How to Start BHRT: What Blood Tests Are Needed?

Bioidentical hormone replacement therapy (BHRT) is a personalized treatment that uses hormones chemically identical to those produced by the human body to address imbalances, particularly during menopause, andropause, or other hormonal conditions. Starting BHRT requires careful planning and medical oversight to ensure safety and effectiveness. A critical first step is obtaining comprehensive blood tests to assess hormone levels and overall health, allowing healthcare providers to create a tailored treatment plan. This video outlines starting BHRT and the essential blood tests needed for successful therapy.

Steps to Start BHRT

Before beginning BHRT, individuals should follow these key steps:

1. Consult a Healthcare Provider: Work with a doctor or specialist experienced in BHRT. They will evaluate your symptoms (e.g., hot flashes, fatigue, low libido) and medical history to determine if BHRT is appropriate.
2. Complete Blood Tests: Blood tests provide a baseline for hormone levels and other health markers, guiding the customization of BHRT.
3. Review Results and Develop a Plan: Your provider will analyze test results to prescribe bioidentical hormones (e.g., estrogen, progesterone, testosterone) in the appropriate form (creams, patches, injections) and dosage.
4. Monitor and Adjust: Regular follow-up tests and appointments ensure the therapy is effective, with adjustments made to optimize hormone levels and minimize side effects.

Why Blood Tests Are Essential

Blood tests are critical for BHRT because they provide precise data on hormone levels, helping providers identify deficiencies or imbalances. They also assess overall health to rule out conditions that could affect treatment, such as liver or thyroid issues. Accurate testing ensures that BHRT is safe, effective, and tailored to your unique needs.

Essential Blood Tests for Starting BHRT

The following blood tests are commonly recommended before initiating BHRT. The specific panel may vary based on your symptoms, gender, and medical history, but these are the core tests:

1. Estradiol (E2)

• Purpose: Measures the primary form of estrogen, which is crucial for women experiencing menopausal symptoms like hot flashes or vaginal dryness, and for men to monitor potential estrogen imbalances during testosterone therapy.
• Why It’s Needed: Determines if estrogen levels are low, high, or imbalanced, guiding estrogen replacement or suppression.

2. Progesterone

• Purpose: Assesses progesterone levels, which are important for women to balance estrogen and manage symptoms like mood swings or irregular periods. In men, progesterone plays a lesser role but may be tested for overall hormonal balance.
• Why It’s Needed: Believed to ensure proper dosing of progesterone in BHRT to prevent estrogen dominance and support uterine health in women.
• Is It Really Useful? Some of the leaders in the BHRT arena do not use progesterone blood levels due to their wide, day-to-day fluctuations.

3. Testosterone (Total and Free)

• Purpose: Measures total testosterone (bound and unbound) and free testosterone (bioavailable) in both men and women. Low testosterone can cause fatigue, low libido, and muscle loss.
• Why It’s Needed: Identifies testosterone deficiencies, particularly for men with andropause or women with hormonal imbalances, to guide BHRT dosing.

4. Sex Hormone-Binding Globulin (SHBG)

• Purpose: Evaluates SHBG levels, a protein that binds to sex hormones, affecting their availability in the body.
• Why It’s Needed: Helps interpret testosterone and estrogen levels, as high or low SHBG can influence how much hormone is bioavailable or free.

5. Thyroid Panel (TSH, Free T3, Free T4, and TPO antibodies)

• Purpose: Assesses thyroid function, including thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4).
• Why It’s Needed: Thyroid dysfunction can mimic or exacerbate hormonal symptoms, and imbalances may need to be addressed alongside BHRT.
• Importance: If there is a thyroid problem it must be treated concurrently with BHRT.

6. Complete Blood Count (CBC)

• Purpose: Evaluates overall health, including red and white blood cell counts, hemoglobin, and hematocrit.
• Why It’s Needed: Monitors for conditions like anemia or elevated red blood cell counts (common with testosterone therapy), ensuring BHRT is safe.

7. Comprehensive Metabolic Panel (CMP)

• Purpose: Assesses liver and kidney function, glucose levels, and electrolytes.
• Why It’s Needed: Ensures the body can safely metabolize hormones and identifies any underlying health issues that could affect BHRT.

8. DHEA-S (Dehydroepiandrosterone Sulfate)

• Purpose: Measures DHEA, a precursor to testosterone and estrogen, often supplemented in BHRT.
• Why It’s Needed: Determines if DHEA supplementation is necessary to support adrenal function and hormone production.

9. Cortisol

• Purpose: Evaluates adrenal function by measuring cortisol, a stress hormone.
• Why It’s Needed: Chronic stress or adrenal dysfunction can impact hormone balance, and cortisol levels help guide BHRT adjustments.

10. Lipid Panel

• Purpose: Measures cholesterol levels (HDL, LDL, total cholesterol, triglycerides).
• Why It’s Needed: Hormones can affect lipid metabolism, and a baseline is needed to monitor cardiovascular health during BHRT. The standard levels and interpretations are suspect but a llipid panel is still considered to be essential.

Optional Tests

Depending on individual symptoms or health concerns, additional tests may include:

• Follicle-Stimulating Hormone (FSH) and Luteinizing Hormone (LH): To assess reproductive hormone regulation, especially in menopause or andropause.0
• Prostate-Specific Antigen (PSA): For men, to monitor prostate health during testosterone therapy.
• Vitamin D: Low levels can affect hormone production and overall health.
• Insulin and HbA1c: To evaluate metabolic health, especially if weight gain or fatigue is a concern.

Timing and Preparation for Blood Tests

• Timing: Hormone levels fluctuate, so tests are often conducted in the morning when testosterone and cortisol levels are highest. For women, testing may be timed to specific menstrual cycle phases (if still menstruating) for accuracy.
• Preparation: Fast for 8–12 hours if a lipid panel or CMP is included. Avoid strenuous exercise, alcohol, or supplements 24–48 hours before testing, as they can skew results.
• Follow-Up Testing: After starting BHRT, repeat tests (typically every 3–6 months) monitor hormone levels, and adjust dosages to maintain optimal balance.

Working with Your Healthcare Provider

A qualified healthcare provider will interpret blood test results in the context of your symptoms and medical history. They may use results to prescribe FDA-approved bioidentical hormones (e.g., estradiol patches, testosterone gels) or compounded formulations tailored to your needs. Be cautious with compounded BHRT, be sure that your provider chooses a reputable pharmacy. Regular monitoring through blood tests ensures the therapy remains safe and effective.

Conclusion

Starting BHRT requires a thorough understanding of your hormone levels and overall health, which begins with comprehensive blood tests. Essential tests include estradiol, progesterone, testosterone, SHBG, thyroid panel, CBC, CMP, DHEA-S, cortisol, and lipid panel, with additional tests as needed. These tests provide a baseline to create a personalized BHRT plan, addressing symptoms of menopause, andropause, or other hormonal imbalances. By working closely with a healthcare provider and committing to regular monitoring, individuals can safely and effectively use BHRT to improve their quality of life.