Rhein results -- opinions

[aculpep]

Here are my latest urine panel from Rhein.

Testosterone LOW 42 45-85ug/24 hrs

DHEA HIGH 3636 5-1476
*crazy since I'm not taking dhea at all!

ETIOCHOLANOLONE (ET) HIGH 3387 689-3252

11b-OH Etiocholanolone (OHET) LOW 113 134-1186

PREGNANEDIOL (PD) HIGH 536 32-501
*Progesterone metabolite

************************************************
E1 5.0 3-12.0ug/24hrs
2-Hydroxyestrone 4.8
16-a-Hydroxyestrone 1.1
E2 1.5 0-7.0
E3 3.9 1-16
Total Estrogens 10 4-22
CORTISOL 139 35-168

 

[hardasnails1973]

Here are my latest urine panel from Rhein.

Testosterone LOW 42 45-85ug/24 hrs

DHEA HIGH 3636 5-1476
*crazy since I'm not taking dhea at all!

ETIOCHOLANOLONE (ET) HIGH 3387 689-3252

11b-OH Etiocholanolone (OHET) LOW 113 134-1186

PREGNANEDIOL (PD) HIGH 536 32-501
*Progesterone metabolite

************************************************
E1 5.0 3-12.0ug/24hrs
2-Hydroxyestrone 4.8
16-a-Hydroxyestrone 1.1
E2 1.5 0-7.0
E3 3.9 1-16
Total Estrogens 10 4-22
CORTISOL 139 35-168

Dhea-s is the stored version of the hormone and dhea s- needs to be metabolized by the liver to dhea. From high dhea could be a stress reaction or you could actuall just a fast metaboliser of it causing a defieincy in the blood. For some reason progesterone may be diverting to dhea pathway vs testosterone pathway, but atleast its not going down the estrogen pathway which is very good.

 

[aculpep]

Do you think everything else looks ok? I know you've studied the estrogens a lot. I have other tests but it was a lot to type. I did the whole $225 rhein panel.

Dhea-s is the stored version of the hormone and dhea s- needs to be metabolized by the liver to dhea. From high dhea could be a stress reaction or you could actuall just a fast metaboliser of it causing a defieincy in the blood. For some reason progesterone may be diverting to dhea pathway vs testosterone pathway, but atleast its not going down the estrogen pathway which is very good.

 

[JanSz]

Do you think everything else looks ok? I know you've studied the estrogens a lot. I have other tests but it was a lot to type. I did the whole $225 rhein panel.

You are not gaining anything but witholding available information.

 

[hardasnails1973]

You are not gaining anything but witholding available information.

Give it all to us..

 

[Scottyo]

Anyone know how accurate the rhein or equivalent testosterone urines are in terms of in comparison to blood work on test? Anyone here have data from urines AND bloodwork at the same time to check this?

 

[JanSz]

Anyone know how accurate the rhein or equivalent testosterone urines are in terms of in comparison to blood work on test? Anyone here have data from urines AND bloodwork at the same time to check this?

My understanding, it may not be true.
--------------------------------------

There are hundrets indicators that we measure.
They all asses our heath status, and any of them provides some information.

I am not an expert on tests, but
if one was able to get perfectly accurate measurements
of one indicator in three places in ones body

blood
urine
saliva

they signify different things.
Some conclussion could be drawn about metabolism.

Howewer when the indicator is
Testosterone and Estrodial, our present system of adjustments is based on blood test.

When indicator is 2/16 estrogens ratio, we use urine tests.
===========================================

So if one wants to know if he uses big enough testosterone shots, he uses blood.
In that case getting saliva or urine results is useles
when the purpose is T dose adjustment.

And so on about other indicators.

The fact that a person is not able to get blood test but is able to get urine or saliva test is not relevant.

 

[galapagos]

I had a similar Rhein result:

Testosterone 37 (45-85)
DHEA 2063 (5-1476)

 

[Scottyo]

that was my assumption as well...and that HE HAS VERY GOOD reason for doing so.

 

[cpeil2]

Are you able to describe details of that approach?

I think he actually is coming to prefer urine results.

I can't share his treatment algorithm or his decision-making process because I don't know what it is, but he uses the Rhein panel results to determine someone's status and to make treatment decisions in the same manner that other docs use BW. He doesn't use urines exclusively.


Obviously, there are a lot of important things that can only be measured in blood, i.e. most proteins such as SHBG, LH, FSH, prolactin.


And blood lipids, chemistry, liver panel, and CBC are obviously BW.

 

[JanSz]

I think he actually is coming to prefer urine results.

I can't share his treatment algorithm or his decision-making process because I don't know what it is, but he uses the Rhein panel results to determine someone's status and to make treatment decisions in the same manner that other docs use BW. He doesn't use urines exclusively.


Obviously, there are a lot of important things that can only be measured in blood, i.e. most proteins such as SHBG, LH, FSH, prolactin.


And blood lipids, chemistry, liver panel, and CBC are obviously BW.

Until I know what to do with results
any testing is useless to me.

Personally I hate black boxes.

I want to understand my treatment.

At Genova Diagnostics there is a lots of information that helps in understanding their tests.

They also have

"Interpretative Guidelines"

unfortunately it is accessible by password only.
I will have to ask my doc if he could help me with getting access there.

 

[cpeil2]

Until I know what to do with results
any testing is useless to me.

Personally I hate black boxes.

I want to understand my treatment.

At Genova Diagnostics there is a lots of information that helps in understanding their tests.

They also have

"Interpretative Guidelines"

unfortunately it is accessible by password only.
I will have to ask my doc if he could help me with getting access there.

Oh, useless to you personally - glad you clarified.

 

[JanSz]

Oh, useless to you personally - glad you clarified.

I was hoping that you or somebody else would come forward with explanations on how to use those urine tests.

Lets start with:
Testosterone and Arimidex dose adjustment based on urine tests.

Second;
Conclusions that can be drawn from comparing (insert list here) simultaneously tested in blood and urine

At the moment that list probably would be:
Testosterone
E2
DHEA
Cortisol

----------------------------------------------------------------
Give your best shot, please.
It is really interesting topic.
Expand on the list as much as you can.
Possibly this topic is discussed in some internet text book, lets get link.

 

[cpeil2]

I was hoping that you or somebody else would come forward with explanations on how to use those urine tests.

Lets start with:
Testosterone and Arimidex dose adjustment based on urine tests.

Second;
Conclusions that can be drawn from comparing (insert list here) simultaneously tested in blood and urine

At the moment that list probably would be:
Testosterone
E2
DHEA
Cortisol

----------------------------------------------------------------
Give your best shot, please.
It is really interesting topic.
Expand on the list as much as you can.
Possibly this topic is discussed in some internet text book, lets get link.

I guess I don't understand your question. If the urine test reports that your T is low, your T is low.


The urine tests report the hormone level with a reference range. You use the reported level with the reference range just the way you would a blood level with its reference range. I suppose there is a little bit of a difference because, since the urine testing has not been in use nearly as long as blood testing, there isn't nearly as much of a knowledge base to fall back on.

 

[JanSz]

I guess I don't understand your question. If the urine test reports that your T is low, your T is low.


The urine tests report the hormone level with a reference range. You use the reported level with the reference range just the way you would a blood level with its reference range. I suppose there is a little bit of a difference because, since the urine testing has not been in use nearly as long as blood testing, there isn't nearly as much of a knowledge base to fall back on.

#1, urine testing, indeed, may have smaller database and the ranges may be more uncertain then for blood.

#2, level of hormones in urine relative to level in blood probably have something to do with a state of liver and kidneys.

For example, I have a Phil in mind, he is using much more testosterone than average would indicate. On the amount of testosterone he is using most would have much higher TT level. His liver or kidney clear testosterone fast.

Another example, HAN, he had a time when his urine E2 was high and at the same time E2 in the blood was hard to find.

==========================
So when comes to Testosterone my experience is that I realy want to use blood, because I have a chart and when I know TT and SHBG I am able to find what the FreeT is, and that is what I want to regulate.
When I know TT level in urine I still do not know much.

Similarly with E2 and I believe FreeE2, other than blood test I do not know proper ranges and I cannot get FreeE2 using urine.

 

[cpeil2]

#1, urine testing, indeed, may have smaller database and the ranges may be more uncertain then for blood.

#2, level of hormones in urine relative to level in blood probably have something to do with a state of liver and kidneys.

For example, I have a Phil in mind, he is using much more testosterone than average would indicate. On the amount of testosterone he is using most would have much higher TT level. His liver or kidney clear testosterone fast.

Another example, HAN, he had a time when his urine E2 was high and at the same time E2 in the blood was hard to find.

==========================
So when comes to Testosterone my experience is that I realy want to use blood, because I have a chart and when I know TT and SHBG I am able to find what the FreeT is, and that is what I want to regulate.
When I know TT level in urine I still do not know much.

Similarly with E2 and I believe FreeE2, other than blood test I do not know proper ranges and I cannot get FreeE2 using urine.

No, you do get free hormone. The T value reported by the Rhein panel is free T - the E2 reported is free E2.


I know what you are saying, and anomalous results like HAN's bother me about the urine test.

Don't forget, thought, that the urine is a 24-hour hormone profile, reporting the total amount of a particular hormone excreted in the urine in a 24-hour period. The blood on the other hand is only a spot level. It doesn't say anything about what the level of hormone was the hour before the blood is drawn or what it will be the hour after.

I am merely speculating, but I could imagine a scenario, where the total amount of a hormone excreted in the urine was high, reflecting, overall, a high level of the hormone and yet, at the time during that 24-hour period when the blood was drawn, the blood level of that hormone was at a nadir, leading to a low reading. Thus, it could appear that the urine level and the blood level do not correlate. Because of this, trying to draw a direct parallel between the two types of testing is not valid. They don't track each either in linear fashion.

This is still only a partial explanation of HAN's results. I do not understand why his urine would show high E2 and his blood level would be nearly undetectable.

 

[JanSz]

No, you do get free hormone. The T value reported by the Rhein panel is free T - the E2 reported is free E2.


I know what you are saying, and anomalous results like HAN's bother me about the urine test.

Don't forget, thought, that the urine is a 24-hour hormone profile, reporting the total amount of a particular hormone excreted in the urine in a 24-hour period. The blood on the other hand is only a spot level. It doesn't say anything about what the level of hormone was the hour before the blood is drawn or what it will be the hour after.

I am merely speculating, but I could imagine a scenario, where the total amount of a hormone excreted in the urine was high, reflecting, overall, a high level of the hormone and yet, at the time during that 24-hour period when the blood was drawn, the blood level of that hormone was at a nadir, leading to a low reading. Thus, it could appear that the urine level and the blood level do not correlate. Because of this, trying to draw a direct parallel between the two types of testing is not valid. They don't track each either in linear fashion.

This is still only a partial explanation of HAN's results. I do not understand why his urine would show high E2 and his blood level would be nearly undetectable.

Lets get back to practical life.

I am adjusting my testosterone dose based on my FreeT level.
I calculate FreeT level based on TotalT and SHBG.

I am adjusting my Arimidex/Liquidex dose based on E2 and FreeE2 values.

TotalT, SHBG, E2 and FreeE2 I get using blood test.

How do you propose to go about this two adjustments when one have only urine tests available?

 

[cpeil2]

Lets get back to practical life.

I am adjusting my testosterone dose based on my FreeT level.
I calculate FreeT level based on TotalT and SHBG.

I am adjusting my Arimidex/Liquidex dose based on E2 and FreeE2 values.

TotalT, SHBG, E2 and FreeE2 I get using blood test.

How do you propose to go about this two adjustments when one have only urine tests available?

Use the T measurment and E2 measurement from the urine test in the very same way that you use the blood values.

 

[JanSz]

Use the T measurment and E2 measurement from the urine test in the very same way that you use the blood values.

At the present time I do not think I will do it.
I will stick to blood tests for this two values.

But I would welcome any research that supports using urine tests for T & E2 adjustments.

Possibly current patients of dr's J, S or M may chime in, it is cutting edge, one have to be open to new research.

 

[Contraband]

I am merely speculating, but I could imagine a scenario, where the total amount of a hormone excreted in the urine was high, reflecting, overall, a high level of the hormone and yet, at the time during that 24-hour period when the blood was drawn, the blood level of that hormone was at a nadir, leading to a low reading. .

Me and Hans have had several phone conversations about this subject and that is exactly the theory I was bringing up.

The urinary analysis is a 24 hour picture of whats going on. If something shows up low on urines and high in bloods, it may be because it was temporarily spiked(this will show up in bloods, this is common with DHEA, it can spike up as a reaction to cortisol). Yet if urinary shows DHEA low, that is usually a better indicator because it is an overall all day look, and won't be suspect to errors due to spikes.

The same thing can happen with FT. FT spikes and crashes all day long. This is why many feel FT is useless in bloods(and why SHBG in itself is not reliable) because FT can spike, and by quite a wide margin.

For example - Go run down the block, better yet sprint, and then run back. Guess what happened? Your body just sent out a huge boost of LH that probably spiked your FT by about 20 percent.

TT on the other hand is a good test for bloods. TT is pretty constant, and doesn't react to spikes of FT/LH or crashes. It follows a linear curve throughout the day. I would say that a TT on bloods to be a good marker for whats going on. In urines, FT is a good marker for whats going on. FT in bloods, as I mentioned above, isn't accurate. Neither is DHEA or pregnenolone. DHEA is pretty accurate in urines.

 

[JanSz]

Me and Hans have had several phone conversations about this subject and that is exactly the theory I was bringing up.

The urinary analysis is a 24 hour picture of whats going on. If something shows up low on urines and high in bloods, it may be because it was temporarily spiked(this will show up in bloods, this is common with DHEA, it can spike up as a reaction to cortisol). Yet if urinary shows DHEA low, that is usually a better indicator because it is an overall all day look, and won't be suspect to errors due to spikes.

The same thing can happen with FT. FT spikes and crashes all day long. This is why many feel FT is useless in bloods(and why SHBG in itself is not reliable) because FT can spike, and by quite a wide margin.

For example - Go run down the block, better yet sprint, and then run back. Guess what happened? Your body just sent out a huge boost of LH that probably spiked your FT by about 20 percent.

TT on the other hand is a good test for bloods. TT is pretty constant, and doesn't react to spikes of FT/LH or crashes. It follows a linear curve throughout the day. I would say that a TT on bloods to be a good marker for whats going on. In urines, FT is a good marker for whats going on. FT in bloods, as I mentioned above, isn't accurate. Neither is DHEA or pregnenolone. DHEA is pretty accurate in urines.

While getting ready for blood draw,
keep as many factors as humanly possible, constant.
Variables are not conducive to good blood testing.
Before blood draw, I do not think it is good idea to do anything except getting out of bed, shower and go to laboratory, with out undue rushing.
The time of blood draw should be same as the T shots, on the day of the shot, before shot.

 

[rick055]

Can't lab error be accountable for some differences, also?

I don't know anything about lab testing, but I imagine there are certain protocols that need to be followed. What if it was left in the heat a little too long? To cold? Not centrifuged correctly?

Could any of that cause an anomaly which would skew the correlation between bloods and urines?

 

[JanSz]

Can't lab error be accountable for some differences, also?

I don't know anything about lab testing, but I imagine there are certain protocols that need to be followed. What if it was left in the heat a little too long? To cold? Not centrifuged correctly?

Could any of that cause an anomaly which would skew the correlation between bloods and urines?

Even with assumption that laboratory did not make any errors in following ther procedure, there is still room for variability.

Do not even call that an error,
variability of testosterone level with time from last shot
that may cause
variability in estrogens
many others.
=============================

but;

we also had reports on this board of outright errors made by RheinLabs.

 

[rick055]

we also had reports on this board of outright errors made by RheinLabs.

What kind of errors and how did they know?

Do they repeat for free if there's an error?

 

[rightship3]

we also had reports on this board of outright errors made by RheinLabs.

Link or reference?

 

[JanSz]

Link or reference?

Do a search on this Male Anti-Aging Medicine board.
You will find it.

I do not have any other infirmation on this topic.

 

[rightship3]

Do a search on this Male Anti-Aging Medicine board.
You will find it.

I do not have any other infirmation on this topic.

I did...and found nothing. Please share this information - even if its anecdotal.

 

[cpeil2]

I did...and found nothing. Please share this information - even if its anecdotal.

A can't remember the facts clearly, but a couple of guys had results that didn't make sense. They repeated the test and the result was more what would have been expected.


This kind of error, of course, is part of the testing landscape. Only a couple of weeks ago, I had a blood panel done. The serum iron level was very low, indicating I had a serious iron deficiency. I repeated the test two days later, with TIBC and ferritin, and everything was mid-range.