T Nation

What to Make of My Blood Test?

I am 34 years old, been having a lot of symptoms of low T, fatigue, cloudy, low sex drive at times, lack of ability to gain muscle, I stay sore for a long time after workouts, etc etc. So I got blood work done and my numbers came back as the following:
Testosterone| 386 ng/dL| normal range 240 - 871 ng/dL||
Note New Normal Range
Note New Methodology|

FREE TESTOSTERONE 0.314 nmol/L
VitD, 25-Hydroxy Tot 28 ng/mL
TSH 0.81 uIU/mL
Total cholesterol 208 mg/dL
Triglyceride 100 mg/dL
HDL cholesterol 57 mg/dL
LDL,Direct 128 mg/dL
Cholesterol to HDL Ratio 3.6

Sodium 139 mmol/L
Potassium 4.5 mmol/L
Chloride 103 mmol/L
CO2 (Bicarbonate) 27 mmol/L
Glucose 97 mg/dL
BUN 15 mg/dL
Creatinine 1.10 mg/dL
GFR Est-Other 87

|GFR Est-African American| 101
|Calcium| 9.3 mg/dL|
|Total Protein| 7.2 g/dL|
|Albumin| 4.1 g/dL|
|Total Bilirubin| 0.8 mg/dL|
|Alkaline Phosphatase| 53 U/L|
|AST| 19 U/L|
|ALT| 35 U/L|

White Blood Cell Count 6.2 K/uL
Red Blood Cell Count 5.23 M/uL
Hemoglobin 15.9 g/dL
Hematocrit 49.0 %
MCV 94 fL
MCH 30.4 pg
MCHC 32.4 g/dL
RDW 11.9 %
Platelet Count 216 K/uL

Hemoglobin A1c 5.0 %
Average Glucose 97 mg/dL

The nurse practitioner who order my lab work said everything is “Within range” but I kind of feel as if I should feel a lot better given the amount of effort I put into my physical and mental health.

Not that it is a big deal, but is a total cholesterol of 208 within range at your lab?

Regardless, someone with double your testosterone would also be within range and probably feeling a lot better than you. You need to have more tests, especially thyroid.

TSH
free T4
free T3
reverse T3
DHEA-S
IGF-1
FSH
LH
Estradiol
VitD
SHBG (yours appears low)
PSA

Cholesterol is on the high side. The ideal range for that was 100-200 I think. So not too far out. I’m not real concerned about that though.

So with my NP already saying everything looks good etc. how should I go about getting more blood work and potentially seeing how I would react to trt or other treatment?

This nurse practitioner has failed you by not ordering the proper testing because nurse has no clue, this is the problem we all face. Nurse practitioners aren’t properly trained in hormones, a nurse practitioners doesn’t normally do hormones therapy.

You must provide lab ranges because I have no idea if Free T is low or mid range, stange Total T is in US units and Free T in nmol/L.

Missing SHBG, Sensitive estradiol, LH, FSH. Doctors only care about “in range” and even if you have all the classic low T symptoms they do not care. You are way below average for men in your age group, something your doctor did not consider.

These reference ranges are not the word of God, they are suggestions of what may be considered low and just because someone is in range doesn’t mean they don’t have an androgen deficiency.

This is where a lot of doctors fail miserably. You can go private and self pay for TRT and work with competent experienced doctors because I’m certain any TRT protocol this nurse practitioners comes up with will worsen your condition.

So the “Range” they are giving me is
Male (17 - 65 yrs): 0.091 - 0.579nmol/L and I am at 0.314 nmol/L

I sent an email to the NP and asked for a referral to an endocrinologist in my insurance network. Hopefully I can jump through their hoops and get someone with more knowledge that can advise me more.

The NP basically said that I need to eat better, workout better, sleep better, stress less etc etc etc. However I feel like I already hit those marks the best I can given my work and lifestyle and have done what I can to maximize my hormone production naturally, but a not getting the results I feel like I should for the effort put forth.

Five years ago if I was on the same routine I am now, I would have seen dramatically different results both mentally and physically. Now however I feel flat during and after workouts, but also my muscles don’t repair themselves like they use to so I am sore longer, need extra rest, etc and it snowballs from there.

So muscle recovery is a classic sign of the beginnings of low testosterone. Ever since I started my new TRT protocol, every couple of weeks muscle recovery is improving. Sleep is better and less is needed for restful sleep.

The NP did not fail The standard lab testing for your reported symptoms were performed. Typically those labs performed are standard, IF there is something really abnormal and if your symptoms persist, then and only then are more tests required. IF your symptoms persist and nothing is found in the blood work, then you are referred to a specialist, which in your case is the Endocrinologist. An MD would have done the same thing!!
Most insurance companies will not pay for any treatment if testosterone levels are within normal range.
Your labs are pretty normal.

It seems normal continues to be redefined as time goes on, these normal ranges have nothing to do with health and happiness, it has to do with when insurance will approve treatment.

I don’t accept the normal state of affairs, studies show levels below 440 ng/dL is associated with heart disease and cardiovascular disease. That is not normal, and we shouldn’t accept it as normal.

I don’t think I would call an endocrinologist a specialist, at least not in the field of TRT.

You have to earn that title.

So I was referred to an endocrinologist in my network. Found a paper he wrote last year on trt for a local medical journal. Based on what he wrote I am fairly certain he won’t end up treating me.

If anyone wants to read it it’s on page 27

Injections once or twice weekly that caught my eye, seems like a cookie cutter approach as if we are are clones of the same person. The T gels are easier and more profitable for your doctor, if it quacks like a duck…

TRT must be individualized to match your specific biomarkers, insurance health care providers do not have that kind of time to spend with the patients which is why I believe insured healthcare cannot do TRT effectively.

My appointments with my private hormone doctor is 1 hour long, you’re lucky if you get 10-15 minutes with an insurance provider because they have 30 patients to see in an 8 hour shift.

Get the patient in and out of the office as fast as possible by giving him the cookie cutter protocol with minimal testing to appease the insurance companies.

You wonder why there are so many men suffering and seeking these forums for help.

If you show this study to your doctor and he still insists on transdermals, you know for certain it’s about the bottom line and your health is a distant second.

CONCLUSIONS:
Intramuscular TRT is more effective than transdermal formulations at increasing LBM and improving muscle strength in middle-aged and older men, particularly in the lower extremities.
https://www.ncbi.nlm.nih.gov/pubmed/29542875

Makes me wonder if I should try IM. Never did that always did subq.

How is this profitable for the doctor? They write a script, patient takes it to a pharmacy and gets it filled. Pharmacy profits.

The insurance companies are charged $600 - $800 and doctors gets a cut of the profits, insurance companies hate transdermals and are starting to push back by denying them outright. Compare those prices to an average of $47 for 3 months supply of Test cypionate to $1800 for the same 3 months.

The Gel are patented or rather the delivery method is patented therefore is very profitable for the doctors and the pharmaceutical companies, injections are not profitable because there is no patent. Think about, your a doctor and prescribing T gel gets you $350 for every prescription and prescribing Test cypionate gets you nothing because there’s no patent attached to it.

Think about it the next time you visit a doctor, is he doing right by you or himself, after all it’s a business and not a charity.

The makers of the medicine keep stats on Drs that prescribe their medication. Not sure how they know maybe pharmacy give them the info?

So you know the makers keep the Drs happy with stuff…

My kids pediatrician gave my son ear drops brand name no generic newer drug. Cost an arm and a leg. And $50 copay for me. I was always given ones that have generics cost less than $10 copay. They get incentives for prescribing it. It has to be.

The pharmaceutical companies look at the number of prescriptions filled within the drug rep’s territory. It screws them over when you fill your prescription at a pharmacy which is not in the area of the doctor’s practice, because the pharmacy may be in another reps territory. The rep may know who uses (Rx) his products, but that assumes the patients live and use a pharmacy within the rep’s territory.

The trips, meals, gifts, etc., have been greatly limited over the last several years due to regulations on the industry. Used to be, if you worked in a pharmacy, you could tell what docs are in bed with which pharmaceutical house by the prescribing practices. Not so much now, it’s considered a kickback.

Are you sure about that? Kickbacks are illegal.