Basic Endocrinology Question: Can Someone Be Within the Reference Ranges, but Still Be Sick?


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Hi Everyone,

I never quite understood how reference ranges were developed and how they worked.

1. and other sites explain reference ranges well:

- Formed on millions of subjects
- Using billions of data points
- Are extra generous to account for infants, children, teenagers, adults, elderly people, even pregnant people.

So, almost all of the time, if the reference ranges say "normal" then someone is truly healthy. No further pharmaceutical requirement is mandatory.

Still, doctors have discretion to say "you are within the reference ranges, but you still complain of low libido, ED, depression after you turned 50, so we can try you on TRT." Same thing goes with any medication...thyroid, growth hormone, iron supplementation for anemia, vitamin D for vitamin D deficiency.

2. Nevertheless, many "functional medicine" pseudoscience chiropractors, etc. want a way to call themselves doctors, and sometimes even use real tests inappropriately:

3. In my case, I have always been in the reference ranges, just low on them:

"T4 5.5 or 6.0, on the 5-12 reference range; TSH normal"
"Testosterone, upon rising and fasted, around 330, on a 300-1200 range; LH normal"
"GH within range, although low"

4. Still, in retrospect, I am so mad an irresponsible laypeople, or wannabe doctors (like chiropractors or alternative medicine doctors):

"You feel tired in the morning, and often drink coffee to wake up, there must be something wrong with you. I am up at the crack of dawn."
"If I had as strict diet and exercised as much as you, I'd be a beast."

"Your testosterone levels and GH are in the reference range, and so are mine. But, I am 20 years older than you, so it necessarily means you are screwed. There must be something seriously wrong with you."

5. Can anyone advise in my case?

I always wondered if my problem gaining strength or muscle mass was because of reference ranges in the normal range, but low normal.

I wondered if my slower than average metabolism was because of the normal-ranged T4 and TSH, but still in the lower end.

A few real doctors have tried to explain. It just means my body can get by with less. Having a normal testosterone level of 900 (compared to my 330), may not simply mean more muscle mass, but also post more liability for the heart, etc.


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A few real doctors have tried to explain. It just means my body can get by with less. Having a normal testosterone level of 900 (compared to my 330), may not simply mean more muscle mass, but also post more liability for the heart, etc.
this is accurate. we are all different. I am a lot like you. low in everything but otherwise healthy and vigorous.

your issue with strength and mass might be more due to your training and eating habits, if we are gonna have this talk you really need to have a deep long look in the mirror to see if there is room for improvements.

otherwise, we are just spinning wheels.

for example, I myself am endomorphic and easily gain fat. thus, I have spent my life trying to stay lean. after 20 yrs I realize, I would p0robably be much stronger and bigger if I wasn't always trying to lose body fat.

Rich Tits

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More to @xR1pp3Rx's example, hormonal and nutritional parameters and the like (through blood work) are medicine's broad strokes of teasing out what are essentially multifaceted genetic and environmental factors affecting your physiology. Is your low normal testosterone affecting your ability to optimally gain muscle? Obviously. The question is to what extent? There are a plethora of biochemical and cellular factors such as androgen receptor density, shbg levels, free testosterone, fiber type, fiber number, size of satellite cell pool, inducibility of that pool, myokine signalling, immune cell recruitment in repair, mtor responsiveness, bmp signalling pathways, myostatin levels, follistatin levels, igf-1 receptor density, MGF expression etc etc etc. Notice how only a few of what I mentioned are caught on a panel. Blood work past a certain point isn't correlative to optimization of your health/goals. It's a pragmatic macroscropic look into the existence of and/or future likelihood of health problems in the absence of intervention. Healthy is a blanket term with generally lackluster qualitative definitions predicated on non-comprehensive quantitative measurements. Once you entangle quality of life into the term, the more nebulous the concept is. I put forth this novel, all in all, to say that millions of people are metrically "normal" though sufficiently distinct phenotypically within these ranges due to the the influence of the quantity of these hormones as well as the interplay with gene variability/expression and environment.
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