What Screenings Should You Get Before Starting Testosterone?

Starting testosterone safely requires more than checking hormone levels before the first injection. Dr. O’Connor explains that a comprehensive medical history and appropriate screening should come before TRT, beginning with the ABCDs™ and extending to cardiovascular, kidney, prostate, thyroid, mental health, medication, and family-history considerations.

He emphasizes understanding existing blood pressure and cholesterol problems and determining whether cardiovascular disease may already be present. Rather than waiting for a heart attack or stroke to reveal underlying disease, Dr. O’Connor discusses evaluating cardiovascular risk before testosterone begins and considering family history, alcohol use, medications, and other health factors.

Mental health history also matters. Dr. O’Connor specifically discusses depression and anxiety and explains that men with these conditions may require additional consideration when starting testosterone. He also stresses reviewing current medications, medication allergies, and the complete medical history instead of treating testosterone as an isolated hormone decision.

The evaluation should also include the heart, kidneys, prostate, and thyroid. Dr. O’Connor explains that testosterone does not cause prostate cancer but that existing prostate disease still needs to be understood, particularly in older men. Blood pressure is another major concern because androgens can adversely affect cardiovascular health in susceptible individuals.

Once testosterone begins, the focus shifts from baseline screening to ongoing monitoring. Dr. O’Connor discusses continued laboratory surveillance, including red blood cells, and emphasizes that men using testosterone or anabolic steroids should understand their underlying health first, reduce modifiable risks such as excessive sodium intake, and continue monitoring as their treatment progresses.