Proper monitoring of men on testosterone replacement therapy has been dictated by several medical guidelines groups. However, most of them fall short in guiding doctors on what to if different key variables are not optimal. The following list includes all important blood tests and health variables for men before they are prescribed testosterone and while on testosterone replacement therapy.
The following panels can be obtained on DiscountedLabs.com, the most affordable online lab test company (No doctor visit required. Prescription provided. Most US cities except the following states: NY, NH, MA and RI).
Pre- TRT Male Hormone / Wellness Panel
Testosterone replacement therapy- Target Blood Test Limits
Hematocrit under 53 (donate blood if equal or over 53. High hematocrit (large amount of red blood cells) makes your blood thick which is not good for your cardiovascular health)
PSA under 3 (4 is max since doctors will not prescribe TRT at this number)
Estradiol (ultrasensitive) between 20-50 pg/mL (anastrozole may be needed at 0.5-0.5 mg per week in some men with sensitive estradiol over 40 pg/mL if breast tenderness is experienced)
Blood pressure under 135/85 (high blood pressure can make you feel winded, increase cardiovascular risks and affect kidneys)
Estimated Glomerular (eGFR) (kidney function) over 60 ( keep blood pressure under control and avoid supplements that may load your kidneys)
Liver enzymes not elevated over 20 percent of top value of reference range. (Exercise can increase ALT and AST. Testosterone in gels, injections, pellets etc does not increase liver function. Be careful with supplements!)
TSH under 2.5 (higher numbers can point at low thyroid function, which causes a lot of the symptoms of low testosterone)
Total Testosterone over 500 ng/dL (many men feel better above 600-700 ng/dL)
Free Testosterone equal or above 2 percent of total (lower percentage means your sex hormone binding globulin is high and grasping more testosterone).
If donating blood to bring hematocrit down, ferritin never under 30 ng/mL or micrograms/liter (low ferritin can increase fatigue).
Free T3 (if hypothyroid and on treatment) in the upper quartile of range. (depending on range it can be 3.7- 4.2 pg/mL)
HDL over 40 mg/dL (low levels of good cholesterol can affect cardiovascular health- Higher T doses can decrease HDL)
For more information: Testosterone Side Effect Management Table
OPTIMUM REQUIRED LAB WORK (Preferred but not mandatory)
1 ——- Estradiol- sensitive via LC/MS test (not EIA!) [Quest Labs code 30289]
(Labcorp code: 140244) (baseline, week 6 or 8, month 6)
GOAL: 20-50 pg/mL
2 ——- Testosterone, Free, Bio/Total (LC/MS/MS) (baseline, week 6-8, month 6, then yearly)
GOAL: Total testosterone over 500 ng/mL and free T 2 percent or more of total T.
3 ——- DHEAs (baseline, month 6, month 12 (if supplementing))
4 ——- Comprehensive Metabolic Panel w/EGFR (baseline, week 6-8, month 6 and then once a year)
GOAL: Normal CBC including liver enzyme elevations under 20 percent and eGFR over 60
5 ——- CBC w/ diff/PLT (baselines, week 6-8, month 6 and then once or twice per year)
GOAL: Normal CBC
6 ——- Lipid profile (fasting sample) (baselines, month 6, then once per year unless high)
GOAL: Normal lipids
7 ——- T3, free (for those with low thyroid symptoms)
GOAL: Upper quartile free T3
8 ——- T4, free (for those with low thyroid symptoms)
Goal: Normal free T4
9 ——- Ultrasensitive TSH (baseline, month 6, yearly after that depending on value and treatment)
GOAL: TSH under 2.5
10 ——– Prostatic Specific Antigen (PSA) (Baseline before testosterone treatment, 6-8 weeks after and then yearly)
GOAL: PSA under 3
11——– LH and FSH (for men not on testosterone yet)- Used to diagnosed primary or secondary hypogonadism. Do not waste money testing your LH and FSH if you are on testosterone since they will be undetectable.
For those with excessive fatigue: Saliva Cortisol + DHEA (4 specimens during one day) (you can wait for after 6 weeks on TRT). Ferritin is also a test that can be considered.
GOAL: Normal cortisol graph and values along with proper cortisol/DHEA ratios
Vitamin D (25 (OH)D test)- Most people have low vitamin D, so spending money on this may be optional. Taking 5000 IU per day brings blood levels up to desired range in most people.
Folate and Vitamin B-12- Low only if you suffer from malnutrition or malabsorption.
Easy to understand lab test descriptions and their targets from stopthethyroidmadness.com
And from DiscountedLabs.com
Lab test results mean little unless health information is provided. Here is a sample health questionnaire that could be filled at baselines, week 6 or 8 and then every 6 months to assess progress in quality of life.
ADAM questionnaire about symptoms of low testosterone
(Androgen Deficiency in the Aging Male)
This basic questionnaire can be very useful for men to describe the kind and severity of their low testosterone symptoms.
1. Do you have a decrease in libido (sex drive)? Yes No
2. Do you have a lack of energy? Yes No
3. Do you have a decrease in strength and/or endurance? Yes No
4. Have you lost height? Yes No
5. Have you noticed a decreased “enjoyment of life” Yes No
6. Are you sad and/or grumpy? Yes No
7. Are your erections less strong? Yes No
8. Have you noticed a recent deterioration in your ability to play sports? Yes No
9. Are you falling asleep after dinner? Yes No
10. Has there been a recent deterioration in your work performance? Yes No
If you answered Yes to number 1 or 7 or if you answer Yes to more than 3 questions, you may have low Testosterone.
Posting blood test results without comprehensive quality of life information may not get you the best quality of input from members of this site.To save time and make your questions clearer, please review this list. You can copy and paste it on a post and add your answers if you wish. This will ensure that you get the best quality input from members.
HEALTH AND QUALITY OF LIFE INFORMATION:
Do you have small children?
Do you still want to have children?
Have you lost weight in the past 6 month? If yes, how many pounds?
Have you gained weight in past 6 months? If yes, how many pounds?
Has your body tone changed in the past 6 months (harder, softer)?
When was your last complete physical examination?
What were the results of that exam?
(FOR OVER 40) Did you have your prostate examined by digital rectal exam?
(FOR OVER 40) Did you have your PSA checked?
If so, what was it?
Are you taking testosterone now?
If answer to above question is NO, have you taken testosterone in the past? How long and when did you last stop?
Do you urinate alright (you fully void)?
How many times do you get up at night to urinate ?
Does it hurt when you urinate?
Is there any blood in your urine?
Have you had prostatitis (prostate/urinary infections) in the past?
Describe any acne history:
Did you have gynecomastia (increased breast tissue swelling) when young?
Do you have cold intolerance?
Do you bruise easily?
Do you have:
Decreased sexual potency (erection quality). If so, is this causing stress in your relationship?
Decreased sex drive
Do you have morning erections? _____ If yes, how many times per week (estimate)?
Do you feel your testicles are smaller than they used to be?
Generalized muscle aches and pains
Previous heart attack
Previous clotting issues
Sensitive or swollen nipples?
Can you feel any lumps around your nipples?
Are you losing your hair?
Have you ever taken Propecia or Proscar (finasteride) for hair loss or prostate inflammation or Accutane for acne?
Have you had a traumatic head injury?
Have you taken pain killers (opiates) for several months?
Have you ever been diagnosed with sleep apnea via a sleep study? If yes, do you use a CPAP machine?
Do you take frequent naps?
Do you feel refreshed when you wake up in the morning?
Average hours of sleep per night:
Do you usually go to bed after 10 pm ?
DIET AND EXERCISE
Tell us about your diet (The more details, the better)
Do you exercise? If yes, what type and how frequently?
Do you feel that you procrastinate a lot and do not have enough mental focus to finish projects?
Are you experiencing a lot of stress lately? For how long and why?
MEDICATIONS AND SUPPLEMENTS
Do you take any prescription medications or medications bought on the internet or black market?
If so, please list, and give dosages:
What supplements do you take (vitamins, minerals, neutraceuticals, etc.)? List all (with amounts or dosages) each day.
QUESTIONS FOR STEROID USERS ONLY
How many times have you been on a steroid cycle (if any)?
How long ago was your first steroid cycle (if any)?
How long was your break before starting this cycle?
Were you losing it before you started using steroids (AAS only)? If so, is it falling out more quickly now?
Did you have swollen or painful nipples BEFORE you ever used steroids (for men who have used anabolics steroids- AAS)?
Have you needed to donate blood or get a therapeutic phlebotomy due to high hematocrit (red blood cell volume)?
Describe your past usage, if any, of hCG, Nolvadex, Clomid, Arimidex or finasteride:
Have you ever had any problems (side effects) with any of the medications mentioned in the last question If so, please describe:
Did you use a post-cycle therapy (PCT) program after stopping the cycle (s)? If yes, please describe:
Did you get your total and free testosterone tested after PCT?