Critical Labs BEFORE Hormone Therapy!

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So you’ve taken the low T quiz and answered yes to 3 or more of the questions so you may have low testosterone. Your body has been talking to you and you notice that you have low energy and don’t have the get up and go to use to have, your libido has taken a vacation and that your erections are not as strong, you are gaining fat around the middle, and your muscles are shrinking, and you’re feeling like a grumpy old man. Your doctor has performed the physical exam and now it’s time to get the right labs and make the diagnosis. When you have your laboratory performed what we’re doing is gathering your personal biomarkers, which allows us to understand your current state of health.   This health baseline will help not only to make the diagnosis but also to guide your therapy. I personally love looking at biomarkers as we are getting an intimate view of what is occurring inside your body. The following table below is the initial screening labs that should be ordered prior to the initiation of hormone therapy.  The 2010 Endocrine Society guidelines, Urology guidelines, and Reproductive Medicine guidelines for the diagnosis of low T are only screening labs to make a diagnosis, but are insufficient prior to the initiation of hormone replacement therapy.

Alpha Male Medical Institute Initial Screening Labs


  • Total Testosterone
  • Testosterone Bioavailable or Weekly Bound
  • Testosterone Free
  • Cortisol AM
  • SHBG
  • HgA1c
  • Thyroid Panel (TSH, FT4, FT3, rT3)
  • LH/FSH
  • DHT
  • DHEA-Sulfate
  • Sensitive Estradiol
  • Liver panel
  • Serum Chemistries
  • Lyme titer if relevant by history


  • CBC
  • Insulin Immunoassay
  • Lipid Panel or Lipoprotein panel
  • Prolactin
  • Vitamin D
  • Cardiac CRP
  • Homocysteine
  • Iron
  • TIBC
  • Ferritin
  • IGF-1
  • IGF-BP3
  • PSA
  • Uric Acid
  • Urinalysis



Biomarkers to Strongly Consider:

  • IgG Food Sensitivity Testing
  • Micronutrient Testing
  • Lp-PLA2
  • MPO
  • NMR lipid, VAP, Berkley Heart Lab, or Cleveland Heart Lab
  • APO E


If you have a family history of an inherited blood clotting disorder, have had a previous blood clot, have an immediate family member who has had a blood clot, or are not sure then you should consider these labs as well.  There is strong evidence to support that having a pre-existing clotting disorder called (thrombophilia-hypofibrinolysis) combined with hormone therapy could potentially lead to a thromboembolic event such as a DVT, PE, Osteonecrosis of the femoral head, or worse.

* adverse interactions with birth control pills, estrogen replacement therapy

  • Factor V Leiden mutation*
  • Factor VIII
  • Factor XI
  • Factor II (Prothrombin Gene)*
  • Anticardiolipin antibody IgG/IgM*
  • Lupus Anticoagulant*
  • Fibrinogen
  • Homocysteine
  • Protein C & S Deficiency*
  • Lp(a)
  • PAI gene-Plasminogen Activator Inhibitor
  • Platelet P1A2 polymorphism for glycoprotein IIIa

Think these disorders are rare?  Think again!  Below is the Population Prevalence of Thrombophilia-Hypofibrinolysis.

  • 3% – eNOS T786C
  • 20 % – Plasminogen Activator Inhibitor gene 4G/4G
  • 6% – Factor V Leiden mutation
  • 11% – MTHFR
  • 5% – Prothrombin gene
  • 3% – Protein C deficiency
  • 1.5% – Protein S deficiency
  • 10% – Homocysteine > 13.5 umol/L
  • 20% – Lp(a)
  • 11% – Factor VIII >150%
  • 25% – Factor XI >150%
  • 3% – Anticardiolipin Antibody IgG > 22GPL/ml, IgM > 10 MPL/ml
  • 2.5% – Lupus Anticoagulant

How thrombophilia-hypofibrinolysis interacts to create a thrombus.

  • eNOS T786C – Smoking
  • Plasminogen Activator Inhibitor gene 4G/4G – Insulin, Triglycerides, Estrogen
  • Factor V Leiden mutation – MTHFR, Estrogen, Smoking, Protein C or S deficiency
  • MTHFR – Factor V, Estrogen
  • Prothrombin gene – MTHFR, Estrogen, Smoking, Factor V
  • Protein C deficiency – Estrogen
  • Protein S deficiency – Estrogen
  • Homocysteine > 13.5 umol/L – Estrogen
  • Lp(a)
  • Factor VIII >150%
  • Factor XI >150%
  • Antocardiolipin Antibody IgG > 22GPL/ml, IgM > 10 MPL/ml
  • Lupus Anticoagulant

All the Best in Health and Wellness,

Dr. Rob

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