Blood Testing Part 1 - Which tests and why?

By: Dr Deborah Black

Dr Deborah Black BSc. (Hons), Ph.D

Deborah is a member of the Client Care Team at Eden New Life, providing support to all our existing and potential new subscribers. She holds a Ph.D. from the University of Glasgow, and has several years’ experience assisting the provision of healthcare services for transgender, non-binary and intersex people. As a trans woman, Deborah has both the lived experience and insight into the issues and challenges facing our community. 

This is the first of two articles about blood testing that explain exactly what they are, why they are important, and finally your options and costs for tests. 

Why do we need blood tests?

We all need to have blood tests from time to time as part of our general healthcare. They are used as a check to make sure we are well, and to monitor the progress of any treatment we are receiving. In gender-affirming care, blood tests are similarly used to check how our bodies are reacting to the medication we are taking and to monitor things such as hormone levels (e.g. oestrogen and testosterone). This allows our specialists to ensure that you are getting effective and safe treatment. All our clients need to have a comprehensive blood test before starting gender-affirming treatment. Our specialists first need to have an understanding of your general health and to be aware of any issues at the outset. Blood tests are a non-optional requirement when accessing medication through Eden services to ensure your well-being.

Why regular blood testing is a good thing

In addition to the comprehensive blood test at the start of any treatment, you will also need to have regular tests (usually every 12 weeks after starting treatment for at least the first year). When taking gender-affirming medication it is important that you have regular blood tests. Our specialists know where your hormone levels need to be in order to keep you safe and to achieve your desired transition goals, whether this be feminisation or masculinisation. Our specialists will use these results to determine if any changes are needed to your recommended medication or medication dosage.

These regular blood tests also monitor things like liver function, cholesterol, and blood count, which can be affected by hormones over time. Our specialists use your results to catch any potential issues early, before they become problems. It’s a simple but important step that keeps your treatment on track and supports your long-term health. Your safety and well-being is always at the centre of everything we do. Our specialists will always contact you immediately by phone if there are any urgent concerns with your blood test results.

What are the different sets of blood tests required?

Starting out with care

As mentioned above, our clients need to have a comprehensive blood test before starting any treatment. We refer to this as a Type 1 blood test. This is the blood test you will be asked to have at the very beginning of any treatment. You’ll also need to have this  comprehensive check periodically (usually annually) to make sure there has been no major changes in your general health.

Here is a list of all the elements in a Type 1, comprehensive blood test:

(1) FBC (Full Blood Count)

(2) U&Es (Urea and Electrolytes)

(3) LFTs (Liver Function Tests)

(4) Fasting lipids

(5) HbA1c (diabetes)

(6) Oestradiol

(7) Testosterone

(8) Prolactin

(9) Sex-hormone binding globulin (SHBG)

(10) Follicle-stimulating hormone (FSH) 

(11) Luteinizing hormone (LH)

Amongst other things, this test checks that your liver and kidneys are working as they should. Our specialists need to know this as different hormones can affect these organs. The test also ensures that you do not have undiagnosed diabetes. But if you already know you have diabetes, our specialists make sure that it is under control. Your immune system is also checked to see that it is working as it should and that you have the right amount of red cells in your blood (low red blood cells can make you feel tired). Lastly, this blood test provides a baseline level of all your current hormones. From this, your response to any prescribed hormone medication can be effectively monitored.

Follow up tests - Feminising

Once treatment begins, you’ll need to have frequent monitoring blood tests (especially during the first year of treatment). These tests are usually every 12 weeks and are focussed on both monitoring the progress of hormone treatment as well as checking important things, such as liver function.

Depending on whether you are following the feminising or masculinising route, these tests are labelled Type 2 and Type 3 respectively. Here is a list of all the elements in the Type 2 test for monitoring feminising treatment:

Type 2 (follow up):

(1) Oestradiol

(2) Testosterone

(3) LFTs (Liver Function Tests)

This test helps our specialists check your response to the oestrogen hormone that you are taking. This is to ensure that the amount of oestrogen in your body is clinically at the correct level so you get the best physiological outcome (i.e. the best feminising outcome in your case). Your testosterone level is also checked to ensure that it is being lowered by the oestrogen. If it isn’t, our specialists may need to prescribe you additional medication (commonly known as blockers). Lastly, this test monitors your liver function, as for some people, oestrogen can affect how your liver works.

Follow up tests - Masculinising

Here is a list of all the elements in the Type 3 test for monitoring masculinising treatment:

Type 3 (follow up):

(1) FBC (Full Blood Count)

(2) Testosterone

(3) LFTs (Liver Function Tests)

(4) Fasting lipids

This test helps our specialists check your response to the testosterone hormone that you are taking. This is to ensure that the amount of testosterone in your body is clinically at the correct level so you get the best physiological outcome (i.e. the best masculinising outcome in your case). As testosterone can sometimes cause your body to produce too many red blood cells, your full blood count is monitored by our specialists. Lastly, this test monitors your liver function and cholesterol, as for some people, testosterone can affect your liver and metabolism.

Are there any alternatives to blood tests? (Hint: Unfortunately not!)

Most people do not enjoy having their blood taken for testing. Unfortunately, when it comes to safe gender-affirming care, the use of venous blood samples (i.e. where the blood is taken from a vein) is unavoidable.

We sometimes get asked about 'finger-prick' self-tests that can be done at home. Unfortunately, they aren’t suitable as about 1 in 5 of these tests fail, thus requiring a second (or third, or fourth…) test. Some of the tests required are quite sensitive, and the samples, being so small, often do not survive the transit time through the postal service. This wastes time and delays treatment, and is something we all want to avoid. Other alternatives to blood tests, such as saliva or urine tests, are ineffective in gender-affirming care. They generally do not give accurate results for important things such as hormone levels.

In gender affirming care, blood tests are unavoidable. But they are there to keep us safe and healthy, and importantly to make sure that we are getting the most effective treatment leading to the best possible outcomes, whether this be feminisation or masculinisation. If you need any advice or support with understanding the different blood test requirements, you can contact our team at any time.

Watch out for the second article in this series next week, which explains the various different options for getting blood tests for your Eden care, and the costs.

Best regards, Deborah