What Blood Tests Do I Need To Start Testosterone Replacement Therapy?

December 12, 2018

Navigating the Path to TRT: Understanding the Essential Blood Tests

Testosterone Replacement Therapy (TRT) has emerged as a viable option for men experiencing the effects of low testosterone (hypogonadism). However, embarking on this journey requires a comprehensive evaluation from a licensed and experienced healthcare provider to ensure both safety and efficacy. Signs and symptoms are often only one aspect of determining whether a patient has low testosterone. An ADAM test for androgen deficiency can be used to gauge if low T. Here, we’ll talk about the crucial blood tests necessary to start TRT, providing valuable insights for men considering hormone replacement therapy.

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The Importance of Blood Tests for Men Looking to Start TRT

Before starting TRT, a series of blood tests are needed for the doctor for several reasons. One is to Confirm low testosterone levels. Even though the signs and symptoms may be there, you’ll need to know definitively what the hormone levels are to ensure the diagnosis is accurate and not due to other underlying medical conditions. These tests help identify potential risks, such as cardiovascular issues or liver problems, that could be exacerbated by testosterone therapy as well as evaluating the patient’s overall health and identify any potential risks or contraindications for TRT.

This can also rule out other causes besides andropause or hypogonadism. It’s important for the physician to accurately diagnose hypogonadism and differentiate it from other conditions that may mimic its symptoms. Blood tests can identify potential underlying issues like thyroid problems or pituitary gland disorders that might be affecting hormone levels and provide an accurate medical picture for the doctor to use in determining both eligibility and potential protocol moving forward. The healthcare provider will be able to Identify potential underlying medical conditions, such as pituitary tumors or thyroid dysfunction, that could be contributing to low testosterone levels. So, what blood tests do you need to start testosterone replacement therapy?

Key Blood Tests for TRT Evaluation:

Hormone Levels. This information is for general knowledge and informational purposes only and does not constitute medical advice. This is a partial list of some of the most common tests to be performed when trying to test, diagnose and treat a patient for Low T. It's crucial to discuss your specific levels with your bloodwork/hormone levels with a doctor. They can interpret your results in the context of your individual health history and symptoms to determine if testosterone replacement therapy or any other medical treatment is appropriate for you… These are general guidelines. Reference ranges can vary slightly between laboratories and Individual values can vary depending on factors such as age, overall health, genetics and more.

Total Testosterone: Measures the total amount of testosterone in the blood. Typically tested in the morning when levels are highest. Normal ranges can vary based on age and laboratory methods however normal testosterone levels in adult men generally range from 300 to 1,000 nanograms per deciliter (ng/dL).

Free Testosterone: Measures the unbound testosterone available for biological activity, providing a more accurate reflection of the body's available testosterone. Normal free testosterone levels in men typically range from 50-250 picograms per milliliter (pg/mL). Free testosterone levels can be influenced by several factors, including age, body fat percentage, and the time of day the blood sample was taken. Interpreting free testosterone levels requires careful consideration of other factors, such as total testosterone, SHBG (sex hormone-binding globulin) levels, and individual symptoms.

Sex Hormone-Binding Globulin (SHBG): This protein binds to testosterone, making it unavailable for use. SHBG levels are crucial for interpreting total testosterone levels. Normal SHBG (Sex Hormone-Binding Globulin) levels in men typically range from 10 to 57 nanomoles per liter (nmol/L).

Luteinizing Hormone (LH): Helps determine the cause of low testosterone. High LH levels usually indicate primary hypogonadism (problems with the testicles), while low LH levels may suggest secondary hypogonadism (problems with the pituitary gland). Normal Luteinizing Hormone (LH) levels in adult men generally range from 1.8 to 8.6 IU/L.

Follicle-Stimulating Hormone (FSH): Primarily involved in sperm production, FSH levels can provide further insights into testicular function. Normal Follicle-Stimulating Hormone (FSH) levels in adult men typically range from 1.5 to 12.4 mIU/mL.

Estradiol (E2): Evaluates estrogen levels, which are converted from testosterone. Maintaining a healthy balance between testosterone and estrogen is essential. Normal estradiol levels in men typically range from 10 to 40 picograms per milliliter (pg/mL).

Prolactin: High prolactin levels can interfere with testosterone production and may indicate pituitary gland issues or tumors. Normal prolactin levels in men typically range from below 20 ng/mL

Thyroid Function Tests. Thyroid function tests, such as measuring Thyroid-Stimulating Hormone (TSH), Free T3, and Free T4, are crucial before starting Testosterone Replacement Therapy (TRT). This is because thyroid dysfunction can mimic or contribute to symptoms of low testosterone, such as fatigue, decreased libido, and changes in mood. By assessing thyroid function, healthcare providers can ensure that any observed symptoms are accurately attributed to low testosterone and not an underlying thyroid issue.

Thyroid-Stimulating Hormone (TSH): Evaluates thyroid function, as thyroid disorders can impact testosterone production and mimic symptoms of low T. Normal TSH (Thyroid-Stimulating Hormone) levels in adult men generally range from 0.4 to 4.0 mIU/L.

Free T3 and Free T4: Measure the active forms of thyroid hormones. Free T3 (Triiodothyronine): The normal range in men is 2.0 to 4.4 picograms per deciliter (pg/dL) Free T3 represents the active form of thyroid hormone that is not bound to proteins and is available for use by the body's cells. Free T4 (Thyroxine): The normal range in men is 0.9 to 1.7 nanograms per deciliter (ng/dL) Free T4 is the main circulating form of thyroid hormone.

Complete Blood Count (CBC) A Complete Blood Count (CBC) is a comprehensive blood test that evaluates various components of your blood, including red blood cells, white blood cells, and platelets. In the context of Testosterone Replacement Therapy (TRT) eligibility, a CBC is crucial because testosterone therapy can increase red blood cell production. By assessing baseline red blood cell counts (hemoglobin and hematocrit) before starting TRT, doctors can monitor for potential side effects like an increase in red blood cell count (polycythemia), which can increase the risk of blood clots.

Hematocrit. Hematocrit is the percentage of red blood cells in your blood. Normal hematocrit levels in men typically range from 41% to 50%.

Lipid Panel: A lipid panel is a blood test that measures the levels of different types of cholesterol such as total cholesterol, LDL, HDL and triglycerides in your blood. estosterone therapy can sometimes slightly increase the risk of cardiovascular events. A lipid panel helps assess your baseline cardiovascular risk by measuring the overall amount of cholesterol in your blood. High levels of LDL cholesterol ("Bad" Cholesterol) can contribute to plaque buildup in the arteries, increasing the risk of heart disease. HDL cholesterol ("Good" Cholesterol) helps remove excess cholesterol from the bloodstream. Triglycerides are another type of fat in the blood. High triglyceride levels can also increase the risk of heart disease. A lipid panel can be used to monitor the effects of testosterone therapy on your cholesterol levels. Some men may experience slight changes in their cholesterol levels during treatment. By assessing your baseline cardiovascular risk through a lipid panel, your doctor can make informed decisions about the suitability of TRT and monitor for any potential side effects.

Liver Function Tests (LFTs) Evaluates liver health, as some forms of testosterone therapy can potentially affect liver function.

Kidney Function Tests. Assesses kidney function, as kidney disease can impact hormone production and metabolism.

Fasting Blood Glucose and Hemoglobin A1c. Evaluates blood sugar levels to screen for diabetes, as metabolic health can influence testosterone levels. Fasting Blood Glucose normal ranges are 70-99 mg/dL (3.9-5.5 mmol/L) Normal Hemoglobin A1c ranges are Less than 5.7%.

Prostate-Specific Antigen (PSA) is a protein produced by the prostate gland. Normal PSA Levels can vary significantly with age. Generally, a PSA level below 4 ng/mL is considered within the normal range for most men, however this is a general guideline, and values can vary. Testosterone therapy can potentially stimulate prostate growth so doctors will monitor PSA levels before and during TRT to assess the risk of prostate enlargement. TRT has been proven to not be a cause of prostate cancer however men with preexisting cancer should not take testosterone as it will potentially exacerbate the condition.

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Additional Tests (Case-Specific):

Iron Studies and Ferritin: To rule out iron overload, which can affect testosterone production.
DHEA-S: Evaluates adrenal function, as DHEA-S is a precursor hormone to testosterone.
Bone Density Scan (DEXA): Recommended if there are concerns about bone health, as low testosterone can increase the risk of osteoporosis.

Working with a Qualified Healthcare Provider

Navigating the path to TRT requires a collaborative approach with a qualified healthcare provider, such as an endocrinologist, urologist or internist who specializes in hormone therapy. They will be able to Interpret and Analyze the results of all tests and interpret their significance as well as Develop a Personalized Treatment Plan. It’s important to determine the most appropriate TRT regimen based on individual needs and medical history as all patients are unique in their goals, history, symptoms and their response to medications. It’s important that they discuss potential risks and benefits of treatment and for anyone who begins therapy, that they monitor progress and adjust treatment as needed. A qualified TRT clinic can help a patient navigate this path.

Disclaimer: This information is for general knowledge and informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for any health concerns or before making any decisions regarding your health or treatment.

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