T Nation

Which Bloods Tests are a Waste?


#1

Total testosterone
Bioavailable testosterone
Free testosterone
SHBG
DHT
E2
LH
FSH
Prolactin
Cortisol

CBC
-HB
-PCV
-RCC
-WBC
-WBC & diff
-MCH
-MCHC
-MCV
-RDW
-Platelet count

Thyroid Panel
-TSH
-Total T3
-Free T3
-Total T4
-Free T4

CMP
General
-Glucose
-Calcium
Liver
-ALP
-ALT (SGBT)
-AST (SGOT)
-Total bilirubin
-Direct bilirubin
-Indirect bilirubin
Kidney
-Urea Nitrogen (BUN)
-Creatinine
Electrolytes
-Potassium
-Sodium
-CO2, bicarbonate
-Chloride
Proteins
-Albumin
-Total protein

Lipid panel
-Cholesterol
-Total cholesterol
-HDL
-LDL
-VLDL

I know the more the merrier but considering I'm paying for this pout of my own pocket...it adds up to a pretty penny.

I got about %90 of low T symptoms so I'm now considering TRT. I've been doing a lot of research and read up on the subject quite extensively here and elsewhere. My main concern right now is the above. Insurance won't be covering my quest so if some things are not necessary, id rather spend the money elsewhere.

And yeah, I've read KSman's sticky. I know some of the above he says is a waste of money, but a lot were not mentioned, which is a big reason why I am posting this...to make sure...since somewhere else they should be done...hence the confusion. So basically, just looking for your expertise and advice is all. Thanks!


#2

Assuming you are generally in good health, you could start with just total testosterone and SHBG (free/bioavailable T can be calculated from these two numbers). This should tell you immediately if you are on the right track with your testosterone hypothesis.

Be aware that there are dozens of other conditions with the same general symptoms as low T. You don’t want to jump on TRT if your symptoms are due to, say, mono or another infection, stress/depression, thyroid problems, or an autoimmune condition.


#3

[quote]seekonk wrote:
Assuming you are generally in good health, you could start with just total testosterone and SHBG (free/bioavailable T can be calculated from these two numbers). This should tell you immediately if you are on the right track with your testosterone hypothesis.

Be aware that there are dozens of other conditions with the same general symptoms as low T. You don’t want to jump on TRT if your symptoms are due to, say, mono or another infection, stress/depression, thyroid problems, or an autoimmune condition.
[/quote]

Just did a free testosterone test and it turned out to be just like I expected. Can’t remember the exact number as the print out is back home and I’m in a different city but it was considerably lower than the lab normal range (and we all know how low that already is).

So i ask again. Which of the above tests are a waste of time and money to do pre TRT?


#4

[quote]seekonk wrote:
Assuming you are generally in good health, you could start with just total testosterone and SHBG (free/bioavailable T can be calculated from these two numbers). This should tell you immediately if you are on the right track with your testosterone hypothesis.

Be aware that there are dozens of other conditions with the same general symptoms as low T. You don’t want to jump on TRT if your symptoms are due to, say, mono or another infection, stress/depression, thyroid problems, or an autoimmune condition.
[/quote]

Just did a free testosterone test and it turned out to be just like I expected. Can’t remember the exact number as the print out is back home and I’m in a different city but it was considerably lower than the lab normal range (and we all know how low that already is).

So i ask again. Which of the above tests are a waste of time and money to do pre TRT?


#5

Doing FT and SHBG is mostly a duplication of effort. Skip SHBG.

Thyroid: TSH, fT3, fT4 do not test T3, T4
Thyroid antibody testing is part of diagnostics when thyroid problems are detected by the above.
Your own oral body temperatures are a better measure of things than labs in some cases as the lab ranges are useless.
Your iodine intake is something that YOU need to be aware of.

LH/FSH is not needed while on TRT as these will be zero. Exception is that then an elevated FSH is a marker for testicular cancer.

The other panels are cheap and you cannot cherry pick whats in them.

You missed hematocrit that is TYPICALLY part of CBC.
Over 45 requires PSA and DRE [digital rectal exam]

If T levels are low, DHT will be low and testing DHT has no value. When on TRT after 6 months, one can test DHT and rarely it will be too high. If normal, no real need to be testing DHT routinely.

Prolactin is tested when young men have low LH/FSH when age related LH/FSH decline is not expected. Older men do not need to have prolactin screened for secondary hypogonadism. I have suggested prolactin for guys in their mid-thirties. Prolactin is typically elevated by a prolactin secreting pituitary adinoma. With primary hypogonadism and elevated LH/FSH, there is no reason to test prolactin. Save prolactin as a followup for low LH/FSH in younger males. If there are multiple indications of multiple pituitary problems, prolactin might be orders as part of a battery of pituitary hormones: TSH, IGF-1 [for GH levels], ATCH, LH/FSH, hCG, prolactin …


#6

[quote]KSman wrote:
Doing FT and SHBG is mostly a duplication of effort. Skip SHBG.

Thyroid: TSH, fT3, fT4 do not test T3, T4
Thyroid antibody testing is part of diagnostics when thyroid problems are detected by the above.
Your own oral body temperatures are a better measure of things than labs in some cases as the lab ranges are useless.
Your iodine intake is something that YOU need to be aware of.

LH/FSH is not needed while on TRT as these will be zero. Exception is that then an elevated FSH is a marker for testicular cancer.

The other panels are cheap and you cannot cherry pick whats in them.

You missed hematocrit that is TYPICALLY part of CBC.
Over 45 requires PSA and DRE [digital rectal exam]

If T levels are low, DHT will be low and testing DHT has no value. When on TRT after 6 months, one can test DHT and rarely it will be too high. If normal, no real need to be testing DHT routinely.

Prolactin is tested when young men have low LH/FSH when age related LH/FSH decline is not expected. Older men do not need to have prolactin screened for secondary hypogonadism. I have suggested prolactin for guys in their mid-thirties. Prolactin is typically elevated by a prolactin secreting pituitary adinoma. With primary hypogonadism and elevated LH/FSH, there is no reason to test prolactin. Save prolactin as a followup for low LH/FSH in younger males. If there are multiple indications of multiple pituitary problems, prolactin might be orders as part of a battery of pituitary hormones: TSH, IGF-1 [for GH levels], ATCH, LH/FSH, hCG, prolactin …it

[/quote]

Thyroid:

TSH
fT3
fT4

LH/FSH (because it’d a pre TRT test and not a test when I’m on TRT like you said)

hematocrit

Prolactin (cz I’m 35)

Is this all I should be testing?


#7

No, you asked what not to test, not what to test.


#8

[quote]KSman wrote:
No, you asked what not to test, not what to test.[/quote]

OK I’m a little confused now…simply what should I omit from the list in the OP? There are 46 tests on there.

You said “LH/FSH is not needed while on TRT”. But I’m not on TRT. I’m inquiring about what to test BEFORE TRT. Therefore I assume LH/FSH is important to test, correct?

As for Prolactin…you said "Prolactin is tested when young men have low LH/FSH when age related LH/FSH decline is not expected."
I’m 35 and I’m not sure why I have low test. So I’m guessing I should test for Prolactin, correct?

I understand I should add hematocrit to the list.

Sorry, I just want to be precise about this. You can simply copy and paste the list in the OP and just delete from it what is not necessary and add what I missed…and then post the reply. Actually, that would be preferable. Easier for me to understand.

Thanks a lot KSman…and anyone else who contributes!


#9

KSman,

Will LH and FSH drop to zero while on TRT if taking HCG? I’m sure that this is a dumb question, but I thought that HCG preserved ITT production and LH/FSH wouldn’t drop to zero if that were the case.

I’m sure that you’re right. Would you point out where my understanding is flawed, I just like to understand how everything interacts with TRT and you’re a damn good resource to do that.

Thanks.


#10

Phob: hCG works on the LH receptors. If not on TRT and T increases as a result, then LH/FSH can be expected to decrease.

If on TRT, LH/FSH will go to zero and you take hCG to compensate for the lost LH.

You need to understand things better and then you would not ask such a question.

Swoocher: I was providing general advice that provided reasons. You have interpreted things correctly. You are not on TRT and should test LH/FSH and prolactin.


#11

[quote]KSman wrote:
Phob: hCG works on the LH receptors. If not on TRT and T increases as a result, then LH/FSH can be expected to decrease.

If on TRT, LH/FSH will go to zero and you take hCG to compensate for the lost LH.

You need to understand things better and then you would not ask such a question.

Swoocher: I was providing general advice that provided reasons. You have interpreted things correctly. You are not on TRT and should test LH/FSH and prolactin.[/quote]

:frowning:

Kinda back to square one now, KSman.
My OP question has yet to be answered then.