One of the very common questions that I get on the Peak Testosterone Forum is "what tests should I get after I am on HRT?" The answer really has to be split up into two parts in my opinion, based on whether you are talking about short term maintenance lab work or medium term. As to why the latter is necessary - I will explain below:
The following labs are usually run every three months and sometimes every six once the patient has stabilized:
1. PSA. This test is controversial and some feel it is so inaccurate that it only makes things worse. Personally, I think it still provides good information. It is true that usually a rising PSA signifies inflammation rather than cancer, but this is still good information and gives the patient something to work on. Regardless, virtually all doctors will pull this number and watch for two metrics:
a) PSA < 2.5 (or some other threshold) [NOTE: The PSA should really be below 1.0 ideally for anti-aging purposes or perhaps 1.5 for some men on HRT.]
b) PSA < 1.0 within any rolling year. In other words, your doctor will also likely watch that PSA does not rise more than one point in any one year time period.
If the above values are exceeded, you may be forced off of HRT until you get urologicial clearance. I know, because it happened to me. See my story High PSA But No Cancer if you are interested.
3. Hematocrit, Hemoglobin and/or RBC Counts. Doctors will pull various combinations that basically check to make sure that the extra testosterone is not causing you to overproduce red blood cells. (See my page on Testosterone and Anemia for details.) This is extemely important, because if these go too high, your blood essentially starts to "sludge" and you are at increased risk of stroke and heart attack. You will also likely feel lousy and can experience light-headedness, dizziness and shortness of breath. We have had a couple of guys experience very serious issues from this, the most extreme discussed in this case here of Testosterone Abuse.
3. Estradiol. It is always good in my opinion to monitor estradiol levels, especially if your testosterone levels have been boosted significantly from your TRT protocol. This is probably the biggest thing that sabotages TRT results and makes guys feel lousy even though they have significantly boosted their low testosterone. The problem, generally, is that we gain weight as we age and end up significantly overweight. That extra fat tissue is high in aromatase and converts a significant percentage of your new testosterone into estradiol. And, as estradiol goes up, mood, erectile strength and libido go down; water retention and bloating can increase, etc. And, in the long term, high levels of estradiol can increase arterial plaque and prostate issues potentially. See my pages on Estradiol Issues for more information.
I should add that the majority of physicians know little to nothing about estradiol in men. They will not monitor it and do not think it causes any issues. Of course, I could not disagree with this more strongly as I believe both high (and low) levels can cause both short and long term issues. This should change over the next five to ten years as some study work is now being done on men.
4. HDL. Reasonable doses of testosterone are not supposed to significantly lower HDL, but they probably do in some men. Nor are they supposed to negatively alter LDL either. But we're all individual and some studies show negative lipid results, so it's a good idea to monitor this and make sure you are moving in the right direction. See my page on Testosterone and HDL for additional information.
5. Blood Pressure. It's always a good idea to monitor blood pressure before and after T therapy. An elevation of blood presure is probably the most common serious side effect that I see and can increase long term risk of erectile dysfunction, stroke and heart disease if left untreated. In addition, some men with existing high blood pressure could be at risk for hospitalization or worse by ignoring this.
6. Liver and Kidney Function. These should be periodically monitored. HRT seems to rarely cause issues with these, but it is possible, especially if there are undelrying issues.
MEDIUM and LONG TERM:
Several of the online physicians that have done HRT for years have observed a partial shutdown effect. Basically, HRT bypasses the pituitary in some ways and this can lead to some atrophy according to this school of thought. Because of this, the following hormones can partially be shut down:
1. Thyroid Hormones. (See Thyroid Tests.)
2. DHEA. (See my DHEA Pages.)
3. Cortisol. (See my Cortisol and Stress Pages .)
4. Progesterone. (See my Progesterone Pages)
NOTE: Of course, fertility is almost always shut down considerably on HRT. Some doctors are now adding HCG to their regimens to maintain fertility levels.