Why These Tests?
Most TRT clinics run 5–10 markers and call it “comprehensive.” That's enough to check testosterone and hematocrit—but not enough to catch the metabolic, cardiovascular, thyroid, and micronutrient changes that testosterone therapy can trigger. We test 120+ biomarkers per year because optimizing hormones without monitoring the systems they affect isn't optimization—it's guesswork.
Two Panels, One Protocol
Your provider selects the right panel based on where you are in treatment:
- Annual Panel (65+ biomarkers) — Full baseline. Run once per year. Covers hormones, thyroid, cardiovascular, metabolic, hematology, and micronutrients. This is the most comprehensive TRT monitoring panel available at any consumer clinic.
- Follow-Up Panel (60+ biomarkers) — Core monitoring every 3–6 months. Thyroid markers (TSH, Free T4, Free T3) can be added for patients on thyroid medication or with thyroid concerns.
Full Panel Breakdown
| Biomarker | Annual | Follow-Up |
|---|---|---|
| Hormones | ||
| Luteinizing Hormone (LH) | ||
| Follicle Stimulating Hormone (FSH) | ||
| Total Testosterone [LCMS] | ||
| Free Testosterone [Equilibrium Dialysis] | ||
| Estradiol, Ultrasensitive [LCMS] | ||
| Cortisol | ||
| Prolactin | ||
| Prostate | ||
| PSA, Total & Free | ||
| Thyroid | ||
| TSH | * | |
| Free T4 (FT4) | * | |
| Free T3 (FT3) | * | |
| Cardiovascular / Lipids | ||
| Lipid Panel (Total Cholesterol, HDL, LDL, Chol/HDL Ratio, Non-HDL Cholesterol, Triglycerides, TG/HDL Ratio) | ||
| hs-CRP | ||
| Metabolic | ||
| CMP (Comprehensive Metabolic Panel) | ||
| GGT | ||
| Insulin | ||
| HbA1c | ||
| Estimated Average Glucose (eAG) | ||
| HOMA-IR Score | ||
| eGFR | ||
| FIB-4 Score | ||
| Hematology | ||
| CBC (with Differential & Platelets) | ||
| Micronutrients | ||
| Ferritin | ||
| Vitamin D (25OHD) | ||
| Magnesium, RBC | ||
| Phlebotomy | ||
| Venipuncture (Draw Fee) | ||
| Total biomarkers | 65+ | 60+ |
* Thyroid markers (TSH, Free T4, Free T3) included on follow-up panels for patients on thyroid medication or with thyroid concerns, at provider discretion.
What Each Test Measures
Hormones — LH, FSH, Testosterone, Estradiol, Cortisol, Prolactin
LH & FSH measure pituitary signaling to the testes. On TRT, both suppress—tracking them confirms the exogenous testosterone is working and helps guide fertility-preservation protocols.
Total & Free Testosterone (LCMS + Equilibrium Dialysis) are the gold-standard assays. LCMS avoids the cross-reactivity issues of immunoassay, and equilibrium dialysis is the most accurate free-T method available.
Estradiol (Ultrasensitive LCMS) tracks estrogen conversion via aromatase. Elevated E2 causes water retention, mood changes, and gynecomastia. The ultrasensitive assay catches small shifts that standard tests miss.
Cortisol (Annual only) screens for adrenal dysfunction. Chronic stress or adrenal insufficiency can mimic low-T symptoms.
Prolactin (Annual only) rules out pituitary adenomas, which can suppress testosterone production independently of TRT.
Thyroid — TSH, Free T4, Free T3
TSH is the primary thyroid screening marker. Subclinical thyroid issues cause fatigue, weight gain, and brain fog—symptoms often blamed on low testosterone.
Free T4 and Free T3 measure active thyroid hormones. T3 is the biologically active form; poor T4-to-T3 conversion is common and missed by TSH-only testing. Included annually and on follow-up panels for patients with thyroid concerns.
Prostate — PSA, Total & Free
PSA (Total & Free) monitors prostate health. TRT can increase PSA modestly; tracking the free-to-total ratio helps distinguish benign changes from clinically significant elevation. Checked on every panel.
Cardiovascular — Lipid Panel, hs-CRP
Lipid Panel (6 markers) tracks cholesterol and triglycerides. Testosterone can shift HDL/LDL ratios—monitoring ensures cardiovascular risk stays managed.
hs-CRP (Annual only) measures systemic inflammation. Elevated hs-CRP is an independent cardiovascular risk factor and can indicate chronic inflammatory conditions that affect treatment response.
Metabolic — CMP, GGT, Insulin, HbA1c
CMP (14 markers) covers kidney function, liver enzymes, electrolytes, and blood glucose. Testosterone is liver-metabolized—CMP catches hepatic stress early.
GGT is a sensitive liver enzyme that rises before ALT/AST. Particularly useful for detecting early liver stress from oral medications or alcohol.
Insulin measures fasting insulin to screen for insulin resistance—a condition testosterone therapy can improve but that needs baseline tracking.
HbA1c reflects 3-month average blood sugar. TRT improves insulin sensitivity in many men; HbA1c tracks that improvement objectively.
Hematology — CBC with Differential & Platelets
CBC is the single most important safety marker on TRT. Testosterone stimulates erythropoiesis—red blood cell production. Elevated hematocrit (polycythemia) increases blood viscosity and clot risk. CBC with differential also screens for infection, anemia, and immune function.
Micronutrients — Ferritin, Vitamin D, Magnesium RBC
Ferritin measures iron stores. As TRT increases red blood cell production, iron demand rises. Low ferritin limits your body's ability to respond to testosterone and causes fatigue independent of hormone levels.
Vitamin D (25OHD) functions as a hormone precursor. Deficiency is linked to low testosterone, poor bone density, and immune dysfunction. Supplementation is straightforward once identified.
Magnesium, RBC measures intracellular magnesium—more accurate than serum magnesium. Magnesium supports testosterone production, sleep quality, and over 300 enzymatic reactions. Deficiency is common and underdiagnosed.
120+ biomarkers. Included. Not upsold.
Most TRT clinics test 5–10 markers and call it comprehensive. Open TRT runs 65+ biomarkers annually and 60+ on follow-up—via Quest Diagnostics, the largest clinical lab network in the U.S. All included in your membership. No upcharges. No surprise lab invoices.