Blood Testing Part 1 - Which Tests and Why?

At a Glance

Blood tests are an essential part of gender-affirming hormone therapy (GAHT), helping clinicians assess overall health, establish baseline hormone levels and monitor treatment safety and effectiveness over time. Regular testing allows specialists to adjust hormone dosages, identify potential health concerns early and ensure treatment remains aligned with an individual’s transition goals while supporting long-term wellbeing.

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 PhD 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. Click here for Part 2.

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 used to check hormone levels (e.g. oestrogen and testosterone) and to assess how your body is responding to the medication you are taking. 

This helps  our specialists to understand how your body is reacting and to ensure that you are getting effective and safe treatment. In this guide, explore the types of blood tests for hormone levels and monitoring and why all our clients need to have a comprehensive blood test before starting gender-affirming care.

Why Regular Blood Testing Is a Good Thing

First, our specialists must understand your general health background and be fully  aware of any issues at the outset. Blood tests are a requirement when accessing medication through Eden New Life’s services to ensure your well-being.

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). These interim tests have less panels and so are cheaper, if you PAYG for them.

When taking gender-affirming medication, it is important that you have regular blood tests. Our specialists are able to understand, through these blood tests, 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 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 are 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, giving you additional peace of mind

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 have been no major changes in your overall 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 ensure it is working as it should and that you have the right number of red blood cells (low red blood cell counts can make you feel tired). 

Lastly, these blood tests check all your current hormone levels. From this baseline, 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 blood tests to check oestrogen levels are usually done every 12 weeks and focus on both monitoring the progress of hormone treatment and 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) test for hormone levels:

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 oestrogen in your body is at a clinically appropriate level so you achieve the best physiological outcome (i.e. the best feminising outcome in your case). 

Your testosterone level is also checked to ensure that oestrogen is lowering it as required. 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 oestrogen can affect how your liver works for some people.

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) test for hormone levels:

• FBC (Full Blood Count)

• Testosterone

• LFTs (Liver Function Tests)

• Fasting lipids

  
  

This test helps our specialists assess your response to the testosterone hormone that you are taking. This is to ensure that your testosterone level is within a clinically appropriate range so you achieve 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, our specialists monitor your full blood count. Lastly, this test monitors your liver function and cholesterol levels, as testosterone can affect the liver and metabolism in some people.

Are There Any Alternatives to Blood Tests?

Unfortunately, no. Most people do not enjoy having their blood taken for testing. But 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 required tests carried out on your blood sample are quite sensitive, and the finger-prick samples, being so small, often do not survive the transit time to the laboratory. 

These failures waste time and delay treatment, which 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.

How Eden New Life Makes Blood Testing Accessible and Convenient

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. 

We can help you with:

• Affordable subscription plans that include up to four blood tests per year

• Access to our PAYG blood testing service

• Checking blood tests referred by your GP

If you need any advice or support with understanding the different blood test requirements, you can contact our team at any time. Learn more about blood tests by booking your first chat with our team today.