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Tests to Request From Your Doctor

Standard XXY care monitors testosterone. Your actual risk profile is broader.

This page covers what to request, why it matters, and how to ask for it.

The Baseline Panel

Request all of these together. Frame it as: "I'd like a comprehensive baseline for my XXY risk profile."

Metabolic

Test	Why	Target Range
HbA1c	Long-term glucose control; diabetes risk 6x elevated	<5.7%
Fasting insulin	Insulin resistance detection; catches problems before glucose goes abnormal	<10 μIU/mL ideal
Lipid panel	Cardiovascular risk; metabolic syndrome component	LDL <100, HDL >40, TG <150
hsCRP	Inflammation marker; cardiovascular risk	<1.0 mg/L ideal, <3.0 acceptable

Script:

"Research shows XXY men have 4.4x higher metabolic syndrome prevalence and significantly elevated diabetes risk. I'd like HbA1c, fasting insulin, and hsCRP in addition to standard lipids – these detect insulin resistance and inflammation before fasting glucose becomes abnormal."

Reference: Bojesen et al. (2006) Diabetes Care

Bone Health

Test	Why	Target Range
25-OH Vitamin D	Critical for bone; predicts BMD better than testosterone	40-60 ng/mL (100-150 nmol/L)
DEXA scan	Bone density baseline; 25-48% have osteopenia/osteoporosis	T-score > -1.0
Calcium	Bone metabolism	8.5-10.5 mg/dL
PTH	Secondary hyperparathyroidism common in XXY	15-65 pg/mL

Script:

"XXY research shows 25-48% prevalence of osteopenia or osteoporosis, often present regardless of testosterone status. Muscle strength and vitamin D predict bone density better than testosterone in this population. I'd like a DEXA baseline and vitamin D level. Also requesting PTH – secondary hyperparathyroidism is documented in XXY."

Reference: Grande et al. (2023) Endocr Connect; Ferlin et al. (2010) Mol Hum Reprod

Coagulation / VTE

Test	Why	Target Range
Factor VIII	Often elevated in XXY; procoagulant	<150%
Homocysteine	Thrombophilia marker	<10 μmol/L ideal

Script:

"Swedish registry data shows XXY men have 6.4x higher VTE risk overall, and 12x higher before age 30 – comparable to inherited thrombophilia. I'd like baseline Factor VIII and homocysteine. More importantly, I need to discuss VTE prophylaxis protocols for surgery or long-haul travel."

Reference: Zoller et al. (2016) J Am Heart Assoc

Critical ask: Establish that you should receive prophylactic anticoagulation for surgery, same as inherited thrombophilia patients.

Autoimmune

Test	Why	Risk Context
TSH	Hypothyroidism 2.7x risk	0.5-2.5 mIU/L optimal
TPO antibodies	Autoimmune thyroid marker	Negative
ANA	Screening for SLE, Sjogren's	Negative or low titer
GAD65 antibodies	Type 1 diabetes 6.1x risk	Negative

Script:

"English national registry data shows XXY men have significantly elevated autoimmune risk – Sjogren's 19x, SLE 18x, Addison's 12x, Type 1 diabetes 6x, RA 3.3x, hypothyroidism 2.7x. These are typically female-predominant diseases, likely due to X chromosome gene dosage. I'd like baseline thyroid with TPO antibodies, ANA, and GAD65."

Reference: Seminog et al. (2015) Autoimmunity

Hormonal (Standard, But Complete)

Test	Why	Notes
Total testosterone	Standard monitoring	Trough level if on TRT
Free testosterone	More accurate for tissue availability	Calculate or measure
Estradiol	Can elevate on TRT	20-30 pg/mL on TRT
SHBG	Affects free T calculation	20-50 nmol/L typical
LH, FSH	Baseline or monitoring	Suppressed on TRT

Your endocrinologist likely covers this. If not:

Script:

"I'd like comprehensive hormone panel including free testosterone and estradiol, not just total testosterone."

The Full Request List

Print this or copy it:

Metabolic:

HbA1c
Fasting insulin
Lipid panel (LDL, HDL, triglycerides)
hsCRP

Bone:

25-OH Vitamin D
Calcium
PTH
DEXA scan (imaging, may need separate referral)

Coagulation:

Factor VIII
Homocysteine

Autoimmune:

TSH
TPO antibodies
ANA
GAD65 antibodies

Hormonal:

Total testosterone
Free testosterone (or SHBG to calculate)
Estradiol

How to Present This

Opening Frame

"I've been researching the full risk profile for Klinefelter syndrome based on recent literature. The standard hormone-focused monitoring misses several significant risks that are well-documented. I'd like to establish a comprehensive baseline."

If They're Receptive

Walk through the domains. Offer the references if they want them.

If They Push Back

"I understand this is more extensive than standard practice. The research is clear that standard practice for XXY is inadequate – it focuses on hormones while missing domains with equal or greater mortality impact. I'm happy to provide the journal references."

If They Refuse

You have options:

Ask them to document the refusal in your medical record
Request referral to endocrinology or hematology for specific domains
Seek a second opinion
Use private testing for some markers (vitamin D, glucose, lipids widely available)

You shouldn't have to fight for evidence-based screening. But sometimes you do.

Frequency

Test Category	Baseline	Ongoing
Metabolic (HbA1c, insulin, lipids, hsCRP)	Once	Every 6-12 months
Bone (Vitamin D, calcium, PTH)	Once	Vitamin D: quarterly until optimized, then 6-monthly
DEXA	Once	Every 2 years (annually if osteopenic)
Coagulation (Factor VIII, homocysteine)	Once	Not routine unless abnormal
Autoimmune (TSH, TPO, ANA, GAD65)	Once	TSH annually; others if symptoms emerge
Hormonal	Per your TRT protocol	Typically every 3-6 months

What You Can Test Yourself

Some markers don't require a GP:

Test	Home Option	Cost
Fasting glucose	Glucometer from pharmacy	$30 + strips
Vitamin D	Home test kits (finger prick, mail-in)	$40-60
Blood pressure	Home monitor	$50-80

See Track Yourself (Coming Soon) for full DIY protocol.

The Point

These tests exist. The evidence for requesting them exists. The gap is that no one's offering them to you.

You have to ask.

This page gives you the language to ask effectively – and the references to back it up if challenged.