Medically reviewed by Uri Gedalia, MD, FACS
Chief Medical Officer, TrufaMED Urgent Care & Concierge Medicine
Board-Certified, General Surgery
Last reviewed: August 2026
Men’s hormone optimization has moved from niche to mainstream. Patients in their late 30s, 40s, and 50s arrive in our preventive care program asking specifically about testosterone, cortisol, thyroid, and metabolic markers. Most have been told by their PCP that their labs are ‘normal,’ which often means they are within the reference range, not that they are optimal.
This post is the panel we run for adult men interested in a serious hormone workup, what the optimal ranges are, and what we do clinically with the results.
The Full Panel
- Total testosterone (morning draw)
- Free testosterone (calculated or direct, preferably equilibrium dialysis if direct)
- SHBG (sex hormone binding globulin)
- Estradiol: sensitive assay (the standard immunoassay is unreliable in men)
- DHEA-S
- Cortisol AM (8 AM draw, fasted)
- Prolactin
- LH, FSH
- Full thyroid: TSH, free T4, free T3, reverse T3, anti-TPO, anti-TG
- IGF-1
- PSA in men over 40 or with family history
- Comprehensive metabolic panel, lipid panel, hsCRP, homocysteine
- Hematology: CBC with differential, ferritin
- Vitamin D 25-OH
- Fasting insulin and HbA1c
- Optional: full cardiovascular panel including ApoB and Lp(a)
The Optimal Ranges
Reference ranges are population-wide; optimal ranges are where most healthy adults function best:
- Total testosterone: ~600-900 ng/dL in symptomatic adult men. Lab reference range often goes down to 250-300; this is far from optimal.
- Free testosterone: 15-25 pg/mL typically
- Estradiol (sensitive): 20-35 pg/mL in adult men (not too high, not too low)
- DHEA-S: above 200 mcg/dL in middle-aged men is reasonable
- Cortisol AM: 10-15 mcg/dL fasted at 8 AM
- TSH: 1.0-2.5 mIU/L typically; higher TSH with low free T3 may warrant evaluation
- Free T3: upper half of reference range correlates with better energy/metabolic patterns
- IGF-1: middle of reference range adjusted for age
- Vitamin D 25-OH: 40-60 ng/mL
- HbA1c: under 5.4% optimal
- Fasting insulin: under 8 mU/L optimal
- hsCRP: under 1.0 mg/L optimal
What Drives Sub-Optimal Hormones
Before reaching for TRT or supplements, address the upstream drivers:
- Inadequate sleep: even one week of 5 hours/night reduces testosterone in healthy young men by 10-15%
- Visceral adiposity: converts testosterone to estradiol via aromatase
- Inadequate resistance training
- Chronic alcohol exposure
- Chronic stress with elevated cortisol
- Sub-clinical thyroid dysregulation
- Inflammation from poor sleep, poor diet, or untreated dental/gut conditions
- Endocrine-disrupting chemicals from plastics and personal care products
Many patients see meaningful improvements in their testosterone simply by sleeping more, losing visceral fat, and dialing in training before any intervention is needed.
When We Consider TRT
TRT is considered when:
- Clinical symptoms of hypogonadism are present (low libido, erectile dysfunction, fatigue, brain fog, depression, muscle loss, low motivation)
- Total testosterone consistently below 350 ng/dL on two morning draws
- Reversible causes have been addressed: sleep, weight, training, alcohol, sub-clinical thyroid issues
- No active contraindications (active prostate cancer, untreated severe sleep apnea, high hematocrit, fertility preservation if planning children)
Treatment is highly individualized. We do not run a one-size-fits-all protocol.
Cost
Full hormone panel out-of-pocket: approximately $450 to $700 depending on which add-ons are included. Most components are covered by insurance when clinically indicated.
TRT pharmacy costs are modest for the medication itself (testosterone cypionate is inexpensive). Follow-up labs and visits add to the annual cost. Concierge membership often makes the ongoing care more straightforward.
Frequently Asked Questions
How often should I retest?
Baseline panel, then 6-week recheck if anything is being adjusted (lifestyle, supplement, or medication). Annual recheck if stable.
Can I get this panel without seeing a physician first?
We require an initial visit to set up the appropriate panel for your history and goals. Subsequent reorders can be done with shorter follow-up visits.
Will my insurance cover the panel?
Most insurance covers the components when ordered by a physician for clinical evaluation. Some specialty markers may be self-pay.
Do you treat low testosterone in younger men (under 35)?
We evaluate. Younger men with low testosterone need careful workup for reversible causes (pituitary, testicular, medication-induced) before TRT is considered.