Rank | Blood Test | Notes |
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1 | Free Testosterone, Free, Direct With Total Testosterone | Directly measures the amount of bioavailable testosterone and the total amount in your blood. Crucial for diagnosing low testosterone and monitoring TRT effectiveness. Different labs might use slightly different names (e.g., "Testosterone, Free, Direct With Total Testosterone, LC/MS-MS"), but they measure the same key analytes. |
2 | Estradiol, Sensitive, LC/MS | Measures the primary form of estrogen. Important for monitoring potential side effects of TRT, as testosterone can aromatize (convert) into estrogen. The "sensitive" assay is preferred for men as it has a lower detection range. |
3 | Complete Blood Count (CBC) With Differential | Assesses overall blood health, including red and white blood cell counts, and platelets. Important to monitor as TRT can sometimes affect red blood cell production (erythrocytosis). |
4 | Prostate-Specific Antigen (PSA) Total+ | A marker for prostate health. Important to monitor, especially in men over 40 or those with a family history of prostate issues, as TRT *might* have an impact on PSA levels in some individuals. The "%" often refers to the percentage of free PSA, which can provide additional information. |
5 | Lipid Panel | Measures cholesterol and triglycerides. Important for assessing cardiovascular risk, which can be influenced by hormone levels and lifestyle changes associated with TRT. |
6 | Metabolic Panel (14), Comprehensive | Provides a broad overview of your body's chemical balance, including kidney and liver function, electrolytes, and blood glucose. Important for overall health assessment and to monitor for any potential metabolic changes. |
7 | Sex Hormone-binding Globulin (SHBG) | Measures the protein that binds to testosterone and estrogen in the blood. Knowing SHBG levels helps in more accurately determining the amount of free (bioavailable) testosterone. |
8 | Follicle-stimulating Hormone (FSH) and Luteinizing Hormone (LH) | These pituitary hormones stimulate testosterone production in the testes. Measuring them can help determine the cause of low testosterone (primary vs. secondary hypogonadism) *before* starting TRT. Their role in ongoing monitoring during TRT is less direct. |
9 | Dihydrotestosterone (DHT) | A more potent androgen than testosterone. While not always routinely monitored, it can be important in some individuals due to its role in certain androgenic effects (e.g., hair loss, prostate issues). |
10 | Insulin-like Growth Factor-1 (IGF-1) With Z Score | Primarily reflects growth hormone levels and has various metabolic effects. May be monitored in some individuals, but not as directly related to TRT management as the hormones listed above. The Z-score helps interpret the IGF-1 level relative to age and sex. |
11 | Thyroid-stimulating Hormone (TSH) | The primary marker for thyroid function. While thyroid issues can sometimes overlap with testosterone issues, it's not a direct marker for TRT management unless there's a known thyroid condition or symptoms suggesting one. |
12 | Free Thyroxine + T4 | Measures the free and total levels of the main thyroid hormone. Similar to TSH, important for overall health but not a primary marker for TRT unless indicated by symptoms or other findings. |
13 | Cortisol | A stress hormone with various effects on the body. While important for overall health, it's not routinely monitored for TRT unless there are specific concerns or symptoms related to adrenal function. |
14 | Insulin | Measures blood sugar regulation. While metabolic health is important in the context of TRT, insulin levels are not a direct marker for TRT effectiveness or typical side effects, unless there are specific concerns about insulin resistance or diabetes. |
15 | Triiodothyronine (T3), Free | Another thyroid hormone. Similar to TSH and T4, it's important for overall health but not a primary marker for TRT unless indicated by symptoms or other findings. |