Help Interpret Lab Results
- 11-17-2006, 01:54 PM
Help Interpret Lab Results
Any help is appreciated
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....
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.
-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?
- 11-17-2006, 01:58 PM
Howd you get sick, what do you mean by sick, have you cycled before if so what?
- 11-17-2006, 02:47 PM
Originally Posted by somewhatgifted
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)
11-17-2006, 02:52 PM
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..
11-17-2006, 03:34 PM
not really stressedOriginally Posted by hardasnails1973
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?
11-17-2006, 04:05 PM
(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.Originally Posted by ECTOmorph
11-17-2006, 04:38 PM
11-17-2006, 05:16 PM
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.Originally Posted by ECTOmorph
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.
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
Bioavailable Testosterone (AKA "Free and Loosely Bound")
Free Testosterone (if Bioavailable T is unavailable)
Estradiol (specify the Extraction Method, or "sensitive" assay for
Comprehensive Metabolic Panel
PSA (if over 40)
IGF-1 (if HGH therapy is being considered)
Two weeks after initiating a transdermal, or five weeks after the
first IM injection:
Free Testosterone (if Bioavailable T is still unavailable)
Estradiol (specify the Extraction Method, or "sensitive" assay for
DHT (especially if patient is using a transdermal delivery system)
FSH (3rd Generationultrasensitive assay this time)
Comprehensive Metabolic Panel
PSA (for more senior patients)
IGF-1 (if GH Therapy has been initiated already)
INDIVIDUAL ASSAYS EXPLAINED
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:
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.
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.
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
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
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
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.
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.
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.
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.
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.
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).
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.
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
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.
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
11-17-2006, 07:22 PM
depends day to day but moslty wheat bread, meats, eggs, milk, whey protein, fish, chicken, penaut butter, fish oils, ectOriginally Posted by hardasnails1973
very clean healthy diet
11-17-2006, 07:25 PM
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 highOriginally Posted by pmgamer18
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
11-18-2006, 01:25 AM
lol i thought u were exagerating at first then i read this somewhere....Originally Posted by pmgamer18
"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....
11-18-2006, 10:57 AM
Yep I do feel seeing him is your best bet. What state are you in I am in MI.Originally Posted by ECTOmorph
11-18-2006, 11:16 AM
IndianaOriginally Posted by pmgamer18
I can take 69 straight there...bout 2 hours
11-18-2006, 11:25 AM
How about referencing this quote.Originally Posted by ECTOmorph
11-18-2006, 11:26 AM
11-18-2006, 11:36 AM
11-18-2006, 12:29 PM
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 downOriginally Posted by B5150
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 tuesdayOriginally Posted by pmgamer18
any idea how long it usually is to get a new patient appointment?
11-18-2006, 01:43 PM
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.Originally Posted by ECTOmorph
11-18-2006, 06:57 PM
oh okOriginally Posted by pmgamer18
arent any extra visits 50 bux? my co pay is usually only 20
11-19-2006, 11:43 PM
Sent an email to Dr John...hopefully if everything goes smoothly I can get an appointment here soon
11-20-2006, 10:50 AM
GreatOriginally Posted by ECTOmorph
11-25-2006, 10:28 AM
Thanks been looking for something like this for a long time.Originally Posted by B5150
11-25-2006, 06:19 PM
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.Originally Posted by somewhatgifted
11-26-2006, 08:31 PM
Me too, one was a line graph.Originally Posted by colkurtz_spf
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.
11-26-2006, 10:02 PM
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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