If you are transgender/transfeminine which labs should your doctor order to monitor levels, or if you are DIY/no insurance, how do you get them, and how much does it cost?
Dr. William Powers has this list posted in his wiki:
- 4021 – ESTRADIOL
- 10231 – COMPREHENSIVE METABOLIC PANEL
- 6399 – CBC (INCLUDES DIFF/PLT)
- 745 – PROGESTERONE
- 15983 – TESTOSTERONE, TOTAL, MS
- 23244 – ESTRONE
- 7137 – FSH AND LH
- 496 – HEMOGLOBIN A1c
- 36169 – ESTRADIOL, FREE
- 30740 – SEX HORMONE BINDING GLOBULIN
- 37104 – ESTRONE SULFATE
- 7600 – LIPID PANEL, STANDARD
- 90567 – DIHYDROTESTOSTERONE
- 92208 – 3A ANDROSTANEDIOL GLUCURONIDE, ELISA
I believe Dr. Powers may use Quest labs, which are far away from me personally; also he is not my doctor to be clear. I typically use LabCorp, and before finding a new doctor I was using HealthLabs.com.
So what is the cost of these if you are DIY and don’t have a doctor to order them? Again using HealthLabs.com:
- Estradiol/Free, Estrone, Lipid Panel, Hemoglobin, LH, CBC, Testosterone/Free, Basic Metabolic Panel: https://www.healthlabs.com/transitional-hormone-wellness-panel
- Dihydrotestosterone: https://www.healthlabs.com/dihydrotestosterone-dht-testing
- SHBG (Sex Hormone Binding Globulin): https://www.healthlabs.com/sex-hormone-binding-globulin-shbg-testing
- Liver Function: https://www.healthlabs.com/liver-function-test
If you are taking Bicalutamide particularly, the Liver Function test is a good idea. From Dr. Powers list, the above HealthLabs.com items cover the items I made bold. There are definitely some holes in the HealthLabs.com list I provided; however, I strongly recommend you get a doctor to order the full list in that case due to the overlap/additional costs by ordering from HealthLabs.com or similar sites. The total cost of the list I provided, with a bulk discount, should be around $420.
Personally I have not done SHBG labs, which might be interesting to know, based upon Dr. Powers updated theory on Estradiol serum levels based upon SHBG, and less focus on the hormone absorption curve from various types of Estradiol applications.
In short, I will now be setting my goal estradiol level for each individual patient at the level at which they have the greatest fraction of E2 free pre-boron and simultaneously have an LH and FSH of zero with a SHBG goal of 115.
That number seems to range from 200pg/ml to 700pg/ml in 95% of my patients, and so I think that in doing so, I can use less estrogen to get more effect if I figure out exactly what that happy number is.
If you’ve noticed I cite Dr. Powers a lot, it’s because he actively shares clinical / applied research and results… I think most doctors shy away from this due to fear of liability, critical/contradictory peer review, etc. There’s sort of the science of HRT vs. the applied results of HRT. Dr. Powers I believe is much more focused on the applied results of HRT rather than the deeper science which when applied extremely broadly, may not yield specific outcomes that his patients are seeking.
Dr Powers is a wonderful dude. When I first started practicing trans medicine a few years ago, I reached out to him for advice a few times, and he was always very helpful. His methods really helped open my eyes early on to how dumb some of the current practices/guidelines in trans medicine are, how restrictive. So glad I got that perspective early on.