Hello... Advice on Lab tests for newbie

[aculpep]

Hey all, first time posting here... I am looking into HRT and after reading for 3 days though Id ask the experts. Note, I am also a type 1 diabetic on an insulin pump ad I'm 38 yo.

Previous tests from 2005 Labcorp:

Free T Direct - 11.0 pg/ml (8.7-25.1)
DHEA - 327ng/dl (146-850)

I have new tests coming for below:
Free T
Total T
IGF-1
He wouldnt do an E2 test, said it wasn;t medically necessary, He's internal medicine not an endo.

Are these numbers low? Will taking dhea bring up my T levels or help at all? Im sick of just eeking by in life, diabetes is hard enough.

Thanks in advance for any advice/direction.

[pmgamer18]

You know 2005 is a long time ago yet if your new test show your low and you go on TRT it may help you with type 1 diabetic. You do need your E2 tested don't let any Dr. tell you this crap tell him your paying for it and you want it. Go to AllThingsMale.com and read TRT: A Recipe for Success and in this are the tests you need and why. So if your tests come back low keep testing to try and find out why your low. Don't see a Endo they are not good Dr.'s for this.
Phil

[aculpep]

But is 11 low even back then? My energy and well being has only gotten worse. Dr said if T is low he'd test for E2. Hard to find a dr who knows about this stuff on my pacificare hmo insurance plan.

Thanks

You know 2005 is a long time ago yet if your new test show your low and you go on TRT it may help you with type 1 diabetic. You do need your E2 tested don't let any Dr. tell you this crap tell him your paying for it and you want it. Go to AllThingsMale.com and read TRT: A Recipe for Success and in this are the tests you need and why. So if your tests come back low keep testing to try and find out why your low. Don't see a Endo they are not good Dr.'s for this.
Phil

[pmgamer18]

But is 11 low even back then? My energy and well being has only gotten worse. Dr said if T is low he'd test for E2. Hard to find a dr who knows about this stuff on my pacificare hmo insurance plan.

Thanks

Yes 11 is low but you can't tell just doing Free T you need more.

[JanSz]

Hey all, first time posting here... I am looking into HRT and after reading for 3 days though Id ask the experts. Note, I am also a type 1 diabetic on an insulin pump ad I'm 38 yo.

Previous tests from 2005 Labcorp:

Free T Direct - 11.0 pg/ml (8.7-25.1)
DHEA - 327ng/dl (146-850)

I have new tests coming for below:
Free T
Total T
IGF-1
He wouldnt do an E2 test, said it wasn;t medically necessary, He's internal medicine not an endo.

Are these numbers low? Will taking dhea bring up my T levels or help at all? Im sick of just eeking by in life, diabetes is hard enough.

Thanks in advance for any advice/direction.

Hard to find a dr who knows about this stuff on my pacificare hmo insurance plan.

In the grand scheme of things, the tests that are coming will help you very little.

No mater how you slice it, with out good blood test and possibly other tests, nobody can help you, including self help.

Since you are diabetic, you must be dealing with endo.
Some of them know TRT, if not, but willing, they are equipped to help you.
This board is run by DO, Dr John,
if you can see him, that is your best bet.
That may be a problem if you must rely on your insurance.
The other possibility would be to get willing doctor to consult with Dr John.
Another possibility is to get a list of Osteopahs in your area,
they are more likely to help you. Get the list from here:
American Osteopathic Association

Still another, get a list of thyroid top doctors:
Thyroid Disease Information Source -- Bestselling Books, News, Information on Living Well With Hypothyroidism, Autoimmune Disease, Thyroid Diet, Home Page of Mary Shomon
thyroid frequently need attention.

If you go a self help route, like I did so far (or was forced to do), you still need to get a (friendly) doctor who will write necessary scripts, or at least some of them.

Since you have mention insurance, one important item on any script (for which you hope to get reimbursed) is ICD-9 code.
Insurance=clerks, clerks deal with requirements. If the paper is correctly written= better chance at reimbursement.
------------------------------------------
I will post now two list of tests, initial testing (long), periodic testing (short), and list of my ICD-9 codes. You have to add to those lists the diabetic stuff.
Good luck.
------------------------------------------
Complete metabolic Panel
Hepatic Function Panel
Lipid Panel
CBC

Total Estrogens
estrone
Estradiol, sensitive
Progesterone
Pregnenolone
Total Testosterone
Free Testosterone (calculated)
Bio-available Testosterone (calculated)
Albumin
sex hormone–binding globulin (SHBG), serum
DHT (dihydrotestosterone)
Hematocrit
prolactin, serum
FSH (3rd Generation)
LH
Thyroid Stimulating Hormone (TSH)
Free (T3) triiodothyroxine
Free T4
Total T4
Total T3
DHEA Sulfate
Cortisol, AM/PM
SOMATOMEDIN C (IGF-1)
IGF-BP3
C-reactive protein (high-sensitivity)
Fibrinogen
Hemoglobin A1C
Lp(a) lipoprotein
Bilirubin
AST (SGOT)
ALT(SGPT)
VLDL
Homocysteine
Insulin, fasting
Glucose, plasma
Magnesium
Vitamin D, 1, 25-Dihydroxy
Folate
Vitamin A
Ferritin
B12, selenium, zinc, copper
Free PSA
FreePSA/Total PSA
aldosterone
Estradiol, Bioavailable
============================== ===============
========================
Total Estrogens
estrone, serum
Estradiol, sensitive
Progesterone
Pregnenolone
Total Testosterone
Free Testosterone
Bioavailabe Testosterone
DHT
prolactin, serum
SHBG
Albumin
TSH
Free (T3)
Total T3
Free T4
DHEA Sulfate
Cortisol AM/PM
Hematocrit
============================== ===========
===================
ICD9Data.com - Free 2007 ICD-9-CM Medical Coding Database
257.2 Other testicular hypofunction 2007 ICD-9-CM Diagnosis 257.2 - Other Testicular Hypofunction
272.4 Other and unspecified hyperlipidemia 2007 ICD-9-CM Diagnosis 272.* - Disorders of lipoid metabolism
601.9 Prostatitis unspecified 2007 ICD-9-CM Diagnosis 601.* - Inflammatory diseases of prostate
780.4 Dizziness and giddiness 2007 ICD-9-CM Diagnosis 780.4 - Dizziness And Giddiness
780.79 Other malaise and fatigue 2007 ICD-9-CM Diagnosis 780.79 - Other Malaise And Fatigue
788.41 Urinary frequency 2007 ICD-9-CM Diagnosis 788.41 - Urinary Frequency

MESO-Rx - View Single Post - Adrenal fatigue, does it really exist?
255 Disorders of adrenal glands
For coding adrenal fatigue, I just use the code for Other Specified Disorders of the Adrenal Glands - which I call Adrenal Fatigue
255.8 Other specified disorders of adrenal glands 2007 ICD-9-CM Diagnosis 255.8 - Other Specified Disorders Of Adrenal Glands
HGH and Insurance Coverage
Dr. John 12-17-2006, 06:25 AM
ICD-9 253.3 Adult Onset Growth Hormone Deficiency
============================== ================
============

[JanSz]

Are these numbers low? Will taking dhea bring up my T levels or help at all? Im sick of just eeking by in life, diabetes is hard enough.

Thanks in advance for any advice/direction.

Adjusting your
adrenals
thyroid
gonads

should ease your diabetic problems.

[bobbyn]

hey jan...guys

hope everyones feeling ok. i see so many different ranges....

do different labs use different ranges / scales?

bob

[aculpep]

Yeah I am thinking and seeing Dr John if I cant find anyone local. I'm very new to this and I dont know much about him. Only thing is, it doesnt matter if Im diagnosed if my dr wont write the scripts that Dr John recommends I assume I'm still out of luck? My insurance should pay for labs so thats the brunt of the cost. Actually my friend takes androgel and I though of trying it one day to see if I felt any better.
I think I will find an endo and see if he can help or will work with Dr John.
Oh yeah, Im having T3, T4 and TSH checked also Left those out.

Thanks for the response.


[QUOTE=JanSz;762494]In the grand scheme of things, the tests that are coming will help you very little.

No mater how you slice it, with out good blood test and possibly other tests, nobody can help you, including self help.

Since you are diabetic, you must be dealing with endo.
Some of them know TRT, if not, but willing, they are equipped to help you.
This board is run by DO, Dr John,
if you can see him, that is your best bet.
That may be a problem if you must rely on your insurance.
The other possibility would be to get willing doctor to consult with Dr John.

[bobbyn]

hey aculpep,

i tryed getting one of my (3) doc's in the middle...big waste of time... even if you get one of your docs to say ok...at some point he's not going to agree with dr john (because your doc isn't going to know any better) and the protocal is going to shat the bed.

take the drive or fly out to see dr john...you'll be way better of in the long run. either way you pay dr john for the initial consult so the only addition is the time and cost to get out there....

the way i see it...having someone in the middle is just an obsiticle


take drive...listen the radio....you can probally use the down time )

bob

[JanSz]

Yeah I am thinking and seeing Dr John if I cant find anyone local. I'm very new to this and I dont know much about him. Only thing is, it doesnt matter if Im diagnosed if my dr wont write the scripts that Dr John recommends I assume I'm still out of luck? My insurance should pay for labs so thats the brunt of the cost. Actually my friend takes androgel and I though of trying it one day to see if I felt any better.
I think I will find an endo and see if he can help or will work with Dr John.
Oh yeah, Im having T3, T4 and TSH checked also Left those out.

Thanks for the response.

FreeT3<-----most important
FreeT4

[JanSz]

But is 11 low even back then? My energy and well being has only gotten worse. Dr said if T is low he'd test for E2. Hard to find a dr who knows about this stuff on my pacificare hmo insurance plan.

Thanks

On the left coast there is Dr Marianco, you may try him.
He usually posts on the other board, but not lately.
His posts are notable, often long and well written.

Link to start you off.
MESO-Rx - View Single Post - Blood Labs In - Please Advise
you can send PM to him
or see his web site:
Definitive Psychiatry

[hardasnails1973]

On the left coast there is Dr Marianco, you may try him.
He usually posts on the other board, but not lately.
His posts are notable, often long and well written.

Link to start you off.
MESO-Rx - View Single Post - Blood Labs In - Please Advise
you can send PM to him
or see his web site:
Definitive Psychiatry

Jansz
I saw on one post that you mentioned low LH levels was an indication that your body was making too much test, but if my test levels are low then would using hcg over ride this negative feed back loop and what does Low LH actuall mean in regards to testosterone production?

[cpeil2]

Jansz
I saw on one post that you mentioned low LH levels was an indication that your body was making too much test, but if my test levels are low then would using hcg over ride this negative feed back loop and what does Low LH actuall mean in regards to testosterone production?

hCG might drive your LH lower because it is an LH analog. Since you are getting what passes for LH from an exogenous source, homeostatic mechanisms might cut back your native production of LH. Only speculating here - I'm no expert.

[hardasnails1973]

hCG might drive your LH lower because it is an LH analog. Since you are getting what passes for LH from an exogenous source, homeostatic mechanisms might cut back your native production of LH. Only speculating here - I'm no expert.

Good point and also could the excessive DHT or high bioavailable estrogen (high normal shbg) , instead of the testosterone cause the same effect if high serum testosterone to turn off the LH.

[cpeil2]

hCG might drive your LH lower because it is an LH analog. Since you are getting what passes for LH from an exogenous source, homeostatic mechanisms might cut back your native production of LH. Only speculating here - I'm no expert.

You also have to look at T level. If LH is low and T level is low, then it means you have a broken HPTA - probably pituitary.

If LH is low and T is in an acceptable or high range, the LH means you are producing enough testosterone, maybe not too much. Assuming that one has a healthy HPTA, I suspect there is no such thing as too much T.

If your HPTA is broken, that's another case--the problem ordinarily is not enough T. But may be it could become disordered in such a way as to result in too much T. Who knows--these hormonal pathways are very tricky.

[hardasnails1973]

You also have to look at T level. If LH is low and T level is low, then it means you have a broken HPTA - probably pituitary.

If LH is low and T is in an acceptable or high range, the LH means you are producing enough testosterone, maybe not too much. Assuming that one has a healthy HPTA, I suspect there is no such thing as too much T.

If your HPTA is broken, that's another case--the problem ordinarily is not enough T. But may be it could become disordered in such a way as to result in too much T. Who knows--these hormonal pathways are very tricky.

Excessive estrogen will jam up that HPTA quciker then anything as well as small bacterial overgrowth ..

[cpeil2]

Good point and also could the excessive DHT or high bioavailable estrogen (high normal shbg) , instead of the testosterone cause the same effect if high serum testosterone to turn off the LH.

You're asking if an accumulation of, essentially, testosterone by-products would suppress LH in the same way that high testosterone would.

I can't answer that. It depends on how specific the feedback mechanisms are.

[aculpep]

Hey Bob,

After searching for a doc on my insurance I think I'm going to take your advice!
What I was thinking was I'd have to take Dr. John's recommendation back to my primary care doc to get the scripts which I knew wouldnt work. I guess thats not the case. Anyways I think I found a doctor here! Woohoo! I actually didnt realize my surgeon used to do anti-aging stuff and recommended a dr to me. She's not on my insuraance but I dont care because labs and scripts are so all I'm out is $300 consult and $150 for followup which is worth it if it gets me feeling normal again.
Only other question I have now is there any specific questions to ask her before spending $300 and finding out she's not what I'm looking for?

Thanks!

hey aculpep,

i tryed getting one of my (3) doc's in the middle...big waste of time... even if you get one of your docs to say ok...at some point he's not going to agree with dr john (because your doc isn't going to know any better) and the protocal is going to shat the bed.

take the drive or fly out to see dr john...you'll be way better of in the long run. either way you pay dr john for the initial consult so the only addition is the time and cost to get out there....

the way i see it...having someone in the middle is just an obsiticle


take drive...listen the radio....you can probally use the down time )

bob

[bobbyn]

aculpep,
well....first, i think you want to make sure that this is what she does all the time. i prefer to get a lead on a dr from other guys that are using him or her. that's why i went with dr john....alot of the guys on this list have good things to say about him.

as the guys pointed out...your labs are not complete. if it were me, my first choice would be dr john....my second would be to go in to talk with her to see what labs she orders and what her protocal will be. if she doesn't order the proper labs or puts you on an outdated trt program i think it would be safe to say that she's not the one...

the initial consult is the same...300...the f/u is more..
whats stopping you from going to see dr john? where do you live?

bob

[aculpep]

Hey Bob,

Yeah I'm going to ask my surgeon today about her and he will know. It's just easier since she's local if she is skilled in HRT.
My next choice would be Dr. John but since he isn't local to tx makes things harder having to fly up, take vacation and all that, not to mention followup appts. I'm going to exhaust my local search before going out of state. There has to be someone good at HRT in tx!

Thanks

aculpep,
well....first, i think you want to make sure that this is what she does all the time. i prefer to get a lead on a dr from other guys that are using him or her. that's why i went with dr john....alot of the guys on this list have good things to say about him.

as the guys pointed out...your labs are not complete. if it were me, my first choice would be dr john....my second would be to go in to talk with her to see what labs she orders and what her protocal will be. if she doesn't order the proper labs or puts you on an outdated trt program i think it would be safe to say that she's not the one...

the initial consult is the same...300...the f/u is more..
whats stopping you from going to see dr john? where do you live?

bob