TRT Monitoring Panel: Blood Work for Men on Testosterone Therapy

Free testosterone (equilibrium dialysis) and total testosterone (mass spectrometry); estradiol by an ultrasensitive LC/MS method designed for the low levels found in men; a complete blood count with differential, including hemoglobin and hematocrit; total PSA; a comprehensive metabolic panel (glucose, kidney function with eGFR, electrolytes, calcium, protein, albumin, bilirubin and the liver enzymes ALT, AST and alkaline phosphatase); and a standard lipid panel (total cholesterol, LDL, HDL, non-HDL cholesterol and triglycerides).

Adult men who are already on testosterone therapy prescribed by a clinician and need their routine monitoring labs, for example at the 3-to-6-month check after starting or changing treatment, or at the yearly check. It is also useful for men who want a complete set of results to bring to a new prescriber. If you have not started testosterone and want to know whether your level is low, the TRT Baseline Panel is the better fit. Available to adults 18 and over only.

Further reading: High Estradiol in Men: Causes, Symptoms & Testing Guide; PSA Test: When to Start, How Often, and What's Elevated.

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The Endocrine Society guideline recommends checking testosterone 3 to 6 months after starting therapy, hematocrit at baseline, at 3 to 6 months and then yearly, and PSA 3 to 12 months after starting for men who choose prostate monitoring; after the first year, prostate monitoring follows the usual screening guidance for your age and risk. When to draw relative to your dose depends on the form of testosterone, and the guideline gives formulation-specific timing (for example, midway between injections for testosterone cypionate or enanthate, and 2 to 8 hours after applying a gel). Ask the clinician who prescribes your treatment which timing they want, and book a morning appointment after an 8- to 12-hour fast.

Each result is read against Quest's reference range and against your own earlier results. Testosterone well above or below the range your clinician is aiming for, a hematocrit that has climbed (the guideline treats above 54% as a reason to reassess therapy), or a PSA that has risen more than 1.4 ng/mL in the first year of treatment or is confirmed above 4.0 ng/mL are the findings most likely to prompt a change of plan or a referral. A high or low estradiol is interpreted together with testosterone and any symptoms. Raised liver enzymes, reduced kidney function, high glucose or unfavorable cholesterol are general health findings that your clinician weighs alongside your treatment. Do not change your dose or stop treatment based on these results yourself. JustLabs results are informational: review them with the clinician who manages your testosterone therapy.