The baseline panel does three jobs at once: it establishes whether the patient qualifies for therapy, it records the safety values you will monitor for years, and it is the first invoice the patient sees. A sloppy panel misses a prolactinoma; a bloated panel costs $600 and scares off the patient. This is the male baseline the operating team uses across our clinics, with the reasoning for each line and the pricing math behind it.
The core panel (order on every new male patient)
| Test | Why it is on the panel | Note |
|---|---|---|
| Total testosterone | Diagnostic anchor; guidelines call for two morning values | Draw before 10 a.m., fasting preferred; LC-MS/MS method where available |
| Free testosterone (or SHBG to calculate) | Catches symptomatic men with normal total but high SHBG | Equilibrium dialysis or calculated; be consistent |
| SHBG | Explains discordant total/free; shifts with thyroid, insulin, liver | Needed for calculated free T |
| Estradiol, sensitive (LC-MS/MS) | Baseline for later aromatization management | Standard immunoassay overreads in men |
| LH and FSH | Distinguishes primary from secondary hypogonadism; informs fertility counseling | Low T with low/normal LH = secondary; investigate |
| Prolactin | Rules out pituitary cause when T is low with low LH | Marked elevation warrants imaging referral |
| CBC with hematocrit | The number TRT most reliably raises; baseline is mandatory | Hematocrit above your threshold at baseline = evaluate first |
| CMP | Liver and kidney function, glucose, electrolytes | Fasting |
| Lipid panel | Cardiometabolic baseline; TRT and oral agents can shift it | Fasting |
| HbA1c | Insulin resistance is common in low-T men and changes the plan | Add fasting insulin if metabolic picture is unclear |
| PSA | Required baseline before testosterone in age-appropriate men | Follow guideline thresholds for urology referral before starting |
| TSH with free T4 | Thyroid dysfunction mimics and compounds low-T symptoms | Add free T3 or antibodies when indicated |
| Vitamin D, 25-OH | Deficiency is common and cheap to correct | Patient-visible quick win |
Add-ons by clinical picture
- DHEA-S when fatigue and low libido persist with adequate testosterone, or in men over 50.
- IGF-1 if growth hormone secretagogues or peptides are part of your offering; baseline is essential before any such therapy.
- hs-CRP and ferritin for inflammatory or iron questions; ferritin also matters if you plan to manage hematocrit with phlebotomy.
- Fasting insulin when HbA1c is borderline and the patient is overweight.
- Semen analysis referral when fertility matters in the next 1–2 years. Testosterone suppresses spermatogenesis; document the discussion before the first dose.
What not to order at baseline
Full micronutrient panels, hormone metabolite urine tests, food sensitivity panels, and genetic panels add cost without changing the first decision. They belong in a second-tier offering for established patients who ask for them, priced separately.
Logistics that make or break the panel
- Morning, fasting, before 10 a.m. Put it on the requisition and in the patient’s text reminder. A 3 p.m. non-fasting draw can misclassify a patient.
- Two draws for diagnosis. Guidelines expect low testosterone confirmed on two separate mornings. Many clinics run the full panel once and a repeat total/free testosterone a week later at minimal cost.
- Standing order. A signed standing order for the baseline panel lets staff release requisitions the same day a patient enrolls. The Institute’s telemedicine hormone clinic operations playbook covers how the standing order, the lab account and the patient text sequence fit together.
- Result routing. Results land in the EHR, staff flag abnormal values against your written thresholds, and the clinician reviews before the consult.
Pricing the panel
Cash-pay clinics typically open a direct-bill (client-bill) account with a national reference lab, which prices tests at wholesale rates far below retail. Reasonable 2026 wholesale estimates for the core panel above run roughly $90–$180 depending on the lab, your negotiated schedule, and whether the sensitive estradiol and free T by dialysis are included. Draw fees and courier add $10–$25. Retail for the same panel at the lab’s patient-pay price can exceed $500.
Three pricing models work:
| Model | Typical patient price | When it fits |
|---|---|---|
| Bundled into the enrollment fee | $0 line item; enrollment $250–$500 includes baseline labs | Simplest; raises conversion; margin lives in the enrollment |
| Separate lab fee with markup | $199–$349 for the core panel | Transparent; patients compare favorably to retail |
| Pass-through at cost | $100–$200 | Membership-heavy clinics that make margin on the subscription |
Whichever you choose, state it on the pricing page and in the financial consent. A patient who discovers a lab bill after enrolling is a patient who posts about it. The Institute’s pricing and revenue guide works through how lab pricing interacts with membership tiers.
Documenting the result
The note should record the two testosterone values with draw times, the symptom inventory, the LH/FSH interpretation, the PSA and hematocrit baselines with the thresholds you applied, and the decision. That paragraph is what makes the first prescription defensible.
FAQ
Is a single testosterone value enough to start therapy?
Major guidelines call for two morning values below threshold plus consistent symptoms. A second total and free testosterone is inexpensive and makes the chart far stronger — document both.
Should every patient get a PSA?
Follow current guideline age ranges and shared decision-making, and document the discussion. For men in the age range where testosterone therapy warrants prostate monitoring, a baseline PSA before the first dose is standard practice.
Can I use an at-home finger-stick kit instead of a venous draw?
Some clinics use them for convenience, but accuracy for free testosterone and sensitive estradiol is limited. Our clinics use venous draws for baseline and reserve at-home options for selected follow-ups where the result quality is acceptable.
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