Understanding Your Labs
🩸 Hemoglobin & Hematocrit
Effect of TRT: Testosterone signals your kidneys to release erythropoietin (EPO), which stimulates bone marrow to produce more red blood cells. This can improve mild anemia and boost energy.
Safety Concern: If Hb/Hct rise too high, blood becomes “thicker.”
Monitoring Steps:
- Baseline testing before therapy
- Check‑ins at 8 weeks, then every 6 months
- Management if levels rise too high
- Therapeutic phlebotomy (similar to donating blood) lowers Hb/Hct safely


🧬 LH & FSH
Why test before TRT: Identifies the root cause of low testosterone.
- Primary hypogonadism: LH/FSH high, testes not responding → TRT is standard treatment.
🧪 PSA (Prostate‑Specific Antigen)
Purpose: Protein from prostate cells, key for prostate health monitoring.
Before TRT: Establish a baseline PSA to detect pre‑existing conditions like
BPH.
During TRT: PSA may rise slightly. Concern is a rapid or significant increase.
Monitoring:
- Test every 6 months
- Refer to urology if PSA rises substantially


💪 Total vs Free Testosterone
Total Testosterone (TT): Measures all testosterone (bound + free).
Free Testosterone (FT): The active hormone available to cells.
Why check both:
- Normal TT but low FT can still cause symptoms
- Borderline TT clarified by FT
- Monitoring both ensures safe, effective TRT
⚖️ Estradiol Balance
Why it rises on TRT: More testosterone → more conversion to estradiol via aromatase.
Role in men:
- Maintains bone density & cardiovascular health
- Regulates libido & mood
Monitoring: Regular blood tests keep estradiol in the optimal range.


🔄 Thyroid Function (TSH, T3, T4)
TSH: Pituitary signal to thyroid T4: Inactive thyroid hormone T3: Active hormone regulating metabolism & energy
Why test with TRT:
- Symptoms overlap with low T
- Thyroid dysfunction impacts testosterone production & SHBG levels
- Full thyroid panel ensures accurate diagnosis before or alongside TRT
🛡️ Thyroid Peroxidase (TPO) Antibodies
Purpose: Diagnose Hashimoto’s thyroiditis (autoimmune hypothyroidism).
Why important:
- Identifies root cause of thyroid issues
- Confirms autoimmune condition
- Predicts future risk of hypothyroidism
- Guides treatment plan

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