Supplemental: Testosterone Replacement Therapy (TRT)

What is Supplemental TRT Testing?

The Supplemental TRT blood test is the most comprehensive and advanced TRT monitoring available. This test adds advanced hormonal markers, thyroid function, complete blood count with differentiation, inflammatory markers, and additional cardiovascular risk factors. It is the ultimate test for men who want maximum insight into their hormonal health during TRT, in complex cases, or when standard TRT monitoring does not adequately explain symptoms. This test is recommended for persistent symptoms despite TRT, suspected coexisting conditions, or for men seeking optimal health.

What is tested?

• Testosterone (total) – Primary male hormone
• Free testosterone – Biologically active form
• SHBG – Sex Hormone Binding Globulin
• LH – Luteinizing hormone
• FSH – Follicle-stimulating hormone
• Estradiol – Main estrogen
• Prolactin – Pituitary hormone
• DHEA-S – Dehydroepiandrosterone sulfate
• PSA (total and free) – Comprehensive prostate assessment
• TSH – Thyroid function
• fT4 – Free thyroxine
• fT3 – Free triiodothyronine
• Complete blood count with differentiation – Hemoglobin, hematocrit, leukocytes, platelets + subtypes
• Complete liver function – ALT, AST, Gamma-GT, Alkaline phosphatase, Bilirubin
• Kidney function – Creatinine, eGFR, urea
• Extended lipid profile – Cholesterol, HDL, LDL, Triglycerides, Non-HDL, Apo B
• Glucose and HbA1c – Blood sugar regulation
• CRP (high-sensitivity) – Inflammatory marker
• Vitamin D – For bone health and immune system
• Ferritin – Iron storage
• Insulin (fasting) – Metabolic health

Why should you get Supplemental TRT testing?

This most comprehensive TRT test is suitable when standard TRT monitoring is insufficient, for persistent symptoms despite optimal testosterone levels, in complex hormonal problems, or for optimal health monitoring. DHEA-S provides insight into adrenal function. Complete thyroid function (TSH, fT4, fT3) is crucial because thyroid problems can limit TRT effectiveness. HbA1c and insulin monitor metabolic health because TRT can affect insulin sensitivity. hs-CRP measures systemic inflammation. Vitamin D and ferritin are important for optimal TRT response. This comprehensive package is recommended at the start of complex TRT trajectories, for unexplained symptoms, or for men who want to preventively optimize all aspects of their health.

What does it indicate?

The results provide the most complete picture of your hormonal and metabolic health during TRT. In addition to all standard TRT markers, adrenal function (DHEA-S), thyroid function (complete analysis), metabolic health (glucose, HbA1c, insulin), inflammatory status (hs-CRP), nutritional status (vitamin D, ferritin), and advanced cardiovascular markers (Apo B, non-HDL) are also measured. This helps explain why some men respond optimally to TRT while others still experience symptoms despite good testosterone levels. Often, coexisting conditions such as hypothyroidism, adrenal fatigue, insulin resistance, or vitamin deficiencies are the explanation.

What does a high level mean?

Elevated testosterone requires dose reduction. Very high hematocrit (above 54%) is dangerous and requires immediate intervention. Elevated estradiol can be treated with aromatase inhibitors. Elevated PSA (especially elevated PSA/free PSA ratio) requires urological evaluation. High DHEA-S can indicate adrenal conditions. Elevated thyroid function (low TSH, high fT4/fT3) can worsen TRT side effects. Elevated HbA1c and insulin indicate insulin resistance or diabetes. High hs-CRP indicates systemic inflammation. High Apo B indicates increased cardiovascular risk despite normal LDL. These comprehensive markers help optimize all aspects of health.

What does a low level mean?

Low testosterone during TRT requires dose increase. Low DHEA-S can indicate adrenal fatigue which limits TRT effectiveness and may require supplementation. Low thyroid function (high TSH, low fT4/fT3) explains persistent fatigue despite optimal testosterone levels and requires thyroid treatment. Low vitamin D limits TRT response and bone health. Low ferritin can explain fatigue. Low HDL and high Apo B increase cardiovascular risk. This complete analysis helps identify and optimize all factors for maximum TRT effectiveness and overall health. It is the gold standard for complex TRT monitoring and preventive healthcare.