What Bloodwork is Needed to Start TRT?

The specific blood tests that one would need to start testosterone replacement therapy (TRT) can vary from one clinic/doctor to the next, but most providers will prescribe lab work that will include free and total testosterone, estradiol, complete blood count (CBC), a comprehensive metabolic panel (CMP), Thyroid Stimulating Hormone (TSH), and prostate-specific antigen (PSA). Your doctor will determine the necessary tests based on your individual past medical history, health profile and signs/symptoms. Finding the route cause of androgen deficiency may also require additional tests like an MRI or ultrasound to see if there are any issues with the pituitary gland or testes which may be a contributing factor as to why a male may have low T.

Testing for hormones provides valuable information about the overall health and wellness of a person as well as the functioning of various systems in the body. The hypothalamus, pituitary, testes are all directly involved in regulation and production and play a pivotal roll in maintaining optimal health and wellness. Specifically, in the context of testosterone replacement therapy (TRT), hormone testing in men may involve the evaluation of several different blood markers:

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What are some of the tests needed to evaluate a patient’s hormone levels?

1. Testosterone Levels: Testing for both total and free testosterone levels will help determine if there is a hormonal imbalance or deficiency and if there are other factors in play, such as SHBG binding serum testosterone levels which reduces its bio-availability. There are several factors that can influence testosterone production in men, such as diet, exercise, sleep, stress, time of day, year, medications and other health related issues, etc… Maintaining a record of testosterone levels overtime may also help a physician in pinpointing causes of andropause if they correspond to certain events in one’s past. The more information, the better it is for a doctor to make an informed decision regarding your health.

2. Estradiol Levels: Monitoring estrogen levels, specifically estradiol, is important to maintain a balanced hormone profile, as imbalances can lead to symptoms like mood swings or fatigue in some men. Estrogen levels will rise and fall in connection to testosterone levels so its important to get a baseline and make sure that there are no other factors influencing their values whether they are high or low. There may be complications when estrogen levels for men on TRT are too high or too low so its important to understand where your numbers are and to make sure that you monitor them as part of a comprehensive follow up program.
3. Complete Blood Count (CBC): This test provides information about red and white blood cell counts, which can indicate overall health and potential issues. A Complete Blood Count (CBC) is a blood test that provides important information about the cellular components of your blood and since testosterone may raise and elevate red blood cell counts, its important to look at these values and keep a record to show potential trends in hematocrit and hemoglobin levels. The key components measured in a CBC include:

1. Red Blood Cell (RBC) Count: The number of red blood cells per volume of blood, indicating oxygen-carrying capacity.

2. Hemoglobin (Hb) Level: The amount of oxygen-carrying protein in red blood cells.

3. Hematocrit (Hct): The proportion of blood that is cellular, indicating the volume occupied by red blood cells which can be elevated when taking testosterone. Its important to check your hematocrit levels when on TRT.

4. White Blood Cell (WBC) Count: The total number of white blood cells, which play a role in the immune system.

5. Platelet Count: The number of platelets, essential for blood clotting.

6. Mean Corpuscular Volume (MCV): The average volume of a red blood cell.

7. Mean Corpuscular Hemoglobin (MCH): The average amount of hemoglobin in a red blood cell.

8. Mean Corpuscular Hemoglobin Concentration (MCHC): The concentration of hemoglobin in a given volume of red blood cells.
CBC results can help identify various conditions, such as anemia, infections, and blood disorders. Interpretation of these results should be done by a healthcare professional in the context of your overall health and medical history.

4. Comprehensive Metabolic Panel (CMP):

A Comprehensive Metabolic Panel (CMP) is a blood test that provides information about the status of your body's metabolism, electrolyte balance, and organ function. The tests included in a CMP typically cover various aspects of your overall health. Where a CMP may not directly provide information regarding your hormones, it may be used to determine the overall wellness of an individual. A standard CMP includes:

1. Glucose: Measures blood sugar levels, which is important for assessing diabetes and carbohydrate metabolism.

2. Calcium: Assesses the level of calcium in the blood, which is crucial for bone health and various physiological processes.

3. Albumin: Measures a protein in the blood that plays a role in maintaining blood volume and regulating pressure.

4. Total Protein: Evaluates the total amount of proteins in the blood, including albumin and globulins.

5. Electrolytes (Sodium, Potassium, Carbon Dioxide): Assesses the balance of electrolytes, essential for nerve and muscle function.

6. Bilirubin: Measures a product of red blood cell breakdown and helps assess liver function.

7. Alkaline Phosphatase (ALP):  Assesses liver and bone health.

8. Aspartate Aminotransferase (AST or SGOT) and Alanine Aminotransferase (ALT or SGPT): Evaluate liver function and assess for liver damage.

9. Blood Urea Nitrogen (BUN) and Creatinine: Assess kidney function and the body's ability to excrete waste products.

A CMP provides a comprehensive overview of your metabolic health and helps identify potential issues with organs like the liver and kidneys. Interpretation of CMP results should be done by you physician as part of your evaluation considering your individual health status and past medical history and is taken as part of the larger picture regarding your overall health. A record of bloodwork may be able to show trends in your blood composition and may be used to detect problems early, before they become a larger problem.

5. Prostate-Specific Antigen (PSA): This test helps assess prostate health, as elevated PSA levels may suggest issues like inflammation or, possibly even prostate cancer. TRT will not cause a patient to develop prostate cancer however patients who may have been diagnosed with prostate cancer can accelerate its growth and is thus contraindicated for patients who wish to start hormone therapy.

6. Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH): These hormones can be measured to evaluate the function of the pituitary gland and testicles. LH and FSH levels may indicate whether the hypothalamus is detecting hormone levels in the blood and responding appropriately. Some medications like Enclomiphene, clomid and hCG either stimulate or mimic the body’s production of these hormones and may be used to treat low T and/or fertility issues.

Hormone and testosterone testing is crucial for understanding and addressing imbalances, guiding treatment decisions, and ensuring overall health and well-being. Interpretation of these results should be done by a qualified medical professional.

When should I get tested to see if I have Low Testosterone?

Men should consider getting checked out and having a blood panel done if they have low testosterone and are beginning testosterone replacement therapy or if they notice any of the signs and symptoms of andropause. Common signs or symptoms of low testosterone include:

• Low iron (anemia)
• Depression ands/or mood changes
• Low sex drive
• Erectile dysfunction (ED)
• Fatigue and lack of energy
• Loss of lean muscle mass  
• Loss of strength
• Brittle bones (low calcium levels)
• Unwanted weight gain/ increased body fat
  

How do I get a prescription for bloodwork to start testosterone therapy?

Unfortunately, testosterone levels are rarely checked with routine bloodwork. To get a prescription for bloodwork to start testosterone replacement therapy (TRT), you should consult with a healthcare provider. Schedule an appointment with a primary care physician, endocrinologist, or a specialist experienced in hormone therapy to ensure the best possible treatment under the guidance of someone experienced in this field of medicine.

During the appointment, discuss your symptoms, medical history, and any concerns you may have which prompted you to seek treatment. The healthcare provider will then be able to determine the appropriate blood tests needed and issue a prescription for them. Some physicians will send you to a lab like Labcorp to get your blood drawn and tested.

Following the evaluation of the bloodwork, the results will help guide decisions regarding starting TRT, if necessary and determine the right medications, strength, dose, and frequency. Everyone is different so individualized treatment is needed. Always seek professional medical advice for personalized care and carefully follow your doctor’s orders to ensure the best medical outcomes.