Testing:
I think that some lab work is a waste or ill-timed. If you cannot take action to change something you measure, then why bother.
hGH, IGF-1: If you cannot afford or will not qualify, don’t bother checking.
LH, FST: If young and hypo, get these checked. If very low, then proceed to eval cancer or lesions to the pituitary. If age related hypo, don’t bother. After TRT is in place, testing LH & FST is insane.
SHBG: You cannot change this directly. If E2 is elevated, SHBG will be too. If you lower E2, SHBG is expected to follow. Otherwise there is nothing that you can do about this. If severe estrogen or estrogen metabolic pathway problems are found later, SHBG might be of limited diagnostic use.
DHT: Testing before TRT creates data and nothing else. After TRT is in place, testing will show that DHT has increased. That has no value at all. Skip the pre-TRT DHT test. Test only after DHT and this, when done at all, is of use to confirm that one is not a DHT over responder. Concern for DHT levels would be when PSA also tracks significantly higher. Note that PSA baseline shift higher most of the time in response to TRT. The prostate makes a one time size increase in response to T&DHT that is independent of any HPT and cell proliferation/inflammation concerns. Testing for this is also part of a concern for prostate problems and getting sued. As part of this, you should have a DRE before and after starting TRT and once a year after that.
PSA: All men should be getting PSA tests done. If PSA is ok and a DRE or sonogram is clear, there is no reason not to do TRT.
Thyroid levels: If one’s metabolism is in decent shape, this should not be tested before TRT. TRT will typically improve or shift thyroid levels. Knowing how much this change was before and after starting TRT is of no value to you. If one does have thyroid issues, it is better to eval thyroid levels after one gets TRT in place as one’s new metabolic baseline. If TRT is in place and R2 numbers are in the lower 20s [using anastrozole], then low energy and/or not loosing fat as expected, they hypothyroidism can be suspected and tests performed. Test for THS, FT3, FT4. Never treat with T3 or T4 alone.
Adrenal: As above. In some cases there will be thyroid and adrenal problems. If that is the case and one corrects low thyroid levels, this increase in metabolism will hit a wall if the adrenals are weak. I do not understand what one feels when that happens, but I get the impression that it is a very serious situation.
Homocysteine and CRP: These should be tested as part of a general health program. TRT improves endothelial functioning and lowers blood pressure. So some post TRT changes could be expected. If these labs are at a level of concern, one should be taking measures immediately as a parallel effort to TRT. Corrective agents will be things like EFAs (fish oils), niacin, folic acid, anti oxidants and other effective supplements.
Pre TRT: TT, FT, E2, PSA are essential.
E2 - estradiol: This can be the basic serum E2 test from labcorp. Many state that for Quest, one needs the high sensitivity test. Do not get total estrogens. Total estrogens can be checked post TRT if there are suspicions of abnormal estrogen metabolic pathways and elevated levels of estrogen metabolites.
Post TRT: Add DHT, many not be any need to repeat routinely.
CBC: One’s complete blood count probably will always include hematocrit. TRT for some will push this above 50%. That can be concern that may require routine blood donation or such.
DHEA’s and pregnenolone: can be checked as part of an age management and general wellness effort. If one starts TRT without hCG, HPTA shutdown will also stop pregnenolone production in the testes, which has its own consequences for mental well-being and also leads to lower DHEA. TRT will shift these numbers. If these are low before TRT, one supplementation can start right away. In my case, starting with T alone dropped these numbers significantly. Adding hCG can improve these numbers, but will not increase these to optimal levels. If pregnenolone is effectively increased, DHEA sometimes follows on its own. Changes to pregnenolone production in response to hCG depends on the ability of the testes to respond to LH and their state of aging etc.
If one pays for all of their labs out of pocket, then it makes sense to control what is tested and when. Savings in lab costs might cover ones costs for test ester and hCG. Lab work is the largest single component of TRT in many cases, unless one is using transdermal testosterone.
