T Nation

Results from Genova Diagnostics

OK, after a couple of months banging my head against a wall with Kaiser I found a local doc who has what he calls an anti-aging clinic and said he works with men who might be experiencing andropause.

So, had a 2 hour office visit and exam and then did the 24 hour urine sample and Fedex’d it off to an east coast lab called Genova Diagnostics. Got my results back and it’s in units of measure that I am unfamiliar with. Very extensive list of hormones and metabolites, many I have no idea what they do. I’ll list a few and see if they make sense to anyone else. (I guess they make sense to the doc; which I’ll get to in a bit.)

About me: 58yo firefighter. Complaints: crapping out in the afternoon and night sweats. Putting on more belly fat even though I really watch my diet. I’m in the gym about 5-7 hours a week and push things pretty hard.

Anabolic/Catabolic Balance
17-Hydroxysteroids Total - 39.3 micromol/24hr
17 Ketosteroids Total 27.2 micromol/24hr
Ratio 0.7 (catabolic)

Hormones (ranges)

Pregnanediol 0.99 (0.50-2.70 micromol/24hr)
DHEA 0.19 ( <=3.00 micromol/24hr)
Testosterone 0.34 ( 0.30-1.07 micromol/24hr)
Androstanediol 0.36 ( <=0.35 micromol/24hr)
Estrone 2.2 ( 2.0-8.0 mcg/g Creat.)
Estradiol 0.6 ( 1.0-4.0 mcg/g Creat.)
Estriol 0.7 ( 2.0-19.0 mcg/g Creat.)

There’s a whole bunch of additional results but I think these are the ones of importance. (I can scan the four pages of results if anyone is interested. Neat color graphs and such.)

Interesting that when I had Estradiol tested with Kaiser the result was 44pg/mL and was high according to what I’ve been reading on this forum. That was a one time blood test. Now with the 24 hour urine test I’m showing way low.

I don’t see TT and FT mentioned specifically. Must be in one of the specific hormone results that I don’t understand.

My doc wants to put me on a bioidentical time release testosterone tablet of 75mg twice a day. I have a concern about oral testosterone and its effects on the liver and I also question “bioidentical” and wonder if it’s more a fad, expensive one at that, and the new in thing with the natural folks. This doc is an MD with about 40 years in medicine but I know he’s into herbal and natural remedy’s and such. He even asked me if I wanted a presciption for medical marijuana. Since I drive fire engines that’s just a big fat no-no. Besides, I tried that crap back in the 70’s. Fun then but just no way interested even if I wasn’t in the fire service.

Thanks in advance guys.

As with saliva tests, there is T, not TT and FT. SHBG bound T is not in your urine.

The trouble with things like this is that no one here understands what it means.

There will be a lot of first pass metabolism of the T in the liver. Same thing happens with E with oral E for women and the liver sees a huge surge of E as the E is collected by the portal vein system, which drives SHBG up which lowers women’s FT and libido. How does this translate to men? The liver will see a huge surge of T, but I don’t know what happens from there other than a lot of first pass metabolism.

Oral T must be costly as you will be taking 140mg/day. Compared to 100mg/wk injected. That is also more T than applied to the skin with T-gels and T-creams.

What form of T is the oral? Testosterone base or?

While women can take oral testosterone, they do not need much. The target serum levels in men requires an order of magnitude more than what works for women. That is a huge difference for the liver.

Ask for injections. Explain that when the T esters [cypionate, ethanate] are absorbed, the body strips off the ester groups to yield bio-T. Injected T esters are a time release bio identical testosterone delivery system.

“”"
Unmodified testosterone is rapidly absorbed by the liver, making satisfactory serum concentrations difficult to achieve.
“”"

Read the protocol for injections sticky.

You will still need to inject hCG and doing orals or transdermals to avoid injecting T when injecting hCG is insane. You will also need to control E2. As the optimal E2 levels for saliva and urine E2 are not known, you would need serum E2 testings.

Get serum tests from now on and seek injections - T+AI+hCG

What were your cortisol levels and ranges?
Do you have data for THS, T3, T4?

You still need serum testing for PSA, homocysteine, CRP, liver enzymes and cholesterol

Your DHEA is way too low.

Pregnanediol is a metabolite of progesterone. Progesterone is a precursor of cortisol.

DHEA supports progesterone production in the adrenals. Low DHEA and progesterone suggests adrenal insufficiency or fatigue. <-- crapping out in the afternoon, craving sugar fixes and many other issues. You should do a 4 sample saliva cortisol test [on a typical stressful day, not time off]. How do you react to major stress?

Do you wear fire retardant pants all of the time while on duty. Not referring to fire suit.

You might also get tested for heavy metals.

I would like to review your lab report.

http://www.medscape.com/viewarticle/550321_4

Sounds ineffective. Products are created to make money. The fact that these things exist does not mean that they are equivalent options. You need also do a cost benefit analysis relative to injections.

Urinary estrogen levels reflect serum testosterone levels because all the estrogen in men comes from the metabolism of testosterone. Low serum testosterone = not much testosterone to metabolize into estrogens = not much estrogen in the urine.

I, too, would be wary of oral testosterone preps. They have liver toxicity.

Your doctor offered you medical MJ without you asking for it? Bad sign. That tells you about the kind of patients he is used to dealing with. Did he, perchance, take the expensive weekend course in anti-aging medicine? Maybe he is hoping to coast into retirement passing out MJ and testosterone scripts.

Kaiser won’t do TRT, is that right? Not surprising. HMO doctors have to follow the approved algorithims and prescribe off of the approved formulary. The official term for that is “best practices”. That’s how they control costs. They have other methods, too.

Thanks both of you.

Ksman, I’m on duty for the next three days and don’t have the lab results with me. I’ll get my G/F to scan and email them to me and forward them on. No fire retardant chemicals while on duty. Nomex and cotton and leather boots. Bunker gear has some but that’s worn infrequently.

Turtello, the doc offered MJ as a way to help me sleep. Sometimes I wake up a couple times a night. Said a couple puffs might do the trick. Still, just not interested. (Gawd… can you see me lighting up at the firehouse!!!)

Well, I just fired my anti-ageing doc! (Damn do I feel empowered. ;> )

I spent a long time researching and studying the hormone system and reading posts here and just about every peer reviewed medical study. And big kudos for KSman for all his help.

Anyway, my now ex-doc wanted me on oral testosterone. I asked several times what form and basically received back “just do as I say”. I wrote a two page synopsis of what I had learned about the hormone system and why I wanted to try something else. (Specifically said I did not want an oral test that used a methyl group.)

Got back the following email:
"If you want to treat yourself, I suggest you enroll in medical school, get a degree, obtain a license and then, although it would be unwise, treat yourself. The saying goes “the doctor who treats himself has a fool for a doctor and an idiot for a patient.” "

Followed again by a “do as I say”.

And this from a guy who states in his book that patients should never follow blindly but question their docs if they have done their research.

I don’t mind being wrong. Just tell me why.

So scratch Dr. Ron Kennedy from the list.

Back to the search.

That was a snarky, unprofessional reply. Good riddance.

Bear in mind that the road of medical progress is littered with sure-fire, can’t miss therapies that had compelling logic according to first principles that were tried and discarded. Discarded, that is, after well designed prospective, controlled, double-blind studies showed they were largely useless or even caused harm in some patients. Remember Vioxx? There are scores of other examples and not just drugs. Surgical procedures, appliances, physical therapy interventions, diagnostic tests - all discarded. Some doctors and patients swore by them, too, but science proved them wrong.

I mention this for you and others because I believe that test + estrogen control + hCG might possibly fit in this category. Or not, it might be the new way forward. T E H sounds good, there is anecdotal evidence it helps some, perhaps many, and the logic seems sound. But the studies that would prove its worth and long term safety have not been done.

In spite of the uncertainty I am on T E H. But I acknowledge the unknown and accept the risk. So far my endocrinologist is on board with me but I had to ask him for it and make my case. My urologist thinks I am nuts and I can understand his point of view, too. He thinks the risk of developing prostate CA is too great. I hope he is wrong but I don’t know. And neither does anyone else.

All this is by way of saying good luck in your search for a new doctor, and don’t be surprised if many doctors won’t touch this.

Edit: Firepig, have you been evaluated for sleep apnea? It can cause poor sleep. You don’t have to be overweight to have it.

Haven’t gone through any testing for sleep apnea. My Kaiser doc suggested it though. (He also thinks I’m a might bit touched but is a professional through and through.) Guess it wouldn’t hurt to take him up on the offer.

Got another email from the arrogant prick former doc saying I was letting my ego get in the way of my health yet still refused to answer what he was prescribing. I guess no one has ever fired him before. Or perhaps it’s an all to common occurence?

apnea: Testing? First ask your GF. She will know something about this.

Doc does not like anyone else playing in his sand box. What is informed concent?

Found another doc through the internet. This one is down in Monterey about 150 miles south of me. Bit of a drive but my cousin and her husband run a dive shop there so I can work a family visit in as well. Have had a couple of email exchanges with him and he seems pretty good. (Guy’s from Poland. I tried a little Russian with him but no reply. Guess Poles still have a distaste for anything Russian.)

Reading some of the articles on his web site it looks like he has written at least one article for Muscle Magazine. Seems pretty practiced with TRT for those looking for clinical relief of low test as well.

http://www.wellnessmd.com/anabolics.html

I think I’ll make an appointment after the holidays. What do you guys think?

Sounds like he will be promoting his proprietary brand of 10% testosterone cream. No mention of estrogen control or hCG.

The article in the second link is confusing and repetitious, just poorly written in general.

This guy is expensive and mostly deals in cash. You will be responsible for billing your insurance company after you pay his bill in cash, in full, at the time of service. Better find out if Kaiser will reimburse you. Bet they won’t.

My advice is to keep looking for a legit endocrinologist who will treat you. Kaiser probably has you boxed in, insurance wise.