TESTS BEFORE INITIATING TESTOSTERONE REPLACEMENT THERAPY (TRT)
1. 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.
1. 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.
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
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
You can consult a doctor of the highest category, candidate of medical sciences, Perelygin I.V.
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The use of medicinal products is permitted only upon a doctor’s prescription. Consultations are provided by clinic specialists in person or online in accordance with applicable law.
The use of medicinal products is permitted only upon a doctor’s prescription. Consultations are provided by clinic specialists in person or online in accordance with applicable law.
