Understanding Your Labs

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

Why test before TRT: Identifies the root cause of low testosterone.

● Primary hypogonadism: LH/FSH high, testes not responding → TRT is standard treatment.

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 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

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.

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

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