Introduction
Hormone therapy plays a crucial role in managing various medical conditions, including hormone imbalances and gender-affirming care. Regular blood tests are essential to monitor hormone levels, ensure treatment efficacy, and identify any potential side effects or complications.
These guidelines outline the minimum recommended blood test requirements. However, individuals have the option to undergo more comprehensive tests or choose to have testing done more frequently if they wish.
Table: Starting Blood Tests for Hormone Therapy
| Gender-Affirming Medication | Minimum Required Tests | More Comprehensive Testing (optional) |
|---|---|---|
| Spironolactone | – Potassium level – Blood pressure measurements |
– Baseline hormones – Full Blood Count – Liver – Kidney – Lipids – Diabetes |
| Cyproterone | – Liver enzyme levels (e.g., ALT, AST) | – Baseline hormones – Full Blood Count – Kidney – Lipids – Diabetes |
| Hormones and other blockers / antiandrogens | – Testosterone – Estradiol – Total testosterone – SGBH – Full Blood Count – Kidney – Lipids – Diabetes |
Table: Monitoring Blood Tests for Hormone Therapy
| Gender-Affirming Medication | Required Tests | Frequency |
|---|---|---|
| Estrogen & Spironolactone | – Testosterone – Estradiol – Potassium levels – Blood pressure measurements |
Every 3 months for the first year, then annually or as advised by your healthcare provider. If you change your dose, resume 3-month checks until stable for a year. |
| Estrogen & Cyproterone | – Testosterone – Estradiol – Liver enzyme levels (e.g., ALT, AST) |
Every 3 months for the first year, then annually or as advised by your healthcare provider. If you change your dose, resume 3-month checks until stable for a year. |
| Estrogen & Finasteride | – Testosterone – Estradiol |
Every 3 months for the first year, then annually or as advised. If you change your dose, resume 3-month checks until stable for a year. |
| Estrogen & GnRHa Blocker | – Estradiol | Every 3 months for the first year, then annually or as advised. If you change your dose, resume 3-month checks until stable for a year. |
| Estrogen alone | – Testosterone – Estradiol |
Every 3 months for the first year, then annually or as advised. If you change your dose, resume 3-month checks until stable for a year. |
| Testosterone alone | – Testosterone – Estradiol – Full Blood Count (including Haematocrit) |
Every 3 months for the first year, then annually or as advised. If you change your dose, resume 3-month checks until stable for a year. |
| Testosterone & GnRHa Blocker | – Testosterone – Full Blood Count (including Haematocrit) |
Every 3 months for the first year, then annually or as advised. If you change your dose, resume 3-month checks until stable for a year. |
| GnRHa Blocker Alone | – None | |
| Finasteride antiandrogen alone | – None – Testosterone optional |
|
| Spironolactone antiandrogen alone | – Potassium – Testosterone optional |
Every 3 months for the first year, then annually or as advised. If you change your dose, resume 3-month checks until stable for a year. |
Understanding the Blood Tests
- Potassium Levels: Monitoring potassium levels is crucial when taking medications like Spironolactone, as it can affect your body’s electrolyte balance. Elevated potassium levels can lead to health complications, so regular checks are essential.
- Blood Pressure Measurements: Spironolactone can affect blood pressure, so routine blood pressure monitoring is necessary to ensure it remains within a safe range.
- Liver Enzyme Levels: Cyproterone may impact liver function, which is why liver enzyme tests (such as ALT and AST) are performed regularly to detect any abnormalities.
- Hormone Level Checks: For those taking testosterone or estrogen as part of gender-affirming care, monitoring hormone levels ensures that the therapy is achieving the desired effects while minimizing potential risks.
- Opposite Hormone Levels: When using non-GnRH agonist blockers to suppress hormone production, it’s essential to check the hormone that you are actively trying to suppress. This helps ensure that the therapy is effectively suppressing the targeted hormone.
Frequency of Blood Tests
For the first year of hormone therapy, it is recommended to have blood tests every three months to closely monitor hormone levels, side effects, and your overall health. Once you have been stable on your medication for a year, your healthcare provider may advise reducing the frequency to annual checks. However, if you make any changes to your medication dose during this time, you should resume three-month checks until you have been stable for another year.
Conclusion
Regular blood tests are a critical component of hormone therapy, helping healthcare providers ensure the safety and effectiveness of treatment. It is essential to follow the recommended testing schedule and make informed decisions about your hormone therapy and overall health. By monitoring hormone levels, electrolytes, and organ function, you can maximise the benefits of hormone therapy while minimising potential risks.