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Hormone Therapy: What blood tests do I need for low testosterone?

Updated: Jul 7, 2023

Hi everyone Felix here Advanced clinical practitioner with Healand Clinic.

A very common question for people who think they may have some of the qualitative symptoms of testosterone deficiency is ‘what blood tests do I need?’ so I thought it might be a good idea to talk about that today.

Whilst there is heavy discussion about the more qualitative symptoms associated with low male Androgen levels such as anxiety, low mood, depersonalisation, erectile dysfunction, brain fog, and of course, reduced libido, it's important that these are looked at in conjunction with the quantitative biomarkers in our blood.

The first thing obvious thing you'll think is that we need to test testosterone levels and you'd be correct however it isn't that simple - we need to look more in depth at this and investigate for causality to see if there are any reversible causes that we can adjust in terms of things like our lifestyle, diet and exercise that may help us naturally increase our testosterone levels and mean that we don't have to commence testosterone replacement therapy (TRT) in the first place.

We need to remember that TRT is actually a lifelong therapy, so what else should we look at?

Well there's FBC which stands for Full Blood Count - here we can examine the red blood cells, the white blood cells, and also the other components that make up our blood such as platelets, hematocrits and haemoglobin.

We need to look at renal and hepatic function so how efficient our kidneys and our liver are working.

Next we would need to look at our thyroid function; the thyroid gland produces, stores and secretes Thyroxine, otherwise known as T4, and Triiodothyronine, also known as T3, through a negative feedback process involving the hypothalamus and pituitary gland.

Now thyroid dysfunction can result in any part of this process being affected so accurate interpretation of thyroid function test is essential, looking mainly at high or low TSH which stands for Thyroid Stimulating Hormone.

Then there are also free thyroid hormone levels if our thyroid is under or overactive - this can impact on our sex hormone binary globulin (SHBG) through an indirect liver interaction causing issues with our steroid hormones.

There are also certain conditions such as Hashimoto's disease which needs to be ruled out.

Hashimoto's is a type of hypothyroidism or underactive thyroid that is autoimmune in nature i.e. our own immune system attacks the thyroid gland and this can ultimately impact on our testosterone levels.

Finally it's also useful to know how certain vitamins and minerals are impacting our hormone panel so I would always recommend looking at your iron, your folate, your vitamin B12, and especially your vitamin D levels, and sometimes we may also need to measure zinc levels too.

Just a quick cursory search of the major online medical databases will show you how much of an impact vitamin D deficiency can have on our testosterone levels - it's actually one of the most common causes for testosterone deficiency in males in the UK.

So what about the hormone panel itself, is it just a question of knowing my total testosterone level and, if it's low, start TRT?

Well no, again it's not that simple.

We need to know the total testosterone level and the free testosterone level along with the SHBG, estradiol and prolactin and probably more importantly what is known as our gonadotropins which are Luteinizing Hormone and Follicle Stimulating Hormone.

Now these last two are key as they let us, as clinicians, know what is happening with your pituitary gland in your brain which is the powerhouse of all our steroid hormone production.

So let's say you had your comprehensive test and your results point to a diagnosis of testosterone deficiency, surely that means that TRT is indicated?

Well again not quite. In order to make a formal diagnosis of testosterone deficiency we need to have at least two low testosterone results at least four weeks apart as per the British

Society for sexual medicine guidelines.

So if you're wondering about how you can go about getting these tests done, there are a variety of online providers, but very few who will give you an experienced analysis of your results in the context of clinical experience in the field of TRT and that's where Healand can help.

We offer a range of blood tests, either the TRT Comprehensive or TRT Comprehensive Plus, which are both Diagnostic and suitable for your first blood test but as I mentioned it is useful for us, as clinicians, to see your vitamin and mineral profile so personally I would recommend the TRT Comprehensive Plus for your second confirmatory test four weeks later.

Should your first comprehensive test have returned low levels you would then need to order the TRT analysis blood test.

Now if this confirms low testosterone levels then please give us a call to discuss if therapy would be in your best interests.

So to summarise, a diagnosis of testosterone deficiency is not something that is jumped to.

We need to look at causality and take appropriate blood tests four weeks apart and assess the quantitative markers alongside the qualitative symptoms from you, the patient, before we make a diagnosis

If you're interested in any of our services including screening blood tests or other treatments then book your free initial consultation with one of our clinicians to discuss your needs.


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