Essential Blood Tests

During hormone therapy, regular blood tests are required to monitor hormone levels, ensure treatment efficacy, and identify any potential side effects or complications.

These guidelines are for the minimum recommended blood test requirements. You can also choose to have more frequent blood tests, or have more comprehensive tests for better understanding of your health.

Pre-Therapy Tests

Gender-Affirming Medication	Required Tests	Optional Testing
Spironolactone	Potassium Blood pressure measurements	Baseline hormones Full Blood Count Liver Kidney Lipids Diabetes
Cyproterone	Liver Enzyme - Liver Function Test	Baseline hormones Full Blood Count Kidney Lipids Diabetes
Hormones and blockers / antiandrogens	None	Testosterone Estradiol Total testosterone SHBG Full Blood Count Kidney Lipids Diabetes

Monitoring Blood Tests for Hormone Therapy

Medicine Combination	Testosterone test	Estradiol test	Haematocrit - Full Blood Count test	Liver Enzymes - Liver Function Test	Potassium - Urea and Electrolytes test
Blood tests are needed every three months until medication has been stable for a year, and then yearly. Any medication change triggers a reset to three-monthly blood tests until stable for a year.
ESSENTIAL
GnRHa (alone)	No	No	No	No	No
Finasteride (alone)	No	No	No	No	No
Spironolactone (alone)	Yes	No	No	No	Yes
Cyproterone (alone)	Yes	No	No	Yes	No
Oestrogen (alone)	No	Yes	No	No	No
Testosterone (alone)	Yes	No	No	No	No
Raloxifene (alone)	No	No	No	No	No
GnRHa + Oestrogen	No	Yes	No	No	No
GnRHa + Testosterone	Yes	No	No	No	No
Finasteride + Oestrogen	Yes	Yes	No	No	No
Finasteride + Testosterone	Yes	No	No	No	No
Spironolactone + Oestrogen	Yes	Yes	No	No	Yes
Cyproterone + Oestrogen	Yes	Yes	No	Yes	No
Testosterone + Raloxifene	Yes	No	No	No	No
Any combination including Oestrogen	No	Yes	No	No	No
Any combination including Testosterone	Yes	No	No	No	No
Oestrogen + Blockers (general rule)	No	Yes	No	No	No
Testosterone + Blockers (general rule)	Yes	No	No	No	No
Spironolactone combinations (general rule)	No	No	No	No	Yes
Cyproterone combinations (general rule)	No	No	No	Yes	No

OPTIONAL
GnRHa (alone)	No	No	No	No	No
Finasteride (alone)	Yes	No	No	No	No
Spironolactone (alone)	Yes	No	No	No	Yes
Cyproterone (alone)	Yes	No	No	Yes	No
Oestrogen (alone)	Yes	Yes	No	No	No
Testosterone (alone)	Yes	Yes	Yes	No	No
Raloxifene (alone)	No	No	No	No	No
GnRHa + Oestrogen	No	Yes	No	No	No
GnRHa + Testosterone	Yes	No	Yes	No	No
Finasteride + Oestrogen	Yes	Yes	No	No	No
Finasteride + Testosterone	Yes	No	Yes	No	No
Spironolactone + Oestrogen	Yes	Yes	No	No	Yes
Cyproterone + Oestrogen	Yes	Yes	No	Yes	No
Testosterone + Raloxifene	Yes	No	Yes	No	No
Any combination including Oestrogen	Yes	Yes	No	No	No
Any combination including Testosterone	Yes	Yes	Yes	No	No
Oestrogen + Blockers (general rule)	Yes	Yes	No	No	No
Testosterone + Blockers (general rule)	Yes	Yes	Yes	No	No
Spironolactone combinations (general rule)	No	No	No	No	Yes
Cyproterone combinations (general rule)	No	No	No	Yes	No

Why do I need these tests?

Potassium Levels must be monitored on medications like Spironolactone as they can affect your body’s electrolyte balance. High potassium levels can lead to muscle weakness and irregular heart rhythms.
Blood Pressure Measurements ensures blood pressure remains within a safe range when you take medications that affect blood pressure, like Spironolactone.
Liver Enzyme Levels can be increased by medications like Cyproterone. High liver enzyme levels can lead to liver damage.
Hormone Level Checks ensure that your hormone therapy is achieving the desired effects while minimising potential risks. If the levels are too low, you won't see the changes you want. Higher levels won't speed up the changes, but do increase the risk of side effects.
Opposite Hormone Levels are checked to make sure that non-GnRHa hormone blockers are effectively suppressing the targeted hormones or if dose adjustments need to be made.

Blood Test Frequency

We recommend that you have blood tests every three months for your first year on hormone therapy. This is to monitor your hormone levels, side effects, and overall health.

Once you have been stable on your medication for a year, we usually recommend only testing once a year.

If you are on a high dose or make a change to your medication, we recommend that you continue monitoring your blood results every three months for at least a year.

You also need to get blood tests done in the following scenarios:

You want to start either cyproterone or spironolactone
You want to increase the dosage of your current medication

See the Pre-Therapy Tests table for reference.

Order Your At-Home Finger Prick Test Through the GenderGP Blood Test Portal Now (Available for Members and Non-Members)

To use the finger prick test, you need to be 16 or older and not taking spironolactone. Vitall, the service provider, will send your blood test results directly to your email address.

If you’re taking spironolactone, you’ll need an intravenous blood sample. You can get this through an online blood test service of your choosing, through your GP if they’re willing to help, or at a private clinic/hospital.

If you need a Blood Test Referral Letter to advise your GP or healthcare provider, you can purchase one here. The letter explains why you need blood tests and which ones you’ll need to get.