Dr. Marianco, Urine more accurate then Blood?

[TylerR]

Hi Dr. Marianco,

Are you saying Urine Test is more accurate then Blood Test?

I'm confused, I have tried both, and from my results of the urine test I don't have any problems, however my blood work shows something is definatly wrong?

My Blood Test show my T levels are are mid range, and E is high. It also shows I have high DHT.

However my Urine Test shows that my T level is in the upper third of the range, and my estrogens are normal, with low DHT numbers. So I'm really confused on which is accurate.

I have had over 5 blood test with the same results, and I've only had one urine test so far.

I know have a lot of fat around my stomach and suffer from some ed, and absolutely no libido.

I'm wondering could there have been an error in the urine sampling? Is it possible that they measured an area of my urine that had more T and balanced hormones?

I'm just confused on which method is accurate.

Please let me know your thoughts.

Also has anyone else had blood test that differed from their urine tests?

How does one go about lowering Estrone levels?

Thank you!!!
Ty

Originally Posted by marianco

When a person has unexpected problems with a treatment, it may be useful to do a comprehensive 24-hour urine test covering all the steroid hormones and their metabolites, thyroid hormones, growth hormone, etc. It is an expensive test.

Meridian Valley Lab in Renton, Washington State is probably the best at the job. It is run by Jonathan Wright, M.D. (who has been doing hormone replacement therapy for about 30 years - more experience than anyone I know) who convinced me in a meeting this past weekend of their usefulness.

With the comprehensive 24-hour urine test, one can tell better how a treatment affects the various hormone metabolic pathways. Given how variable these pathways are between individuals, this lab test is useful to clarify how a person is responding to treatment - particularly when unexpected or unusual things are happening.

For example, Finasteride in a few men can cause an increase in Estrone levels - which may not be caught in when blood testing alone is done. Thus it is not only DHT that is affected - but the levels of other steroid hormones also - in some cases, in unexpected ways. For example, perhaps the increase in Estrone can affect overall anabolism..

[TylerR]

Instead of stomach fat. I mean to say girl fat, like fat around my hips, butt, thighs, and stomach. I wish I was able to edit the above thread.

But I'm still very confused on which method is accurate and how I can treat treat this condition, cuz my blood and urine tests completely contradict each other.

Thanks You!
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[marianco]

Originally Posted by TylerR

Hi Dr. Marianco,

Are you saying Urine Test is more accurate then Blood Test?

I'm confused, I have tried both, and from my results of the urine test I don't have any problems, however my blood work shows something is definatly wrong?

My Blood Test show my T levels are are mid range, and E is high. It also shows I have high DHT.

However my Urine Test shows that my T level is in the upper third of the range, and my estrogens are normal, with low DHT numbers. So I'm really confused on which is accurate.

I have had over 5 blood test with the same results, and I've only had one urine test so far.

I know have a lot of fat around my stomach and suffer from some ed, and absolutely no libido.

I'm wondering could there have been an error in the urine sampling? Is it possible that they measured an area of my urine that had more T and balanced hormones?

I'm just confused on which method is accurate.

Please let me know your thoughts.

Also has anyone else had blood test that differed from their urine tests?

How does one go about lowering Estrone levels?

Thank you!!!
Ty

It is not whether or not one is more "accurate" than the other. Both are "accurate" in what they do.

The question is what test will give one the information one seeks.

Interpreting urine tests of hormones and their metabolites is not as simple as looking at the lab ranges and telling if the level is within that range.

It requires the physician reading the test to know the various steroid pathways in order to interpret what is happening.

A blood test is a snapshot of one moment in time.

A urine test of hormones and metabolites tells one what is happening over an entire day.

Thus both have different purposes.

A blood test showing Testosterone in the mid-range, while the urine test shows it is in the upper range may mean several things.

For example, if a person has a hyperexcretion syndrome, then perhaps testosterone is being excreted too quickly.

Urine testosterone is free testosterone, by the way.

If testosterone in the urine is high, then perhaps it isn't being used - thus the metabolites of testosterone can be low.

One has to look at all the interactions and the big picture to interpret a urine test. It is, however, the only test which can give one an idea of what is happening to the hormones - e.g. what pathways a particular hormone or medication is influencing.

For example, if one takes Finasteride to lower DHT, then some people on a 24-hour urine test will show that not only is DHT being lowered, but Estrone is being increased. This is because blocking 5-alpha-reductase with Finasteride forces testosterone down some other paths - some of which may not be desired.

As another example, if one takes Pregnenolone - some people will end up with no change in their hormones using 24-hour urine tests, some will end up with more DHEA, and some will end up with more estrogens. The pathways an individual takes will vary. But which pathway an individual takes is more clearly seen on a 24-hour urine test.

Unfortunately, this test is quite expensive - about $400 each time it is run. And it is not paid for by insurance - thus one has to pay out of pocket - ouch.

Watching an expert - such as Jonathan Wright, MD - who has done this for over 20 years and his staff - read a 24-hour urine test can be breathtaking by the amount of detail he can extract from the test. Luckily, he and his staff help others are very happy to help other physicians interpret their lab tests.

[TylerR]

Thanks Marianco for your amazing answer.

I'm still unsure of what to do, if I believe my urine analysis I would need to understand the different pathways and see what is that's causing these problems.

Never the less, thank you!!!