Blood and urine lab results seem contradictory: any insight?

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    Blood and urine lab results seem contradictory: any insight?


    After a month of Androgel (1pkt QD) and hcg (200iu QOD), I submitted urine for a lab ordered by Dr. John through Rhein consulting, which showed among other things:

    Total T: 95 (45-85)
    Estradiol: 2.3 (0-7.0)


    5 days later I got blood drawn with these results.
    Total T: 364 (240-950)
    Free T: 11.6 (9-30)
    %Free T: 3.2
    SHBG: 22 (11-80)
    E2: 39 (0-33) !!!!!!!!!!

    Looks like I'm pissing out testosterone, and retaining estrogen. Keep in mind that blood units and urine units are different, so the reference ranges look different.

    So what the heck? Dr. Crisler was happy with my urine labs, but I still don't feel great. The blood test results are closer to how I feel: ESTROGEN DOMINANT!

    Furthermore, I don't think I'm absorbing the gel very well, or perhaps 200iu hcg QD just isn't enough.

    I want an AI. I think I want to go back to shots + hcg

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    Quote Originally Posted by wildfox View Post
    After a month of Androgel (1pkt QD) and hcg (200iu QOD), I submitted urine for a lab ordered by Dr. John through Rhein consulting, which showed among other things:

    Total T: 95 (45-85)
    Estradiol: 2.3 (0-7.0)


    5 days later I got blood drawn with these results.
    Total T: 364 (240-950)
    Free T: 11.6 (9-30)
    %Free T: 3.2
    SHBG: 22 (11-80)
    E2: 39 (0-33) !!!!!!!!!!
    Looks like I'm pissing out testosterone, and retaining estrogen. Keep in mind that blood units and urine units are different, so the reference ranges look different.

    So what the heck? Dr. Crisler was happy with my urine labs, but I still don't feel great. The blood test results are closer to how I feel: ESTROGEN DOMINANT!

    Furthermore, I don't think I'm absorbing the gel very well, or perhaps 200iu hcg QD just isn't enough.

    I want an AI. I think I want to go back to shots + hcg

    DId you apply the gel before the blood test? if so how far
    if you applied it 45-1 hour it still was not peaking yet possible explaining the low testosteorne and may be your body is metabolising estrogen efficenctly.

    Just a theory is that depending on how thick your skin is and absorption rate and possible hypothyroidism . It may have activated the aromatse first spiking the estrogen and then testosterone took longer to absorbs

    Did you take hcg on day you took blood test?
    hcg has half life of 48-60 hours so you might have been peaking on the HCG for the urine test..

    Tell you what i wil never go back to creames or gels 4 weeks 22 lbs gain. I Should have listen a long time ago and stop being a cry baby about needles. Half inch works perfectly fine for me ..

    How was your estrogen metabolism ratio of good :bad if it was elevated with more good then bad estrogen of 39 is not bad, but inrealtions ship to testosterone YIKES. Remember you may have started out with high estrogen but its over a total of 24 hour that is the most important. Blood tests are just space and time thats all..need to look at the whole picture which urine tests do.

    DING DONG
    It just clicked that an excess on a urine test can mean actualy a defieincy..so about not metabolizing would make more sense since the testosterone receptors would be blocked possiblly by estrogen so they have no where to bind and just get pissed out

    Are you using fish oils, How was the total estrogen (e1,e2,e3) levels.

    Right now you need have Dr john go over this and to tweak your protcol he is your dr and one of the best in the business !!
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    Quote Originally Posted by wildfox View Post
    After a month of Androgel (1pkt QD) and hcg (200iu QOD), I submitted urine for a lab ordered by Dr. John through Rhein consulting, which showed among other things:

    Total T: 95 (45-85)
    Estradiol: 2.3 (0-7.0)


    5 days later I got blood drawn with these results.
    Total T: 364 (240-950)
    Free T: 11.6 (9-30)
    %Free T: 3.2
    SHBG: 22 (11-80)
    E2: 39 (0-33) !!!!!!!!!!

    Looks like I'm pissing out testosterone, and retaining estrogen. Keep in mind that blood units and urine units are different, so the reference ranges look different.

    So what the heck? Dr. Crisler was happy with my urine labs, but I still don't feel great. The blood test results are closer to how I feel: ESTROGEN DOMINANT!

    Furthermore, I don't think I'm absorbing the gel very well, or perhaps 200iu hcg QD just isn't enough.

    I want an AI. I think I want to go back to shots + hcg
    I cannot help you with your question sorry.
    But you have unique opportunity to give us inside to Rhein consulting urine tests and specially their reporting on results.
    On their web site they say that they provide profesional interpretation of results.
    If you have a time please post as much as you wish, (up to and including retyping of the whole test) I would be much obligated.
    I thoght that the most important reason for doing this urine test is to get idea about estrogens mapout, 2/16 ratio specifically.
    But I am sure there is more value in that test than just the 2/16 ratio I just do not know what it is.
    Thank you.
    ============================== ============
    your blood, get (Free, bioavailable and total testosterone) (from Quest) and adjust so your free and bio are as much as possible on top but not over.Off hand you are low on T and high on E2.
    You have locked out on SHBG, I think ideal level.
    ++++++++++++++++++++++++++++++ ++++++++++++
    •   
       

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    Quote Originally Posted by hardasnails1973 View Post
    DId you apply the gel before the blood test?
    The blood test was at 8:30, before applying the gel, and the hcg was the day before.

    Quote Originally Posted by hardasnails1973 View Post
    Did you take hcg on day you took blood test?
    No, but I did take it the day the urine was collected.

    Quote Originally Posted by hardasnails1973 View Post
    DING DONG
    It just clicked that an excess on a urine test can mean actualy a defieincy..so about not metabolizing would make more sense since the testosterone receptors would be blocked possiblly by estrogen so they have no where to bind and just get pissed out
    That makes sense to me.

    Quote Originally Posted by hardasnails1973 View Post
    Are you using fish oils,
    Yes.


    Quote Originally Posted by hardasnails1973 View Post
    How was the total estrogen (e1,e2,e3) levels.
    Urine E1: 6.3 (3-12.0)
    Urine E2: 2.3 (0-7.0)
    Urine E3: 4.0 (1-16)
    Serum E1: Not measured
    Serum E2: 39 (0-33)
    Serum E3: Not measured

    Quote Originally Posted by hardasnails1973 View Post
    Right now you need have Dr john go over this and to tweak your protcol he is your dr and one of the best in the business !!
    We went over this last Wednesday, and he thought I was picture-perfect according to the urine labs, but he did tell me I could up my Androgel dose by 25% because I wasn't feeling great.

    I only got that blood results info test this morning.
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    Quote Originally Posted by JanSz View Post
    I thoght that the most important reason for doing this urine test is to get idea about estrogens mapout, 2/16 ratio specifically.
    But I am sure there is more value in that test than just the 2/16 ratio I just do not know what it is.
    Thank you.
    E1 was 6.3 (3-12)
    2-OH-Estrone was 7.5
    16-a-OH-Estrone was not detected
    4-OH-Estrone was not detected

    This is good news. I wasn't even taking DIM or TMG for the prior month.
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    More blood test results, ordered by the urologist that found my varicocele. Later the same day as the AM blood was drawn (results above), PM blood was drawn (about 7 hours after applying Androgel which was applied right after the 8:30 am draw).

    Check this out (4:35pm blood labs):

    Total T 392 (270-1734)
    Free T 100 (250-300)
    E2 31.7 (0-56)
    FSH 0.175 (suppressed, of course)
    LH 0.264 (suppressed, of course)
    PSA 0.641 (GOOD NUMBER!)
    Prolactin 4.95 (2.5-17)
    SHBG 21.3 (13-71)
    TSH 1.17 (should mean thyroid is good)
    Insulin 9.99 (6-30)
    Homocysteine 4.56 (5.0-21)

    I must not be absorbing Androgel, OR, it goes straight to my kidneys and down the toilet. OR it could be my T is just from the Testes alone thanks to HCG, and Androgel isn't doing much for me at all.

    One thing I know for sure is that injections were working, I just didn't like the weekly rollercoaster and occasional bleeding, but I guess I'll just have to deal with that.

    I plan to talk to Dr. Crisler about going back to injections plus hcg.
    Last edited by wildfox; 05-07-2007 at 01:10 PM. Reason: added a little more commentary
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    Quote Originally Posted by wildfox View Post
    E1 was 6.3 (3-12)
    2-OH-Estrone was 7.5
    16-a-OH-Estrone was not detected
    4-OH-Estrone was not detected

    This is good news. I wasn't even taking DIM or TMG for the prior month.
    I slapped on 10% cream 1 ml and test only came up to 307 3 hours before the test so this means I was not absorbing it. Urine test are tricky because an what looks like an excess may be defieincy thats why its important to have other back up to support the testing results. If you would have apllied the gel before then it may have given a more clinical pictures. If dr did not tell you to apply the gel he did it for a reason. from reading Dr john nots he has guys apply gel before blood work, you may be an exception for some reason I do not know...
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    Quote Originally Posted by wildfox View Post
    More blood test results, ordered by the urologist that found my varicocele. Later the same day as the AM blood was drawn (results above), PM blood was drawn (about 7 hours after applying Androgel which was applied right after the 8:30 am draw).

    Check this out (4:35pm blood labs):

    Total T 392 (270-1734)
    Free T 100 (250-300)
    E2 31.7 (0-56)
    FSH 0.175 (suppressed, of course)
    LH 0.264 (suppressed, of course)
    PSA 0.641 (GOOD NUMBER!)
    Prolactin 4.95 (2.5-17)
    SHBG 21.3 (13-71)
    TSH 1.17 (should mean thyroid is good)
    Insulin 9.99 (6-30)
    Homocysteine 4.56 (5.0-21)

    I must not be absorbing Androgel, OR, it goes straight to my kidneys and down the toilet. OR it could be my T is just from the Testes alone thanks to HCG, and Androgel isn't doing much for me at all.

    One thing I know for sure is that injections were working, I just didn't like the weekly rollercoaster and occasional bleeding, but I guess I'll just have to deal with that.

    I plan to talk to Dr. Crisler about going back to injections plus hcg.

    Given the consistancy it shows in the blood results that its low testosterone. also see how e2 is dropping as day goes on!! The inconsistency is rather strange BUT if you had serum free estrodial checked it may show a different pics in relationship to e2. It looks like you are pissing it out more then anything and the second blood test just confirms that. Could it be you are metabiolisming it too fast de to some other hormonal imbalance such as cortisol? ...hmm what about DHT ?
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    Quote Originally Posted by wildfox View Post
    More blood test results, ordered by the urologist that found my varicocele. Later the same day as the AM blood was drawn (results above), PM blood was drawn (about 7 hours after applying Androgel which was applied right after the 8:30 am draw).

    Check this out (4:35pm blood labs):

    Total T 392 (270-1734)
    Free T 100 (250-300)
    E2 31.7 (0-56)
    FSH 0.175 (suppressed, of course)
    LH 0.264 (suppressed, of course)
    PSA 0.641 (GOOD NUMBER!)
    Prolactin 4.95 (2.5-17)
    SHBG 21.3 (13-71)
    TSH 1.17 (should mean thyroid is good)
    Insulin 9.99 (6-30)
    Homocysteine 4.56 (5.0-21)

    I must not be absorbing Androgel, OR, it goes straight to my kidneys and down the toilet. OR it could be my T is just from the Testes alone thanks to HCG, and Androgel isn't doing much for me at all.

    One thing I know for sure is that injections were working, I just didn't like the weekly rollercoaster and occasional bleeding, but I guess I'll just have to deal with that.

    I plan to talk to Dr. Crisler about going back to injections plus hcg.
    Test for
    T3 Free
    T3 uptake
    T3,Total
    T4,Free
    T4,Total
    TSH
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    Quote Originally Posted by hardasnails1973 View Post
    I slapped on 10% cream 1 ml and test only came up to 307 3 hours before the test so this means I was not absorbing it. Urine test are tricky because an what looks like an excess may be defieincy thats why its important to have other back up to support the testing results. If you would have apllied the gel before then it may have given a more clinical pictures. If dr did not tell you to apply the gel he did it for a reason. from reading Dr john nots he has guys apply gel before blood work, you may be an exception for some reason I do not know...
    The only instruction given by Dr. John was to be stable with Androgel and HCG administration for 4 weeks before the urine test. He also wanted me not to take any Pregnenelone or DHEA during these 4 weeks. The only instructions from Rhein was not to take vitamins the day before or day of the urine collection. I complied with these instructions. That urine was collected 4/21.

    On 4/26 the day the blood was drawn twice, I did not put Androgel on before the 8:30AM blood test. I put the A-gel on about 8:45 (after the draw), then the other blood test was drawn 7 hours 50 minutes later.

    Dr. John did not order either blood test. My PCP ordered the first one, and my urologist ordered the 2nd, and he knew I had had blood drawn that same morning by the other doctor.

    I appreciate your feedback.
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    Quote Originally Posted by JanSz View Post
    Test for
    T3 Free
    T3 uptake
    T3,Total
    T4,Free
    T4,Total
    TSH
    Jan, Thanks for the feedback and suggestions. I will mention these at my Thursday urology followup. At that followup, doppler ultrasound will be done on my nads to measure the varicocele. Based on what this urologist told me already, he believes that thyroid issues, if any, could be related to low T. He told me he likes total T around 1000 and free T around 300, with Estradial mid-range, and that in achieving this, other organs get into gear. I was surprised at his knowledge of hormones, which seems comparable to Dr. John's. He has all his labs done in-house. I saw his willing to look at my serum levels as a bonus, since I was seeing him for the pain in my scrotum.
    Last edited by wildfox; 05-07-2007 at 02:06 PM. Reason: Yes, I meant 1000
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    Quote Originally Posted by wildfox View Post
    Jan, Thanks for the feedback and suggestions. I will mention these at my Thursday urology followup. At that followup, doppler ultrasound will be done on my nads to measure the varicocele. Based on what this urologist told me already, he believes that thyroid issues, if any, could be related to low T. He told me he likes total T around 100 and free T around 300, with Estradial mid-range, and that in achieving this, other organs get into gear. I was surprised at his knowledge of hormones, which seems comparable to Dr. John's. He has all his labs done in-house. I saw his willing to look at my serum levels as a bonus, since I was seeing him for the pain in my scrotum.
    You have probably ment T~1000, important is freeT and that he wants ~300 which is top of his range, good.
    As you may know I am not comfortable with individual test specifically for FreeT, the test usually is a crook.
    I explained it here:
    MESO-Rx - View Single Post - Attention all those on Sub-q injections
    Also I personally do not like in-house laboratories.
    Even the national laboratories have a quality issues.
    You will newer hear about some little lab on dead end street.
    But I am not a doctor, just ED suferer.
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    Quote Originally Posted by JanSz View Post
    You have probably ment T~1000, important is freeT and that he wants ~300 which is top of his range, good.
    As you may know I am not comfortable with individual test specifically for FreeT, the test usually is a crook.
    I explained it here:
    MESO-Rx - View Single Post - Attention all those on Sub-q injections
    Also I personally do not like in-house laboratories.
    Even the national laboratories have a quality issues.
    You will newer hear about some little lab on dead end street.
    But I am not a doctor, just ED suferer.
    Yes, I meant 1000. Thanks for spotting that. I editted my post. What I like about this urologist is that my insurance has already paid him and his in-house lab fees. I had to pay for the Urine labs and also Dr. John's fees out of pocket. If I don't have in-house labs, I have to use Labcorp, otherwise I have to pay for everything.

    I like Dr. John and am very grateful for all his help. However, having insurance pay for this stuff is very nice. I won't say yet that I found a local alternative. Been there, done that....with disappointment, which is why I've stuck with Dr. John. That this urologist wants to be thorough about my hormones was a welcome surprise. When I told him what I was taking (1 packet Androgel daily, 200 iu hcg every other day) he commented that he's never seen those amounts to be enough. Hmm. He seems to be in the race, at least.

    Anyway, I faxed this info to Dr. John and am waiting for a response.
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    Quote Originally Posted by wildfox View Post
    Yes, I meant 1000. Thanks for spotting that. I editted my post. What I like about this urologist is that my insurance has already paid him and his in-house lab fees. I had to pay for the Urine labs and also Dr. John's fees out of pocket. If I don't have in-house labs, I have to use Labcorp, otherwise I have to pay for everything.

    I like Dr. John and am very grateful for all his help. However, having insurance pay for this stuff is very nice. I won't say yet that I found a local alternative. Been there, done that....with disappointment, which is why I've stuck with Dr. John. That this urologist wants to be thorough about my hormones was a welcome surprise. When I told him what I was taking (1 packet Androgel daily, 200 iu hcg every other day) he commented that he's never seen those amounts to be enough. Hmm. He seems to be in the race, at least.

    Anyway, I faxed this info to Dr. John and am waiting for a response.
    LabCorp is a fine lab. Just forget their FreeT test.
    Get
    TotalT
    SHBG
    Albumin
    from one blood draw and calculate youself
    FreeT
    BAT
    there are links to a calculators here:
    MESO-Rx - View Single Post - Attention all those on Sub-q injections

    One packet (5grams) of Androgel is rarely enough.
    7.5gram or 10 grams is more likely.
    You may want to reduce volume by using 10% Tcream
    I found that I need to double the cream dose to make it equal at the blood level.
    ---------------------------------------------------
    I used to use 10grams Androgel (latter reduced to 7.5)
    10grams of 1% gel =100mg of testosterone.
    so when I switched to T cream I started on the same amount of applied T, that is;
    My cream is 100mg/gram so I used 1gram/day
    Blood test came out short.
    I increased to 2grams/day, next blood test will show me if that is enough.
    AFAIK, Dr John's have 5% gell, going by same logic one would start at 2grams and then increase to 4, or just start at 4 and lower it latter if need be.
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    Quote Originally Posted by JanSz View Post
    LabCorp is a fine lab. Just forget their FreeT test.
    Get
    TotalT
    SHBG
    Albumin
    from one blood draw and calculate youself
    FreeT
    BAT
    there are links to a calculators here:
    MESO-Rx - View Single Post - Attention all those on Sub-q injections

    One packet (5grams) of Androgel is rarely enough.
    7.5gram or 10 grams is more likely.
    You may want to reduce volume by using 10% Tcream
    I found that I need to double the cream dose to make it equal at the blood level.
    ---------------------------------------------------
    I used to use 10grams Androgel (latter reduced to 7.5)
    10grams of 1% gel =100mg of testosterone.
    so when I switched to T cream I started on the same amount of applied T, that is;
    My cream is 100mg/gram so I used 1gram/day
    Blood test came out short.
    I increased to 2grams/day, next blood test will show me if that is enough.
    AFAIK, Dr John's have 5% gell, going by same logic one would start at 2grams and then increase to 4, or just start at 4 and lower it latter if need be.
    Dr. John does have a more concentrated gel. It "frosted" on me, and I thought that was a problem. I also felt worse on it than I did on Androgel+HCG. I could ask him about prescribing the cream you mentioned from women's international.
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    Quote Originally Posted by wildfox View Post
    Dr. John does have a more concentrated gel. It "frosted" on me, and I thought that was a problem. I also felt worse on it than I did on Androgel+HCG. I could ask him about prescribing the cream you mentioned from women's international.
    While your urologist seem to be on top of his game and you got really lucky to find a good urologist all the ones I saw said I am normal and ask for psyche evaluation and prescription of paxil with tt of 305 ..IDIOTS !!
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    Quote Originally Posted by wildfox View Post
    Dr. John does have a more concentrated gel. It "frosted" on me, and I thought that was a problem. I also felt worse on it than I did on Androgel+HCG. I could ask him about prescribing the cream you mentioned from women's international.
    He may not like to support competition.
    But there may be a absorption difference between gel an a cream for some people.
    In my experience Androgel (a gel) got right thru me, never any hint of frosting, high blood T levels.
    If Dr John's gel is similar just 5x more concentrated I would assume that gel should be better (absorbability vise) than cream.
    Bottom line, one would have to try both, do blood test and see results.
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    JanSz: regarding your "competition" comment...

    I should hope that providing appropriate TRT for me would not be based on "competition". Right now the main part of my TRT is Androgel, and Dr. John gains nothing from my use of that. I doubt he makes much from my use of Signature Pharmacy products that he prescribes either. He certainly doesn't make much from my $50 VOV, compared to those who contract with my insurance, basically sitting on their ass saying "gee, I don't know what to make of this, you should see an endocrinologist, but you look good".

    I'm sad at any implication that Dr. John is in competition or wants to avoid it. I know that he has had other doctors visit his practice so that they can learn from him.

    I believe Dr. John wants the best for his patients.
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    From what I see here you need to go back to shots and if you want to keep E2 down try doing the shots 2 x's a week or even better every 3 days. With your HCG the 2 days each in between your T shots. So if you were going to do 100mgs a week of T this would be 43 mgs every 3 days.
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    Quote Originally Posted by pmgamer18 View Post
    From what I see here you need to go back to shots and if you want to keep E2 down try doing the shots 2 x's a week or even better every 3 days. With your HCG the 2 days each in between your T shots. So if you were going to do 100mgs a week of T this would be 43 mgs every 3 days.
    i second that notion. Since swtiching to 2 time a week shots its been night and day with results and also a 22 lbs increase in 4 weeks of lean muscle as well
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    Thanks for the feedback guys. I plan to discuss this with Dr. John soon.
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    Quote Originally Posted by hardasnails1973 View Post
    i second that notion. Since swtiching to 2 time a week shots its been night and day with results and also a 22 lbs increase in 4 weeks of lean muscle as well
    EVERYONE who is switching over to more frequent injects has seen drastic improvements in not just BW, but pretty much everything else that goes along with TRT management. You name it.
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    Quote Originally Posted by wildfox View Post
    JanSz: regarding your "competition" comment...

    I should hope that providing appropriate TRT for me would not be based on "competition". Right now the main part of my TRT is Androgel, and Dr. John gains nothing from my use of that. I doubt he makes much from my use of Signature Pharmacy products that he prescribes either. He certainly doesn't make much from my $50 VOV, compared to those who contract with my insurance, basically sitting on their ass saying "gee, I don't know what to make of this, you should see an endocrinologist, but you look good".

    I'm sad at any implication that Dr. John is in competition or wants to avoid it. I know that he has had other doctors visit his practice so that they can learn from him.
    I believe Dr. John wants the best for his patients.
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    Quote Originally Posted by Dr. John View Post
    Where did you have the labs done? Of note, Free T is notoriously innaccurate, espcially at local hospitals and LabCorp.
    What did the urinary androgen metabolites tell us?

    And yes, it is important to remember that what ends up in the urine is what the kidneys decide to put there. And what remains in the serum is what the kidneys have not excreted.
    I think we should ask for the money back when they insist on doing FreeT lab.

    No kidding, just read this:
    http://jcem.endojournals.org/cgi/reprint/86/6/2903.pdf

    I would appreciate review (and corrections) of my study on this subject and how to deal with it, here:
    MESO-Rx - View Single Post - Attention all those on Sub-q injections
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    Quote Originally Posted by Dr. John View Post
    E lags behind T.
    SO when does e2 peak according to tesotsterone injections vs the creame. SO if a person injects 48 hours you wll have a peak testosterone levels, but when approximately would that estrogen level be peaking or would it occur at that 48 hour mark or even a day or so later. Point being people that are taking armidex on the day of there shot are being mislead that it going to keep the e2 down from the injection at that time, but rather a few days later. If we could be given a chart when t : e2 comparision with armidex and t injection that would be peaking that would be an interesting thing to see..

    SO if one is high on testosteorne metabolites in urine then what concludsion can be drawn?
    Is the body not absorbing it or its it not being utlized once in the blood stream or is there possible kidney abnormalities
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    Quote Originally Posted by JanSz View Post
    I think we should ask for the money back when they insist on doing FreeT lab.

    No kidding, just read this:
    http://jcem.endojournals.org/cgi/reprint/86/6/2903.pdf

    I would appreciate review (and corrections) of my study on this subject and how to deal with it, here:
    MESO-Rx - View Single Post - Attention all those on Sub-q injections
    .
    .
    Quote Originally Posted by Dr. John View Post
    This post by you was of great service. I have now added that study to the lectures I give while training other doctors.
    Thank you Doctor;

    I would like to point to this part in my post, specially the line about huge error (1.5–2.2)x, some practical approach on how to deal with that error would be helpfull,
    reminder, CalcV is how things are done now,
    I guess the current test from Quest is ladden with this error:
    -------------------------------------------------------------

    This paper, written in 2006, discuses FreeT and Bio-Available-T in light of discovery that SHBG is build differently than thought of in 1990.
    -------http://www.atypon-link.com/WDG/doi/pdf/10.1515/JLM.2006.050
    Other than understanding the issue little better I am not able to make use of their recommended charts, they are of too small resolution. Wish there was a calculator similar to above posted but based on this new science, (hint, hint).
    I take three values from this paper.
    Table 2, 10 healthy young men , BAT level=5.5(nmol/L)
    Table 4, 10 male control subjects, FT level=199(pmol/L)
    and (most disturbing)
    CalcV was reported to overestimate BAT by a factor of 1.5–2.2
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    Quote Originally Posted by Dr. John View Post
    Then you did not follow my instructions, and this is why your labs are invalid. How can I measure the serum concentration of a drug if you do not take the drug?

    This is why my instructions say to "TAKE ALL MEDICATIONS AS PRESCRIBED". I also wanted you to wait at least 2 hours after application to have the draw done, for absorption time.

    The urines showed how much is getting in.

    My advice was to "hold" and look for improvement. I was waiting for downstream flow of hormones in you, rather than just jack up the dose right away.
    Two blood draws were done that day. Neither was ordered by Dr. John. The first at 8:30 right before applying Androgel, the other at 4:35 pm the same day, about 8 hours after applying the Androgel.

    As I had been steady-state with the daily Androgel and every-other-daily HCG, and given Androgel's 5 day half-life, I don't see how 24 hours after the last Androgel the level would be as low as it was.

    That's why I asked the question.
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    Quote Originally Posted by Dr. John View Post
    Where did you have the labs done? Of note, Free T is notoriously innaccurate, espcially at local hospitals and LabCorp.

    What did the urinary androgen metabolites tell us?

    And yes, it is important to remember that what ends up in the urine is what the kidneys decide to put there. And what remains in the serum is what the kidneys have not excreted.

    And let's be sure to make the distinction: to say I am "happy" with the labs does not mean I am happy with the patient's results. Finding purpose, and balance, in the lab panels of challenging patients is a good point to reach along the way.
    Both sets of labs were do in-house where each respective doctor has his clinic. Outside of that context, LabCorp is my only option in order to get insurance to pay.
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    So back to my original point: the blood lab results seemed to me to contradict the urine lab results, and based on my limited medical education (towards nursing not osteopathic medicine), my subjective feeling seems to be reflected more by the blood results than the urine results, which surprised me. Given that I asked "what the heck?" and sought others' insights.

    Thanks for all the feedback, especially from Dr. John for his time, pro bono.
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    Quote Originally Posted by wildfox View Post
    Two blood draws were done that day. Neither was ordered by Dr. John. The first at 8:30 right before applying Androgel, the other at 4:35 pm the same day, about 8 hours after applying the Androgel.

    As I had been steady-state with the daily Androgel and every-other-daily HCG, and given Androgel's 5 day half-life, I don't see how 24 hours after the last Androgel the level would be as low as it was.

    That's why I asked the question.
    Please post results or point me to them.
    Very interesting study.
    When did you apply Androgel prior to 8:30AM
    Amount of gel, (I think 5grams right?)
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    Quote Originally Posted by JanSz View Post
    Please post results or point me to them.
    Very interesting study.
    When did you apply Androgel prior to 8:30AM
    Amount of gel, (I think 5grams right?)
    Androgel 5g 1%, one packet daily is what I had been taking.

    On the day of the blood tests, which were not ordered by Dr. John, the Androgel was applied right AFTER the blood was drawn at 8:30am. That ordering physician wanted me to be fasting and not take any meds until after that draw. The second lab's blood was drawn at 4:35pm that same day, 8 hours after applying the gel.

    The blood tests were not ordered by Dr. John. They were ordered by two different local physicians, who had their own reasons for doing so. Neither has suggested modifying my TRT. The first doctor is monitoring my cholesterol, glucose, HbA1C and other lipid stuff. The other is the urologist that found my varicocele.

    I have posted all mentioned results from the three different labs in this thread already. In fact, you already quoted the afternoon labs with your "05-07-2007 11:36 AM" post, JanSz.
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    Thank you for the authoritative answer Dr. John. I understand.
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    Quote Originally Posted by Dr. John View Post
    The blood test is invalid; therefore it cannot contradict anything. What a waste of time, and money.
    Not to mention a waste of a good vein and also shouldn't those test be done fasting ?
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    Quote Originally Posted by wildfox View Post
    Androgel 5g 1%, one packet daily is what I had been taking.
    On the day of the blood tests, which were not ordered by Dr. John, the Androgel was applied right AFTER the blood was drawn at 8:30am. That ordering physician wanted me to be fasting and not take any meds until after that draw. The second lab's blood was drawn at 4:35pm that same day, 8 hours after applying the gel.

    The blood tests were not ordered by Dr. John. They were ordered by two different local physicians, who had their own reasons for doing so. Neither has suggested modifying my TRT. The first doctor is monitoring my cholesterol, glucose, HbA1C and other lipid stuff. The other is the urologist that found my varicocele.

    I have posted all mentioned results from the three different labs in this thread already. In fact, you already quoted the afternoon labs with your "05-07-2007 11:36 AM" post, JanSz.

    Quote Originally Posted by Dr. John View Post
    Here's an important learning point for your doctor: what exactly was that T test supposed to show? How you are when you are NOT taking the Androgel? What good does that do? Of what value is a test which is drawn under conditions the patient never sees.
    I was properly taught in my Osteopathic medical training to never order a lab which does nothing to either reinforce, or alter, treatment.

    This is a mistake neophytes often make. Therefore I stress it in my lectures.
    I know it is of crucial importance and I am not able to grasp it.
    Please forgive me.
    I would say that the patient sees that condition every 24 hours. Morning draw time is about when his T is most likely at the lowest.
    -----------------
    Line #1 in his statement, patient have a long going stable routine.

    #2 http://androgel.com/images/ProfessionalInfo.pdf
    Figure2 page 5
    says that (in stablilzed patient) maximum T blood level happens around 2 hours after application,
    the minimum is right before application

    #3 if one wants to know maximum, draw blood 2hrs after application
    if one wants to know minimum, draw blood right before application

    I thought it is simple like that, apparently there is more to it.
    Please help.

    ps. drawing blood 8 hours after gell application indeed is rather vague and open to interpretations.
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    What the heck!? Every other post I've read on this forum says to use Free T as a test and now you are saying not to?
    Even Dr. Johns sticky lists FreeT as a test and this is what I showed my doctor. And noone seems to know what BioT is that I talk to or has a lab code for it.

    • Total Testosterone
    • Bioavailable Testosterone (AKA “Free and Loosely Bound”)
    • Free Testosterone (if Bioavailable T is unavailable)


    Quote Originally Posted by JanSz View Post
    I think we should ask for the money back when they insist on doing FreeT lab.

    No kidding, just read this:
    http://jcem.endojournals.org/cgi/reprint/86/6/2903.pdf

    I would appreciate review (and corrections) of my study on this subject and how to deal with it, here:
    MESO-Rx - View Single Post - Attention all those on Sub-q injections
    .
    .
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    Quote Originally Posted by Dr. John View Post
    His mornng draw occurred AFTER the time he normally would have applied the T gel. So the test was done with the patient in a state he normally never lives in.

    What good does drawing a serum level at that time do, anyway? What information of any use does it provide?

    We draw labs to properly titrate drug dose (in this case). Can anyone make an arguement this assay helps us do that?

    The time to draw is roughly 2 hours status post application, for serum. But the absolute best is the 24 hour urine panel, as we then find out just how much got into the system, both by T excretion and urinary metabolites (as long as no DHEA was taken within a couple days of the urine collection, as doing so floods the metabolites).

    I hope this FINALLY clears up this point. But do not feel bad about that--look how many doctors don't understand it, either.
    Getting back to the Fig 2 and 180 days stabilized patient,
    http://androgel.com/images/ProfessionalInfo.pdf
    blood drawn 2 hours after application of Androgel coincides with maximum testosterone concentration.
    We can reasonably say that that level is maintained for about 2 hours during 24 hours period.
    The rest of the time levels are lower or much lower.
    I read from that chart
    Maximum=825
    Minimum=680
    Knowing the maximum from the (properly taken) blood test,
    I assume that one would like to have Free and BioAvailable testosterone levels at maximum range if not slightly over it.
    Total Testosterone would have secondary significance, largely depending on SHBG level.
    http://www.questdiagnostics.com/hcp/.../Table%201.pdf

    FreeT (46-224)
    BioAvailableT (110-575)
    ============================== ====
    I do not feel bad at all, I feel lucky, it is great learning experience,
    THANK YOU Doctor!
    Attached Images Attached Images  
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    Quote Originally Posted by JanSz View Post
    Getting back to the Fig 2 and 180 days stabilized patient,
    http://androgel.com/images/ProfessionalInfo.pdf
    blood drawn 2 hours after application of Androgel coincides with maximum testosterone concentration.
    We can reasonably say that that level is maintained for about 2 hours during 24 hours period.
    The rest of the time levels are lower or much lower.
    I read from that chart
    Maximum=825
    Minimum=680
    Knowing the maximum from the (properly taken) blood test,
    I assume that one would like to have Free and BioAvailable testosterone levels at maximum range if not slightly over it.
    Total Testosterone would have secondary significance, largely depending on SHBG level.
    http://www.questdiagnostics.com/hcp/.../Table%201.pdf

    FreeT (46-224)
    BioAvailableT (110-575)
    ============================== ====
    I do not feel bad at all, I feel lucky, it is great learning experience,
    THANK YOU Doctor!
    Ah yes, the graph I've often pondered.

    JanSz, my 364 is quite a bit below the daily low point, no?

    Based on what I had been doing, I should have been around the 24 hour point of the solid (30 day) line for Androgel 5G. Around 620 if I were a good absorber. So I got 364 (240-950). Granted the scale in the graph is shifted up about 50 from the scale used in the in-house lab.

    And I was taking HCG every other day too, so I would think I'd be close to or a little above that black line. But the point is moot now, I think, given the feedback from Dr. John.

    I will be discussing this again in another VOV with Dr. John very soon.
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    Quote Originally Posted by Dr. John View Post
    Besides, patients may get their meds anywhere that is best for them. It's the law, and makes sense (Consumer Protection).

    But if a patient tells me he wants to get his compounded meds somewhere that I know produces inferior products, I owe it to him to save him (and myself fo rthat matter) the trouble, if I can. There are enough variables to start with, without worrying about drug delivery, too.

    I have now switched to University Compounding Pharmacy. Now that I have seen and used it, their T gel is the best yet.
    Good to know about approved pharmacy.
    Additionally I have found on their website list of doctors that use their services.
    Please make sure that Dr. John Crisler is on their list
    University Compounding Pharmacy
    University Compounding Pharmacy Custom Prescriptions: Doctor's Referral List
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    Quote Originally Posted by aculpep View Post
    What the heck!? Every other post I've read on this forum says to use Free T as a test and now you are saying not to?
    Even Dr. Johns sticky lists FreeT as a test and this is what I showed my doctor. And noone seems to know what BioT is that I talk to or has a lab code for it.

    • Total Testosterone
    • Bioavailable Testosterone (AKA “Free and Loosely Bound”)
    • Free Testosterone (if Bioavailable T is unavailable)
    For what it's worth I read this at this link.

    Testosterone Nation - The Big T

    However, when in the blood, 60% of the big T released from the boys down below is bound up by a protein known as SHBG, or sex-hormone binding globulin. SHBG is produced and released by the liver. The important point is that the Testosterone bound to SHBG is biologically inactive and this is why there's an important distinction between total T and bioavailable T.

    Total T represents all the Testosterone in the blood, while bioavailable T represents the non SHBG bound Testosterone. There are other proteins in the blood that bind Testosterone, too, but their binding is rather weak, so this T is bioavailable and these proteins can still enter the cells to produce and effect all the things we're interested in.

    As I said, bioavailable T represents the Testosterone that is not SHBG bound, while free T represents the Testosterone that's not bound to any blood proteins at all. It's tricky, I know, but I hope that it's now evident that although only about 2% of the T in blood is technically considered free T, there is a larger percentage of T (about 40% or so) that is bioavailable because it's only weakly bound to non SHBG blood proteins.

    I'm taking you through this complex path for good reason. When trying to increase T levels in the body, one must attempt to not only increase total T. More importantly, one must attempt to increase bioavailable T. If you increase total T, but you increase SHBG to a larger extent, they you will actually have less bioavailable T for muscle building purposes!
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    Quote Originally Posted by aculpep View Post
    What the heck!? Every other post I've read on this forum says to use Free T as a test and now you are saying not to?
    Even Dr. Johns sticky lists FreeT as a test and this is what I showed my doctor. And noone seems to know what BioT is that I talk to or has a lab code for it.

    • Total Testosterone
    • Bioavailable Testosterone (AKA “Free and Loosely Bound”)
    • Free Testosterone (if Bioavailable T is unavailable)
    FreeT can be assayed or calculated.
    Assayed FreeT done at research laboratories are the most acurate.
    Assayed FreeT as sold to the general public by generally accessible laboratories are poor approximation not worth the paper they are written on.


    FreeT does not need to be assayed, it can be calculated (to reasonable accuracy) using TotalTestostrone, SHBG and Albumin.

    Only Quest will do this test, it is called
    Free BioAvailable and Total Testosterone.
    ============================== ==========
    Well just read the story I put together here:
    Anabolic Steroids - MESO-Rx - View Single Post - Attention all those on Sub-q injections
    ============================== ==========
    And scratch your head because those (best available to us tests) have an error of 1.5–2.2 times.

    I was not able to have anyone address this at all.
    But I will keep posting this from time to time,
    hopefully someone knowledgable enough will take note and give some reasonable guidance.
  

  
 

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