The labs for hormone therapy depend on who is being treated. For men considering testosterone therapy, guidelines require specific blood tests before treatment. For women with menopause symptoms, the picture is different: an FSH test usually is not needed after age 45, and the FDA recommends against using hormone levels to guide dosing. This guide explains which tests are used, what each one shows, and where testing has limits.
Labs for hormone therapy in men
The American Urological Association (AUA) guideline on testosterone deficiency sets out the testing clearly.
To make the diagnosis
- Total testosterone, twice. Two measurements on separate occasions, both taken early in the morning. The AUA uses a level below 300 ng/dL as a reasonable cut-off, and the diagnosis also requires symptoms or signs.
- Luteinizing hormone (LH). Measured in men with low testosterone, to show whether the cause lies in the testicles or in the pituitary gland.
- Prolactin. Measured when testosterone is low and LH is low or low-normal.
Before starting treatment
- Hemoglobin and hematocrit. Testosterone therapy increases the risk of a high red blood cell count, so a baseline is needed.
- PSA. Measured in men over 40 before starting, to exclude prostate cancer.
- Estradiol. Measured in men who have breast symptoms or enlarged breast tissue.
- A fertility evaluation, for men who want children, because testosterone therapy affects sperm production.
Other tests are sometimes added. MedlinePlus explains that an SHBG test helps show how much testosterone is free for the body to use, which can matter when the total level and the symptoms do not match. See our guide to the symptoms of low testosterone.
Labs for hormone therapy in women
For menopause, the decision to treat rests mainly on symptoms, age and medical history.
MedlinePlus says that for women aged 45 or older, FSH testing “usually isn’t needed,” because high FSH is a normal sign of perimenopause and menopause. It lists the situations where testing is useful:
- premature menopause, at age 40 or younger;
- early menopause, before age 45;
- symptoms that may be related to menopause when the cause is not clear;
- irregular or stopped periods in women of childbearing age.
Estrogen results are hard to interpret on their own. MedlinePlus notes that estrogen levels in women change so often that testing may need to be repeated to see a trend. Cleveland Clinic adds that blood tests may not be accurate in someone who still has periods.
Testing to set the dose
Some clinics test hormone levels repeatedly to “customize” a dose. Cleveland Clinic reports that the FDA recommends against using hormone levels to guide the dosing of hormone therapy in women, because normal levels fluctuate from day to day. The Endocrine Society says claims that saliva tests can do this “are not supported by scientific data.”
The Menopause Society describes finding the right dose as a period of trial and error, with adjustments over time. See our guides What is HRT? and bioidentical hormone therapy.
What each test shows
| Test | What it shows |
|---|---|
| Total testosterone | The amount of testosterone in the blood, bound and free |
| SHBG | How much testosterone is free for the body to use |
| FSH and LH | Pituitary hormones that control the ovaries and testicles; help find the cause of abnormal sex hormone levels |
| Estradiol (estrogen) | Estrogen level; varies widely in women through the cycle and with age |
| Progesterone | Whether ovulation is occurring; varies through the cycle |
| TSH | How well the thyroid is working |
| DHEA sulfate | How well the adrenal glands are working |
| PSA | A screening test for prostate cancer |
| Complete blood count | Blood cell counts, including hemoglobin and hematocrit |
| Comprehensive metabolic panel | Liver and kidney health, blood glucose and electrolytes |
The descriptions are from MedlinePlus, the U.S. National Library of Medicine’s patient resource. Not everyone needs every test. Your clinician chooses based on your symptoms and medical history.
Getting useful results
- Timing. Testosterone is highest in the morning, so samples are taken between about 7 and 10 a.m.
- Cycle day. For women who still have periods, the day of the cycle changes estrogen and progesterone results.
- Illness and medicines. Recent illness and some medications can change results. Tell your provider what you take.
- Repeat tests. One abnormal result is rarely enough. The AUA requires two low testosterone results before a diagnosis.
Monitoring during treatment
Testing does not end once treatment starts. The Endocrine Society says men on testosterone need regular visits and blood tests, and the AUA guideline calls for on-treatment monitoring of testosterone levels and symptoms. For women, ACOG recommends reviewing the decision to continue hormone therapy every year.
Frequently asked questions
Do I need blood tests before starting HRT for menopause?
MedlinePlus says FSH testing usually is not needed at 45 or older. It is more useful if you are younger or the cause of your symptoms is unclear. Your clinician decides which tests are worthwhile for you.
Are saliva hormone tests reliable?
The Endocrine Society says the claims made for saliva testing to customize hormone doses are not supported by scientific data.
How often are labs repeated?
It depends on the treatment. Ask your provider what will be checked and when.
Next step
You can read about hormone therapy at Beauté Medical Aesthetics, or book a consultation to discuss which tests apply to you.
Sources
- American Urological Association. Testosterone Deficiency Guideline. Statements 1–3, 6, 7 and 9–12.
- MedlinePlus, U.S. National Library of Medicine. Follicle-Stimulating Hormone (FSH) Levels Test, SHBG Blood Test, Estrogen Levels Test and related test pages.
- Cleveland Clinic. Bioidentical Hormones.
- Endocrine Society. Compounded Bioidentical Hormone Therapy. Position statement, 2019.
- Endocrine Society. Hypogonadism in Men.
- The Menopause Society. Menopause Topics: Hormone Therapy.
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