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Where, when, and why/how we monitor

Where can I have my labs drawn?

Labs can be drawn either at your local Planned Parenthood Great Plains health center or at a Quest lab location. All labs drawn at PPGP health centers are sent to Quest labs for processing. 

Labs can be drawn in-person at your appointment at PPGP (if the timing is appropriate with your medications), or you can take a paper lab order to your closest Quest Lab station

Note: lab slips are generated with one’s legal name as recorded in the electronic medical record for correlation with insurance and your electronic medical record file (MyChart).

When should I have labs drawn?

Labs work is usually done more frequently in the first year of hormone therapy and less frequently as time passes. You can expect labs every three months when starting hormones; some health conditions and circumstances require more frequent bloodwork.

How should my lab draws be timed?

After your initial baseline lab tests, we recommend that you use your medications consistently for at least 4–6 weeks before having hormone levels drawn. Your clinician will make a recommendation for when your next lab testing should be performed based on whether you are starting on a new regimen, making adjustments, or maintaining a stable regimen.

Daily gels, patches Any time of day. Do not draw blood from an area where you applied medication.
Pills twice daily Mid-day, ideally 3–4 hours after pill use (but not a strict requirement)
Weekly injections 3–4 days after your weekly injections
Every-other-week injections Approximately 7 days after your injection

If you desire to have labs drawn at your in-person PPGP appointment, please consider the timing of your injections when booking your appointment.

Why do folks on hormones need to have labs drawn?

Checking labs helps us to optimize hormone regimens and ensure safety. Checking hormone levels also helps to guide dosing changes in line with an individual’s embodiment goals. 

Specifically, by medication, these are some of the labs we follow:

  • Spironolactone: Spironolactone should only be used by people with normal kidney function, and in rare cases people taking it can develop high potassium levels. Use requires monitoring of kidney function (creatinine) and potassium levels. 
  • Hemoglobin, hematocrit: Testosterone can increase red blood cell counts; when red blood cell counts are very high, there could be an increased risk of blood clots. Use requires monitoring of red blood cell count levels (hemoglobin, hematocrit).
  • Estradiol: For people taking estradiol (estrogen), we follow estradiol levels; for most individuals 50–200 pg/mL is an appropriate estradiol level for estrogen-based therapy.
  • Testosterone: For people taking testosterone, we follow testosterone levels; for most individuals 320–900 ng/dL is an appropriate level for testosterone-based hormone therapy. At higher levels, extra testosterone is converted by the body into estradiol. For people using medications to block testosterone production, the goal testosterone level is typically less than 55 ng/dL.
  • Additional labs such as an A1C (diabetes screening), lipid panel (cholesterol screening), or liver function testing may be recommended.

Once hormone levels are in the physiologic range, dose increases are not associated with improved response.

Hormone levels are useful for the following reasons:

  • To optimize therapy by having patients in the target hormone range.
  • To inform conversations with patients related to dosing changes.
  • For management of symptoms of hormone fluctuations, (e.g., check peak/trough on injections, and change to more stable dosing method if wide variation).
  • To ensure patients are in the appropriate physiologic range in the setting of conditions such as hyperlipidemia or polycythemia.

How will I get my results?

After having your labs done, unless there is an abnormal result, we will not be contacting you with lab results. But, if desired, you can view your own results on your MyChart portal.

How are lab costs billed?

If you do not have insurance, you will pay PPGP directly for lab costs for labs ordered by a PPGP clinician that are drawn either at PPGP or Quest Labs. If you have insurance, Quest will bill your insurance for your labs; you may receive a bill from your insurance company, and the amount is dependent on your insurance plan (and PPGP cannot quote a cost). If you have a special circumstance and are having labs drawn at another facility (a non-Quest lab, such as a hospital lab), you or your insurance will be billed directly by that facility for the lab costs (and PPGP cannot quote a cost).