A practical schedule for staying inside guardrails
Ongoing Monitoring & Follow-Up Labs
The goal of follow-up labs is not to chase “perfect numbers.” It’s to catch drift early: hematocrit creeping up, lipids worsening, liver markers changing, or hormones moving out of your normal range.
If you’re still learning what the markers mean, read How to read common lab markers before acting on trends.
What “good monitoring” actually means
Good monitoring is consistency: same timing, same protocol stability window, and the same core panel. That’s how you get comparable data and can act on trends instead of one-off spikes.
Repeatable labs + trends beat “one good result” every time. If you’re planning changes, model them first with the TRT dose calculator so your before/after comparison stays clean.
Follow-up testing schedule (simple version)
After starting TRT or making a change
- 6–8 weeks after any change (dose, frequency, ester, injection route): run your core panel.
- If you change again, reset the clock. Don’t test weekly and panic-adjust.
Once stable
- Every 6 months if you want tighter guardrails or have prior drift.
- Every 12 months if you’re low-risk and trends have been stable.
Test timing rule
- Test at the same time relative to injections each time (pre-injection/trough is the default). If you need help standardising timing, follow the pre-injection bloodwork checklist.
What to track long-term (core markers)
This shortlist covers safety and the most common drift points on TRT.
Hormones
- Total Testosterone (TT)
- Free Testosterone (FT) — if SHBG changes, estimate FT using the free testosterone calculator.
- SHBG
- Estradiol (E2, sensitive)
Blood / viscosity risk
- CBC (hematocrit, hemoglobin, RBC)
Liver / kidney / metabolic health
- CMP (ALT/AST, creatinine, electrolytes)
- Lipid panel
Situational add-ons (use when relevant)
- Prolactin – libido/ED issues, nipple sensitivity, odd mood swings.
- TSH + Free T4 (± Free T3) – fatigue, cold intolerance, stubborn weight changes.
- PSA – follow clinician guidance based on age and risk.
- HbA1c – metabolic risk or weight changes. Use the BMI calculator to keep body-weight context consistent when comparing labs over time.
How to use trends (what actually triggers action)
Stop treating labs like pass/fail. Monitoring is trend management.
- Hematocrit creeping up → verify hydration and timing, then act with your clinician.
- Lipids worsening → address diet, weight, cardio, and sleep before touching dose.
- E2 rising with symptoms → check consistency, body fat, alcohol, and injection frequency. See side effects & monitoring for context.
- TT/FT drifting → confirm adherence (missed shots, late dosing). If frequency is the variable, review weekly vs every N days before changing dose.
If you changed timing or protocol, you broke comparability. Fix that first.
After protocol changes: what to re-test
Use this when you change dose/frequency/ester and want a clean before/after.
Minimum re-check (6–8 weeks post-change)
- TT, FT, SHBG, E2 (sensitive)
- CBC
- CMP
Model the new schedule in the TRT dose calculator, then confirm with properly timed follow-up labs.
Common questions
Can I test sooner than 6 weeks?
You can, but it usually creates confusion. Most changes need time to stabilise. Early testing is how people overreact to transient shifts.
Do I need labs forever?
Yes. Long-term hormone use requires long-term monitoring. The schedule can relax once stable, but it doesn’t disappear.
Should I test at trough every time?
For consistency, yes. Peaks can be useful for specific questions, but trough is the best repeatable baseline for most people.
Key takeaways
- Re-test 6–8 weeks after any meaningful protocol change.
- Once stable, monitor every 6–12 months depending on risk.
- Use the same timing (pre-injection/trough) so results stay comparable.
- Track trends across tests—don’t chase a single “weird” number.
If you haven’t already, read How to read common lab markers, then standardise timing with the pre-injection bloodwork checklist.