The why's and the how's for FOLX testosterone HRT lab requirements, and what exactly it is those labs are looking for.
Hormones are the body’s chemical messengers, and hormone replacement therapy (HRT) is essentially kicking off a whole new slew of chemical signals to the body by traveling through the bloodstream to different tissues and organs to tell them what kind of work they need to do or stop doing.
Because HRT is introducing something new to the chemical makeup of bodies, labs are used to monitor safe hormone levels and effects, and to make sure bodily changes are aligned with what each person wants from their testosterone regimen. When our clinicians order labs for those on T, we’re testing for a couple things.
A testosterone lab checks the amount of testosterone in the bloodstream. The T in the bloodstream is what’s available for the body to use and create bodily changes like hair growth, voice deepening, muscle growth. Based on the individual taking testosterone, they may desire slower or quicker bodily changes which may be impacted by dose (more on that here), this test is one of the factors that helps determine if the current T dosage is right for the desired speed of change.
While fairly uncommon, testosterone can increase the hemoglobin (the protein in red blood cells responsible for carrying oxygen from the lungs to the rest of the body) and hematocrit (the volume of red blood cells in the blood) in the blood. If these increase too much, the blood becomes ‘thicker,’ which can increase the risk of blood clots. Blood clots, in turn, can lead to risk for stroke or heart attack, so it’s crucial to keep an eye on this.
At FOLX, we run standard labs associated with HRT to assess hormone levels, as well as labs to monitor the direct impact hormones can have on your health. We want to only run labs that are necessary for the care we are providing so we can keep costs low for members. We do not run other labs such as: lipid panels, A1C (to check for diabetes), CBC (complete blood count) or CMP (comprehensive metabolic panels). Some folx may have other medical conditions that may benefit from closer lab evaluation -- we review some of those conditions in our Informed Consent process so that folx can make their own decisions how to proceed.
At this point, FOLX is not offering primary care. However, we are happy to help you find a primary care provider to help you monitor any other medical conditions.
At FOLX, we do not base medical decisions solely on labs. It is much more important to hear from our members about how they are feeling. We will communicate with our members about any lab results, and if there are any concerns from a medical perspective, but we do not adjust dosages just based on what a lab result says. We want to hear from the members themselves about what feels right in their body and how they want to move forward before finalizing any changes.
It can be a bit harder to measure an accurate level of testosterone in the bloodstream for people who take weekly or biweekly injections, because the level of testosterone goes up quite high right after the injection, and drops down a bit lower coming up to the next injection. Therefore it’s recommended folx on injectable testosterone try to schedule labs around half-way between injections, or at the end of the injection cycle to get the most accurate results.
For those on daily forms of testosterone such as gel, folx can still have some fluctuation in levels, but they’ll be a bit less drastic than those on injectable. (Read up more on T routes here.)
As folx are starting testosterone, or coming back to it after a long break or lapse in care, we need to monitor their testosterone and hemoglobin levels every three months. After typically two-to-four rounds of labs, folx generally find their resting dose, which is the dose that suits their body and their desired speed of change. From there on out, we generally recommend labs every year, for however long folx are on testosterone, just to keep an eye on things and adjust if needed.
Presently, FOLX is able to order labs sent to members’ nearest Quest Diagnostics PSC (Patient Service Center). The Quest Diagnostics test requires going in-person and having a vial of blood drawn through a needle. Important to know if you choose to go to Quest -- they are required to use members’ legal names on the lab requisition form, which can be uncomfortable for some, and can lead to Quest technicians using deadnames or incorrect pronouns, as well as encountering unpredictable nonbinary- and trans-competency and sensitivity among technicians. Unfortunately, this is the widest reaching network of in-person labs to support our telehealth care. We are working to improve lab testing for our members, but we wouldn’t feel right not sharing this.
Finally, for those switching over to FOLX for HRT care, we are able to accept testosterone and hematocrit labs that were drawn within the last year, as long as they were done while on the same route and dosage requested from FOLX. One less needle!
So, that’s that on that for testosterone labs. For those ready to get started with FOLX for testosterone, the process begins here. For existing FOLX members with additional questions about labs, don't hesitate to schedule time with a clinician. And for those who’ve just got some more questions, read up on testosterone here, and feel free to reach out to us at firstname.lastname@example.org.