Hormone Replacement Therapy (HRT) For Men

Hormone Replacement Therapy (HRT) for men—most often testosterone therapy—is used to treat clinically confirmedtestosterone deficiency. Because symptoms (fatigue, low libido, depressed mood, reduced muscle) can overlap with other conditions, lab testing is essential both before starting therapy and for ongoing safety checks.

A proactive plan begins with two separate morning total testosterone measurements, plus free testosterone context (via SHBG/albumin or equilibrium dialysis), LH/FSH to classify primary vs. secondary hypogonadism, and prolactin when indicated. Safety baselines include CBC (hematocrit/hemoglobin), PSA with clinician review based on age/risk, A1c/glucose, lipids, and liver enzymes. After therapy starts, regular labs help optimize dosing, check erythrocytosis, and track cardiometabolic health. Labs guide screening, diagnosis, and monitoring but do not replace a clinician’s exam or individualized care—especially if symptoms are severe.

Signs, Symptoms & Related Situations

• Typical low-T symptoms: low libido/erections, fatigue, depressed mood or irritability, decreased muscle mass/strength, increased fat mass, reduced shaving frequency, hot flashes in severe deficiency.

• Exam or history clues: small or soft testes, delayed puberty history, prior testicular injury/surgery, pituitary disease, chronic opioid or glucocorticoid use, infertility.

• Safety-related: sleep apnea, high hematocrit, prostate disease history, uncontrolled heart failure (require clinician oversight).

• When to seek urgent care: chest pain, sudden shortness of breath, one-sided weakness, severe headache, or vision loss.

Symptoms and risks always require clinician evaluation.

Why These Tests Matter

What testing can do

• Confirm deficiency with repeat morning testosterone and classify cause with LH/FSH (testicular vs pituitary/hypothalamic).

• Set baselines and monitor safety: hematocrit/hemoglobin, PSA, liver enzymes, lipids, and glucose/A1c.

• Optimize therapy over time using consistent, route-appropriate timing of blood draws.

What testing cannot do

• Diagnose from a single value or without symptoms.

• Replace clinician judgment about therapy candidacy, fertility plans, or prostate evaluation.

• Provide dosing, timing, or medication changes—those decisions belong with your clinician.

What These Tests Measure (at a glance)

• Total Testosterone (morning, two separate days): first-line assessment; draw ~7–10 a.m. (less strict in older men). Avoid testing during acute illness.

• Free Testosterone (calculated or measured): adds context when SHBG is high/low (age, obesity, thyroid/liver disease, medications).

• SHBG & Albumin: needed to calculate free T; SHBG shifts can mask true androgen status.

• LH & FSH: high values suggest primary (testicular) hypogonadism; low/normal suggest secondary(pituitary/hypothalamic).

• Prolactin (when indicated): screens for hyperprolactinemia in low-T with low/normal LH/FSH or symptoms (galactorrhea, headaches/vision changes).

• Estradiol (sensitive LC/MS preferred): helps assess gynecomastia, symptoms from aromatization, and balance on therapy.

• CBC (Hemoglobin/Hematocrit): looks for erythrocytosis on therapy—elevations require clinician review.

• PSA (age/risk-based) & Digital Rectal Exam (clinical): prostate baseline/monitoring per clinician guidance.

• Comprehensive Metabolic Panel (AST/ALT, creatinine, electrolytes): medication safety and general health.

• A1c/Glucose & Lipid Panel (± ApoB): cardiometabolic risk that can change with therapy, weight, or training.

• Optional thyroid screen (TSH ± Free T4): hypothyroidism can mimic or worsen symptoms.

Quick Build Guide

How the Testing Process Works

1. Establish the diagnosis: obtain two morning total testosterone tests on different days; add SHBG (and free T) for context.

2. Determine the cause: check LH/FSH (± prolactin) to distinguish primary vs. secondary hypogonadism.

3. Set safety baselines: order CBC, PSA, CMP, A1c/glucose, lipids (± estradiol).

4. Begin therapy (clinician-directed): once started, schedule labs at consistent times relative to dose/route for apples-to-apples comparisons.

5. Monitor and adjust: repeat labs per your clinician’s plan to track hematocrit, prostate markers, liver enzymes, and cardiometabolic risk.

Interpreting Results (General Guidance)

• Low total T on two mornings plus symptoms supports deficiency; SHBG and free T refine interpretation.

• High LH/FSH → primary testicular issue; low/normal LH/FSH → secondary/pituitary pattern (may need imaging/other labs).

• Hematocrit rising on therapy warrants clinician review; severe elevation increases blood viscosity risk.

• PSA changes require age- and history-specific clinical interpretation.

• Estradiol may rise on therapy (aromatization); interpret symptoms and numbers together with a clinician.
  Always interpret labs with a qualified healthcare professional; trends and standardized timing matter.

Choosing Panels vs. Individual Tests

• Baseline (before HRT): Total T (×2) • SHBG/Albumin • Free T • LH/FSH • Prolactin (as indicated) • CBC • PSA • CMP • A1c/Glucose • Lipids • Estradiol (LC/MS).

• Early follow-up (route-consistent timing): Testosterone • CBC • PSA • Estradiol • CMP.

• Long-term monitoring: Testosterone (interval per clinician) • CBC • PSA • Lipids/A1c • CMP; add SHBG/Free T if body weight, thyroid status, or meds change.

FAQs

Why two morning testosterone tests?
Testosterone peaks in the morning and varies day-to-day. Two separate mornings improve accuracy.

What’s the difference between total and free testosterone?
Total T is all circulating hormone; free T is the small fraction not bound to proteins. SHBG shifts can make free T more informative.

Will HRT affect fertility?
Testosterone therapy can suppress sperm production. Discuss family planning with your clinician before starting.

How often should I test on therapy?
Clinicians often check labs several weeks after starting or changing therapy, then periodically once stable.

Do I need estradiol testing?
It can help when symptoms suggest imbalance (breast tenderness, fluid retention) or during dose adjustments.

Can supplements or meds affect results?
Yes. Biotin may interfere with some immunoassays; list all meds (including inhaled/topical steroids, opioids, thyroid meds, and oral estrogen).

Related Categories & Key Tests

• Hormone Tests Hub

• Men’s Hormone Tests • Testosterone Tests • Erectile Dysfunction Evaluation • Thyroid Testing • Cardiometabolic Health

• Key Tests: Total Testosterone (morning ×2) • Free Testosterone • SHBG • LH/FSH • Prolactin • Estradiol (sensitive LC/MS) • CBC (Hemoglobin/Hematocrit) • PSA • Comprehensive Metabolic Panel • Lipid Panel • A1c/Glucose • TSH

References

• Endocrine Society Clinical Practice Guideline on Testosterone Therapy in Men with Hypogonadism.
• American Urological Association Guideline: Evaluation and Management of Testosterone Deficiency.
• International Society for Sexual Medicine — Recommendations on investigation of low testosterone and monitoring.
• FDA safety communications and labeling for testosterone products.
• Reviews on SHBG/free testosterone assessment and assay method considerations (LC/MS vs immunoassay).
• Cardiometabolic monitoring guidance in men receiving testosterone therapy.

Available Tests & Panels

Your HRT for Men menu is pre-populated in the Ulta Lab Tests system. Start with diagnostic confirmation (two morning total T with SHBG/free T), classify with LH/FSH (± prolactin), and set safety baselines (CBC, PSA, CMP, A1c/glucose, lipids, estradiol). After therapy begins, repeat labs on a consistent schedule and timing relative to dosing. Review all results with your clinician to personalize care.