The full 23-biomarker panel — what's on it, why, and what it tells you.
Most TRT clinics order four to six markers — total testosterone, sometimes free T, hematocrit, PSA. That's reading a quarter of the chart. TruWell orders all 23 biomarkers every quarter and a Utah-licensed nurse practitioner reads them in context. Here's the full list with what each marker actually tells your provider.
TruWell EditorialReviewed by Utah-licensed nurse practitionerPublished ≈ 9 min read
There's a difference between ”checking your testosterone” and reading the panel that actually tells your provider whether a protocol is working. Most TRT clinics do the first. TruWell does the second.
Here's the full 23-biomarker panel a Utah-licensed nurse practitioner reads on every TruWell patient, every 90 days — grouped by what each marker is actually for. Reference ranges below come from LabCorp 2026 standards. ”Optimal” targets reflect typical clinical practice patterns where most TRT patients report symptom resolution.
Hormonal Axis 8 markers
01 · Total Testosterone
Ref: 264–916 ng/dL
Optimal: 700–950
The headline number. Tells you how much testosterone is circulating in total — bound and unbound. Misleading on its own without SHBG and free T.
02 · Free Testosterone
Ref: 9.3–26.5 pg/mL
Optimal: 18–25
The biologically active fraction (~1–3% of total). What your tissues actually use for libido, energy, mood, muscle synthesis. The number that explains how you feel.
03 · SHBG
Ref: 16.5–55.9 nmol/L
Optimal: 20–45
Sex hormone binding globulin. Determines how much testosterone is bound (inactive) vs. free (active). Without SHBG, total T is half the story.
04 · Estradiol (E2)
Ref: 7.6–42.6 pg/mL
Optimal: 20–30
Estrogen in men — essential, not the enemy. Drives bone density, joint health, libido, mood, lipid metabolism. Crashed (<15) or elevated (>38) both cause symptoms.
05 · DHT (Dihydrotestosterone)
Ref: 30–85 ng/dL
Optimal: 40–70
Most potent androgen, derived from testosterone via 5-alpha reductase. Drives libido, virilization. Elevated DHT can accelerate hair loss; suppressed DHT can blunt libido.
06 · LH (Luteinizing Hormone)
Ref: 1.7–8.6 mIU/mL
On TRT: typically suppressed
Pituitary signal that tells the testes to make testosterone. On exogenous TRT, LH suppresses — expected. Important for diagnosing the type of hypogonadism (primary vs. secondary).
07 · FSH (Follicle-Stimulating Hormone)
Ref: 1.5–12.4 mIU/mL
On TRT: suppressed
Pituitary signal that drives spermatogenesis. Suppresses on TRT — relevant for fertility planning. If preserving fertility matters, HCG can be layered in to maintain testicular function.
08 · Prolactin
Ref: 4.0–15.2 ng/mL
Optimal: <15
Elevated prolactin can blunt libido and suppress the gonadal axis. Worth measuring at least at baseline to rule out a prolactinoma if libido doesn't respond to optimized testosterone.
Thyroid + Metabolic 4 markers
09 · TSH
Ref: 0.45–4.50 µIU/mL
Optimal: 1.0–2.5
Thyroid-stimulating hormone. Drives SHBG (high thyroid → high SHBG), interacts with testosterone metabolism, affects energy. Misread thyroid mimics testosterone deficiency.
10 · Free T4
Ref: 0.82–1.77 ng/dL
Optimal: 1.1–1.5
Free thyroxine — the storage form. Pairs with TSH for full thyroid picture. Low free T4 with high TSH = hypothyroidism (mimics low T symptoms).
11 · Free T3
Ref: 2.0–4.4 pg/mL
Optimal: 3.0–4.0
Free triiodothyronine — the active form. Drives cellular metabolism. Low free T3 = sluggish energy, weight gain, depression — even when TSH looks ”fine.”
Percentage of blood that's red cells. Testosterone increases red cell production. Above 52% = clinical concern (hyperviscosity, clot risk). Daily subq protocols typically stabilize hematocrit better than weekly IM.
14 · Hemoglobin
Ref: 13.2–17.1 g/dL
Optimal: 14–16
Oxygen-carrying protein. Tracks with hematocrit. Elevated hemoglobin without elevated hematocrit suggests dehydration; both elevated suggests TRT-related polycythemia.
15 · RBC (Red Blood Cells)
Ref: 4.20–5.80 M/µL
Optimal: 4.5–5.4
Red cell count. Together with hematocrit + hemoglobin, gives the full erythropoiesis picture. Trend over time matters more than any single value.
16 · Ferritin
Ref: 30–400 ng/mL
Optimal: 80–250
Iron storage protein. Low ferritin = depleted iron stores → fatigue, poor exercise recovery. High ferritin can signal inflammation or iron overload. Important context for hematocrit interpretation.
Lipid Panel 4 markers
17 · Total Cholesterol
Ref: <200 mg/dL
Optimal: 150–199
Sum of LDL + HDL + 20% of triglycerides. Useful but not the whole picture. The breakdown matters more than the total.
18 · LDL Cholesterol
Ref: <100 mg/dL
Optimal: <100
”Bad” cholesterol. Carries cholesterol from liver to tissues. Excess testosterone with aggressive aromatase inhibition can shift LDL upward — another reason not to crush estradiol.
19 · HDL Cholesterol
Ref: >40 mg/dL
Optimal: >50
”Good” cholesterol. Estradiol supports HDL — another reason E2 matters. Watching HDL trends on TRT helps catch over-aromatization or AI overuse.
20 · Triglycerides
Ref: <150 mg/dL
Optimal: <100
Reflects metabolic health more than dietary fat. Elevated triglycerides (>150) with low HDL signals insulin resistance — pairs with HbA1c for the metabolic picture.
Inflammation, Liver, Kidney 3 markers
21 · hs-CRP
Ref: <3.0 mg/L
Optimal: <1.0
High-sensitivity C-reactive protein. Systemic inflammation marker. Elevated hs-CRP correlates with cardiovascular risk, blunts testosterone signaling, and predicts metabolic deterioration.
22 · ALT (Alanine Aminotransferase)
Ref: 6–40 U/L
Optimal: 10–25
Liver enzyme. Elevated ALT can signal fatty liver, alcohol load, or medication burden. Liver health matters for testosterone metabolism, SHBG synthesis, and lipid handling.
23 · PSA (Prostate-Specific Antigen)
Ref: <4.0 ng/mL
Watch trend, not absolute
Prostate health marker. Testosterone replacement does not cause prostate cancer (modern literature is clear on this), but PSA monitoring catches benign prostatic changes early. Trend over quarters matters more than any single reading.
Optimization isn't more markers. It's reading the right markers in context.
Why most clinics order four to six markers
Cost reimbursement, supply-chain inertia, and provider training. Most insurance reimbursement for TRT monitoring covers total T, hematocrit, and PSA. Anything beyond that is considered ”extra” — even when those extras (free T, SHBG, estradiol, hs-CRP) are exactly what determine whether the protocol is working.
The result: a patient gets a label saying ”your testosterone is normal” while half the chart that would explain why he still feels symptomatic was never tested.
TruWell orders the full 23 every quarter regardless of insurance posture. Labs are ordered through LabCorp at-cost (no markup). The interpretation work is done by a Utah-licensed nurse practitioner who reads the markers in context — together, not in isolation.
Reading markers together — three concrete examples
Example 1 — Total T 600 but symptomatic. Reading total T alone says you're ”fine.” Reading SHBG (62 nmol/L) + free T (7.5 pg/mL) explains why you feel terrible. SHBG is binding most of the testosterone. The fix isn't more testosterone — it's lowering SHBG via daily subq stabilization, thyroid management, insulin sensitivity.
Example 2 — Joint pain on TRT. Total T 800, free T 22, estradiol 11. Reading T alone says ”great.” Reading estradiol says crashed. Joint pain is an E2 deficiency symptom. Fix isn't more testosterone — it's pulling back on any aromatase inhibitor and letting estradiol settle into 20-30.
Example 3 — Energy still low. Total T 850, free T 23, estradiol 28, hematocrit 47 — all great. But TSH 4.2, free T3 2.1, ferritin 28. The TRT is optimized; the thyroid and iron are the problem. Without those markers on the panel, the patient would be told ”your TRT is dialed in, must be something else” and walk out with the problem unsolved.
How TruWell handles this
23 markers, every 90 days, read by a licensed provider — included in the $140 all-in.
Labs ordered through LabCorp at-cost. Quarterly cadence catches drift before it becomes symptoms. Every panel is reviewed by a Utah-licensed nurse practitioner who reads the markers in context — together, not in isolation. The protocol adjusts from real data, not from extrapolation. No add-on fees.
What's NOT on the standard panel
Three markers that are sometimes worth ordering, but not on every quarterly panel:
IGF-1. Growth hormone proxy. Useful for athletic-performance optimization but not standard TRT monitoring.
Cortisol (AM). Stress hormone. Worth measuring if mood/sleep don't respond to optimized testosterone.
Vitamin D (25-OH). Affects testosterone production, immune function, mood. Often deficient in northern-latitude men. Worth measuring at baseline.
If symptoms suggest one of these is relevant, your TruWell provider adds it to a specific panel. They're available — they're just not on the routine quarterly default because not every patient needs them.
Want a provider to read your full panel — all 23 markers, in context?
Send us your last six months of labs (any clinic, any vendor — LabCorp, Quest, hospital draw). A Utah-licensed nurse practitioner reads them as a complete picture and tells you exactly what your current protocol is missing. No charge. No commitment to switch.