T Nation

Question About Differences Between Reference Ranges

Hey all,

The other day I was looking at my lab work, and something caught my eye.

The lab i’ve been going to uses a Total T reference range 1.7 to 7.5 ng/ml - which works out to 170 to 750 ng/dl

Back in the country where I was diagnosed with low T, the reference ranges were 300 to 1000 ng/dl

Are the differences just national standards?
For example, if I had blood drawn at both labs on the same day, would I get the same result in ng/dl- regardless of their reference ranges?

Or is this like a Spinal Tap thing? Where the scale would change the result?

There are differences within countries. The US has had various lab ranges depending on who is doing the test.

99% of this is dictated by insurance companies or national healthcare systems. Make the normal range larger and fewer people will be out of range. Fewer people out of range means fewer people who have to be treated.

2 Likes

Jesus

SO, basically if I get tested today in country A and B, I would show up at 690 ng/dl in both?

(Or, lab A and lab B with different reference ranges between them)

Yeah no kidding! I was lucky to get tested in a more reasonable environment. Just think of how many poor sods there are out there crawling around feeling like arse.

Assuming they’re both using accurate tests, yeah you’d be in the same area numbers wise. Like if you drew six vials and sent three to Lab A and three to Lab B you’d get the same results (assuming they’re the same kind of test) but they may have different ranges listed.

Isn’t it based kn a period of their samples so can change with time?

I thought they used 2 standard deviations from the mean based on a normalised distribution. Basically do you fall within 95% of the population so 2.5% above and 2.5% below?

I did consider, if this is the case and the private companies doing these follow this process then the range could be artificially low based on the bias people that test have been having symptoms and also at the top end skewed based on the fact large numbers are medicating with existential Test.

I’ve been told several things by people who work in the professional laboratory and insurance industries, who would seem to know more about this than I would. Some have been mentioned above.

They’ve lowered testosterone ranges over the years as more men dropped out of the lower normal range into low or deficient. This would follow the bell curve which would have 90-95% normal and those are the very top and bottom out of range.

Ranges vary dependent on the technique and equipment utilized, or individual lab procedures.

Ranges are negotiated with major insurance carriers. For example, I don’t know if this is true but, reportedly, BC/BS negotiated with Quest to drop the testosterone bottom range from 350ng/dL to 250. So, as mentioned by iron_yuppie, fewer would qualify for treatment, as a guy at 290 is now “in normal range” which saves BlueCross money. To motivate Quest to agree, they pay them a little extra for other tests, so it’s a win win. I suppose they have actuarial people who figure all this out.

So, Quest is “in network” with BlueCross, and that is nationally, and there is a bulk discount. This is why, if you didn’t have insurance to bill, the cash fee for your labs is $2600. They do bill that to BC, but BC pays $320 as the negotiated discount, and you may pay pay $80, your %, or a co-pay. When you get your explanation of benefits, you’ll be told you “saved” $2200 by using an “in network” provider. They would allow a larger reimbursement to an out of network lab, but your end will be higher as well, with either a larger out of network deductible or larger co-payment, or both, applied.

Smaller labs have picked up on all of this, and offer to provide labs at a cheaper cash fee for those that do not have insurance which would approve, or cover, certain tests and allow one to order their own tests, though some states do not allow that.

I use a certain MRI facility for patients who have terrible or no insurance. They’ve agreed to charge the Medicare allowance to cash patients, which would be something around $300-400 of the $1800 billed.

The health of the public is controlled by the government, the pharmaceutical companies, the major insurance companies, and to a lesser extent, large hospitals. When I go to BHRT conferences around the country and meet other doctors, from multiple specialties, the #1 reason I hear behind their interest in running a hormone practice is to get out from under insurance company control. I’d say the #2 reason is to get into a wellness care model and keep people healthy, rather than treating them after they are sick.

I have some friends who just quit, brilliant doctors with skill and tons of knowledge and experience, retiring in their 50s. They’re happy, they hang out or travel, take up hobbies, whatever, but it is sad. They are simply ground down and beat up by the system, their words. I understand, but I see a huge waste of talent and ability.

I just noticed I went on a bit of a rant. Sorry.

4 Likes

I wish I could find the posts from @johann77 but he went into how the tests actually work and how ranges are developed somewhere along the way that seemed like good info. I’m not saying the ranges haven’t gone down, I think they have, but I also was convinced that some of the change could be from standardizing the testing methods as well.

I’ll try to dig through his posts later and find it. Too much to do from my phone

If you google testosterone testing standardization there are some CDC documents on the overall goals, etc

2 Likes

See, found it

1 Like

Since you said more and more men are dropping below the normal range, this makes me wonder what the bell curve would look like 100 years ago…or 200 years ago. Has our lack of good food and stressful lives made us all lower and lower?

Would the bell curve be 450-1350 in 1920? or higher in 1820? Hmmmmm?

It makes me think running above the “normal” range isn’t as bad as we may think.

It’s probably a little bit of everything. It’s fun to speculate what levels may have been years ago and whether or not they would have been at all different from today.

There are many beginning to agree with that statement.

I generally run between 1200-1400 total testosterone and my free T is above normal range. I feel fine at this dose and my blood work is fine. No hemoglobin or HCT issues, no blood pressure issues, etc. Yet I hear so many people warn of how this is bad for me long term but they never really say why. My Doctor thinks it’s perfectly fine and he’s been in this field for many years and he’s well renowned. My thoughts are that people probably naturally had these levels many years ago and they did fine. We’re just measuring ourselves to today’s lower levels and freaking ourselves out every time our levels get even a little high.

2 Likes

It’s because they don’t have an answer. Running a little higher has never been shown to be a serious risk, but people freak out when something goes above what they perceive to be the limit.

2 Likes

I’ve actually been considering this lately…

Lifestyle wise, I’m in a better position now to start making more gains, so I’ve considered shortening the time between injections to bump up my levels a little.

That means I’ll likely be “over the limit” more than normally, so I was a bit concerned about spontaneously combusting or something.

Lucky.

If I were that high my doctor would probably cut me off completely. Cold turkey.

How long have you been running that high?

I’ve been running these levels for roughly 6 years. I’d lower my dose and try things occassionally but for the most part, I stay over 1200 total T. I haven’t felt or seen any adverse side effects from it. I’m more muscular and feel better mentally where I’m at. My doctor is happy with my numbers so I’m gonna roll with it…for life probably.

1 Like

Does your doctor show up unannounced with a syringe and take your blood?

Hahah - no - but he’s the type of dude who just looks like he would go around hiding behind bushes with a syringe in his hand and a knife in his teeth.

:smiley:

Nah, I shouldn’t complain though, I got him to prescribe a decent enough protocol.
But if I try to play with the dose and duration I need to be careful that I clear out enough before getting the bi-annual bloodwork.