What Lab Tests Should Women Over 40 Ask Their Doctor For?

Nikkiey: What happens at most annual appointments is your doctor runs a basic panel, right? They look at your numbers and they tell you everything is within normal range. What I need you to understand is that the standard lab work almost never includes a comprehensive hormonal panel. Getting a clear picture of where your hormones actually are is foundational to understanding why your body is doing what it is actually doing. And your doctor may push back, guys. Some will say, oh, this isn't necessary. You are paying for this appointment. You deserve complete information about your body.

What's going on, everybody? Hey, you guys. Welcome back to another episode of The WarriorBabe Show. Or if this is one of your first episodes, my friends, welcome to the show. I am your host, Nikkiey Stott. And on these episodes, we talk about mindset, methodologies, and tactics that will help you lose body fat, build muscle, be strong, and feel insanely confident. So today, I am excited to have this conversation with you guys.

This is in the top five topics I want to talk about. There have been a few recently that I've been excited to share with you, and today is another one of those. It sits at the intersection of two things that I care deeply about. Obviously, I care so deeply about you guys and about women's health, and also about women being their own best advocates. So today, I want to have a conversation with you about the conversations you need to be having with your doctor.

Not the ones that you are having right now, but the ones that you need to be having. You may casually be going in for checkups. You may just be listening to what the doctor is recommending. But I want to teach you guys to be your best advocates in those situations, so that if something feels off, or something needs to go a little bit deeper that doctors aren't naturally going to be looking at, you have the confidence and the authority and the boldness to say, hey, can we look at this?

To not just agree with everything that your doctor is saying. Because here is what I do know. As someone from a nursing background before founding WarriorBabe, and as someone who has worked with thousands of women on their own health and their body composition, most women walk out of their appointments or annual appointments with an "everything looks normal" and almost no real information about what is actually happening in their bodies, from their PCPs, from their doctors, even from specialists in these areas.

Normal is not the same as optimal, my friends. And fine is not good enough when it comes to your health. So I just pray and hope that this episode can be your script moving forward. I'm going to specifically talk about five different conversations, five areas where I would encourage you guys to push further. And I hope to be able to teach you to ask harder questions and advocate for yourself with confidence.

Because I wouldn't want you to passively accept whatever you are handed. I hope that you are able to ask questions and demand answers and leave every appointment actually knowing something. And to have peace with connecting the dots on what you may be feeling, and then be provided the answers because you had the courage and the boldness to speak up and advocate for yourself. Right? Because if you guys go back to an episode I shared around this time last year, I was going through hormonal changes myself.

I did a whole episode on it. I just needed answers because I knew something wasn't right within my body. I'm very in tune with things, and things were off. Really off. And I sought out answers. So I'm using my background in the healthcare field, helping women, and my own journey to lead this conversation with you guys today. So the first conversation, and I think this is the one that I'm most passionate about, is obviously hormones.

This is especially true coming from a PCP, and even coming from an endocrinologist, which is kind of scary. But it comes down to finding a really good one. You've got to. And that comes with advocating for yourself, so I'll just add that as well. But typically what I've heard and seen is your doctor runs a basic panel, right? They look at your numbers and they tell you everything is within normal range. And you walk out knowing nothing more than when you walked in. What I need you to understand is that the standard lab work almost never includes a comprehensive hormonal panel.

Most basic blood work checks your thyroid, and often just checks your TSH, which I'll talk about in a second. Not the full picture. And that is about it for your hormonal health. Estrogen, progesterone, testosterone, DHEA, cortisol, insulin: these are all things that are rarely tested unless you specifically ask. And for a woman who is in there, for me being in my 30s, for women listening to this who are in their 40s and 50s, these hormones are everything.

They determine your energy. They determine your mood, your sleep quality, your body composition, your libido, your ability to build muscle, your metabolic rate, your experience of perimenopause and menopause. Getting a clear picture of where they actually are is foundational to understanding why your body is doing what it is actually doing, why you may be feeling off, and why things just don't feel like they did.

In my case, I felt a drastic shift within a six to eight month period. I'm like, something is off. I need answers. There's so much more when you're able to get a full picture. So here's what I would recommend, the exact thing to ask for. I would ask for a full thyroid panel, not just your TSH. Like I mentioned a second ago, that is pretty much the only thing the majority of PCPs will look at when it comes to your hormone levels.

You want TSH, but you also want free T3, free T4, and thyroid antibodies. The TSH alone tells you almost nothing about how your thyroid is actually functioning. Subclinical hypothyroidism, where your TSH looks normal but the rest of the panel is off, is massively underdiagnosed in women.

And it produces symptoms that look exactly like overtraining and under-eating. This was me, guys, last year. I was fatigued. My body was more bloated rather than weight gain. It could have been weight gain; I don't really go on the scale anymore. But I could see visible changes happening in my body. Cold intolerance. Brain fog. I talked about all of this inside the episode around this time last year, maybe mid-summer or later in the year, once I started figuring out what was going on. That is hypothyroidism.

But those things are massively underdiagnosed because the majority of doctors only look at your TSH, and that can look totally normal. But the rest of the things, like your free T3, your free T4, your antibodies, could be off, and they're telling you the entire story. So that is what I would ask for when it comes to your thyroid panel. Another thing: I would ask for estradiol, progesterone, and testosterone if you are experiencing symptoms of hormonal imbalance.

You're experiencing things like irregular cycles, worsening PMS. This was me, my friends. My luteal phase was whack. All of a sudden my boobs were extremely sensitive and tender. Walking downstairs to let my dog out, I had to hold them because it was painful from them bouncing. TMI, but we're friends here. My mood:

you did not want to be around me in those two weeks. I was very, very snappy. And if you are experiencing those, on top of low libido, or brain fog, or sleep disruption... I've preached about this; I'm a really good sleeper. But coming up on the last two weeks of my luteal phase, before I get my period, my sleep was experiencing massive disruption. And it's normal to feel bloated, but if you're seeing actual uncomfortable waking for months on end,

if it's actually compounding over certain months, then these are your numbers. These numbers are critical: the estradiol, the progesterone, and the testosterone. These are things that you need to look at. Don't accept "your body is probably just stressed," because I ran with that narrative for a while personally. Don't accept that as a diagnosis without the data to back it up. For me, my testosterone was low. And now I'm also on progesterone support, because it's helping with my worsening PMS in those two weeks.

Low, low, low doses. And I'm not on any HRT, for those of you that have been sliding into my DMs and asking me. I'm not on HRT, but I will talk about that in a minute. So that's in terms of a hormonal profile. All of these are linked to hormones, so these are things that I would be looking for. Another thing that I would ask for in this bucket... and this is just conversation number one, my friends. You may have to listen to this podcast over, or save it, or take notes at a later time. But I would highly recommend that you come back to it, because again, I just pray that it serves you with encouragement

to go into conversations with your doctors moving forward, and that you're able to get a full picture of your health. Another one would be asking for fasting insulin and HOMA-IR, not just your fasting glucose. Okay? Because yes, that'll tell you some things, but fasting glucose can look completely normal while insulin resistance is already well established. Insulin resistance is one of the most common and most underdiagnosed metabolic issues in women.

I've seen this in hundreds, if not thousands, of women inside of WarriorBabe. And it directly impacts your ability to achieve body composition goals. It impacts your energy. It impacts your fat loss in ways that no nutrition plan can fully compensate for without addressing the underlying issue. So if you are somebody who is six months into a program, you're following all of the things, which is totally normal, guys, and you're not seeing the results that you want, I've always gone back to my clients and said, dude, this is a layer deeper than what a nutrition plan

or a workout program is going to be able to identify and fix. And I've always encouraged members to go and look at their blood work, so that I can have a fully rounded picture of what is actually going on. Because you can be crushing it with your nutrition, and there's nothing more defeating than crushing it and not getting the results. Underlying lab work or issues could be the underlying factor as to why you're not seeing those results.

So ask for that. Another thing, and don't worry, I'll wrap back around at the end, but again, do your due diligence and take your notes. Something else that came up as low for me is DHEA, DHEA-S. Okay? And your cortisol. If you are experiencing chronic fatigue, burnout, or the inability to recover from training, which was me, inability to recover from training, these are markers of adrenal function

that almost never get tested in routine blood work. I can be honest with you. Granted, I worked in the emergency room, but even going to a PCP, I had never seen my DHEA tested until I went to a functional doctor and my DHEA was tested. So the conversation that I would have is: I would like a comprehensive hormonal panel, including full thyroid, sex hormones, and fasting insulin. I want to understand where my hormones actually are,

not just whether they're within a reference range. And side note, keep this in the back of your mind, guys: these reference ranges take the average of our entire society, and our entire society is way off the range of healthy. So just keep that in mind. That would be what I would say: I want a complete, comprehensive hormonal panel, including my full thyroid, sex hormones, and fasting insulin. And I want to know whether they're optimal for my age,

my symptoms, and me. And your doctor may push back, guys. Some will say, oh, this isn't necessary. If you're watching the video, you can see me blinking right now, you guys. Push back politely and firmly. You are paying for this appointment. You deserve complete information about your body. Okay? So that is conversation number one that I would have, which is your hormones: thyroid, sex hormones,

fasting insulin. Quick break. If you're finding this episode helpful so far, it would mean a lot if you could hit pause for just a second, leave a quick rating or a review, or share it with someone who could benefit from it. Your support helps more women discover these tools to build muscle, lose fat, and feel confident. Thank you so much for being a part of this journey with me. The second conversation that I would have, and I don't think this one gets enough credit or is talked about enough, at least until recently,

when it started in a couple of big conversations, is your bone density. Your bone density peaks in your late 20s to early 30s and begins declining after that. The rate of decline accelerates significantly in perimenopause and menopause, as you've heard me talk about, due to the loss of estrogen, which is protective for your bones. Women lose up to 20% of their bone density in the five to seven years following menopause. You guys have heard of

hip fractures, osteoporosis. This is the time when people are being diagnosed with these things, or maybe they've already had a fracture. Okay? The standard recommendation for a DEXA scan, the gold standard bone density test, is age 65 for women of average risk. Personally, in my opinion, I think that is too late. And I would argue that people in the healthcare field who are aware of these things will also agree with me on this. So the conversation I would recommend

that you guys have is: I would like to talk about getting a baseline DEXA scan for my bone density. I strength train consistently, and I want to understand where my bone density is now so that I can pay attention to it, track it over time, and address any concerns proactively instead of reactively. That's what I would say to my doctor. Especially, guys, if you have risk factors: a family history of osteoporosis, a history of low body weight,

or disordered eating, a history of, and I always say this wrong, amenorrhea, long-term use of certain medications, or if you are in perimenopause or early menopause. This is where I push even harder for this test. Because the information that it gives you is going to be irreplaceable. And addressing this

concern early, through strength training, through nutrition, and if needed, medical intervention, is dramatically more effective than addressing it in the future, after you have a fracture, after you have a diagnosis of osteoporosis. In my opinion, hear me out, age 65 is a little too late for these reasons. You are being reactive in that arena.

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Get the data and act on it. Again, some doctors are going to push back. Just stand firm in what you're asking for. It's your body, your health. The person that you could be talking to doesn't strength train, doesn't take... just think about that. Granted, they should care about the people they're talking to, but sometimes you're not going to get that. So you've got to care more than the other person cares. Conversation number three that I would have

is around your metabolic health. Most people have had their cholesterol checked, but far fewer people have had a real conversation around metabolic health. And I wouldn't expect you guys to, because it's more of an advanced topic. But this is why I'm having this conversation with you guys. So, just to give you an idea, metabolic health refers to how well your body is managing blood sugar, insulin, inflammation, and energy metabolism. And the standard cholesterol panel,

your total cholesterol, your LDL, your HDL, your triglycerides, only tells part of the story, and unfortunately, often the least important part. So what I would ask for beyond the standard panel... I think the standard panel is important, but in addition to the standard panel, I would be looking for advanced lipid testing. So ask for your ApoB, A-P-O-B, and LDL

particle number, rather than just the LDL cholesterol. Standard LDL measures the amount of cholesterol in your LDL particles, but what actually predicts cardiovascular risk is the number of LDL particles circulating in your blood. To break that down a little bit further: two women could have the same LDL number and wildly different cardiovascular risk profiles based on particle size and number.

That's where ApoB gives you that picture. For me, my ApoB needs a little bit of attention. And personally, cardiovascular disease runs in my family, so these are things I'm paying attention to. Another one is your high-sensitivity C-reactive protein. This is a marker of systemic inflammation. Chronic low-grade inflammation is one of the most significant drivers

of cardiovascular disease, of metabolic dysfunction, and of accelerated aging. And it is almost never included in standard blood work unless you ask. If your high-sensitivity C-reactive protein is elevated, that is a signal that something in your lifestyle, whether it be your diet, your sleep, your stress, your gut health, something in that arena, needs addressing, because it's causing systemic

inflammation. Right? When you guys hear people say, oh, it's just inflammation, oh, it's just inflammation, this is the marker that you want to get tested to determine if that is actually true for your body. Because what it's signaling is coming from what I just said: sleep, stress, diet. And that's going to need some type of addressing. My first look would be: what does your diet look like? That's how we're going to be able to fix it. It is also a significant driver of

cardiovascular disease, so that's why I would highly recommend it. This is a part of your metabolic health. Okay? Another thing, which I already talked about, but I can't express the importance of it enough, is your fasting insulin. I mentioned it in the hormone conversation, but it belongs here too. Understanding your insulin sensitivity is foundational to metabolic health. Most women have their fasting insulin tested, but they don't understand

the ranges of it, unless they specifically ask the question: tell me more about that. What your fasting insulin looks like tells you more about your metabolic risk than anything else on a standard panel. So again, these are conversations that I would have with your doctor. There's one more coming to mind: your homocysteine. That's a marker of cardiovascular risk as well as B vitamin status. It is rarely tested but highly informative, especially for women

with a family history of heart disease. So I would just keep that in mind. So the conversation that I would go in with in this category... you may want to schedule an hour-long conversation with your doctor. Don't just be the person who walks in, hears "oh, everything's normal," and walks out. Seriously, I'm encouraging you guys, and hopefully after this conversation you feel very empowered to have these conversations. Go in and say: I want to go beyond the standard lipid panel and get a more complete picture of my metabolic health. Can we add ApoB? Can we add the high-sensitivity CRP?

Can we add fasting insulin and homocysteine to my blood work? Not every doctor will be familiar with all of these, I'll just add that fun fact there. Some will be dismissive about it. Find one who isn't. Find one who is really hearing you and working with you, who is a cheerleader for you in this. Because your metabolic health at 40 years old determines your quality of life

at 70. So it's really important that you be proactive now rather than reactive later. This deserves a complete picture, not just a checkbox: here's your lipid panel, it's this, okay. What about all of these other tests? Right? Another conversation that I would have is around perimenopause and menopause. Fun fact: not a lot of endocrinologists, hormone specialists, or PCPs who refer you to X, Y, and Z have this conversation, which is crazy.

And then you, who are going through these symptoms, spend years suffering through symptoms that are completely addressable. Perimenopause is the transition period before menopause, which can happen, like me, in your early to mid-30s. There's a lot of nuance, with new research coming out nowadays. You're going to go through menopause around your 50s, right? Well, perimenopause happens about 10 to 15 years before that.

During this time, your estrogen and progesterone levels fluctuate wildly before ultimately starting to decline. And guys, the symptoms are real. I'll be the first one to tell you that. They're significant, and they're widely underdiagnosed: irregular periods, worsening PMS, all the things I said earlier, anxiety, sleep disruption, brain fog, hot flashes, weight gain around the midsection, joint pain, decreased libido, mood swings, and changes in your body composition where you don't respond to the approaches that used to work.

The things that you used to do. This is me. If you go back to the episode that I shared last year, I was starting to experience these symptoms. And I'm just so blessed and fortunate that I understand this world, and I'm like, red flag, let's get ahead of this now. That's why I'm encouraging you guys, through my education in the nursing field, through working with people through WarriorBabe, and through my own experience in this. Because some of you guys are like, well, I can't listen to a girl who's never been through menopause. Well, from my background,

from coaching women, and from my own journey, please just hear me out here. It's here, and it's being deployed through the people on my team. And the people on my team are also outwardly searching and researching education around these topics. But anyway, most women are just told... and please, rebuke this, refuse this. If your doctor says this, be like, absolutely not, I rebuke that. No. Here are the questions I have for you. Most women are told

that this is just part of aging, or this is probably stress. My friends, ladies, I love you. They are not. They are a direct physiological result of hormone fluctuation, and there are real, evidence-based interventions available. So the conversation that I would recommend you have with your doctor is: I'm really in tune with my body, and I'm experiencing symptoms that I haven't noticed before, and I think they may be related

to perimenopause. And before you say, oh, that's just a hot topic right now: no, I actually feel like I'm experiencing these things. I want to discuss what is happening hormonally, what my options are, including hormone replacement therapy, and how to support my body through this transition in a way that protects my long-term health. That's something that I would say. Now, on that thought about HRT, guys: like I said, I'm not on it. But this topic has had a complicated public reputation for the past 20 years,

solely based on a single study that has since been significantly reanalyzed and recontextualized. The current evidence is wildly supportive of this, and strongly suggests that for most healthy women who initiate it before age 60, or within 10 years of menopause, HRT is safe. I've heard women in their later 60s and 70s say, I wish I had never believed these things, the reputation that it got, and that I had gotten on it.

So I'm saying HRT is safe and effective, and in many cases protective of cardiovascular health, bone density, cognitive function, and quality of life. So in my opinion, you deserve a doctor who is up to date and current on this type of research. If yours dismisses the conversation without engaging with it with the proper evidence, then I would push back a little bit, because they're living in

old narrative beliefs around this topic. So this is important, in my opinion. And this is just my opinion; this is how I would handle this personally if I was in your shoes: I would leave a physician who is not up to date in this arena. And I may get pushback on that, and that's okay. This is my firm truth, and this is where I stand with it. So whether or not HRT is right for you, the conversation still needs to happen. Not when your symptoms are unbearable, but now.

Proactively. Again, this whole conversation I'm having with you today is in hopes that it's proactive and not reactive. Because the women who navigate this transition the best are the ones who walk into it informed, and they also have a better quality of life for the long term. The last type of conversation that I would recommend is one around your mental health. And I think this one gets siloed in a way that does not serve women in the best light. It's treated as entirely separate from physical health,

when the connection is actually profound and direct. Your mental health and its physical connection: specifically, anxiety, depression, chronic stress, and burnout have measurable, documented physical consequences. Elevated cortisol from chronic stress will directly impact your fat metabolism. It will directly impact your sleep. It will directly

suppress your immune function. It will also directly accelerate your muscle loss. Also, depression and anxiety, as real as they are, will change your appetite. They will change your motivation in ways that make every physical health goal harder to achieve. And the connection with your gut means that your mental health affects your digestion, inflammation,

and the way that your body absorbs nutrients. And that's going to show up in the way that you're reaching your body composition goals and in your energy. Obviously, some PCPs will refer you out in this. But keep in mind, a PCP is just that: a general health practitioner. They're going to screen briefly for this in an annual appointment. But a real conversation about mental health, specifically about how chronic stress and anxiety are affecting your physical health,

the treatments and options that are available, rarely happens unless you initiate it. Because again, it's just a screening. It's a quickly answered question: do you experience this? That's how I've experienced it. For those of you who actually experience these things, it can feel daunting, and maybe an unsafe area to express them. But I hope that I can encourage you to bring it up. The conversation

that I would have is: I want to talk about the physical impact I'm feeling from the weight of stress that I'm carrying. I feel like I have a little bit of anxiety that's developing. I want to understand how my mental health is affecting other areas of my body. Is it affecting my hormones? Is it affecting my metabolism? Is it affecting my body? I want to discuss possible interventions that are available beyond just trying to reduce my stress. What are things

I can look into? Therapy? Things that hopefully a doctor would be able to hear you out on and lean into. Because in my opinion, the answer to chronic stress is not just do some breathing exercises, some yoga, and some deep meditation. That can be really hard for people in this arena to do. So sometimes it is therapy. Sometimes it is lifestyle restructuring. Sometimes it is getting on

a better route with your nutrition, your diet, and finding forms of exercise that are going to help you. Your mental health is not separate from your physical health. They are actually part of each other. That's why I think it is really important to make that connection, and it deserves a clinical conversation, not just a checkbox or a question that gets overlooked. So, of all of those conversations, the five of them, write them down. Maybe you're going to have to

relisten to this podcast episode. I highly encourage you to, until you feel confident, so that when you schedule your next appointment, you take it into that appointment. So again, first one: hormones. A full panel, not just your TSH: the full thyroid panel, sex hormones, fasting insulin. Number two is your bone density: a baseline DEXA starting sooner than 65 years old. I would do it in your 30s, in your 40s. Three is your metabolic health, beyond just a standard

cholesterol check. It's your ApoB, it's your CRP, it's your fasting insulin, it's the advanced lipid testing, your cortisol, your LDL. Yeah, your ApoB. Ask for those things. Number four was perimenopause and menopause: proactively having those conversations and saying, hey, I'm experiencing these things. If you are in your 30s or later 30s, stop ignoring or pushing away these symptoms.

You guys, I've seen that in real time with people. They're saying these things, but they're just pushing them away and ignoring them. Stop ignoring it. Your body is your own personal advocate, telling you something is off. Your body knows before your brain does. Okay? So listen to your body. If something feels off, address it. And then five is the mental health component. It has a physical connection, and it deserves a real conversation, not just a question, a checkbox, and done. And I'd like to say this too:

you are not being difficult when you ask for these things. You are being informed. You are being your own best advocate. I would just highly encourage you to have these types of conversations. And I hope that by leaving this podcast today, you feel empowered to go into your doctor, show up prepared, ask the hard questions, and leave with real answers. You are a woman who deserves to take your health seriously, and who deserves to

care for yourself more than, unfortunately, maybe your doctor cares for you. I just have to say that directly. Your body deserves complete information, so get it. Okay? And I'm saying prayers for all of you guys. I just pray that you have encouragement to have these conversations, the hard conversations, and that you feel well prepared leaving this conversation to go act on it. All right. And share this episode, guys. Please share this episode with the people in your life who have ever left a doctor's appointment knowing less than she needed to and feeling like she had more questions

than she did going into it. Share this episode with them. All right, I will see you guys in the next one. Love y'all. Peace out. Hey, really quick before you go, I have one small favor to ask. If this episode brought you value or sparked something in you, take just a moment to hit that review button. Your rating and review make all the difference in helping more women discover the tools they need to transform their fitness and their confidence. It takes less than a minute, but it can change the path

of someone else's journey. Thank you so much for leaving that review. I appreciate you so much.