Starting testosterone replacement therapy (TRT) or hormone replacement therapy (HRT) without baseline biomarker testing is clinically irresponsible — and a red flag for any provider that does it. Baseline labs serve multiple essential functions: confirming clinical need, establishing reference values for monitoring, and screening for contraindications that could make hormone therapy unsafe.
Why Baseline Testing Matters
Confirming Clinical Need
Symptoms like fatigue, low libido, and mood changes are non-specific — they have dozens of potential causes. A testosterone reading below 300 ng/dL (confirmed on two separate morning draws) is required to diagnose hypogonadism clinically. Without lab confirmation, you cannot distinguish low testosterone from thyroid dysfunction, depression, sleep apnea, or other conditions that cause identical symptoms.
Screening for Contraindications
Several conditions make TRT or HRT inadvisable or require monitoring adjustments:
- Active or suspected prostate cancer (TRT contraindication)
- Elevated PSA requiring urological evaluation before starting
- Elevated hematocrit (>50%) — TRT further elevates red blood cell counts
- Untreated severe obstructive sleep apnea — worsened by TRT
- Uncontrolled heart failure
Establishing Monitoring Baselines
On hormone therapy, your values will change. Without pre-treatment baselines, you cannot meaningfully evaluate whether those changes are within safe parameters or require dose adjustments. Hematocrit, PSA, estradiol, and testosterone levels all require baseline values to interpret correctly during monitoring.
Required Testing for TRT (Men)
Hormone Panel
- Total testosterone (two morning draws — 7–10 AM)
- Free testosterone
- SHBG (Sex Hormone-Binding Globulin)
- Estradiol (E2)
- LH and FSH (distinguishes primary from secondary hypogonadism)
- Prolactin
Safety Panel
- Complete Blood Count (CBC) with hematocrit
- Comprehensive Metabolic Panel (CMP) — liver and kidney function
- Lipid panel
- PSA (required for men 40+; strongly recommended for all)
- TSH (thyroid screening)
Required Testing for HRT (Women)
Hormone Panel
- Estradiol (E2) — the primary marker for HRT candidacy
- FSH — elevated FSH (particularly >40 mIU/mL) indicates menopause transition
- Progesterone
- Total and free testosterone (for libido and energy considerations)
- DHEA-S
- TSH (thyroid dysfunction is common in perimenopause)
Safety Panel
- CBC
- CMP (liver function)
- Lipid panel (estrogen affects cardiovascular risk profile)
- Fasting glucose or HbA1c
What Happens With Your Results
A qualified hormone therapy clinician will review your results in the context of your symptoms and health history to determine:
- Whether your levels are clinically low enough to warrant treatment
- Whether any contraindications need to be addressed before starting
- What starting protocol (dose, delivery method, frequency) is appropriate
- What monitoring schedule will keep your therapy safe
Red Flags: Providers Who Skip Testing
Avoid any provider who:
- Prescribes TRT or HRT based on a symptom questionnaire alone
- Does not require at minimum total testosterone and a basic safety panel
- Does not establish ongoing monitoring protocols after prescribing
- Does not check PSA before prescribing testosterone to men over 40
These practices are below the standard of care and put your health at risk. Rigorous testing requirements are a quality signal, not a bureaucratic hurdle.
Frequently Asked Questions
How quickly can I get results and start treatment?
With a home kit, typical timeline is: order kit (day 1), collect and mail sample (day 2–3), lab processing (day 3–5), clinician review and consultation (day 6–8). Most programs complete initial intake and first prescription within 1–2 weeks of ordering.
What if my testosterone is in the "normal" range but I still have symptoms?
Normal range (300–1,000 ng/dL) is broad. A 45-year-old with 310 ng/dL may be technically normal but functionally deficient relative to where they were at 30. Free testosterone, SHBG, and symptom severity all factor into clinical decision-making. This is why a clinician consultation — not just raw numbers — matters.
Get the Baseline Testing You Need Before Starting Hormone Therapy
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