What Tests Are Included in a Health Checkup Before Starting Hormone Therapy?
“Just take hormones - there’s no need to get any tests first, right?” This is a very dangerous misconception. Hormones are not vitamins; they are substances that alter how the entire body functions, from the liver, kidneys, and heart to the blood vessels. If you start without knowing whether your body is ready,
This article will clearly explain what health checks you need before starting hormone therapy and which ones you should not miss, so you can get started with confidence and as safely as possible.
Why should you get a health check before starting hormone therapy?
Hormone therapy, whether for gender affirmation or to manage menopause, is a medical process that requires assessment and close follow-up by a doctor because the hormones you take can stimulate or suppress the function of several organs at once.
Everyone’s body is different. Some people may have underlying conditions they are unaware of, such as high blood lipids, impaired liver function, or a risk of blood clots. These are things you need to know before starting hormones, not after side effects occur. Health checks before starting hormone therapy are therefore intended to
- Give the doctor a picture of your body’s “starting point” to compare with results after starting hormone therapy
- Screen for diseases or risk factors that could worsen with hormone use
- Help the doctor choose the type, dose, and form of hormone that is right for each person
- Reduce the risk of long-term complications, such as heart disease, liver disease, or blood clots
In simple terms, this is not just a pointless formality. It is an important step that helps ensure bodily changes happen safely and lead to good long-term results.
Checklist: What health checks do you need before starting hormone therapy?
When you see a doctor for an assessment before starting hormone therapy, most tests focus on blood work. They can be divided into the following easy-to-understand categories:
1. Check baseline hormone levels
This measures the levels of sex hormones currently in your body, providing a baseline for comparison after you start taking medication.
- Total Testosterone: Measures male sex hormone levels
- Estradiol (E2): Measures female sex hormone levels
- Prolactin: A hormone produced by the pituitary gland. It is especially important for people taking feminizing hormones because some medications may cause prolactin levels to become too high.
2. Check liver and kidney function
- Liver Function Test (AST, ALT, ALP): The liver is the first-line organ responsible for metabolizing hormones. If the liver is inflamed or its function is abnormal, medication may put too much strain on it.
- BUN & Creatinine (with eGFR calculation): Checks kidney function, especially for people who need certain medications that suppress male sex hormones and affect electrolyte levels and the kidneys’ ability to excrete water.
3. Check complete blood count (CBC)
- Check hemoglobin and hematocrit: For people preparing to take testosterone, this hormone stimulates red blood cell production. If the blood becomes too thick, there may be a risk of high blood pressure or blood clots.
4. Check blood lipids and sugar (Lipid Profile & Fasting Blood Sugar)
- Cholesterol, triglycerides, and good/bad cholesterol (HDL/LDL): Sex hormones directly affect how fats are distributed and how they build up in blood vessels.
- HbA1c or fasting blood sugar: Some types of hormones may increase insulin resistance. Checking these levels beforehand can help prevent diabetes in the long term.
5. Check blood electrolyte levels
- Check potassium, sodium, and chloride levels, especially for people taking medications that suppress male sex hormones and may raise blood potassium levels.
MTF vs. FTM comparison table: How do the tests differ?
Although the basic tests are similar, the focus of follow-up differs depending on the person’s goals:
| Patient group | Primary hormones taken | Tests the doctor pays particular attention to | Key risks to monitor |
|
MTF (transgender women) | Estrogen + Anti-androgen | Prolactin, Potassium, Liver Function, Lipid Profile | Blood clots, elevated potassium, increased liver enzymes |
|
FTM (transgender men) | Testosterone | Hematocrit (blood concentration), Liver Function, Lipid Profile | Thickened blood (Polycythemia), fat buildup in blood vessels |
Who should get a health check before starting hormone therapy?
It is not only people who are about to start hormone therapy who should get checked. The following groups should also make it a priority:
- People planning to start gender-affirming hormone therapy
- People already taking hormones who have never had a health check
- Women going through menopause who are considering hormone replacement therapy (HRT)
- People with underlying conditions, such as high blood pressure, diabetes, or high blood lipids, who need further risk assessment before using hormones
- People who plan to have children in the future should also consult a doctor about fertility preservation before starting hormones
What are the risks of starting hormone therapy without getting tested first?
Many people may think, “I can just buy medication and take it myself—it saves time and money.” But the truth is that taking hormones without a doctor’s care is much riskier than you might think. Risks range from minor side effects such as nausea and dizziness to serious conditions such as blood clots, stroke, or impaired liver or kidney function. By the time you notice some of these problems, it may already be too late.
A health check before starting is like a “protective shield” that helps the doctor detect warning signs early, before they become major problems.
After starting hormone therapy, how should you follow up?
An initial test alone is not enough because the hormones you take will continue to affect your body. Doctors generally schedule periodic follow-ups to
- Check whether hormone levels in the blood are within the appropriate range
- Adjust the dose to suit your body at each stage
- Monitor side effects and complications
- Regularly monitor liver, kidney, and cardiovascular health
Keeping your medical appointments is just as important as getting the initial tests.
Reference :
Phyathai 3 Hospital What Tests Are Included in a Health Checkup Before Starting Hormone Therapy?
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