Understanding the Essential Labs for Women on Hormone Replacement Therapy (HRT)

So what are the minimum labs we’re looking at when we do hormone replacement therapy? We obviously want to look at an estrogen level, so an estradiol, we definitely want to look at a progesterone level, and we also want to look at least a total testosterone, if not a total and free testosterone. And then of course, I always like to check a blood count, a CBC looking at white blood cells, red blood cells, platelets. Basically, I’m looking to make sure that there are no changes in the red blood cell count. And then I also like to look at a metabolic profile to make sure kidney and liver function is stable. It’s usually, if anything was to be off, it would lean more towards liver dysfunction. But knock on wood, I really have not ever seen that on appropriate doses of bioidentical hormone replacement therapy. So again, minimums to check in blood work would be an estradiol level, a progesterone and a testosterone level.

And then if we want to get really advanced and find out more about hormone metabolism, meaning how are you processing these hormones in your body, then I like to do something called a DUTCH test. So DUTCH stands for Dried Urine Testing of Comprehensive Hormones. And this is where I get to see what estrogen metabolites are doing, so two hydroxy estrogen, four hydroxy estrogen, 16 hydroxy estrogen. I get to see how you’re doing with your DHEA levels, your cortisol levels, and what happens to your cortisol curve throughout the day. I get to look at your testosterone metabolism, all of it. So we can get really advanced when and if we need to.