Q & A With Dr. J: The Truth About Labwork
Your questions answered with Dr. Michelle Jacobson OBGYN, Chief Medical Officer at Coven Women’s Health
1. “My labs are ‘normal,’ but I feel awful. What does that mean?”
First — I believe you.
Second — “normal” is a statistical term. It means your value falls within a population range. It does not automatically mean you are thriving.
That said, we don’t treat numbers in isolation. We treat people.
If your labs are normal and you feel unwell, we step back and ask:
Are we asking the right clinical question?
Are we missing iron deficiency without anemia?
Are sleep, stress, nutrition, or mood playing a role?
Is this a hormonal transition that won’t be captured by a single blood test?
Normal labs do not invalidate symptoms. But they also don’t always mean you need more testing.
They mean we need thoughtful interpretation.
2. “What ferritin level do you consider acceptable?”
Many labs list ferritin as normal if it’s above 15–20 µg/L.
In practice, many women feel unwell at levels that technically fall within range — especially those with heavy periods, postpartum changes, or high physical demands.
Ferritin is a storage marker. It tells us about iron reserves, not just anemia. It can also represent inflammation.
We look at:
Symptoms
Full iron studies
Menstrual history
Inflammation markers
There isn’t one magic number.
There is context.
3. “What’s the right vitamin D level?”
The goal is to avoid deficiency and support bone health.
More is not always better.
Vitamin D is important — especially in Canada — but megadosing without indication is not evidence-based medicine.
We individualize:
Supplementation dose
Re-testing intervals
Risk factors for deficiency
We correct deficiency thoughtfully.
We don’t chase extremes.
4. “Should I test my hormones?”
It depends on why.
Hormones fluctuate daily, monthly, and across life stages. A single lab value rarely captures that complexity.
We test hormones when the result will change management.
For example:
Suspected thyroid dysfunction
Amenorrhea
PCOS evaluation
Early menopause
Specific symptom clusters
We don’t routinely test every reproductive hormone in every woman with fatigue or mood changes.
Testing should answer a clinical question.
5. “Do you test free testosterone in women?”
Sometimes — but not reflexively.
Testosterone levels in women are low and difficult to measure accurately. Many analytical laboratory procedures are unreliable at female ranges.
A “low” value does not automatically require treatment.
If someone has persistent low desire, fatigue, or specific clinical indicators, we may assess it — but always in context.
We don’t order it because the internet says we should.
Total testosterone is used to monitor testosterone replacement, following international guidelines.
6. “What about DUTCH testing or salivary cortisol panels?”
These tests can look comprehensive.
The more important question is: Does the test improve outcomes or change treatment decisions in a meaningful way?
For most routine women’s health care, major clinical guidelines do not require these tests.
They can sometimes create more confusion than clarity.
They are not validated nor are they first-line care.
Evidence-based medicine matters.
7. “What do you mean by ‘optimal’ vs ‘normal’?”
“Optimal” is not a medical term. It’s often used in marketing.
In medicine, we assess:
Deficiency
Risk
Disease
Symptom burden
Long-term health implications
We are not trying to push every number to the top of a range.
We are trying to reduce risk and improve how you feel.
That’s different.
8. “If labs aren’t everything, what do you focus on?”
At Coven Women’s Health, we focus on:
A detailed history
Symptom patterns
Menstrual and reproductive history
Metabolic health
Sleep
Nutrition
Mental health
Stress load
Lab work is one piece of the puzzle. It is not the whole picture.
9. “When should I push for more testing?”
If:
Your symptoms are persistent and unexplained
You’ve been dismissed without evaluation
There’s a strong family history of disease
Something feels significantly different or new
Advocacy is important.
But more testing should still be strategic — not reactionary.
10. “What’s the biggest misconception about women’s lab work?”
That if we just find the right number, everything will make sense.
Women’s health is not a scavenger hunt for a single abnormal value.
It’s pattern recognition.
It’s risk assessment.
It’s listening carefully.
It’s knowing when a lab matters — and when it doesn’t.
Good care is not trendy. It’s thoughtful.
