The Testosterone Blood Panel Cheat Sheet: 14 Markers, What They Mean, What to Do

A testosterone level without context is nearly meaningless. Total T of 500 could mean everything is fine or everything is wrong, depending on a dozen other markers. Here's the comprehensive panel that gives you the complete picture — whether you're evaluating whether you need TRT, monitoring treatment, or optimizing your protocol.

The Essential 14

1. Total Testosterone

The headline number. Reference range: 264-916 ng/dL. Always draw before 10am for accurate results. Two morning draws are required for diagnosis — one sample can be misleading.

2. Free Testosterone

The biologically active fraction. This correlates with symptoms better than total T. Request calculated free T (from total T, SHBG, albumin) or equilibrium dialysis — avoid the direct/analog method, which is unreliable.

3. SHBG (Sex Hormone-Binding Globulin)

The protein that binds testosterone and makes it inactive. High SHBG = low free T even with normal total T. Increases with age, thyroid hormone, and liver disease.

4. Estradiol (Sensitive Assay)

Must use the sensitive/LC-MS assay — the standard immunoassay is inaccurate for male estradiol levels. Optimal on TRT: typically 20-40 pg/mL. Used to determine if an AI is needed (usually it isn't).

5-6. LH and FSH

Distinguish primary (testicular) from secondary (pituitary/hypothalamic) hypogonadism. Low LH + low T = secondary. High LH + low T = primary. On TRT, both will be suppressed to near-zero — this is expected.

7. Prolactin

Elevated prolactin can suppress testosterone production. Very high levels may indicate a pituitary adenoma. Should be checked at least once in the initial evaluation.

8. CBC (Complete Blood Count)

Includes hematocrit and hemoglobin — the critical TRT safety markers for polycythemia monitoring. Also screens for anemia and other blood disorders.

9. CMP (Comprehensive Metabolic Panel)

Liver function (AST, ALT) and kidney function (creatinine, BUN). Oral testosterone products can stress the liver; injectable and transdermal generally don't. Kidney function is relevant for overall metabolic health.

10. Lipid Panel

TRT can modestly affect cholesterol profiles. Typically: slight HDL decrease, LDL varies. AIs can worsen lipid profiles significantly, which is another reason to avoid them when possible.

11. PSA (Prostate-Specific Antigen)

Baseline before starting TRT, then monitored regularly. TRT may raise PSA modestly (typically 0.5-1.0 ng/mL). Rapid rises or values above 4.0 warrant urological evaluation.

12. Thyroid Panel (TSH, Free T4)

Thyroid dysfunction mimics many low-T symptoms. Always rule it out before attributing symptoms to testosterone deficiency alone.

13. DHEA-S

Adrenal androgen precursor. Low DHEA-S may indicate adrenal insufficiency as a contributor to fatigue and low libido independent of testosterone.

14. IGF-1

Growth hormone surrogate marker. Low IGF-1 alongside low T may indicate broader pituitary dysfunction. Also relevant for men interested in the metabolic health picture beyond testosterone.