At QueerDoc we aim to personalize your experience to meet your needs, goals, values, and health status. That means we don’t have a cookie cutter set of labs that everyone starts with or everyone gets at follow-up. There are labs that most people can consider when they are considering gender affirming care, so we will review those today.
Most hormonal labs are best collected from a morning blood sample. You don’t usually need to be fasting, but it is best to go first thing in the morning for lab work.
For adult folx interested in testosterone
Labs before starting testosterone might include some baseline tests:
- Serum estradiol
- If you have irregular cycles:
- Serum total testosterone
- Serum 17-hydroxyprogesterone
- If you smoke tobacco/nicotine products, e-cigs, vapes or have asthma or sleep apnea (or other conditions that might affect oxygen needs or red blood cell production):
- Hemoglobin and/or hematocrit
- If you have conditions that affect your liver, medications that affect the liver, or drink more than 7 alcoholic beverages per week:
- AST (aspartate aminotransferase)
- ALT (Alanine transaminase)
- If you have diabetes or are at higher risk of diabetes, consider blood sugar or hemoglobin A1c tests.
- If you have cholesterol issues or are at higher risk of cholesterol issues, consider a lipid panel.
- If you have a thyroid condition, consider thyroid testing with a TSH/T4.
Many of our patients at QueerDoc who don’t have other health conditions, have had monthly and predictable cycles, and are under 45, often chose to waive any baseline lab testing as the likelihood of concerning results is very, very low. They understand that we may miss a baseline hormonal variation related to a difference in sex development (sometimes refered to as intersex conditions) which could affect future fertility and cancer risks. They also understand that unexpected results at their 3 month follow-up visit may necessitate stopping testosterone for a period of time to determine baseline values in light of the unexpected results.
Follow-up labs on testosterone:
- Serum estradiol (until menstrual cessation achieved)
- Serum total testosterone
- Hemoglobin and/or hematocrit
- AST/ALT, if other risk factors for liver stress
- Monitoring of conditions possibly affected by testosterone with blood sugars, lipids, or thyroid studies might be recommended as well.
For adult folx interested in estrogen based therapies, progesterone, plus or minus anti-androgens:
Labs before starting estradiol might include:
- Serum total testosterone levels
- If you have diabetes or are at higher risk of diabetes, consider blood sugar or hemoglobin A1c tests.
- If you have cholesterol issues or are at higher risk of cholesterol issues, consider a lipid panel.
- If you have a thyroid condition, consider thyroid testing with a TSH/T4.
Labs before starting anti-androgens:
- If you are considering bicalutamide, these are *REQUIRED*:
- AST (aspartate aminotransferase)
- ALT (Alanine transaminase)
- If you are considering spironolactone AND are over 45, have high blood pressure, diabetes, or kidney issues:
- Serum creatinine
- Serum potassium
Many of our patients at QueerDoc who don’t have other health conditions, have had an expected pubertal experience, and are under 45, often chose to waive any baseline lab testing as the likelihood of concerning results is very, very low. They understand that we may miss a baseline hormonal variation related to a difference in sex development (sometimes refered to as intersex conditions) which could affect future fertility and cancer risks. They also understand that unexpected results at their 3 month follow-up visit may necessitate stopping gender care prescriptions for a period of time to determine baseline values in light of the unexpected results.
Follow-up labs on estradiol:
- Serum estradiol (unless you are taking tablets)
- Serum total testosterone
- Monitoring of conditions possibly affected by testosterone with blood sugars, lipids, or thyroid studies might be recommended as well.
Follow-up labs on anti-androgens include AST and ALT for those on bicalutamide. Potassium and creatinine are monitored in folx who needed baseline labs or anyone over 100mg daily dose of spironolactone.
“I usually tell patients that we make dosing decisions together based on their experience of their treatment plan. Labs are less important for dosing adjustments and there more for me to help keep them safely away from extremes of too much or too little.”
Dr. Crystal Beal, Founder QueerDoc
If you dive into Reddit, Transfeminine Science, or The Powers’ Method, you will find thoughts and opinions about looking at estrone and estradiol, monitoring total and free testosterone plus DHT, and other hormonal and binding globulin assays. At QueerDoc, we are happy to work with folx who are interested in these data points as long as they understand and consent to the details:
- These tests have no guideline recommendations on levels.
- There is no expert consensus on how to interpret these levels or what ranges to strive for.
- There is no one size fits all approach, or BEST approach, to gender care.
- Target lab ranges are actually less important than your personal experience of your treatment plan in making dosing decisions.
- You may incur a large bill as these tests are more expensive and as they are not part of the national standard of care, your insurance may decline to cover them.
Our biggest goals at QueerDoc include transparency and truly informed consent. We want to help you achieve want you want for your embodiement goals for your body, mind, emotional, and sexual health. Our clinician’s have longer appointment times in order to have enough time to really clarify your goals and help you understand the potential risks and benefits of all the possible options. Take this quiz now to help understand your own goals and possible treatment options:
