HRT monitoring — labs to get and where
This guide is harm-reduction information. It is not medical advice. Lab results require interpretation, and the safest interpretation comes from a clinician.
Without monitoring, HRT is guesswork. Lab work tells you whether your hormones are at safe levels, whether your liver is handling the medication, and whether anything quiet is going wrong. Skipping labs is the most common mistake people make on self-administered HRT.
What labs to get
For trans-feminine HRT (estrogen + antiandrogen)
| Test | Why it matters | Target |
|---|---|---|
| Estradiol (E2) | Confirms estrogen is working | 200–300 pg/mL |
| Testosterone (total) | Confirms antiandrogen is working | <50 ng/dL (suppressed to female range) |
| Prolactin | CPA elevates prolactin; very high prolactin suggests dose reduction | <25 ng/mL ideally |
| Liver function (ALT, AST, GGT) | CPA and bicalutamide are hepatotoxic | Within normal range |
| Potassium | Only relevant if on spironolactone | 3.5–5.0 mEq/L |
| Lipid panel | Yearly baseline | Within normal range |
| Brain MRI (when indicated) | If on long-term CPA and developing headaches, vision changes, or other neurological symptoms — rule out meningioma | Non-negotiable when symptomatic |
For trans-masculine HRT (testosterone)
| Test | Why it matters | Target |
|---|---|---|
| Testosterone (total) | Confirms dose is correct | 400–700 ng/dL |
| Estradiol (E2) | Should drop naturally; very high E2 may suggest aromatization | <50 pg/mL |
| Hematocrit / hemoglobin | Testosterone increases red blood cell count; high hematocrit raises clotting risk | <54% hematocrit |
| Lipid panel | Testosterone affects cholesterol | Within normal range |
| Liver function | Yearly baseline | Within normal range |
When to test
- Baseline (before starting HRT): liver function, lipids, complete blood count, basic metabolic panel. Establishes your starting point.
- 3 months after starting: full hormone panel + liver function. Confirms the regimen is working and not damaging anything.
- 6 months after starting: repeat hormone panel. Adjust doses based on results.
- Yearly thereafter: full panel + liver + lipids. Ongoing monitoring.
If you change a dose or add a medication, retest in 6–8 weeks.
How to time the blood draw
Hormone levels vary throughout the day. To get a meaningful reading:
- Estradiol: Test 3–6 hours after taking your dose if oral, or just before your next dose if injected. Sublingual estradiol peaks fast and falls fast — test 3 hours after a sublingual dose.
- Testosterone: Morning is best. Levels peak in the early morning and decline through the day.
- Prolactin: Morning, after at least 30 minutes of rest. Stress and exercise spike prolactin. Do not test right after running for the bus.
Where to get tested in Iraq
Iraqi private labs that handle hormone panels exist in:
- Baghdad — multiple private labs in Karrada, Mansour, and Jadriya
- Basra — several private labs in the city center
- Erbil — private labs in the Italian Village area and downtown
- Sulaymaniyah — private labs in Salim Street and Bakhtiari
- Najaf — limited but available
Practical tips:
- Pay in cash. Many private labs do not require ID for cash transactions. This protects your privacy.
- Use a fake or partial name if asked, where this is legal in your jurisdiction. Some labs will accept a single name without checking ID.
- Pick up results in person. Do not have results sent to your home address.
- Keep results out of family-shared cloud accounts. Save them somewhere only you can access — a personal email account, an encrypted note app, or a USB drive.
- Some labs run cheaper than others. A full hormone panel ranges from roughly 30,000 to 80,000 IQD across labs.
What to do with the results
Compare your numbers to the targets above. A few common scenarios:
- Estradiol is below target, testosterone is suppressed: Increase estrogen dose or improve sublingual technique. Do not increase antiandrogen.
- Estradiol is in range, testosterone is still high: Increase antiandrogen by a small amount and retest in 6–8 weeks. Do not skip ahead with large dose increases.
- Liver enzymes (ALT/AST) are 2–3× upper normal: Reduce or stop the antiandrogen. Retest in 4 weeks. If still elevated, switch antiandrogens.
- Liver enzymes are 5×+ upper normal: Stop the antiandrogen immediately. See a clinician.
- Prolactin is significantly elevated (>50 ng/mL): Reduce CPA dose. If symptoms (headache, vision changes, milk discharge), stop CPA and seek imaging.
A note on community lab interpretation
The collective has people who have read their own labs for years and can help interpret yours if you share them. We are not doctors. We can flag obvious problems and suggest dose adjustments based on community knowledge, but we cannot diagnose you. If something looks seriously wrong on your labs, please see a doctor — even an internist who is not familiar with HRT can interpret liver function and red blood cell counts.
If you would like to share lab results for community feedback, reach out via the community channel. We will never store or share them.