When a DirectCare AI clinician opens a new patient's bloodwork, they don't read the panel top-to-bottom in lab order. They open 12 markers first, because those 12 — read together — tell us almost everything we need to know about what's going on metabolically and hormonally.
Here are the 12, in the order we look at them, and what each one is telling us.
The hormone block.
1. Total testosterone. The headline hormone. We want morning, fasting values. For men: typical young-adult range is 600–900 ng/dL. For women: 25–60 ng/dL.
2. Free testosterone. What's actually available to your tissues. Often more clinically useful than total.
3. SHBG (sex hormone binding globulin). The protein that locks up sex hormones. High SHBG and "normal" total testosterone can functionally mean low free testosterone. Often elevated in perimenopausal women on oral estrogen.
4. Estradiol. Drives mood, sleep, skin, vaginal tissue, bone, and cardiovascular health in women — and matters more in men than most people realize. Too low or too high both produce symptoms.
5. LH and FSH. The pituitary signals. Tell us whether low testosterone or low estradiol is primary (the gonad is the bottleneck) or secondary (the brain is the bottleneck). Determines which protocol fits.
The metabolic block.
6. Fasting insulin + HOMA-IR. Insulin resistance precedes almost every metabolic problem we treat. Fasting insulin under 6 µIU/mL is excellent; over 12 means we're paying attention. HOMA-IR (calculated from fasting glucose × fasting insulin) is the cleanest single metric.
7. HbA1c. Three-month average blood sugar. Under 5.7 is ideal; 5.7–6.4 is prediabetic; over 6.5 is diabetic.
8. Triglycerides + HDL. The single most predictive ratio for metabolic health and cardiovascular risk is triglycerides-to-HDL. Under 1.5 is excellent; over 3 is a red flag regardless of total cholesterol.
The thyroid + foundation block.
9. TSH + free T3 + free T4. Subclinical hypothyroidism mimics nearly every menopausal and andropausal symptom and is missed constantly. We don't read TSH alone — we read the trio together.
10. Vitamin D (25-OH). Almost everyone is deficient. Target 50–80 ng/mL. Under 30 affects bone, mood, immune function, and hormone receptor sensitivity.
11. Ferritin. Iron stores. Critical for women (drives hair loss, fatigue) and underweighted in men (low ferritin can mask hidden bleeding). We want it 50–150.
12. hs-CRP. High-sensitivity C-reactive protein. The cleanest single marker of systemic inflammation. Under 1.0 is ideal. Over 3.0 is a flag — and inflammation undermines almost every protocol we'd prescribe.
What the other 60+ markers are for.
The full panel is broader for good reason: liver and kidney function, CBC, the lipid sub-fractions, hormones we screen but don't necessarily act on, autoimmune markers. They're part of the safety net.
But the protocol decisions — what HRT cream, what testosterone dose, whether to start a GLP-1, whether to add a thyroid medication, whether to push iron supplementation — come from those 12.
Why the panel matters more than the prescription.
The most common reason a telehealth protocol doesn't work isn't the medication. It's that the protocol was started without the panel — meaning the medication was matched to the symptom, not the cause.
The right protocol is downstream of the right panel. The right panel takes 30 minutes at a draw site and tells your clinician the next 12 months of your care.
Clinician-ordered, 80+ biomarker panel.
Real bloodwork, results in 3–5 days, with a personalized plan from a US-licensed clinician. Not a chart you have to decode yourself.
See my numbers →Editorial disclosure: This article is for informational purposes only and does not constitute medical advice. All treatments at DirectCare AI are prescribed by US-licensed clinicians based on individual medical evaluation. Compounded medications are not FDA-approved as finished products; their active ingredients are individually FDA-approved. Always consult a US-licensed clinician before starting or changing any therapy.