What Bloodwork to Get Before Peptides and HRT (Exact Lab List)

Your skin is thinner, your sleep is worse, your body composition shifted sometime around 37, and you're done waiting for a doctor who takes 90 seconds to tell you everything's "normal." Before you start any peptide or HRT protocol, you need a specific set of labs that gives you real numbers, not vibes. This article is the exact list, what each result means for your protocol, when to draw, and where to get it all done for $130–$300 with no referral.

Key Takeaways

• A complete baseline panel for peptides or HRT runs 15–25 markers and costs $130–$300 through direct-to-consumer labs (2025 pricing).
• Draw blood on cycle day 2–4 if you're still menstruating, first thing in the morning, fasted for 10–12 hours, and stop biotin supplements 72 hours before.
• Retest at 6–8 weeks after starting your protocol, then a full panel at 3–6 months, then annually.
• "Normal" lab reference ranges are population averages that include sick people. Optimal ranges for estradiol, free testosterone, thyroid, and IGF-1 are narrower, and knowing the difference is the whole point.
• IGF-1 is non-negotiable before any GH-secretagogue peptide (CJC-1295, ipamorelin, tesamorelin). Without it, you're flying blind on growth hormone axis response.

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Why You Need Labs Before You Touch a Single Peptide or Hormone

A protocol without baseline bloodwork is a guess with a syringe. That's not caution talking. That's math. If you don't know where your estradiol sits today, you can't measure whether your HRT dose is actually doing anything in 8 weeks. If you don't have a pre-protocol IGF-1 number, you'll never know if your GH-secretagogue peptide is moving the needle or just moving your money.

Here's the other reason: labs are your leverage. Plenty of providers will prescribe HRT based on symptoms alone, and for straightforward menopause cases, NICE guidelines support that approach. But if you want testosterone added, or you're stacking peptides, or you want to optimize rather than just "treat symptoms," you need numbers that prove what's happening inside you. A provider who sees your SHBG is 120 nmol/L can't hand-wave away your low free testosterone. A fasting insulin of 14 mIU/L tells a completely different metabolic story than an HbA1c of 5.4% alone.

Bloodwork also protects you from yourself. You want to know your liver enzymes are clean before you add compounds your liver processes. You want to confirm your kidney function is solid before starting a GLP-1 agonist. These aren't barriers to entry. They're the foundation that makes everything after them work better.

Think of it this way: the $150 you spend on labs now saves you from 3 months of a protocol that wasn't calibrated to your actual biology.

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The Exact Labs to Order: Baseline Panel for Peptides and HRT

Not every woman needs every marker. Your panel depends on what you're planning to run. Here's the full menu, organized by category, with notes on which protocols require which tests.

If you're starting HRT only: Safety baseline + full hormonal panel + thyroid + metabolic markers + vitamin D and ferritin. That's roughly 18 markers.

If you're starting GH-secretagogue peptides (CJC-1295/ipamorelin, tesamorelin): Everything above plus IGF-1. Non-negotiable. IGF-1 is how you measure whether the peptide is actually increasing your growth hormone output.

If you're starting GLP-1 agonists (semaglutide, tirzepatide): Safety baseline + HbA1c + fasting insulin + fasting glucose + eGFR + lipid panel + thyroid. Personal or family history of medullary thyroid carcinoma is a contraindication for GLP-1 receptor agonists, so thyroid labs and that history matter here. If you're weighing tirzepatide vs retatrutide, the same baseline panel applies to both.

If you're running GHK-Cu or BPC-157: Safety baseline (especially liver enzymes), CRP for inflammation tracking, and CBC. Like most research peptides, these aren't FDA-approved for injection, which is exactly why the interesting real-world data lives in what women are actually reporting. Women on GHK-Cu protocols consistently report visible skin changes by weeks 4–6, and having a CRP baseline lets you track whether the anti-inflammatory mechanism is showing up in your bloodwork too.

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What Each Marker Actually Tells You (and Your Provider)

Numbers without context are just numbers. Here's what the important ones actually mean for your protocol decisions.

Estradiol (E2). In perimenopause, this number is a moving target. It can swing from 30 pg/mL to 400 pg/mL within the same cycle. A single reading isn't destiny, but it tells your provider where you are right now. Postmenopausal women typically sit below 30 pg/mL. On transdermal HRT, most providers target 50–200 pg/mL depending on symptoms. If your E2 comes back at 15 pg/mL and you feel like your skin aged 5 years overnight, that's not in your head.

FSH. A level above 25–30 mIU/mL on two separate draws, combined with missed periods, generally confirms you're in menopause. The Endocrine Society uses FSH alongside symptoms to guide HRT initiation. Under 40 with an FSH that high? That's premature ovarian insufficiency (POI), and it changes the entire conversation about how long you'll be on HRT.

SHBG (Sex Hormone-Binding Globulin). This is the one your regular doctor probably doesn't order, and it's the one that changes everything about how you read your testosterone. SHBG is a protein that binds to sex hormones and makes them unavailable. If your total testosterone looks "fine" at 35 ng/dL but your SHBG is 110 nmol/L, your free (usable) testosterone is in the basement. Oral estrogen raises SHBG. Transdermal estrogen doesn't raise it as much. This single marker can determine which HRT route makes more sense for you. The British Menopause Society specifically recommends checking SHBG and free testosterone before adding testosterone to HRT.

Fasting Insulin. Your HbA1c can be 5.3% (perfectly "normal") while your fasting insulin is 15+ mIU/L, which signals insulin resistance that hasn't shown up in glucose yet. This is the metabolic context that makes a GLP-1 agonist a smart move rather than a vanity play. Optimal fasting insulin is typically below 8 mIU/L. If yours is 12–20+, you're metabolically primed for a GLP-1 and your provider should know it.

IGF-1 (Insulin-like Growth Factor 1). This is the downstream marker of growth hormone. GH itself is pulsatile (it spikes and drops throughout the day), so a single GH blood draw is nearly useless. IGF-1 gives you the 24-hour average picture. Before starting CJC-1295/ipamorelin or tesamorelin, you need to know your baseline. Women running GH-secretagogue peptides typically see IGF-1 rise 30–80% from baseline over 8–12 weeks. If your baseline IGF-1 is already above 300 ng/mL (age-adjusted high), that changes the risk-benefit conversation and a peptide-literate provider will want to discuss it.

Ferritin. This is iron storage, and it's the most underrated marker on this list. A ferritin of 15 ng/mL is technically "in range" at most labs. It's also low enough to cause fatigue, hair thinning, brain fog, and cold intolerance that looks exactly like hypothyroidism. If you're about to start HRT or peptides and your ferritin is below 50 ng/mL, fixing that first can change how you respond to everything else.

Free T3 and Free T4. TSH alone is a screening test, not a diagnosis. A TSH of 3.5 mIU/L is "normal" but can coexist with a low free T3 that explains why you're exhausted and holding weight. If you're spending money on peptides to improve body composition and your thyroid conversion is sluggish, you're fighting uphill. Get the full picture.

CRP (C-Reactive Protein). Systemic inflammation is the background noise that makes everything harder: slower healing, worse skin, more visceral fat. A CRP above 3.0 mg/L is elevated. Women running anti-inflammatory peptides like GHK-Cu or BPC-157 use CRP as one objective marker to track whether the protocol is working beyond what they see in the mirror.

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When to Test: Timing Your Labs by Cycle, Protocol, and Route

Bad timing ruins good labs. A testosterone drawn at 4 PM will read 20–30% lower than the same woman's morning draw. An estradiol pulled on cycle day 21 tells a completely different story than cycle day 3. Here's how to time it right.

Pre-Protocol Draw

If you're already in menopause and not cycling, the cycle-day rule doesn't apply. Just do a morning fasted draw on any day.

Re-Test Schedule

6–8 weeks post-start. This is your first progress check. On HRT, you're looking at whether estradiol has reached target range and whether symptoms are responding. On GH-secretagogue peptides, IGF-1 should be moving upward. On GLP-1s, check HbA1c trajectory and metabolic markers. This draw doesn't need to be the full panel. Focus on the markers specific to your protocol plus liver enzymes.

3–6 months. Full panel repeat. This is where you see the real picture: lipid changes, thyroid shifts (HRT can alter thyroid binding), SHBG movement, and whether your dose needs adjustment.

Annually. Full safety and hormonal panel. Even if you feel great, annual labs catch drift before it becomes a problem. Providers who are serious about long-term peptide and HRT management will require this.

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Where to Order Labs Without a Referral (and What They Cost)

In most U.S. states, you can order your own bloodwork online, walk into a Quest or Labcorp draw site, and have results in 2–5 business days. No doctor visit. No referral. No insurance needed (and frankly, insurance rarely covers peptide-related labs anyway).

The move: If you already have a provider or telehealth clinic in mind, ask whether they bundle labs into the consultation cost. Many do, and it saves you from ordering twice. If you want to show up to your first appointment with numbers already in hand (power move), order through Ulta Lab Tests or Walk-In Lab 2 weeks before your consult. For guidance on finding a peptide-prescribing doctor, we've covered that separately.

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How to Read Your Results Before Your Provider Does

Here's the thing about standard lab reference ranges: they're built from the general population, which includes people who are sick, sedentary, and metabolically compromised. "Normal" on a Labcorp printout means "you're not dying." It doesn't mean optimal. And optimal is where the protocol decisions live.

Some key differences between "in range" and "where you actually want to be":

Estradiol (E2). Labcorp reference range for premenopausal women: 15–350 pg/mL. That range is enormous and almost meaningless. On HRT, most providers target 50–200 pg/mL for symptom relief and bone protection. Below 30 pg/mL postmenopause with symptoms? That's your case for starting or adjusting.

Free Testosterone. Reference range: 0.1–6.4 pg/mL (Quest). Many women feel best in the upper third. If yours is 0.8 pg/mL and your SHBG is high, you're functionally low regardless of what "in range" says.

TSH. Standard range: 0.4–4.5 mIU/L. The American Thyroid Association acknowledges that the upper limit is debated, and many functional and integrative providers consider anything above 2.5 mIU/L worth investigating, especially if free T3 is on the lower end.

IGF-1. Reference ranges are age-adjusted, and they drop with each decade. A 45-year-old woman with an IGF-1 of 90 ng/mL is "in range" but on the floor. Women running GH-secretagogue peptides typically aim for the upper quartile of their age-adjusted range (roughly 180–250 ng/mL for ages 40–55, depending on the lab).

Fasting Insulin. Many labs don't even flag this until it hits 25 mIU/L. Metabolic optimization providers consider anything above 8–10 mIU/L a sign of developing insulin resistance worth addressing.

Vitamin D. Standard "sufficient" cutoff: 30 ng/mL. Most hormone and peptide providers want you at 50–80 ng/mL for immune function, mood, and hormonal support.

• Liver enzymes (AST or ALT) above 2x the upper limit of normal. Your provider needs to investigate before adding any oral compound.
• eGFR below 30 mL/min. GLP-1 agonists require dose adjustment or may be contraindicated with significant kidney impairment.
• Hemoglobin or hematocrit already at the top of the range. Testosterone therapy can push these higher, increasing clot risk. Your provider will monitor more frequently.
• Fasting glucose above 126 mg/dL or HbA1c above 6.5%. That's diagnostic for type 2 diabetes, not just "metabolic context." It changes the treatment conversation entirely.

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Your Route Map: From Lab Order to Protocol Start

You don't need to figure this out in one sitting. Here's the sequence.

Step 1: Decide what you're planning to run. HRT? GH-secretagogue peptides? GLP-1? A combination? Your answer determines which markers you need from the table above. If you're navigating peptides alongside perimenopause, the hormonal panel becomes especially important.

Step 2: Order your panel. Pick one of the lab services above, or ask your intended provider if they bundle labs into the onboarding. If you're ordering on your own, build a custom panel that covers your protocol's requirements. Budget $130–$300.

Step 3: Get drawn. Morning. Fasted. Cycle day 2–4 if applicable. No biotin for 72 hours. Bring your lab order confirmation and an ID. The draw itself takes 5–10 minutes.

Step 4: Review your results against optimal ranges, not just reference ranges. Use the guidance in this article. Circle anything that's "in range" but not optimal. Note anything flagged high or low.

Step 5: Bring your results to your provider or telehealth consult. A peptide-literate provider or HRT specialist will use these numbers to calibrate your starting dose, flag anything that needs addressing first (like low ferritin or elevated liver enzymes), and set your retest timeline.

You're not asking permission. You're showing up prepared, with data, ready to have a real conversation about what you want and what your body needs to get there. Not sure which protocol fits your labs and goals? Build your personal plan based on where you actually are right now.

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FAQ

Do I need a doctor's order to get hormone and peptide bloodwork? In most U.S. states, no. Direct-to-consumer lab services like Ulta Lab Tests, Walk-In Lab, and Any Lab Test Now let you order and pay out of pocket without a referral. A handful of states (New York, New Jersey, Rhode Island) have restrictions. Check your state's rules on the lab service's website before ordering.

Which labs do I need specifically for GH-secretagogue peptides like CJC-1295 or ipamorelin? At minimum: IGF-1, fasting glucose, HbA1c, CBC, CMP (which includes liver enzymes), and a lipid panel. IGF-1 is the most important single marker because it's the only reliable way to measure whether the peptide is increasing your growth hormone output. Retest IGF-1 at 6–8 weeks.

What bloodwork should I add if I'm starting a GLP-1 like semaglutide? HbA1c, fasting glucose, fasting insulin, eGFR (kidney function), lipid panel, and a CMP. If you have any personal or family history of medullary thyroid carcinoma or MEN2 syndrome, your provider needs to know before prescribing. Thyroid labs (TSH, free T4) are also standard.

How much does a full baseline hormone panel cost out of pocket? $130–$300 through direct-to-consumer labs in 2025. A basic hormone panel (estradiol, FSH, SHBG, total/free testosterone) runs about $130–$150. Adding metabolic, thyroid, and peptide-specific markers pushes it to $200–$300. Some telehealth providers bundle labs into their consultation fee ($150–$400 total).

Should I fast before my hormone blood test? Yes, if your panel includes fasting glucose, fasting insulin, or a lipid panel (and it should). Fast for 10–12 hours. Water and plain black coffee are fine. Hormones like estradiol, FSH, and testosterone don't strictly require fasting, but since you're drawing everything at once, fasting covers all your bases.

What day of my cycle should I get blood drawn for HRT baseline? Cycle day 2–4 (counting the first day of your period as day 1). This is the early follicular phase, when FSH, LH, and estradiol are at their most stable and interpretable. If your cycles are irregular or absent, any day works. Just note where you are in your cycle on the lab order.

How often do I need to retest once I'm on HRT or peptides? First retest at 6–8 weeks (focused panel: the markers specific to your protocol plus liver enzymes). Full panel at 3–6 months. Then annually for ongoing monitoring. If your provider changes your dose, reset the clock: retest 6–8 weeks after any adjustment.

Why does my provider want SHBG and not just total testosterone? Because SHBG determines how much of your total testosterone is actually available to your cells. High SHBG (common with oral estrogen, low-calorie diets, and aging) binds testosterone and makes it unusable. A total T of 40 ng/dL with an SHBG of 120 nmol/L means your free testosterone is functionally very low. Without SHBG, the total number is misleading.

Can I use my regular doctor's lab work or do I need a separate panel? You can use existing labs if they're recent (within 3–6 months) and include the markers your protocol requires. The problem: most annual physicals only cover CBC, CMP, lipids, and TSH. They almost never include estradiol, free testosterone, SHBG, IGF-1, or fasting insulin. You'll likely need to supplement with the missing markers through a direct-to-consumer order.

What does it mean if my IGF-1 is already high before starting peptides? An IGF-1 above the upper quartile of your age-adjusted range (roughly above 250–300 ng/mL for women 40–55) warrants a conversation with your provider before starting GH-secretagogue peptides. It could mean your growth hormone axis is already active, or it could flag something that needs further evaluation. It doesn't automatically disqualify you, but it changes the starting dose and monitoring frequency. A peptide-literate provider will know what to do with this number.