

Postmenopausal LH levels are generally >40 IU/L. (Note: FSH is the preferred test to confirm menopausal status.)

FSH and LH are generally elevated in:
- Primary gonadal failure
- Complete testicular feminization syndrome
- Precocious puberty (either idiopathic or secondary to a central nervous system lesion)
- Menopause
- Primary ovarian hypodysfunction in females
- Polycystic ovary disease in females
- Primary hypogonadism in males

LH is decreased in:
- Primary ovarian hyperfunction in females
- Primary hypergonadism in males

FSH and LH are both decreased in failure of the pituitary or hypothalamus.

No clinically significant cross-reactivity has been demonstrated with follicle-stimulating hormone, thyroid stimulating hormone, or human chorionic gonadotropin.