Blood tests on gender-affirming hormones

For trans and nonbinary people taking estrogen-based or testosterone-based hormone therapy, whether just starting or years in.

10 tests explainedAI-verified against cited sources. Awaiting expert reviewLast reviewed 2026-10-19

Gender-affirming hormone therapy is followed with a small set of blood tests. Hormone levels show where your dose is landing, and a few safety tests depend on what you take, such as hematocrit on testosterone or potassium with spironolactone. Hormones also shift some everyday results, so which reference range fits you matters.

The tests that matter most

Most important first. Each one links to its full page, where the note for this group sits near the top.

Estradiol (E2)
If you take estradiol, guidelines suggest checking it about every 3 months in the first year, then once or twice a year once your dose is steady. The aim is a level that matches your gender identity, though WPATH notes ideal targets haven't been settled. Conjugated estrogens can't be followed this way.
Sources: World Professional Association for Transgender Health (2022) and Endocrine Society (2017)
Usual adult range
7.6–42.6 pg/mL
Testosterone, Total
On testosterone, guidelines suggest checking total testosterone about every 3 months until it reaches the goal, timed to the type you use. On estrogen-based therapy, it is checked to see how far your own testosterone has come down.
Sources: World Professional Association for Transgender Health (2022) and Endocrine Society (2017)
Men, 20+
264–916 ng/dL
Men, 18–19
150–785 ng/dL
Hematocrit
Testosterone raises red blood cells, so WPATH recommends checking hematocrit at the start, about every 3 months in the first year, then once or twice a year. A rise into the usual range for cisgender men is expected.
Source: World Professional Association for Transgender Health (2022)
Men, 13+
37.5–51 %
Women, 13+
34–46.6 %
Hemoglobin
Hemoglobin follows hematocrit. After about 6 months on full-dose therapy, it tends to settle into the range of your affirmed gender: higher on testosterone, and lower on estradiol with an androgen blocker.
Source: Journal of Clinical Endocrinology and Metabolism (2021)
Men, 16+
13–17.7 g/dL
Women, 16+
11.1–15.9 g/dL
Potassium
Spironolactone, a common testosterone blocker, can raise potassium, though WPATH calls this uncommon and usually short-lived. The Endocrine Society suggests checking it every 3 months in the first year, then once a year.
Sources: Endocrine Society (2017), World Professional Association for Transgender Health (2022) and Journal of Clinical Endocrinology and Metabolism (2021)
Usual adult range
3.5–5.2 mmol/L
Creatinine
With spironolactone, WPATH suggests checking creatinine along with potassium to watch kidney function. Creatinine also reflects muscle mass, which shifts on hormones, so a 2021 review suggests reading it against the range of your affirmed gender once you've started hormones.
Sources: World Professional Association for Transgender Health (2022) and Journal of Clinical Endocrinology and Metabolism (2021)
Men, 15+
0.74–1.35 mg/dL
Women, 16+
0.59–1.04 mg/dL
eGFR (Creatinine-based)
eGFR is worked out with a sex in the formula, so the number changes depending on which one the lab uses. One review suggests that if either the male or the female estimate points to extra care, clinicians can act on it.
Source: Journal of Clinical Endocrinology and Metabolism (2021)
Usual adult range
60 and above mL/min/1.73 m²
Prolactin
Guidelines differ on this one. The Endocrine Society suggests checking prolactin from time to time on estrogen. WPATH makes no recommendation either way, noting that it isn't clear what a raised level means for health.
Sources: Endocrine Society (2017) and World Professional Association for Transgender Health (2022)
Men, 10+
2.1–17.7 ng/mL
Women, 10+
2.8–29.2 ng/mL
HDL Cholesterol
Both estrogen and testosterone can shift lipids such as HDL cholesterol and triglycerides, WPATH notes, and a 2021 review links testosterone with lower HDL. The Endocrine Society suggests a fasting lipid profile as part of checking heart risk, and WPATH suggests one before and after starting testosterone.
Sources: World Professional Association for Transgender Health (2022), Journal of Clinical Endocrinology and Metabolism (2021) and Endocrine Society (2017)
Usual adult range
40 and above mg/dL
PSA, Total (Prostate-Specific Antigen)
If you have a prostate and take estrogen, PSA is expected to run lower, and there isn't enough data for a separate cutoff. One review suggests reading PSA against the male range, since it depends on prostate size.
Source: Journal of Clinical Endocrinology and Metabolism (2021)
Men
0–4 ng/mL
Men, 40–49
0–2.5 ng/mL

Ranges shown are the usual adult ranges labs print. The range on your own report is the one your result is judged against.

Getting results you can compare

On testosterone, timing matters. WPATH and the Endocrine Society suggest drawing midway between cypionate or enanthate injections, just before the next undecanoate injection, and at least 2 hours after a gel once you've used it daily for a week. WPATH also describes measuring peak and trough levels, the highest and lowest points between injections, as another option.
Sources: World Professional Association for Transgender Health (2022) and Endocrine Society (2017)
WPATH and the Endocrine Society suggest checking hormone levels about every 3 months in the first year or after a dose change, then once or twice a year once the dose is steady.
Sources: World Professional Association for Transgender Health (2022) and Endocrine Society (2017)
The range printed on a report usually follows the sex in the lab's system. A 2021 review suggests the clinician name the range they want on the lab order, usually the one for your affirmed gender once you're on hormones.
Source: Journal of Clinical Endocrinology and Metabolism (2021)

Good to know

Lab reports usually print one range, based on the sex on your record, so a result can be flagged when it's typical for someone on your hormones. A 2021 review proposes using the range of your affirmed gender once you've started hormones, except for PSA and heart troponin, which depend on organ size. It notes hematocrit is often in the affirmed range from about 3 months.
Source: Journal of Clinical Endocrinology and Metabolism (2021)
Much of this rests on limited evidence. WPATH says ideal hormone targets haven't been established, and it suggests rather than recommends the 3-month schedule because no strong studies back specific testing intervals.
Source: World Professional Association for Transgender Health (2022)

Questions you could ask

Which reference range are you using for my results, and can I see both?
When should my blood be drawn relative to my injection or gel?
How often should we check my potassium while I take spironolactone?
Is a prolactin test useful for me?
Which of my results would look different if the lab used the other range?

Sources

Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, Endocrine Society (2017)
Standards of Care for the Health of Transgender and Gender Diverse People, Version 8, World Professional Association for Transgender Health (2022)
Approach to Interpreting Common Laboratory Pathology Tests in Transgender Individuals, Journal of Clinical Endocrinology and Metabolism (2021)

AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-19. How we build and check these pages.

Educational information, not medical advice. Blood Test Tracker doesn’t diagnose or treat, and it doesn’t replace your clinician. Talk with your clinician before changing medications, supplements or care.