Hi Guys.

I´m thinking of starting on androgel under supervision from my GP and regular therapist (but outside of the gender clinic). My GP is a newbie to hormones. I found a callen lorde sheet online with information on how T levels should look like, but I´m unsure as to how to do the checkups.

Do you start with a very low dose, then have your bloodworks done and then see how it affects you and maybe increase?

Thank you very much for any insight

Rowan

Depending on the doctor and if transition is your goal, you would start out with a quarter or half dose and after 1-3 months, you would do a blood workup. Some people have levels that respond extremely well and others need to move to the maximum dosage just to get where they should be. Though I take estrogen, my liver is happy to break down anything passing through it. The price I pay for years of taking good care of my body.

Hey Rowan,

At my first GP appointment where I sought medical transition, I had my blood work done. I presume the tests requested were similar to those I will list below. At my next appointment, my blood levels were reviewed and they came back all clear. I'll skip the part where I saw a Psychiatrist and go straight to the part where I was given my prescription.

My GP went over the pros and cons of gel and injection delivery. They suggested gel primarily because it introduces higher T levels to the body gradually instead of pummeling it with an influx of higher levels. I opted for injections as all of my research had revolved around injections, and because the cost was affordable to me while gel was prohibitively expensive. I was not actually expecting to walk out of that appointment with a script, but I did. I had to wait until I saw my regular GP a week later to begin T as I live 3-4 hrs away from the GP that manages the transition side of my health.

My blood work was then reviewed three months in, while I was on a starting dose of T. As my blood levels then were lower than the goal hormone range, my dosage was increased. Three months later, my blood work was reviewed again and this time my levels were more in line with the goal range. For the first year of HRT, quarterly blood tests are protocol for the clinic I attend. After then, it drops to twice yearly and then once yearly if there are no concerns requiring closer monitoring. I have one more three month test left before I'll find out if testing will be reduced to half yearly instances.

I actually have a pathology request for that, and these are the blood tests that my GP requested:

EUC/LFT; FBC; Glucose/BSL; Oes/Test/LH/FSH; TSH; *Fasting Chol/TG/HDL/LDL

In plain English, those are the following:

EUC - Electrolites, Urea and Creatinine. In other words, a renal/kidney function test
LFT - Liver function test
FBC - Full blood count
Glucose/BSL - Blood sugar level
Oes - Oestrogen
Test - Testosterone
LH - Luteinising hormone
FSH - Follicle-stimulating hormone
Chol - Total blood cholesterol
TG - Triglycerides
HDL - High density lipoprotein (good cholesterol)
LDL - Low density lipoprotein (bad cholesterol)

My blood levels are taken on the day of my HRT injection, prior to administering T. Some require fasting like the one above, some don't. Good luck!

I started on a half dose of gel for one month to ease into testosterone. At the one month mark I increased to a full dose. At 3 months on T, my levels were checked to see if a change in dose was needed.

You would want to get T and E tests done for sure. My doctor also orders a CMP and Lipid Panel in addition to those just to make sure the T isn't negatively impacting other parts of me that wouldn't be outwardly noticeable.

My doctor requires that people do labs before they start HRT, so she has a baseline to work off of. This lab work was much more extensive, and I can get you a list of all those tests if you would like. I was also required to have labs done every quarter for the first year just to ensure that everything was going well.

Thank you so much for the replies.

My GP will help me with monitoring, but she won´t prescribe, so I am getting my hormones from external parties (I made sure it´s completely safe).

I am opting to go on gel, first because as suggested by Venom it has slower release, and also it´s not safe for me to use needles (could cause spread of a physical condition).

The dose I can get here is 50mg androgel. Someone who was on androgel told me that that was pretty much a safe starting dose, but reading your replies I´m thinking maybe it´s better to start on 25mg.

Thank you for the blood test listing, I believe these are also on the Callen Lorde protocol, but I can´t be sure anymore so it´s good to have them. I´d definitely be interested in the lab works suggested by your dr. Max!

With gel, I think the only change is the quantity that you're applying. I don't think I've seen different concentrations of gel, outside of stuff from compounding pharmacies. But not sure what you have available there, could be different.

As far as lab tests, these are verbatim what is listed on my lab reports list. If you need more details about what each one is/does, let me know and I can click into them and see. Once I click into them I can also see reference ranges and whatnot, so if you'd like to compare numbers and see if yours is in line I can help with that. I go to a big LGBTQ clinic not unlike Callen Lorde. For my starting lab work I had:

- A complete STD panel and HIV test (required by the clinic)
- TSH+T4+T3
- Comp. Metabolic Panel (14)
- Lipid Panel
- CBC w/ Differential Platelet

For quarterly follow-up appointments:

- Comp. Metabolic Panel (14)
- CBC w/ Differential Platelet
- Testosterone, Serum
- Estradiol

At the 1 year mark, I do everything listed above and Hemoglobin A1c, but that might just be because diabetes runs in my family.

 When I started T last year, I was on Androgel once a day. After a month of applying daily, I had enough and switched to injection. Within the first year on T, I had blood work done and visit with my endo every 3 months to make sure the dosage and changes are working. As a matter of facts, I was started on half the dose and they dropped my dose to about 40% of a regular dose after the first 3 months. After 1 year, my endo appointment changed to every 6 months now. Once your T-level become steady and you will be on what is called "maintenance" dose, most doctors will see you once every 6 months just to make sure your blood work comes back normal.

Mod Edit:Dosage

Thanks Max, I have no idea what most of those mean, but I am hoping my doc will know I´m not sure if the terminology is universal (though I imagine it would be) and that all docs understand it...

Just in case, if you have the time to explain it a little, that´d be great but I will take these to my doc anyway and hopefully to an open-minded endo they´ve recommended to me.

I think I got some info lying around from Callen Lorde about how T levels should look like. Going to look that up. If I can´t find it I´ll get back at you 

Thanks for the help everyone.

Quote from: November Fox on July 12, 2016, 03:56:19 AM
Thanks Max, I have no idea what most of those mean, but I am hoping my doc will know I´m not sure if the terminology is universal (though I imagine it would be) and that all docs understand it...

Just in case, if you have the time to explain it a little, that´d be great but I will take these to my doc anyway and hopefully to an open-minded endo they´ve recommended to me.

I think I got some info lying around from Callen Lorde about how T levels should look like. Going to look that up. If I can´t find it I´ll get back at you 

Thanks for the help everyone.

Your T levels should eventually get to a cis male level from what I understand. Any endo should know those numbers.

Sure!

- A complete STD panel and HIV test (required by the clinic): Self explanatory. It was required and she told me it was a "complete panel", but I'm not sure what all it tested for.

- TSH+T4+T3: These are thyroid tests. A lot of symptoms of hormonal imbalance or hormonal issues are also symptoms of thyroid issues, so it helps to see if there are issues with the thyroid to rule out any problems with your dosage.

- Comp. Metabolic Panel (14): This measures your blood glucose level, kidney, and liver function. Since HRT can have an impact on these, it is important to check it regularly. The early symptoms of issues with the kidney and liver, you may not otherwise notice.

- Lipid Panel: This will tell you your high and low cholesterol. A lot of studies cite a decrease in HDL (the good cholesterol) with testosterone use, so you'll want to have this tested to ensure that your cholesterol is where it should be. High cholesterol leads to heart disease, and is best avoided

- CBC w/ Differential Platelet: The important thing included in this test is a red blood cell count. T can lead to an increased red blood cell count, which can cause circulation issues. So you'll want to get this tested to make sure this is at an optimal level. If it is high, you can give blood regularly to reduce it.

- Testosterone, Serum: This will tell you your T level, and should give you a male reference range for where you should be at. In conjunction with the Estradiol test, it can tell you if your dose is good for you or not.

- Estradiol: This will tell you how effective the T has been for you. It should be reduced to below 50 ideally, though a lot of masculinization can occur before that point. If it is higher than 50, you may be seeing some T convert to E and may need to lower your dose.

Hope this helps! Your doctor will probably have info on reference ranges. Just make sure they are using the male reference ranges for you.

Apologies for reacting so late, I didn´t realize you had answered

In the end I ended up doing all those and they came out fine. Which I find mildly weird since I have a beard (and I have had it when I started T). You´d think that something is at least slightly off when a female-born individual grows a beard.

Right now I´m still wondering if I should go and get another test but I´m not exactly sure what I should get tested. I mainly want to know if my levels are in order. Does that mean getting checked just for T levels and estradiol?

Thanks for the help Couldn´t do this without you (I mean you guys are more informed than my GP  )

My first year I had blood tests for my T levels one month after I started and then every 3-6 months. (I was overseas so my testing was varied). Back in the states I get blood drawn every 3 months and like FTMax I get a total screening for my lipid panels and my hormone functions. Before my hysto I had my estrogen levels checked as well as my testosterone.

My first doctor only checked my T levels and my current checks everything, so every doctor differs. You can always ask to have extra levels checked.

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To make the most of your time, I'd say wait until you're a full 3 months on to get tested for anything, and then do a combination of the above items that you think are important. For levels, you'd just need the T and estradiol tests. I'd probably add in the CBC along with those just to check on your red blood cell count.

After I got my hysterectomy I wanted to have levels tested immediately but my doctor said with any kind of hormonal change, it can take up to 3 months to see the full effect. I still get my E checked, because my T levels are always on the high end of the reference range and we want to be sure it isn't converting to E.

Ok.

Yeah I know it´s customary to have the test at three months (at least it usually is, here too). I guess I´ll just do that. I feel like my moods fluctuate a bit but I had that before I started T, it´s easy to start blaming the T for everything but I guess I´ll just have to continue working on some issues.

Quote from: FTMax on July 07, 2016, 06:28:50 PM
I started on a half dose of gel for one month to ease into testosterone. At the one month mark I increased to a full dose. At 3 months on T, my levels were checked to see if a change in dose was needed.

You would want to get T and E tests done for sure. My doctor also orders a CMP and Lipid Panel in addition to those just to make sure the T isn't negatively impacting other parts of me that wouldn't be outwardly noticeable.

My doctor requires that people do labs before they start HRT, so she has a baseline to work off of. This lab work was much more extensive, and I can get you a list of all those tests if you would like. I was also required to have labs done every quarter for the first year just to ensure that everything was going well.

Okay so which is it? Here I see people saying they should have Estrogen tested, but I posted about the fact that my Estrogen wasn't tested and had different folks saying blood testing of Estrogen is pointless. I think someone even posted a monthly cycle chart which I'm unsure of the relevance of because I'm amenorrheic at this point. Cis men have T cycles too but guess what, you're not going to cycle like that on HRT.

So should it be tested or not?

Edited to add: okay, so Estradiol, not Estrogen. Same class of hormones, different chemical state.

Quote from: AnxietyDisord3r on August 20, 2016, 04:34:18 AM

Quote from: FTMax on July 07, 2016, 06:28:50 PM
I started on a half dose of gel for one month to ease into testosterone. At the one month mark I increased to a full dose. At 3 months on T, my levels were checked to see if a change in dose was needed.

You would want to get T and E tests done for sure. My doctor also orders a CMP and Lipid Panel in addition to those just to make sure the T isn't negatively impacting other parts of me that wouldn't be outwardly noticeable.

My doctor requires that people do labs before they start HRT, so she has a baseline to work off of. This lab work was much more extensive, and I can get you a list of all those tests if you would like. I was also required to have labs done every quarter for the first year just to ensure that everything was going well.

Okay so which is it? Here I see people saying they should have Estrogen tested, but I posted about the fact that my Estrogen wasn't tested and had different folks saying blood testing of Estrogen is pointless. I think someone even posted a monthly cycle chart which I'm unsure of the relevance of because I'm amenorrheic at this point. Cis men have T cycles too but guess what, you're not going to cycle like that on HRT.

So should it be tested or not?

Edited to add: okay, so Estradiol, not Estrogen. Same class of hormones, different chemical state.

https://labtestsonline.org/understanding/analytes/estrogen/tab/test/

Estradiol should be tested along with testosterone levels, especially in the early stages of HRT as you're trying to find the right dose where you're within the male reference range but you're not so high that it's converting to E. The threshold where it starts to convert is different for everyone, so it could potentially be converting even if your T is on the lower end. That is the way my doctor explained it to me.

Quote from: AnxietyDisord3r on August 20, 2016, 04:34:18 AM
Okay so which is it? Here I see people saying they should have Estrogen tested, but I posted about the fact that my Estrogen wasn't tested and had different folks saying blood testing of Estrogen is pointless. I think someone even posted a monthly cycle chart which I'm unsure of the relevance of because I'm amenorrheic at this point. Cis men have T cycles too but guess what, you're not going to cycle like that on HRT.

So should it be tested or not?

Edited to add: okay, so Estradiol, not Estrogen. Same class of hormones, different chemical state.

Total estrogen is a combination of estradiol and estrone. These are the two major players in the picture and while there are others, they aren't important in this discussion. Estradiol is 10 times more powerful than estrone so it's the major estrogen to be worried about.

As for the chart, that's the reason you don't measure estrogens before T. Once T has had sufficient time for the blocking to take effect, estrogen should be tested.

Quote from: FTMax on August 19, 2016, 11:25:17 AM
To make the most of your time, I'd say wait until you're a full 3 months on to get tested for anything, and then do a combination of the above items that you think are important. For levels, you'd just need the T and estradiol tests. I'd probably add in the CBC along with those just to check on your red blood cell count.

After I got my hysterectomy I wanted to have levels tested immediately but my doctor said with any kind of hormonal change, it can take up to 3 months to see the full effect. I still get my E checked, because my T levels are always on the high end of the reference range and we want to be sure it isn't converting to E.

My doctor said the same after I started hormones and after my hysto. I'm getting a blood draw at 6 weeks after my hysterectomy, but that's due to having chronically low potassium levels and nothing to do with my hormone levels.

I believe that 3 months is the standard waiting period,  like FTMax said.

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