Essential Blood Tests for HRT

Regular blood tests are a vital part of hormone therapy. They help your healthcare provider ensure your treatment is safe and effective. This guide explains the key markers to monitor and why they matter.

Disclaimer: This information is for educational purposes only and does not constitute medical advice. Always consult with your healthcare provider before making any changes to your medication.

Hormone Levels

• Oestradiol — The primary marker for feminising HRT. Helps confirm oestrogen levels are within the target range.
• Testosterone — Monitored on both feminising and masculinising HRT. On feminising regimens, the goal is usually suppression; on masculinising regimens, the goal is to reach the male reference range.
• LH and FSH — Pituitary hormones that indicate how effectively your HRT is suppressing or supplementing natural hormone production.
• Prolactin — Especially important if you are taking cyproterone acetate, which can raise prolactin levels.
• SHBG (Sex Hormone-Binding Globulin) — Affects how much free hormone is available in your body.

Liver Function

• ALT, AST, and GGT — Liver enzymes that can be affected by oral medications, including oral oestradiol and cyproterone acetate. Elevated levels may prompt your provider to adjust your treatment.

Kidney Function

• Creatinine and eGFR — Particularly important if you are taking spironolactone, which can affect kidney function and potassium levels.

Full Blood Count

• Haemoglobin and Haematocrit — Especially critical on testosterone, which stimulates red blood cell production. Elevated levels may require dose adjustments.
• White blood cells, platelets, and other markers provide a broad picture of your blood health.

Lipids

• Cholesterol (Total, HDL, LDL) and Triglycerides — Hormone therapy can affect your lipid profile. Regular monitoring helps manage cardiovascular risk.

Thyroid Function

• TSH, Free T4, and Free T3 — Thyroid function can be affected by hormonal changes. Baseline and periodic checks are recommended.

Vitamins and Minerals

• Vitamin D — Important for bone health, especially on GnRH analogues.
• Vitamin B12 and Folate — General health markers.
• Ferritin — Iron stores, relevant for those whose periods have stopped or started.

Diabetes Screening

• HbA1c — A measure of long-term blood sugar control. Some hormones can affect insulin sensitivity.

How Often?

Testing frequency varies, but a general guide:

• First year of HRT — Every 3 months.
• After the first year — Every 6–12 months, depending on your provider's guidance.
• When changing dose — Typically 6–12 weeks after a dose change.

Your healthcare provider will tailor the schedule to your specific needs.