The Labs I Run

[MrDurden]

I am insured, but want to keep the insurance company out of the loop. The lab fees from Quest are EXPENSIVE, and they don't discount for cash or payment up front.

If anyone has used a more cost-effective blood testing site, please post it.

[Finisher]

Good info......

Finisher

[gregxy]

A couple more questions,

What time of day should blood be taken? I have heard that free T can
vary by 2X depending on time of day


Are salivary tests any good? A salivary test said my free T was above
normal, but the blood test said it was below normal.

[Weatherlite]

Early morning is always the best time as a rule of thumb. Not sure if Free T can vary much throughout the day.

As for saliva tests....worth about as much as the saliva they test IMO. VERY inaccurate results WAY too often.

[ciobl]

Originally Posted by Weatherlite

As for saliva tests....worth about as much as the saliva they test IMO.

[doughbooy]

I see a lot of people saying to get your E2 checked? I don't think I see it listed below, did I miss it?

Originally Posted by SWALE

Total Testosterone
Bioavailable Testosterone (sometimes called “Free and Loosely Bound”)
Free Testosterone (if Bio T is not available)
SHBG
DHT
Estradiol (specify by the “Extraction Method” or “Ultra-Sensitive”)
Total Estrogens
LH
FSH
Prolactin
Cortisol
Thyroid Panel (TSH, FT3, FT4)
CBC
Comprehensive Metabolic Panel
Lipid Panel
Homocysteine
PSA (if over 40)
IGF-1 (if HGH therapy is desired)
Fasting Insulin


At the one month point, I follow-up with these assays:
Total Testosterone
Bioavailable Testosterone
Free T and SHBG (if Bio T is not available)
Estradiol (specify by the “Extraction Method” or “Sensitive”)
DHT (if patient is using a transdermal delivery system)
SHBG
FSH (3rd gen "sensitive" assay)
CBC
Lipid Panel
Comprehensive Metabolic Panel
(if ALT/AST from above are elevated, then get a GGT)

...I hope this helps!


__________________

[ciobl]

you see estradiol ? thats e2

[doughbooy]

Originally Posted by ciobl

you see estradiol ? thats e2

Yes, Thank you.

[12gauge]

thanks for this list, i brought it with me to me check up today. my dr didnt know what most of these test were. The lab technician taking my blood had to call the labs just to find out what was needed.

my arm is killing with all the blood they took!!!

Originally Posted by SWALE

Total Testosterone
Bioavailable Testosterone (sometimes called “Free and Loosely Bound”)
Free Testosterone (if Bio T is not available)
SHBG
DHT
Estradiol (specify by the “Extraction Method” or “Ultra-Sensitive”)
Total Estrogens
LH
FSH
Prolactin
Cortisol
Thyroid Panel (TSH, FT3, FT4)
CBC
Comprehensive Metabolic Panel
Lipid Panel
Homocysteine
PSA (if over 40)
IGF-1 (if HGH therapy is desired)
Fasting Insulin


At the one month point, I follow-up with these assays:
Total Testosterone
Bioavailable Testosterone
Free T and SHBG (if Bio T is not available)
Estradiol (specify by the “Extraction Method” or “Sensitive”)
DHT (if patient is using a transdermal delivery system)
SHBG
FSH (3rd gen "sensitive" assay)
CBC
Lipid Panel
Comprehensive Metabolic Panel
(if ALT/AST from above are elevated, then get a GGT)

...I hope this helps!


__________________

[hackskii]

Hey Dr. Swale, do you check Ferritin, and C-Reactive Protein too?
Or is this more of a special test for us older guys?


Damn dude, I love what you are doing.

If I am way out of state and you allow me to draw blood from Quest, can you do all this from afar?

Sorry man, my HRT Dr is far away too and I would not mind getting a second opinion.

Would my own HRT meds throw the test out, or can you see through it all?

Thanks man!!!!!

Good work you are doing here.

[pmgamer18]

Originally Posted by hackskii

Hey Dr. Swale, do you check Ferritin, and C-Reactive Protein too?
Or is this more of a special test for us older guys?


Damn dude, I love what you are doing.

If I am way out of state and you allow me to draw blood from Quest, can you do all this from afar?

Sorry man, my HRT Dr is far away too and I would not mind getting a second opinion.

Would my own HRT meds throw the test out, or can you see through it all?

Thanks man!!!!!

Good work you are doing here.

Try going to his site and see if your Dr. will work with Dr. John over the phone. Read about it here.
http://www.allthingsmale.com/

[painman]

Would reduced glutathione, plasma sufate, and s.o.d. also be reasonable to check for liver issues?

What if AST/ALT/and GGT were fine but sulfate, glutathione were high? And also if total estrogen is high, fibrinogen is high and ldlis high with hdl low couldn't they also point to hepato issues?

That's my labs. I do have two liver "cysts". Could they cause such?

Much thanks

Originally Posted by SWALE

Good question. Th estandard Comprehensive Metabolic Panel includes AST and ALT. An important addition is GGT as a marker for hepatotoxicity.

[DrG]

SWALE,
I'm an ND. I just started a thread regarding what I'm about to ask. Where do you order your prescription AAS for your patients from? Do you get them locally or online? Which brands are the best that you've found? Feel free to PM me.

[pcgizzmo]

Dr. G, SWALE no longer frequents this board. You can reach his web-site by going to www.allthingsmale.com He has his contact information and some good information about HRT protocols there.

Paul

[marianco]

Originally Posted by SWALE

Here is an absolute bare bones list:

Total testosterone
Estradiol ("sensitive" assay for males)
CBC
Comprehensive metabolic Panel
Lipid Profile

It is still better than what is being accepted by some docs out there.

You must understand, though, that it is not testing for the actual cause of yoour hypogonadism, nor does it attempt to screen for a more serious cause such as a pituitary tumor.

I must finish by saying the trick is in the interpreatation of the labs. That is why doctors go to medical school.

Here's one bare bones list to help make decisions regarding hormone replacement:

Blood tests:
1. Free and Total Testosterone Panel (often gives SHBG and bioavailable testosterone - all for a similar price to total testosterone alone)
2. Estradiol (ultrasensitive)
3. Free T4, TSH (Free T3 would be preferable but can be very expensive)
4. Fasting Comprehensive metabolic panel (usually very inexpensive)
5. Progesterone
6. Hemoglobin A1c

Saliva test:
7. Cortisol x 4 times a day
8. DHEA-s x 2 times a day

Note that from many labs that do Saliva tests, such as salivatest.com, it is possible to do estradiol, progesterone, testosterone also for an inexpensive price, though I haven't found them as reliable as a blood test when it comes to making decisions.

By "bare bones", as opposed to the full panel, many things are not checked as SWALE noted. It does give an idea of reproductive, adrenal, thyroid, and pancreatic hormone function.

[daphne]

one can also go to www.bodylogicmd.com to find a friendly physician or lab to run the tests mentioned. The Life Extension Foundation also runs these tests.

[cpeil2]

Originally Posted by daphne

one can also go to www.bodylogicmd.com to find a friendly physician or lab to run the tests mentioned. The Life Extension Foundation also runs these tests.

Do I smell spam?

[daphne]

No spam, just mentionign a medical group affiliated with the A4M.

[marianco]

Originally Posted by CaesarWilliam

I am down in Latin America. I have never had labs done before. I have located a Blood lab in a town near hear. I want to go get my levels checked. My question is, what test do I have them run? Do I ask for a Hormone test (Testosterone, Estrogen Ect?) Or is there a specific named test? Down here you don't need a doctor for test referals and health care is cheap and very good. I just don't know what to ask for.

Look up sticky called TRT: A Recipe for Success for SWALE/Dr. Crisler's protocol including the initial labs.

The labs need to be customized to the individual. A comprehensive set of labs for my patiens would cost close to $5,000 or more. Not everyone can afford this, even with insurance, nor may it be necessary or practical in order to address the most important problems, so I customize the lab tests for the person.

A fairly comprehensive general initial lab work-up using standard blood and urine tests may include:

REPRODUCTIVE:
Free and Total Testosterone Panel (this includes Total Testosterone, Free Testosterone, Bioavailable Testosterone, and Sex Hormone Binding Globulin), Estradiol, Progesterone, Luteinizing Hormone, Follicle Stimulating Hormone, Prolactin, Prostate Specific Antigen (in men)

THYROID:
Free T4 (Free Thyroxine), Free T3 (Free Liothyronine), Thyroid Stimulating Hormone, antithyroglobulin antibody, antithyroid peroxidase antibody, thyroid stimulating immunoglobulin.

ADRENAL:
Cortisol AM, Cortisol PM, Cortisol-Binding Globulin, Adrenocorticotropic Hormone (ACTH), Dehydroepiandrosterone Sulfate (DHEA-s),

CARBOHYDRATE METABOLISM:
fasting glucose (included in comprehensive metabolic panel when fasting), Hemoglobin A1c, fasting insulin, 3-Hour Glucose Tolerance Test (samples of blood for measuring glucose and insulin are taken at 0, 60, 120, and 180 minutes after ingesting a 1.75 g/kg glucose solution).

GROWTH HORMONE:
IGF-1 (Insulin-like growth factor I / Somatomedin-C), Growth Hormone Stimulation Test using GHRH (growth hormone releasing hormone) plus Arginine (samples of blood for measuring growth hormone are taken at 0, 30, 60, 90, and 120 minutes).

GENERAL:
Comprehensive Metabolic Panel (glucose, urea nitrogen, creatinine, calcium, sodium, potassium, CO2, cholride, total protein, albumin, globulin, total bilirubin, alkaline phosphatase, AST, ALT)
CBC (complete blood count)
Lipid Profile (including total cholesterol, triglycerides, HDL cholesterol, VLDL cholesterol, calculated LDL cholesterol)
Urinalysis
Magnesium
Vitamin D, 1, 25-Dihydroxy
Vitamin B12
Folate
Heavy Metal Screen (blood)

The tests are done in the morning after fasting overnight (no food or drink after dinner except for water). The patient should drink 0.5 liters of water before the test to avoid dehydration. The patient should avoid strenuous activity the day before, avoid restaurant food and stimulants such as coffee, eat their regular meals, and avoid stressful situations for at least 2 days before the test.

Cortisol-PM is done in the afternoon between 4-6 PM on the same day as the morning test.

The 3-hour glucose tolerance test and growth hormone stimulation tests should be done on different days.

ADDITIONAL SPECIALIZED TESTS:

A comprehensive 24-hour urine hormone panel (including DHEA, Androsterone, Etiocholanolone, Pregnanetriol, Cortisone, Cortisol, Tetrahydrocortisone, Tetrahydrocortisol, Allo-tetrahydrocortisol, Aldosterone, Tetrahydrocorticosterone, Allo-tetrahydrocorticosterone, Estrone, Estradiol, Estriol, Pregnanediol, Testosterone, Androsterone, 2-hydroxyestrogens, 16a-hydroxyestrone, 4-hydroxyestrone, 2-methoxyestrone, 2-methoxyestradiol, 5a-androstanediol, 5b-androstanediol, 11b-hydroxyandrosterone, 11b-hydroxyetiocholanolone, Free T3, Free T4, Sodium, Potassium, Calcium, Phosphorus, Magnesium).

24-hour urine growth hormone

Saliva test for Cortisol (4 samples in a day), DHEA-s (2 samples in a day).

Urine test for neurotransmitters (including sertonin, norepinephrine, dopamine, GABA, glutamate, epinephrine)

MRI of Brain

Chest X-Ray

EKG

The follow up tests include a subset of these tests as well as other tests depending on the situation.

[JackBauer]

Originally Posted by SWALE

Here is the standard order for my over 40 patients:

"Even though you will be fasting for 12 hours, please remember to drink lots of water. .

I just had labs done yesterday, and drank plenty the night before, but none before my blood work in the morning. (Fasting)

I chose not to drink because there seemed to be conflicting information online about it, I did not see this thread until today.

How substantial of an impact could me not drinking the morning of the lab test, have on results?

Thanks

[marianco]

Originally Posted by JackBauer

I just had labs done yesterday, and drank plenty the night before, but none before my blood work in the morning. (Fasting)

I chose not to drink because there seemed to be conflicting information online about it, I did not see this thread until today.

How substantial of an impact could me not drinking the morning of the lab test, have on results?

Thanks

Overnight, one can become dehydrated.

Dehydration will artificially raise levels on blood tests.

This will cause low test levels to artifically appear in the "normal" range when they may actually be low. Thus, one risks not finding deficiencies by not drinking water before the lab test.

The amount to drink is about 0.5 to 1.0 liter.

The albumin level is one indication of the amount of dehydration that is occurring.