Lab work protocol questions

[Roguejim]

I fired my former MD when he refused to test my Testo levels when he ran a basic metabolic panel. My new FNP is prescribing lab work for total &free test, CRP cardiac test, hemogram no diff, TSH, vit D, and PSA. He said if I have low T, he will retest it, and add shbg, FSH, LH, and prolactin lab work. I asked about estradiol. He said, "No, I will order estradiol if you are on TRT."

Is there a rationale for putting off the estradiol?
Anything else wrong here?

Thanks.

 

[Vettester Chris]

No, IMO it's always good to get a baseline assessment on everything, including E2, which make sure you get the "sensitive" or ultra-sensitive assay.

Also, cover the gamut on thyroid with TSH, Free T4, Free T3, Reverse T3 and antibodies (TPO and TgAb).

 

[Vince Carter]

I would think that LH and FSH would also be in the most basic of lab tests at this stage of the game. How else does he plan to diagnose Primary or Secondary Hypogonadal? I think if you request those labs and they're written off...you need to keep looking for a Dr. Even when you say that you're paying for the tests, what should it matter, and you get push back, it's not a good sign of things to come.

 

[Roguejim]

I would think that LH and FSH would also be in the most basic of lab tests at this stage of the game. How else does he plan to diagnose Primary or Secondary Hypogonadal? I think if you request those labs and they're written off...you need to keep looking for a Dr. Even when you say that you're paying for the tests, what should it matter, and you get push back, it's not a good sign of things to come.

Thanks guys. I'm not quite sure what the FNP meant by ordering estradiol lab work if I'm on TRT. Does that mean after I've already begun TRT, or after I confirm that I really want to start TRT therapy? As for the FSH and LH, he's delaying those, too, for some reason. Maybe doesn't want unnecessary lab work in case my Testo levels are not low?

 

[Vince Carter]

LH and FSH should be there, if he's not testing those then something is wrong. Those two are key points in making the medical diagnosis so if he's leaving those out...and not testing Estradiol...that's a real problem.
I'd bet ya he runs the wrong E tests and/or says he doesn't know about the ultrasensitive test for me.

 

[Sean Mosher]

Is this new doc open to discussion?
Many things on this site that you could print out and discuss with him/her regarding treatment, pre-treatment blood tests, etc....

https://www.excelmale.com/forum/showthread.php?5823-ExcelMale-com-Guide-to-Testosterone-Replacement

 

[Roguejim]

LH and FSH should be there, if he's not testing those then something is wrong. Those two are key points in making the medical diagnosis so if he's leaving those out...and not testing Estradiol...that's a real problem.
I'd bet ya he runs the wrong E tests and/or says he doesn't know about the ultrasensitive test for me.

Are you saying the LH and FSH must be run at the same time the Testo is run? In other words, if my Testo comes back low, it doesn't make sense to then run the LH and FSH? He's not refusing to run the LH and FSH. He's waiting to see what my Testo comes in at. I must not be understanding something.

 

[Roguejim]

Is this new doc open to discussion?
Many things on this site that you could print out and discuss with him/her regarding treatment, pre-treatment blood tests, etc....

https://www.excelmale.com/forum/showthread.php?5823-ExcelMale-com-Guide-to-Testosterone-Replacement

Thanks, but I don't want a Dr that has to be directed. I will question him further though.

 

[Vince]

Are you saying the LH and FSH must be run at the same time the Testo is run? In other words, if my Testo comes back low, it doesn't make sense to then run the LH and FSH? He's not refusing to run the LH and FSH. He's waiting to see what my Testo comes in at. I must not be understanding something.

By testing your LH and FSH you would be able to know if you are primary or secondary. It's just a standard test that doctors run when you are being tested for low testosterone.

 

[MarkM]

Thanks, but I don't want a Dr that has to be directed. I will question him further though.

You are going to have a hard time finding a doctor that is as educated as they need to be in dealing with all the intricacies of TRT therapy unless you are dealing with Defy, Prime Body, and or a few other like Crisler. If you want proper treatment you are going to have to take ownership and be very involved, which means "directing" your PCP in what your needs are. I've learned that if you educate yourself a PCP is more likely to listen to you and help you. If you leave it up to your PCP to properly treat you without any direction from you then that is a recipe for disaster in my opinion.

 

[Roguejim]

By testing your LH and FSH you would be able to know if you are primary or secondary. It's just a standard test that doctors run when you are being tested for low testosterone.

Yeah, I understand that. What I'm asking is if it makes any effective difference having my LH and FSH tested separately, after the Testo test, as long as they get tested? Yeah, I'm getting stuck twice when I could have gotten stuck just once...

 

[Vince]

Yeah, I understand that. What I'm asking is if it makes any effective difference having my LH and FSH tested separately, after the Testo test, as long as they get tested? Yeah, I'm getting stuck twice when I could have gotten stuck just once...

I believe it's important, I like to know what's wrong. Is there something wrong with your pituitary gland or your testicles. Could you have cancer or maybe some meds you're on. It would be nice to correct the issue and not have to go on trt.

 

[Roguejim]

I believe it's important, I like to know what's wrong. Is there something wrong with your pituitary gland or your testicles. Could you have cancer or maybe some meds you're on. It would be nice to correct the issue and not have to go on trt.

Alright, I must be brain dead. Say I have my Testo tested on a Mon. Following Mon the results come in and show low T. A day or two later, LH and FSH are tested. What's wrong with that?

 

[CoastWatcher]

Alright, I must be brain dead. Say I have my Testo tested on a Mon. Following Mon the results come in and show low T. A day or two later, LH and FSH are tested. What's wrong with that?

Arguably, your doctor might have felt you were unlikely to have presented with low testosterone, but, in the face of confirmed low levels, the necessary question of primary/secondary is being sorted out. You would have saved time if all had been pulled initially, but at least you will have an answer.

 

[Roguejim]

Arguably, your doctor might have felt you were unlikely to have presented with low testosterone, but, in the face of confirmed low levels, the necessary question of primary/secondary is being sorted out. You would have saved time if all had been pulled initially, but at least you will have an answer.

Thank you, and everyone.