What Blood Tests Do You Need Before Starting Hormone Replacement Therapy?

What this means

Hormone replacement therapy (HRT) is a prescription therapy, not a supplement. Before a prescription is written, a clinician needs to know whether a hormone level is actually low, whether something else could explain your symptoms, and whether you have a condition that makes hormone therapy a poor fit. Blood tests answer part of that. They do not replace a history and a physical exam.

Candidacy

Testosterone products are FDA-approved for men with low testosterone together with an associated medical condition. The FDA kept its limitation of use for age-related decline alone in its February 2025 class-wide labeling changes (U.S. Food and Drug Administration, 2025). Menopausal hormone therapy is approved for specific symptoms, and in February 2026 the FDA approved removal of boxed warnings about cardiovascular disease, breast cancer and probable dementia from six menopausal hormone products, while endometrial cancer risk with estrogen-alone therapy remains labeled (U.S. Food and Drug Administration, 2026). Neither change makes HRT suitable for everyone.

Clinical evaluation

Dr. Chantasi starts with your symptoms, medications, personal and family history and a physical exam. Labs are then matched to what that review suggests. Common tests include:

• Total testosterone, drawn on two separate mornings. Levels vary through the day and between days, so one reading is not enough. The Endocrine Society recommends confirming a deficiency with repeat morning measurements, and the American Urological Association uses a total testosterone below 300 ng/dL as a reasonable threshold (Bhasin et al., 2018; Mulhall et al., 2018).
• Additional hormones when the pattern calls for them, such as LH and FSH, which help show whether the problem starts in the testes or in the brain's signaling, and sometimes free testosterone or SHBG when total testosterone is borderline (Bhasin et al., 2018).
• Hematocrit or a complete blood count. Testosterone can raise red blood cell concentration, so a baseline matters (Bhasin et al., 2018).
• PSA and prostate history, discussed with men of screening age, because testosterone therapy is not appropriate in men with prostate cancer (Bhasin et al., 2018).
• Other labs chosen individually, such as thyroid function, blood sugar, cholesterol, kidney and liver tests, when symptoms or history point to another cause.

Blood pressure is also checked, since the FDA now requires class-wide labeling about increased blood pressure with testosterone products (U.S. Food and Drug Administration, 2025).

Available options

Depending on the results, options include FDA-approved testosterone products (injections, gels, patches, oral and buccal forms, and an implantable pellet), menopausal estrogen with or without a progestogen, or no hormone therapy at all. Mainstream alternatives are worth considering first for many people: treating sleep apnea, weight, thyroid problems or medication side effects when those explain symptoms, and non-hormonal medicines or vaginal products for menopause symptoms. Your primary care physician, endocrinologist, urologist or gynecologist may be the right place to start, and you can bring their results to PrimeCell.

Benefits, limitations and risks

Testing reduces the chance of starting therapy for the wrong reason, but it does not guarantee a benefit. A normal result may mean hormones are not the cause of your symptoms. A low result does not by itself mean you should start therapy. Testosterone therapy can raise hematocrit and blood pressure, and the large TRAVERSE trial found a higher rate of atrial fibrillation, acute kidney injury and pulmonary embolism in the testosterone group, alongside no increase in major cardiovascular events compared with placebo in men with hypogonadism (Lincoff et al., 2023). Estrogen-alone therapy still carries an endometrial cancer warning (U.S. Food and Drug Administration, 2026).

What the evidence shows

What it establishes: a single testosterone reading is unreliable, repeat morning testing is the recommended standard, and baseline hematocrit and prostate assessment are part of safe testosterone prescribing (Bhasin et al., 2018). TRAVERSE showed cardiovascular non-inferiority for testosterone in a specific group of men with confirmed hypogonadism (Lincoff et al., 2023).

What it does not establish: that testosterone benefits men whose levels are normal, that it suits older men with age-related decline alone, or that one blood panel can predict who will feel better. Menopause guidance emphasizes individual assessment rather than a fixed lab protocol (The 2022 Hormone Therapy Position Statement of The North American Menopause Society Advisory Panel, 2022).

Recovery and next steps

There is no recovery from a blood draw. If you start therapy, guidelines call for rechecking levels within roughly the first several months, then at least yearly, with blood counts, blood pressure and PSA where appropriate (Bhasin et al., 2018). Bring recent lab results, a medication list and any prior records to your first visit.

Orlando considerations

Telemedicine consultations are possible for some patients, but lab draws and monitoring still happen in person. PrimeCell, in Orlando, can review outside labs, and a written estimate is given before any therapy begins.