Gender incongruence: tests before and during hormone treatment (adult)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Feminising hormones — initial tests
Laboratory tests before the first prescription
- Total testosterone
- Oestradiol
- Serum creatinine with eGFR (if spironolactone considered)if neededSpironolactone being considered: serum creatinine and electrolytes from the initial tests [2].
- Serum electrolytes (if spironolactone considered)if neededSpironolactone being considered: serum creatinine and electrolytes from the initial tests [2].
- ASTif neededHepatotoxic drug being considered (cyproterone acetate, bicalutamide) [2].
- ALTif neededHepatotoxic drug being considered (cyproterone acetate, bicalutamide) [2].
- Serum prolactin (if cyproterone acetate considered, with brain MRI)if neededCyproterone acetate being considered (2nd line, risk of meningioma): serum prolactin and brain MRI before starting [2].
- FBC (for baseline haemoglobin before oestrogens)if needednon-French guidelineWales and Australia do an FBC before any hormone treatment, since lowering testosterone lowers the haematocrit [3,4]. HAS reserves it for masculinising hormones [1].
- Lipid profile (according to general population recommendations)if neededAs in the general population, with no additional test because of the transition [1,2].
- Fasting plasma glucose (according to general population recommendations)if neededAs in the general population, with no additional test because of the transition [1,2].
- HIV serology (STI screening according to general recommendations)if neededSTI screening according to general-population recommendations (practices, partners) [1,2].
- Hepatitis B serology (HBsAg, anti-HBs, anti-HBc) (same)if neededSTI screening according to general-population recommendations (practices, partners) [1,2].
- Hepatitis C serology (same)if neededSTI screening according to general-population recommendations (practices, partners) [1,2].
- Syphilis serology (same)if neededSTI screening according to general-population recommendations (practices, partners) [1,2].
- Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR), sites according to practices (same)if neededSTI screening according to general-population recommendations (practices, partners) [1,2].
Feminising hormones — follow-up
At 3 months, then depending on control, then once a year
- Oestradiol
- Total testosterone
- Serum creatinine with eGFR (if spironolactone)if neededOn spironolactone [1,2].
- Serum electrolytes (if spironolactone)if neededOn spironolactone [1,2].
- ASTif neededOn bicalutamide [1,2].
- ALTif neededOn bicalutamide [1,2].
- Serum prolactin (if headaches, galactorrhoea or visual disturbance)if neededHeadaches, galactorrhoea or visual disturbances [1,2]; on cyproterone acetate, before starting, at 5 years then every 2 years, with brain MRI [2].
- Lipid profile, plasma glucose, STI screening (according to general population recommendations)if neededAs in the general population, with no additional test because of the transition [1,2].
Masculinising hormones — initial tests
Laboratory tests before the first prescription
- FBC (haemoglobin, haematocrit)
- AST
- ALT
- GGT
- ALP
- Total testosterone (for a baseline value before testosterone)if needednon-French guidelineWales and Australia measure testosterone before treatment [3,4]. HAS does not ask for it: its tests cover haematocrit, liver and the general recommendations [1]. NABM code: before treatment, testosterone is within the range of the sex assigned at birth, hence the "woman and child" code (1136) [5].
- Lipid profile (according to general population recommendations)if neededAs in the general population, with no additional test because of the transition [1,2].
- Fasting plasma glucose (according to general population recommendations)if neededAs in the general population, with no additional test because of the transition [1,2].
- HIV serology (STI screening according to general recommendations)if neededSTI screening according to general-population recommendations (practices, partners) [1,2].
- Hepatitis B serology (HBsAg, anti-HBs, anti-HBc) (same)if neededSTI screening according to general-population recommendations (practices, partners) [1,2].
- Hepatitis C serology (same)if neededSTI screening according to general-population recommendations (practices, partners) [1,2].
- Syphilis serology (same)if neededSTI screening according to general-population recommendations (practices, partners) [1,2].
- Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR), sites according to practices (same)if neededSTI screening according to general-population recommendations (practices, partners) [1,2].
- Serum β-hCG (if pregnancy possible)if neededPregnancy possible: testosterone is not a contraceptive [1,2]; test not provided for by HAS, added by some foreign guidelines [8].
Masculinising hormones — follow-up
At 3 months from the start and from each dose change, then once a year
- Total testosterone
- FBC (haemoglobin, haematocrit)
- LH (if gonadectomy)if neededAfter gonadectomy [1].
- Lipid profileif neededAs in the general population; cardiological monitoring is that of men [1].
- Plasma glucoseif neededAs in the general population; cardiological monitoring is that of men [1].
- Timing of the sample: enanthate, halfway between two injections; undecanoate, just before the next injection; gel, after at least one week of daily application and at least 2 hours after application.
Sources (8)
- Haute Autorité de santé. Transidentité : prise en charge de l'adulte. Recommandation de bonne pratique (texte des recommandations), juillet 2025.
- Haute Autorité de santé. Transidentité : prise en charge de l'adulte. Fiche destinée aux médecins spécialistes en médecine générale. Adoptée par le Collège le 17 juillet 2025.
- All Wales Medicines Strategy Group (pays de Galles, Royaume-Uni). Endocrine Management of Gender Incongruence in Adults: Prescribing Guidance for Non-specialist Practitioners. Novembre 2019, mise à jour en octobre 2025.
- Cheung AS, Wynne K, Erasmus J, Murray S, Zajac JD. Position statement on the hormonal management of adult transgender and gender diverse individuals. Med J Aust. 2019;211(3):127-133.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105, chapitre 10 Hormonologie.
- Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903.
- Coleman E, Radix AE, Bouman WP, et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health 2022;23(Suppl 1):S1-S259.
- Haute Autorité de santé. Transidentité : prise en charge de l'adulte. Argumentaire scientifique, juillet 2025 (tableaux 10, 21, 26 et 30).