Bloodwork is the only way to be sure HRT is feminizing and effective. In many countries, it is possible to order blood tests for personal use without a doctor's permission.
E2/estradiol and T/testosterone should be tested every time, though other tests should be run depending on what you take.
Antiandrogens can impact organ functions. You should run specific tests depending on your antiandrogen. Cyproterone acetate and bicalutamide both may rarely cause liver toxicity. This can be monitored via a liver function test (LFT). Spironolactone can cause kidney problems and kidney function and potassium should be tested. Your lab will provide reference ranges. If your levels are abnormal, stop taking the antiandrogen immediately.
Liver toxicity onset with cyproterone ranges from months to a year but is typically within the first six months. You should test for liver function after several months and continue annually.[1]
Liver toxicity from bicalutamide is less common compared to cyproterone, and its onset is typically two to three months, in rare cases taking up to six. You should test liver function after three months and continue annually.[2]
Spironolactone can impact kidney function. Renal (kidney) function and potassium should be tested after three and six months and then annually.[3]
Some individuals may still experience androgenic side effects despite suppressed testosterone; DHT may be the culprit. DHT (dihydrotestosterone) is one of the primary causes of male pattern baldness, and DHT blockers such as dutasteride can be used if levels don't go down.
Places to order private blood tests from
- US https://www.privatemdlabs.com/, https://www.labsmd.com/
- Europe https://www.synlab.com/geographies/country-pages
- UK + Ireland https://www.medichecks.com/
- Canada https://bloodtestscanada.com/
- Spain https://tumedico.es/
- Sweden https://werlabs.se/
- ↑ LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Cyproterone. [Updated 2017 Jul 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548024/
- ↑ LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Bicalutamide. [Updated 2023 Mar 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547970/
- ↑ UCSF Transgender Care. (June 17, 2016). Feminizing hormone therapy. Retrieved from https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy