TESTOSTERONE REPLACEMENT THERAPY (TRT)

Confirmation of Hypogonadism:

Mandatory, in the morning between 8:00–10:00, at least 2 times with a 14-day interval

Total Testosterone
SHBG (Sex Hormone Binding Globulin)
Free Testosterone
Free Androgen Index (FAI)

Without SHBG, testosterone assessment is incorrect.

2. Evaluation of the Hypothalamic-Pituitary-Gonadal Axis
(key to decision: TRT or recovery)
LH
FSH

3. Estrogen Balance
(without this, TRT almost always goes wrong)
Estradiol (E2)

4. Prolactin

Prolactin
Exclude:
Hyperprolactinemia
Medication-induced axis suppression
Functional hypogonadism

5. Prostate

Total PSA
if in doubt → Free PSA

6. Blood and Erythrocytosis Risks
CBC
Hemoglobin
Hematocrit
Red Blood Cells
If hematocrit >48–49% before TRT — resolve first, then hormones.

7. Liver
(hormone metabolism and SHBG)
ALT
AST
GGT
ALP
Bilirubin

Especially important with:
Low SHBG
Gels
Concurrent hepatitis

8. Metabolic Background

Fasting Glucose
Insulin
HOMA-IR
HbA1c

Insulin resistance → low SHBG → illusion of androgen deficiency.

9. Lipid Profile

(androgens predictably change it)
Total Cholesterol
LDL
HDL
Triglycerides

Low HDL before TRT — red flag.

SECOND LINE TESTS (as indicated)
DHEA-S
Morning Cortisol
IGF-1
TSH, Free T4
Ferritin
Vitamin D