TRT Bloodwork Made Easy – A Complete Beginner’s Guide

Last Updated On March 29, 2025

Bloodwork can feel overwhelming, especially if you’re new to Testosterone Replacement Therapy (TRT). But don’t worry – understanding your lab results doesn’t have to be complicated. In this guide, we’ll walk you through the key blood tests for TRT, what the numbers mean, and how to use them to optimize your therapy.

Why Bloodwork is Important for TRT

TRT isn’t just about taking testosterone; it’s about achieving balance in your body. Bloodwork helps you:

• Confirm if you actually need TRT: Low testosterone symptoms like fatigue or low libido might have other causes.
• Track your progress: Is your therapy working? Blood tests can tell.
• Prevent side effects: Monitoring your blood ensures you avoid potential risks, like high estrogen related side effects.

By staying on top of your lab work, you can safely and effectively manage your TRT journey.

Key Blood Tests for TRT

Here’s a breakdown of the most important tests you’ll need, explained in plain language:

1. Total Testosterone (TT)

This is the big one—it measures how much testosterone is in your blood overall. Low TT levels are often the first clue that TRT might be right for you.

Target Range: Typically 300-1,000 ng/dL, but this varies by age and lab.

2. Free Testosterone (FT)

Not all testosterone is usable by your body. Most of it is “bound” to proteins like SHBG. Free Testosterone is the portion that’s available for your body to use for things like energy, muscle building, and mood.

Target Range: About 2-3% of your total testosterone should be free.

3. Estradiol (E2)

Estradiol is a type of estrogen, and TRT can sometimes raise it too high. Elevated E2 may lead to side effects like bloating, mood swings, or even breast tenderness. Balancing testosterone and estrogen is important.

Target Range: Around 20-40 pg/mL is ideal for most men on TRT. However, elevated estradiol isn’t necessarily anything to worry about, unless you actually experience physical symptoms.

4. SHBG (Sex Hormone-Binding Globulin)

This protein binds to testosterone, making it unusable. High SHBG can mean you have less free testosterone even if your total levels are fine.

Target Range: 10-50 nmol/L, depending on your age.

5. Hematocrit (HCT) and Hemoglobin (HGB)

TRT can increase red blood cell production, which is great for energy—but too much can make your blood thick and harder to pump. Monitoring these levels helps you avoid risks like blood clots.

Target Range: Hematocrit should be under 52-54%, and hemoglobin should stay below 17.5 g/dL. However, elevated levels aren’t necessarily anything to worry about, unless you actually experience physical symptoms.

6. Lipid Panel (Cholesterol)

Testosterone can sometimes lower “good” cholesterol (HDL) or raise “bad” cholesterol (LDL). A lipid panel tracks your heart health while on TRT.

Target Range: HDL above 40 mg/dL, LDL below 100 mg/dL.

7. Liver and Kidney Function

Your liver processes medications, and your kidneys filter waste. TRT can put extra stress on these organs, so it’s important to make sure they’re functioning well.

How to Read Your Results

While it’s helpful to have a general idea of what your results should be, it’s important to note that interpretation can vary based on several factors. In some cases, levels that fall outside the “normal” range might not necessarily be a cause for concern, depending on your individual situation.

More recently, it has become evident that previous mainstream concerns over elevated estradiol, hematocrit, cholesterol and prostate cancer have been overblown and are rarely anything to worry about on TRT, unless they were a preexisting condition before TRT.

If you’re unsure about your results, don’t hesitate to ask for help. Whether you’re using a doctor or consulting with experienced members of the TRT community, getting an expert opinion can help you understand what the numbers mean and what adjustments may be needed.

How Often Should You Test?

Blood tests aren’t a one-time deal. Regular testing keeps your TRT on track:

• Before starting TRT: Get a baseline for testosterone, estradiol, SHBG, and red blood cells.
• 6-8 weeks after starting: Check how your body is adjusting.
• Every 3-6 months: Monitor your progress and make tweaks if needed.

Common Pitfalls to Avoid

• Ignoring symptoms: If you still feel off, don’t just rely on the numbers—something may need adjusting.
• Skipping regular testing: TRT can cause changes over time. Regular tests catch problems early.
• Overreacting to results: Small fluctuations are normal. Focus on trends and symptoms, not single numbers.

Using Bloodwork to Optimize Your TRT

Bloodwork is the cornerstone of safe and effective TRT. It allows you to understand where you’re starting from, track your progress, and adjust your treatment for the best results. It’s not a one-time thing – regular testing will help ensure your body responds well to TRT and that you’re getting the most out of your therapy.