Hello... Advice on Lab tests for newbie

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    Hello... Advice on Lab tests for newbie


    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.

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    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
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    Hello... Advice on Lab tests for newbie


    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

    Quote Originally Posted by pmgamer18 View Post
    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
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    Quote Originally Posted by aculpep View Post
    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.
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    Quote Originally Posted by aculpep View Post
    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.
    Quote Originally Posted by aculpep View Post
    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
    ============================== ================
    ============
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    Quote Originally Posted by aculpep View Post

    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.
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    hey jan...guys

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

    do different labs use different ranges / scales?

    bob
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    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.
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    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
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    Quote Originally Posted by aculpep View Post
    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
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    Quote Originally Posted by aculpep View Post
    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
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    Quote Originally Posted by JanSz View Post
    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?
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    Quote Originally Posted by hardasnails1973 View Post
    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.
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    Quote Originally Posted by cpeil2 View Post
    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.
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    Quote Originally Posted by cpeil2 View Post
    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.
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    Quote Originally Posted by cpeil2 View Post
    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 ..
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    Quote Originally Posted by hardasnails1973 View Post
    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.
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    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!


    Quote Originally Posted by bobbyn View Post
    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
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    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
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    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


    Quote Originally Posted by bobbyn View Post
    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
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    Thanks Dr. John.

    It would be great if I didnt have to take as much insulin. The less the better.

    Allen

    Quote Originally Posted by Dr. John View Post
    If you are on an insulin pump, make sure you keep a VERY close watch on your blood sugar levels. TRT can dramatically reduce your insulin requirements, and you risk a potentially fatal hypoglycemic episode.
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    Quote Originally Posted by aculpep View Post
    Thanks Dr. John.

    It would be great if I didnt have to take as much insulin. The less the better.

    Allen
    You may want to look into a herb called gymnema it has been used to help type 1 diabetes, but please with any herbs please speak to a specialist and not no GNC guy. I just have heard several clinical lab studies done that it was promising.
    I used it will one of guys I trained his glucose test game back hypoglycemic we put him on the herb and with in 2 months his blood sugar was completely normal, but again he was not diabteic but prediabetic from GTT ..
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    Quote Originally Posted by aculpep View Post
    Hey Bob,

    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
    good luck with it.....but just so you know after your first visit your f/u visits will be over the phone with back up new labs

    bob
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    I didnt know that, thanks so much for pointing that out Bob, I really appreciate it! That makes things much easier.

    Allen

    Quote Originally Posted by bobbyn View Post
    good luck with it.....but just so you know after your first visit your f/u visits will be over the phone with back up new labs

    bob
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    Maybe I overlooked it and it's already here but it would be great to compile everyone's list of recommended HRT places/doctors in each state as a sticky.

    Thankyou very much for posting this!

    I have all the resources I need now to get started and I really appreciate everyone's help. I'm really glad to have found this site and people who are going through the same struggles.




    Quote Originally Posted by hardasnails1973 View Post
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    My new lab results came in today How does they look? I am surprised that my T level rose after 2 years. I lifted weights day before so wonder if that did something?

    Free T Direct - 13.4 pg/ml (8.7-25.1)
    IGF-1 - 170ng/ml (109-284)
    T4 - 6.4ug/dl (4.5-12)
    T3 - 99ng/dl (85-205)
    TSH - 1.655 uIU/ml (0.35-5.5)
    Cholesterol 197

    Quote Originally Posted by aculpep View Post
    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.
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    Quote Originally Posted by aculpep View Post
    My new lab results came in today How does they look? I am surprised that my T level rose after 2 years. I lifted weights day before so wonder if that did something?

    Free T Direct - 13.4 pg/ml (8.7-25.1)
    IGF-1 - 170ng/ml (109-284)
    T4 - 6.4ug/dl (4.5-12)
    T3 - 99ng/dl (85-205)
    TSH - 1.655 uIU/ml (0.35-5.5)
    Cholesterol 197

    Free T Direct - 13.4 pg/ml (8.7-25.1) - need to be more in upper 1/4 range
    IGF-1 - 170ng/ml (109-284) - not bad
    T4 - 6.4ug/dl (4.5-12) - could be better but how do you feel is the main question
    T3 - 99ng/dl (85-205) you having som adrenal issues conversion is too slow from t4
    TSH - 1.655 uIU/ml (0.35-5.5) - not worth paper its printed on,
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    Yeah my libido is non-existent, even in the morning. And I have such a hard time waking up, I feel like I'm in a coma sometimes. I'm really curious what my E2 is.

    Quote Originally Posted by hardasnails1973 View Post
    Free T Direct - 13.4 pg/ml (8.7-25.1) - need to be more in upper 1/4 range
    IGF-1 - 170ng/ml (109-284) - not bad
    T4 - 6.4ug/dl (4.5-12) - could be better but how do you feel is the main question
    T3 - 99ng/dl (85-205) you having som adrenal issues conversion is too slow from t4
    TSH - 1.655 uIU/ml (0.35-5.5) - not worth paper its printed on,
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    Quote Originally Posted by aculpep View Post
    Yeah my libido is non-existent, even in the morning. And I have such a hard time waking up, I feel like I'm in a coma sometimes. I'm really curious what my E2 is.
    i have a suspcion that your E2 is high and cortisol is imbalance causing the diversion in t4 to t3 conversion. also another culprit is insulin too..how are your sugar cravings ?
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