From the FDA Drug Label
Estrogen administration should be initiated at the lowest dose approved for the indication and then guided by clinical response rather than by serum hormone levels (e.g., estradiol, FSH). The FDA does not provide specific blood work recommendations for hormone replacement therapy.
- The decision to order blood work should be based on clinical judgment and the individual patient's needs.
- Patients on thyroid replacement therapy may require monitoring of their thyroid function to maintain their free thyroid hormone levels in an acceptable range 1.
- Laboratory tests may be necessary to monitor for potential interactions between estrogen and other medications, such as accelerated prothrombin time and increased platelet count 1 1.
From the Research
Hormone replacement therapy (HRT) blood work should typically include comprehensive baseline testing before starting treatment and regular monitoring thereafter, with a focus on minimizing potential side effects and optimizing hormone levels, as evidenced by the most recent study 2.
Initial Testing
Initially, patients should have their:
- Estradiol
- Testosterone
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Thyroid-stimulating hormone (TSH)
- Complete blood count
- Comprehensive metabolic panel
- Lipid profile measured.
Monitoring Schedule
For those on estrogen therapy, estradiol levels should be checked every 3 months initially, then every 6-12 months once stable, aiming for levels between 100-200 pg/mL, as suggested by 2. Testosterone levels should be monitored similarly, targeting the middle of the reference range for the affirmed gender. Some key points to consider when monitoring patients on HRT include:
- Liver function tests, electrolytes, and lipid profiles should be checked annually, but the most recent study 3 suggests that liver enzyme monitoring may not be necessary for a transgender population.
- Prolactin levels should be monitored in patients on estrogen therapy
- Hematocrit and hemoglobin require attention for those on testosterone therapy to watch for polycythemia
- Bone density scans are recommended every 1-2 years for patients at risk of osteoporosis, as mentioned in 2.
Key Considerations
The benefits of HRT in improving the symptoms of menopause are well-established, but potential risks associated with HRT, such as cardiovascular health and metabolic function, should also be considered, as discussed in 2. Overall, the monitoring schedule should be tailored to the individual patient's needs and risk factors, with a focus on minimizing potential side effects and optimizing hormone levels, as evidenced by the most recent study 2.