Blood work is the mainstay of management of TRT. It helps you understand what you are testing, what it means, and therefore enables you to have intelligent conversations with your physician regarding your own personal health.
Before TRT: Blood Tests
Before embarking on any form of TRT, you must first begin a full panel of blood work to better determine your starting point and to determine that you are a proper candidate for treatment.
Testosterone Levels
Total Testosterone: This will give you the measure of all the testosterone present in your blood. This value will be measured in nmol/L, ranging from a normal value of 8.64 to 29 nmol/L.
Free Testosterone: The fraction that can be considered to be active in a biological manner. More useful in diagnosing actual hormonal imbalances. Usually between 0.3 to 1.0 nmol/L.
SHBG (Sex Hormone Binding Globulin): A protein that binds along with the hormone testosterone. Higher SHBG means less free testosterone flowing through your veins.
Other Important Markers
- LH (Luteinising Hormone): Aids in establishing whether the cause is testicular or pituitary
- FSH (Follicle Stimulating Hormone): A key hormone for fertility assessment
- Prolactin: Excess levels can inhibit testosterone secretion
- Oestradiol (E2): While men need some estrogen, too much can be a side effect
Monitoring During TRT
Once you are on TRT, blood tests are done to ensure that the treatment works properly and is also safe for you.
Testing Frequency
- First 6 months: Every 6-8 weeks to dial in your dose
- Stable on treatment: Every 3-6 months
- Yearly: Full panel plus extra markers
Key Markers to Monitor
Haematocrit and Haemoglobin
TRT stimulates the production of red blood cells. Haematocrit above 54% requires dose reduction or phlebotomy. This is one of the most crucial points regarding the safety of the treatment.
PSA (Prostate-Specific Antigen)
Though TRT isn't associated with prostate cancer, one should closely monitor their prostate. It's usual practice to take a baseline reading of the PSA before starting and follow up regularly.
Liver Function Tests
Both ALT and AST values ensure that the liver is clearing medication the way it should. Oral testosterone, though less common, has more effect on the liver compared to injection or gel preparations.
Lipid Profile
TRT may influence cholesterol levels. Such values as total cholesterol, HDL, LDL, and triglycerides should be checked regularly.
Optimal Ranges vs Reference Ranges
There is, however, a crucial difference between "normal" ranges and optimal ranges regarding well-being:
| Marker | Reference Range | Optimal Range |
|---|---|---|
| Total Testosterone | 8.64-29 nmol/L | 20-30 nmol/L |
| Free Testosterone | 0.17-0.67 nmol/L | 0.4-0.7 nmol/L |
| Oestradiol | 41-159 pmol/L | 70-110 pmol/L |
| SHBG | 18-54 nmol/L | 20-40 nmol/L |
When to Test
To obtain accurate results, the timing of your test matters:
- Natural testosterone: Test in the morning (7-10am) when levels peak
- On injections: Test at trough (just before next injection) for consistent results
- On gels/creams: Test prior to application or at the same time each test
Conclusion
Knowing your blood test results changes you from a passive patient into an active participant with your own health. Do not be afraid to ask your clinic for interpretations of your results, and maintain your own records for monitoring your progress.