Blood Tests Required Before Starting Hormone Replacement Treatment

Get expert insights on required lab work including liver function, thyroid tests, and estrogen hormone replacement therapy safety screening.

You're considering hormone replacement therapy but wondering what blood tests you need first. 

Here's what might surprise you: most people starting estrogen hormone replacement therapy don't need any blood tests at all. But there are important exceptions that could affect your treatment plan and safety.

Most People Don't Need Blood Tests to Start HRT

The truth about starting hormone therapy is simpler than you might think. You can usually begin HRT as soon as you start experiencing menopausal symptoms and will not usually need to have any tests first.

This approach focuses on treating your symptoms, not your hormone numbers. Major medical organizations agree on this approach. According to the North American Menopause Society, determining the dosages of menopausal hormone therapy based on blood or salivary hormone testing is meaningless for midlife individuals because these levels vary from day to day and even from hour to hour.

Your hormone levels naturally fluctuate throughout the day, making blood tests unreliable for determining if you need treatment. Instead, doctors focus on your symptoms like hot flashes, sleep problems, and mood changes.

When Blood Tests Become Necessary

Despite the general rule, certain situations require blood testing before you start treatment. These exceptions ensure your safety and help doctors make better decisions about your care.

If you're under 40 with menopause symptoms, blood tests are essential. If under 40 and experiencing menopause symptoms, including irregular periods or the complete stoppage of your menstrual cycle, blood tests are used in the diagnosis of premature ovarian insufficiency (POI) before beginning HRT. This requires two separate FSH tests taken 4-6 weeks apart.

For people aged 40-45, doctors might order blood tests to confirm menopause is causing your symptoms. A blood test to measure your hormone levels may be carried out if you're aged 40 to 45.

Essential Safety Tests for High-Risk Patients

Some people need comprehensive blood work before starting hormone therapy due to underlying health conditions or specific medications. These tests protect you from serious complications.

Test Type	Purpose	Who Needs It
Liver Function Tests	Monitor liver health	All patients taking oral hormones
Complete Blood Count	Check for blood disorders	Everyone starting treatment
Thyroid Function	Rule out thyroid problems	Patients with unclear symptoms
Lipid Panel	Assess heart disease risk	Patients with cardiovascular concerns

Liver function testing is particularly important because your liver processes hormones. 

Liver function tests are essential for monitoring how your body processes hormones during HRT and TRT. Estrogen, in particular, can impact liver enzymes, so regular testing helps ensure the liver remains healthy.

Tests Needed for Specific Medications

Different hormone medications require different monitoring approaches. Some carry higher risks that need careful tracking through blood work. If you're taking testosterone supplements, blood tests become mandatory.

If you feel like you might need testosterone supplements, then it is important for your total testosterone and sex hormone binding globulin (SHBG) baseline levels before starting and as part of ongoing monitoring.

This follows British Menopause Society guidelines to keep testosterone levels in safe ranges.

For people taking spironolactone, kidney function monitoring is critical. Spironolactone should only be used by people with normal kidney function, and in rare cases people taking it can develop high potassium levels. Use requires monitoring of kidney function (creatinine) and potassium levels.

Ruling Out Other Conditions

Sometimes what looks like menopause is actually something else entirely. Blood tests help doctors identify these conditions before starting hormone treatment.

Thyroid problems can mimic menopause symptoms. Some symptoms can be caused by other conditions such as an underactive thyroid or autoimmune disorders.

If there's the possibility that your symptoms may not be a result of menopause, blood tests may be conducted to rule out or confirm other causes.

The most important thyroid test is TSH (thyroid stimulating hormone). The best way to initially test thyroid function is to measure the TSH level in a blood sample.

Changes in TSH can serve as an "early warning system" – often occurring before the actual level of thyroid hormones in the body becomes too high or too low.

Ongoing Monitoring After Starting Treatment

Once you start hormone therapy, regular blood tests help ensure your treatment stays safe and effective. The frequency depends on your specific situation and medications.

Most people need blood tests every 3-6 months initially. Healthcare providers typically conduct blood tests before starting HRT or TRT to establish a baseline, then continue to do so every 3 to 6 months during treatment. This practice enables them to adjust doses as needed.

The monitoring focuses on key safety markers: Complete blood count checks for blood disorders, liver function tests ensure your liver handles the hormones properly, and lipid panels track your cardiovascular health.