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 have testing done more frequently.
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 (unless you are on a high dose – if so, continue every 3 months) 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 (unless you are on a high dose – if so, continue every 3 months) 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 (unless you are on a high dose – if so, continue every 3 months) 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 (unless you are on a high dose – if so, continue every 3 months) 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 (unless you are on a high dose – if so, continue every 3 months) 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 (unless you are on a high dose – if so, continue every 3 months) 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 (unless you are on a high dose – if so, continue every 3 months) 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 (unless you are on a high dose – if so, continue every 3 months) 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 minimising 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.
More Information: How Blood Tests Ensure Safety and Medication Efficacy During Gender Transition, Plasma Versus Serum Blood Tests, Components of a Full Blood Count, Understanding Abnormal Full Blood Count (FBC) Results: Causes and Actions, Overdosing on Estrogen and Adjusting Hormone Therapy Doses, SGBH, Free Androgen Index, and Testosterone Levels in Hormone Therapy, Reference Ranges for Oestrogen and Testosterone, Understanding FSH and LH, Understanding Raised Hematocrit in Gender-Affirming Care, Understanding Prolactin Levels, Spironolactone and Potassium
Frequency of Blood Tests
For the first year of hormone therapy, it is recommended to have blood tests every three months to closely monitor your hormone levels, side effects, and 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 are on a high dose of hormones, we recommend that you continue monitoring your blood results every three months. Additionally, 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.
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
More Information: Timing of Blood Tests for Medication Adequacy, Blood Testing After Bottom Surgery
How to Get Your Blood Tests
Here are your options for performing your blood tests:
- Order an at-home finger prick test through the GenderGP Blood Test Portal. Vitall, the service provider, offers this as an option for GenderGP members and non-members who are 16 or older and not taking spironolactone. The finger prick test is sufficient for all tests aside from potassium level (which requires a venous sample). They will send your blood test results directly to your email address.
Get your tests done through your GP or healthcare provider (if you need a Blood Test Referral Letter to advise them about what you need, you can order one through the Treatment Recommendation form for £20 (Obtaining Letters and Reports).