Help Interpret Lab Results

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    Help Interpret Lab Results


    Any help is appreciated

    Background
    19 years old. Got sick about a year and a half ago for 2 weeks (havnt been sick since). My libido has been 0 ever since then, low energy, erection strength down, weakness, anxiety, ect. Went to a Doc about 1 year ago and told him I suspected low test levels, he did nothing. Symptoms never got better so I just went to a new Doc a week ago. He ordered some lab work. Got a call yesterday from the receptionist and she said everything looked normal, I knew that she would have no clue how to interpret them so I didnt take too much stock in her. so I went and got copies today....

    Labs

    Cortisol 18.1 (AM: 5-23) (PM: 3-16)

    Testosterone 437 (260-980)

    TSH 2.33 (.50-4.40)

    WSR 4 (0-21)

    All Blood glucose stuff was normal excpet calcium was lil high.

    My Questions
    -For a 19 year old, isnt my test pretty low?
    -Isn't my cortisol high regardless of age?
    -Would these test levels be the culprit of my low sex drive, erection strength, weakness, anxiety, ect?

    Thanks guys

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    Howd you get sick, what do you mean by sick, have you cycled before if so what?
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    Quote Originally Posted by somewhatgifted
    Howd you get sick, what do you mean by sick, have you cycled before if so what?
    Never cycled

    I think I had the Flu or Strep Throat th if I remember correctly

    The labs also checked for a ton of different viruses, and came back showing that I have had mono in the past (which I already knew 3-4 years ago)
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    TSh is pretty much worthless of a reading. PRoper testing for thyroid are TSH, free t-3, free t-4. Also like in my case drs never checked your free testosterone, or estrodial, dht, prolactin, dhea-s. How are you sleeping at night and are you waking up with energy? What are you eating pattern like (you eating balanced meals good fat content). Are you over weight, have you been through un neccessary stress such as school, relationships, problems at home, over training, hidden infections, ect Basicallly you need to look at your lifestyle patterns which can contribute to hormonal changes. YOu might just want to try a simple supplement ZMA before going to bed. Its could be a number of variable you just have to rule each one of them out. if you are working out take a week or so off and relax..
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    Quote Originally Posted by hardasnails1973
    TSh is pretty much worthless of a reading. PRoper testing for thyroid are TSH, free t-3, free t-4. Also like in my case drs never checked your free testosterone, or estrodial, dht, prolactin, dhea-s. How are you sleeping at night and are you waking up with energy? What are you eating pattern like (you eating balanced meals good fat content). Are you over weight, have you been through un neccessary stress such as school, relationships, problems at home, over training, hidden infections, ect Basicallly you need to look at your lifestyle patterns which can contribute to hormonal changes. YOu might just want to try a simple supplement ZMA before going to bed. Its could be a number of variable you just have to rule each one of them out. if you are working out take a week or so off and relax..
    not really stressed

    ive used zma, trib, ai, w vaired results

    i eat very very healthy, and am 5'11 175lbs 11% bf

    sleep is good

    the labs also tested for like 30 different infections, and all came back fine

    can anyone tell me what the normal test levels are for a 19 year old?
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    Quote Originally Posted by ECTOmorph
    not really stressed

    ive used zma, trib, ai, w vaired results

    i eat very very healthy, and am 5'11 175lbs 11% bf

    sleep is good

    the labs also tested for like 30 different infections, and all came back fine

    can anyone tell me what the normal test levels are for a 19 year old?
    (260-980) <---- normal ranges, which im sure you know. Id guess your low for your age as your just past your peak hormone wise. Unfortunetely docs wont do any if much without you being out of normal ranges which vary greatly.
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    what do u eat over the day ?
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    Quote Originally Posted by ECTOmorph
    not really stressed

    ive used zma, trib, ai, w vaired results

    i eat very very healthy, and am 5'11 175lbs 11% bf

    sleep is good

    the labs also tested for like 30 different infections, and all came back fine

    can anyone tell me what the normal test levels are for a 19 year old?
    Your levels are normal but for a 85 yr. old man. You need to do more testing to find out what is doing this. Your Cortisol levels were not to high but dam good your morning levels should be the highest in the early morning.
    There are a lot of things that can make your levels go down a fatty liver or a low graid infection. Here is a cut & paste of the tests and why that Dr. John dose get them if you find a problem and fix it your levels will go back up.
    Phil

    INITIAL LABWORK

    Following a good Medical History, which laboratory assays should be
    run as part of your initial hypogonadism workup? Following is my
    list, but certainly other specialists in this area run expanded or
    attenuated panels, per their experience and expertise. Of note,
    there are several other tests which should be included to complete
    the true comprehensive Anti-Aging Medicine workup (i.e.
    homocysteine, fasting insulin, comprehensive thyroid study, etc.),
    as this chapter is concerned solely with administering TRT. And as
    always, the panel is tailored to the individual patient. Here they
    are:

    • Total Testosterone
    • Bioavailable Testosterone (AKA "Free and Loosely Bound")
    • Free Testosterone (if Bioavailable T is unavailable)
    • DHT
    • Estradiol (specify the Extraction Method, or "sensitive" assay for
    males)
    • LH
    • FSH
    • Prolactin
    • Cortisol
    • Thyroid Panel
    • CBC
    • Comprehensive Metabolic Panel
    • Lipid Profile
    • PSA (if over 40)
    • IGF-1 (if HGH therapy is being considered)


    FOLLOW-UP LABS

    Two weeks after initiating a transdermal, or five weeks after the
    first IM injection:

    • Total Testosterone
    • Bioavailable Testosterone
    • Free Testosterone (if Bioavailable T is still unavailable)
    • Estradiol (specify the Extraction Method, or "sensitive" assay for
    males)
    • DHT (especially if patient is using a transdermal delivery system)
    • FSH (3rd Generation—ultrasensitive assay this time)
    • CBC
    • Comprehensive Metabolic Panel
    • Lipid Profile
    • PSA (for more senior patients)
    • IGF-1 (if GH Therapy has been initiated already)


    INDIVIDUAL ASSAYS EXPLAINED

    TOTAL TESTOSTERONE

    This is the assay your patients will most focus on. It's also the
    one physicians who do not understand TRT will use to deny patients
    the testosterone supplementation they want, and need, when Total T
    is at low-normal levels. Total T is important for titration of
    dosing, but its relevance is reduced in older men (by virtue of
    their increased serum concentrations of SHBG), in favor of:


    BIOAVAILABLE TESTOSTERONE

    Where we actually get the "bang" for the hormonal buck, so to speak.
    This is the actual amount the body has available for use, as the
    concentration of hormone available within the capillary beds
    approximates the sum of the Free Testosterone plus that which is
    loosely bound to carrier proteins, primarily albumin. If Bio T is
    not readily available, Free T may be a second choice substitute, as
    Bio T and Free T serum concentrations are well correlated.


    DHT

    This assay is especially important to draw, up-front and at follow-
    up, if a transdermal testosterone delivery system is preferred by
    the patient. I'll explain why later. DHT level may also help
    indicate cause for ED symptoms.


    ESTRADIOL

    There are several reasons why this assay is VERY important, and
    should not be ignored in ANY hypogonadism work-up (or subsequent
    regimen). First, you definitely need to draw a baseline. Next,
    elevated estrogen can, in and of itself, explain hypogonadal
    symptoms. If E is elevated, controlling serum concentrations
    (usually with an aromatase inhibitor, which prevents conversion of T
    into E) may suffice in clearing the symptoms of hypogonadism. And
    finally, rechecking it after beginning the initial dose of
    testosterone will give the astute physician valuable information as
    to how the patient's individual hormonal system functions, as well
    as making sure estrogen does not elevate inappropriately secondary
    to the testosterone supplementation.

    I don't waste time and money drawing estrone and estriol. E2 is the
    player of interest here. Unless you specify a `sensitive' assay for
    male patients, the lab will run the Rapid Estradiol for fertility
    studies in females, which is useless for our purpose here. Quest
    Diagnostics calls this their Estradiol by Extraction Method.

    Some practitioners believe that it is only the T/E ratio which is
    significant, and therefore, as long as E "appropriately" rises with
    elevations in T, all is well. However, the absolute concentration of
    E is of concern, too, especially in light of new information
    pointing to elevated estrogen as cause, or adjunctively encouraging,
    several serious disease processes, including prostate and colon
    cancer.


    LH

    As everyone knows, it is LH which stimulates the Leydig cells of the
    testes to produce testosterone. A caveat, however: LH has a half-
    life of only about 30 minutes. When you combine this fact with the
    absolute pulsatile nature of its pituitary release, care must be
    taken to not place too much weight upon a single draw. A luxury
    would be to acquire serial draws, say, twenty minutes apart.
    However, such would be both inconvenient and probably prohibitively
    expensive for the patient. The most important reason to assay the
    gonadotrophins is to differentiate between primary and secondary
    (hypogonadotrophic) hypogonadism.

    FSH

    The eight hour half-life of this hormone makes it a better marker
    for gonadotrophin production. It is also less an acute phase
    reactant to varying serum androgen and estrogen levels than LH.
    Greatly elevated FSH levels could signal a gonadotrophin-secreting
    pituitary tumor.

    Of note, I run FSH (but not LH) on the follow-up labs, the new third
    generation ("sensitive") assay, to determine the magnitude of HPTA
    suppression secondary to androgen therapy. It also provides valuable
    information for those patients undergoing TRT who are interested in
    the state of their fertility.

    PROLACTIN

    A very important hormone, and must not be overlooked on initial work-
    up. Approaching five percent of hypogonadotrophic hypogonadism is
    associated with hyperprolactinemia, due to inhibition of
    hypothalamic release of LHRH. Its serum concentration must be
    maintained within physiological range (meaning neither too high nor
    too low). Greatly elevated hyperprolactinemia, or hyperprolactinemia
    plus a Total Testosterone less than 150ng/dL, equals a trip to an
    Endocrinologist for an MRI of the sella turcica.

    CORTISOL

    True Anti-Aging medicine must be well-familiarized with the ins and
    outs of this hormone, the only one our bodies cannot live without.
    Elevated levels can cause secondary (hypogonadotrophic)
    hypogonadism. I try controlling elevated cortisol with
    Phosphatidylserine, 300mg QD, with good results. It is just as
    important to watch for depressed cortisol levels, as well. The assay
    of choice for that condition is a 24-hour urine.

    THYROID PANEL

    I have, for my own convenience, omitted the specifics of the
    obligatory thyroid function panel you certainly will want to run.
    Hypothyroidism mimics hypogonadism in several of its effects.

    CBC

    This is just good medicine. Ruling out anemia is important, of
    course, as it may be a cause for the fatigue which brought the
    patient into your office. You also want to establish baseline H&H,
    for those rare cases where polycythemia becomes a problem (and we
    are reminded smokers are at increased risk for polycythemia). Above
    18.0/55.0 TRT is withheld, and therapeutic phlebotomy recommended.


    CMP

    Again, just good medicine. Baseline for sodium (which may elevate
    initially secondary to androgen supplementation) is important. We
    also want to see LFT's, as elevations in same secondary to androgen
    supplementation are listed as a possible side effect in the product
    literature (although I have yet to see this actually happen). I like
    the BUN/creatinine ratio as a marker for hormonal hemo-
    concentration, and also it gives me a hint of how compliant the
    patient will be (because I always tell them to make sure to drink
    plenty of water while fasting for the test).


    Lipid Panel

    This is drawn to provide your bragging rights when you drop the CHOL
    30 points, thanks to your own good administration of TRT. You should
    expect to see lowered TRIG and LDL's, too. Be advised, this will not
    happen if you choose to elevate their androgens above the top
    of "normal" range, i.e. providing what amounts to an anabolic
    steroid cycle. Of course, this would no longer constitute TRT, as
    the practitioner would then be choosing to damage the health and
    well-being of the patient.

    HDL does frequently drop a bit, but that is believed to be due to
    increased REVERSE cholesterol transport; so much of the plaque is,
    after being scavenged from the lining of the CV system by HDL, now
    being chewed up by the liver. Androgens also elevate hepatic lipase,
    and this may have an effect. The important thing to keep in mind is
    that TRT inhibits foam cell formation.

    PSA

    For all patients over 40. Even though prostate CA is rare in men
    under the age of fifty, we don't want it happening on our watch, do
    we? At this time, rises in PSA above 0.75 are a contraindication to
    TRT (until follow-up by a Urologist). You may find that, at the
    initiation of TRT in older men, when serum androgen levels are
    accelerating, PSA may, too. This is especially true when transdermal
    delivery systems are employed, because they more greatly elevate
    DHT. Once T levels have stabilized, PSA drops back down to roughly
    baseline. You won't really see gross elevations in PSA secondary to
    TRT administration in younger patients. New TRT patients need to be
    cautioned, and reminded, to abstain from sexual relations prior to
    the draw, as they may now be enjoying greatly elevated amounts of
    same.

    I get a PSA up front on my over 40 patients, at the one month follow-
    up in my more senior patients, and every six months after that. DRE
    (Digital Rectal Exam) is recommended twice per year as well,
    although the American Academy of Clinical Endocrinologists
    backs "every six to twelve months" in their 2002 Guidelines for
    treating hypogonadotrophic patients with TRT.

    IGF-1

    For those who are considering the addition of GH to their Anti-Aging
    regimen. IGF-1 will rise from testosterone supplementation, and vice
    versa. Let's grab a baseline now, before that happens.


    THINGS TO LOOK OUT FOR:

    CO-MORBIDITIES. Currently, only breast and active prostate cancer
    are absolute contraindications for TRT. Patients with serious
    cardiac, hepatic or renal disease must be monitored carefully due to
    possible edema secondary to sodium retention. Also, TRT may
    potentiate sleep apnea in some chronic pulmonary disease patients,
    although studies have also shown it can actually ameliorate the
    symptoms of sleep apnea.

    DRUG INTERACTIONS. TRT decreases insulin or oral diabetic medication
    requirements in diabetic patients. It also increases clearance of
    propranolol, and decreases clearance of oxyphenbutazone in those
    receiving such medications. TRT may increase coagulation times as
    well.
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    Quote Originally Posted by hardasnails1973
    what do u eat over the day ?
    depends day to day but moslty wheat bread, meats, eggs, milk, whey protein, fish, chicken, penaut butter, fish oils, ect

    very clean healthy diet
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    Quote Originally Posted by pmgamer18
    Your levels are normal but for a 85 yr. old man. You need to do more testing to find out what is doing this. Your Cortisol levels were not to high but dam good your morning levels should be the highest in the early morning.
    thanks.... ive pretty much figured that was my problem since i had every symtom. i was jsut so confused when the lady called and said everything looked normal. then i saw that test looked low to me and cortisol high

    hopefully dr john will see this thread. im thinking about emailing him since hes not too far from me and i really wanna get back to normal, i know most docs wont bother w me
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    Quote Originally Posted by pmgamer18
    Your levels are normal but for a 85 yr. old man.
    lol i thought u were exagerating at first then i read this somewhere....

    "Here are the facts: The average testosterone level in a man of 30 is about 600ng/dL (nanograms per deciliter), and it declines gradually as he gets older. At age 80, the average reading is around 400ng. But these numbers vary: Some men have more, some less."

    So i guess u werent that off

    Im reallt comemplating going to Dr John now....
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    Quote Originally Posted by ECTOmorph
    lol i thought u were exagerating at first then i read this somewhere....

    "Here are the facts: The average testosterone level in a man of 30 is about 600ng/dL (nanograms per deciliter), and it declines gradually as he gets older. At age 80, the average reading is around 400ng. But these numbers vary: Some men have more, some less."

    So i guess u werent that off

    Im reallt comemplating going to Dr John now....
    Yep I do feel seeing him is your best bet. What state are you in I am in MI.
    Phil
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    Quote Originally Posted by pmgamer18
    Yep I do feel seeing him is your best bet. What state are you in I am in MI.
    Phil
    Indiana

    I can take 69 straight there...bout 2 hours
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    Quote Originally Posted by ECTOmorph
    "Here are the facts: The average testosterone level in a man of 30 is about 600ng/dL (nanograms per deciliter), and it declines gradually as he gets older. At age 80, the average reading is around 400ng. But these numbers vary: Some men have more, some less."
    How about referencing this quote.
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    Quote Originally Posted by ECTOmorph
    Indiana

    I can take 69 straight there...bout 2 hours
    Great go to template007 and get his phone number then call Kim and set it up.
    Phil
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    Quote Originally Posted by B5150
    How about referencing this quote.
    i think it was this one. parade.com seems to be down right now, but it was an article on parade.com and that quote was about 1/3 of thr way down

    http://www.parade.com/articles/editi...6/Testosterone

    Quote Originally Posted by pmgamer18

    Great go to template007 and get his phone number then call Kim and set it up.
    Phil
    thanks a lot. im gonna have to run this by my parents first (still on their insurance, im in college right now) and see how the insurance will ahndle this, but ill prolly give kim a call monday or tuesday

    any idea how long it usually is to get a new patient appointment?
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    Quote Originally Posted by ECTOmorph
    i think it was this one. parade.com seems to be down right now, but it was an article on parade.com and that quote was about 1/3 of thr way down

    PARADE Magazine | Do You Need a Testosterone Boost?

    thanks a lot. im gonna have to run this by my parents first (still on their insurance, im in college right now) and see how the insurance will ahndle this, but ill prolly give kim a call monday or tuesday

    any idea how long it usually is to get a new patient appointment?
    Dr. John does not take Insurance there is a charge to see you the first time and anything after that is less then my co-payment.
    Phil
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    Quote Originally Posted by pmgamer18
    Dr. John does not take Insurance there is a charge to see you the first time and anything after that is less then my co-payment.
    Phil
    oh ok

    arent any extra visits 50 bux? my co pay is usually only 20
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    Sent an email to Dr John...hopefully if everything goes smoothly I can get an appointment here soon
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    Quote Originally Posted by ECTOmorph
    Sent an email to Dr John...hopefully if everything goes smoothly I can get an appointment here soon
    Great
    Phil
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    Quote Originally Posted by B5150
    Thanks been looking for something like this for a long time.
    Phil
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    Quote Originally Posted by somewhatgifted
    (260-980) <---- normal ranges, which im sure you know. Id guess your low for your age as your just past your peak hormone wise. Unfortunetely docs wont do any if much without you being out of normal ranges which vary greatly.
    I've seen a few sources that claim a man's testosterone level peaks at 30. I wish I could recall where I read that, but I can't...sorry.
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    Quote Originally Posted by colkurtz_spf
    I've seen a few sources that claim a man's testosterone level peaks at 30. I wish I could recall where I read that, but I can't...sorry.
    Me too, one was a line graph.
    Here is another source: Center For Clinical Age Management - Natural Hormone Replacement, Boca Raton Florida.

    I am abit confused by it as the bottom chart shows it peaks at <25 years of age. And the top one says it peaks at 35-44, wich I find hard to believe.
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    perhaps total test peaks at 35, but at 35 your shbg is higher and free test is lower than at 25
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