What Your Doctor Doesn't Order (But Should)
The standard annual physical bloodwork covers the basics: CBC, metabolic panel, maybe lipids. What it almost never includes: hormonal health, inflammation markers, or anything that would catch the slow decline in metabolic and hormonal function that hits most men in their 30s and 40s.
By the time you're symptomatic (fatigue, low libido, body fat gain, poor recovery), the underlying issue has often been building for years. The right labs catch it early.
Here's the complete panel — what to test, why it matters, and how to read the numbers.
Core Hormone Panel
Total Testosterone The headline number. Normal range is technically 300–1000 ng/dL, but "normal" is doing a lot of work here. A 35-year-old man with a total testosterone of 320 ng/dL is technically "in range" but functionally low. Optimal is generally considered 600–900 ng/dL for most men.
*What to do with it:* If you're symptomatic (fatigue, low libido, brain fog, difficulty gaining muscle) and testing below ~450–500 ng/dL, a conversation about TRT is warranted.
Free Testosterone Only ~2–3% of testosterone is "free" (unbound to proteins). The rest is bound to SHBG and albumin. Free T is what your tissues actually use. A man can have normal total T but low free T — particularly if SHBG is high — and be functionally hypogonadal.
*Optimal:* Around 15–25 pg/mL (varies by lab assay; know your reference range).
SHBG (Sex Hormone Binding Globulin) SHBG binds testosterone and makes it unavailable. High SHBG = low free testosterone even with normal total T. Common in older men, men who are lean, and those on certain medications.
LH (Luteinizing Hormone) and FSH These are pituitary hormones that signal the testes to produce testosterone. Low LH + low T = secondary hypogonadism (the problem is in the brain/pituitary, not the testes). Normal LH + low T = primary hypogonadism (the testes aren't responding). This distinction matters for treatment.
Estradiol (E2) Testosterone converts to estradiol via aromatase. Men need some estrogen for bone density, cardiovascular health, and libido. Too much (common in obese men) causes problems: water retention, gynecomastia, mood issues, reduced libido. Too little (overcorrection on TRT) is also bad.
*Optimal:* 20–30 pg/mL (sensitive assay). The LC/MS-MS assay is more accurate than standard immunoassay for men.
Prolactin Elevated prolactin can suppress testosterone and cause sexual dysfunction. Causes include prolactinoma, certain medications, and stress. Important to check if testosterone is low.
Metabolic Markers
Fasting Glucose and Insulin (not just glucose) Standard fasting glucose tells you if you're diabetic. Fasting insulin tells you if you're insulin resistant years before glucose rises. Most standard panels only order glucose. Request insulin too.
*Optimal:* Fasting insulin <7 mIU/L is ideal. 7–15 is mildly elevated (early insulin resistance). >15 is significant.
HbA1c (Hemoglobin A1c) 3-month average blood glucose. Catches prediabetes (5.7–6.4%) before it becomes diabetes.
Fasting lipid panel with advanced markers Standard lipids give you total cholesterol, LDL, HDL, triglycerides. More useful additions: - ApoB: Counts the actual number of atherogenic particles. More predictive of cardiovascular risk than LDL-C. - Lp(a): Genetically determined, major cardiovascular risk factor, not modifiable by lifestyle — but you need to know if it's high. - Triglycerides: <100 mg/dL is optimal. High triglycerides with low HDL is a classic marker of insulin resistance.
hsCRP (high-sensitivity C-reactive protein) Measures systemic inflammation. <1 mg/L is optimal. >3 mg/L indicates meaningful cardiovascular risk. Elevated without obvious cause may warrant investigation into metabolic health, gut microbiome, or other factors.
Thyroid
TSH (Thyroid Stimulating Hormone) The pituitary signal to the thyroid. Standard reference range (0.4–4.0 mIU/L) is broad and not perfectly correlated with symptoms. Many practitioners treat symptoms at TSH >2.5–3.0 in patients with symptoms.
Free T4 and Free T3 Directly measure thyroid hormone levels. TSH alone misses cases where conversion of T4 to active T3 is impaired.
Thyroid antibodies (TPO Ab, TgAb) If thyroid function is off, these tell you whether it's autoimmune in origin (Hashimoto's thyroiditis is common).
Vitamins and Minerals
Vitamin D (25-OH vitamin D) Deficiency is extremely common, associated with low testosterone, metabolic syndrome, immune dysfunction, and depression. Optimal: 50–80 ng/mL. Most people need supplementation (2000–5000 IU/day) to maintain this.
Magnesium (RBC, not serum) Standard serum magnesium is poorly correlated with actual tissue stores — your body maintains serum levels by pulling from bones. RBC magnesium is more accurate. Deficiency is common with high stress and poor diet.
Ferritin (iron stores) Low ferritin = iron deficiency = fatigue, poor recovery, reduced oxygen-carrying capacity. Men with high ferritin (>200 ng/mL) may have hereditary hemochromatosis or metabolic syndrome.
B12 and Folate B12 deficiency causes fatigue, neurological symptoms, and elevated homocysteine (cardiovascular risk marker). Common in people on metformin, vegans, and those with gut absorption issues.
Complete Blood Count
CBC with differential Catches anemia, infection, blood cell abnormalities. Relevant for men on TRT (hematocrit should stay <54%).
PSA (Prostate Specific Antigen) Recommended starting at 40–45 for men with higher risk (African American, family history), or at 50 for average risk. Relevant for men considering TRT — not because TRT causes prostate cancer (it doesn't), but because undiagnosed prostate cancer is a contraindication.
Putting It Together: The Minimum Annual Panel
If you can only do one panel per year, this covers the most ground: - Total T, Free T, SHBG, LH, Estradiol - Fasting glucose + insulin - HbA1c - Comprehensive metabolic panel - CBC - Lipids + ApoB - hsCRP - Vitamin D, Magnesium (RBC), B12 - TSH, Free T3, Free T4 - PSA (age-appropriate)
This panel is available through most direct-to-consumer lab services (LabCorp, Quest) for ~$200–400. Or through a telehealth physician consultation at Marrow.
[Get your hormones evaluated at Marrow →](/start)
Frequently Asked Questions
What blood tests should a man get to check testosterone?
At minimum: Total Testosterone, Free Testosterone, SHBG, LH, and Estradiol. Total testosterone alone misses cases of low free testosterone (due to high SHBG) and doesn't identify the cause. LH and FSH help distinguish primary versus secondary hypogonadism.
What is a low testosterone level for a man?
Clinically, below 300 ng/dL is considered hypogonadal. But 'normal' doesn't mean 'optimal.' Many men feel significantly better with testosterone in the 600–900 ng/dL range versus 300–400. If you have symptoms of low testosterone — fatigue, low libido, brain fog, difficulty building muscle — get tested and discuss the numbers with a physician.
Can I order my own lab tests without a doctor?
Yes — services like Ulta Lab Tests, Walk-In Lab, and others allow you to order most labs directly without a physician's order (except a few states that require a provider). You can also do labs through a telehealth consultation where a physician orders an appropriate panel.
What's the difference between total and free testosterone?
Total testosterone includes all testosterone in the blood — bound to proteins (SHBG and albumin) and unbound. Free testosterone is the ~2–3% that's unbound and biologically available to your tissues. A man can have normal total testosterone but low free testosterone if SHBG is high — and have all the symptoms of low T despite a 'normal' result.
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