Blood Tests

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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.

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]

  1. 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/
  2. 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/
  3. UCSF Transgender Care. (June 17, 2016). Feminizing hormone therapy. Retrieved from https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy