MTF HRT Blood Tests

This is a list of recommended and/or diagnostically useful blood tests for monitoring male-to-female hormone replacement therapy.

Test list

The various tests on this list should preferably be run before starting HRT to get baseline levels, and then repeated after each medication regimen change that is likely to affect the result.

Hormones and related proteins

Minimum recommended non-optional monitoring list for MTF HRT:

If you care about E1:E2 ratio:

If you are taking oral/rectal progesterone:

Note that progesterone level tested using only immunoassay is not useful for MTF diagnostics as it picks up progesterone metabolites and will heavily over-report progesterone level. This is especially relevant if taking oral progesterone; the value given from immunoassay only will be useless. Progesterone level must therefore be tested using "liquid chromatography - mass spectrometry" (LC-MS) method or by including chromatic separation with the immunoassay in order to provide accurate readings. You should check with the blood test service or the lab in order to find out how they measure the level.

From the above data, the following can be calculated (so having the lab test or calculate these isn't essential):

Adrenal hormones

Adrenal function can play a huge part in transitional success. DHEA level is especially important as it can convert to testosterone in various tissue. Estrogen has a suppressing effect on adrenal function as well, impacting levels of all the main adrenal hormones, and will likely raise blood cortisol level. Therefore monitoring these is strongly advised.

Aldosterone levels may be hard to test because it isn't commonly tested. Most private blood test companies won't even have it as an available test as blood samples have to be kept on ice. Worst case you can skip it.

Liver and kidney function

Oral estradiol and some AAs can interfere with liver and kidney function so checking these out is a good idea. Here are the standard tests:

Vitamins

The following vitamins are important to test for general health wellbeing, happiness, good mood, etc. Cyproterone acetate can also result in B12 being nuked which requires supplementation so this should be monitored at a minimum while taking cypro.

Other potentially worthwhile tests

If you are taking spironolactone for some insane reason:

If taking cypro (with B12 nuking) you might also want to monitor the following that can be impacted by low B12 levels:

When to take the test

The best time to take the test is at the trough point, as this will provide the most diagnostically useful data. Timing if possible should also be kept consistent between tests. If you haven't started HRT yet, then take your test at the time you'd be taking it if you HAD started. If you are on E2 injections, then this should be on the injection day before taking the injection, or the day immediately before your injection if that isn't possible due to e.g. the place where you get blood draws not being open on the injection day. If you are on oral or sublingual E2, then take the test before your normal redose.

Cortisol testing should be done before 10AM, preferably between 8AM and 10AM, and then the timing should be kept consistent between tests.

DHT testing should be done AM.