Steroid profiling plays an important role in the clinical setting and also in the diagnosis of various physiological disorders. Steroids in the research laboratory and patient care has been routinely measured by immunoassay. Limitations of immunoassay in quantifying steroids have been well documented and the advent of advanced mass spectrometry is offering a viable alternative to measure multiple steroids in single reaction. Analytes ranging from the steroid and their metabolites that are present in the body carry out various important functions and are relevant to maintaining homeostasis. Blood plasma and urine samples are the clinical material for such analysis, however, due to the difference in polarity of the target steroid, a major challenge exists as to how faithfully analyze different steroids in the given sample type. These steroids are usually present at very low concentrations in the body and are present in several forms leading to increased complexity. Achieving an excellent chromatographic separation for the analysis of steroids requires an effective sample preparation and analysis procedure. Hence various methods are developed to analyze the presence of steroids and to know their exact concentration in the body. This review covers various analytical methodologies such as chromatographic procedures and downstream mass spectrometry for the identification and measurement of the levels of steroid hormones. At the same time, this review also covers the most recent developments that have taken place in the recent past to cover the enhanced understanding of steroid hormone analysis.