Labs Before Starting Hormone Therapy: What Is Checked and Why

Estradiol, FSH and, where relevant, LH — read alongside age and symptoms, not instead of them. A single hormone panel in perimenopause is famously misleading because the numbers swing week to week; the menopause page explains why we weight the symptom history so heavily and time the draw to the cycle when there still is one.

Progesterone, in a cycling woman, timed to the second half of the cycle, to see whether ovulation is still happening — which decides whether progesterone alone is the first step.

Testosterone and SHBG, because women make testosterone too, its loss contributes to the picture, and the SHBG result changes how every hormone number is read.

Prolactin, if periods have stopped early or unexpectedly, or with any symptom that points to the pituitary.

What we do not order routinely: saliva hormone tests, which do not reliably reflect what matters, and a DUTCH test as a first step — it is a second-line tool with specific uses.

And what is not a lab: current breast screening and, for a woman with a uterus, a clear bleeding history. Both are prerequisites for estrogen, and both are asked about before a prescription.

Total and free testosterone, on a morning draw, repeated if low. The Endocrine Society's rule, and ours: one low value is not a diagnosis. The low testosterone page covers the measurement.

LH and FSH, because they decide whether the problem is in the testes or the signal — the distinction on the primary vs secondary page that decides whether enclomiphene can work.

SHBG, for the same reason as in women: a normal total with a high SHBG is a low free testosterone with a misleading label.

Estradiol, as a baseline, because testosterone converts to it and the ratio is monitored on treatment.

Prolactin, because a raised prolactin suppresses testosterone and points to a cause that needs its own workup.

PSA and hematocrit, before any testosterone therapy, without exception. Testosterone can accelerate an existing prostate cancer and raises red-cell mass; both are monitored throughout treatment against the baseline drawn here. A raised PSA at baseline is a urology referral before a prescription.

The panel is read against your history and your symptoms, not against reference ranges alone — see optimal versus normal. Where a result explains the symptoms without a hormone — thyroid, iron, sleep apnea flagged by the history, a medication — that is treated first, and sometimes the hormone conversation ends there. Where the picture supports hormone therapy, the baseline becomes the reference every future draw is compared to, on the schedule the HRT and TRT pages describe.