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Testosterone Replacement, Low T, HCG, & Beyond
Blood Test Discussion
Quest Lab values from DiscountedLabs.com just not adding up
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<blockquote data-quote="madman" data-source="post: 232024" data-attributes="member: 13851"><p>With a robust TT 756 ng/dL and normal SHBG 30 nmol/L, you can rest assured that your FT level is healthy.</p><p></p><p>Put money on it if you had your FT tested using Labcorp's TT (LC/MS-MS) with FT (Equilibrium Ultrafiltration) your FT would be near the top-end of the assay reference range 5.00-21.00ng/dL.</p><p></p><p>[URL unfurl="true"]https://www.labcorp.com/tests/070038/testosterone-free-equilibrium-ultrafiltration-with-total-testosterone-lc-ms-ms[/URL]</p><p></p><p></p><p></p><p></p><p><strong><em>post #35</em></strong></p><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/could-this-be-low-e2.25618/page-2#post-228324[/URL]</p><p></p><p></p><p><strong>My reply:</strong></p><p></p><p>For the time being stick to testing your FT using Equilibrium Dialysis or Ultrafiltration, especially in cases of ALTERED SHBG!</p><p></p><p>Test using the same lab/same assay (most accurate).</p><p></p><p>Compare your blood work using the same lab/same assay (most accurate).</p><p></p><p>Forget using/relying upon the calculated methods in cases of altered SHBG until this S**TSHOW comes to an end which will be soon enough.</p><p></p><p>If you want to use/rely on the calculated methods then go F**KING NUTS!</p><p></p><p><strong><em>*Currently, the CDC is developing a <u>harmonized method for free T based on calculated free T using REVISED FORMULAE</u>. This may bring the measurement of free T to a referable standard in clinical laboratories and common reference intervals that all clinicians can use</em></strong></p><p></p><p>Now, why the F**K would they go and do that?</p><p></p><p></p><p></p><p><strong>Key Points:</strong></p><p><strong></strong></p><p><strong><em>* Limitations of using free testosterone by equilibrium dialysis and calculated free testosterone concentrations in practice are the <u>lack of assay standardization, an accuracy-based quality control program, and a harmonized reference range</u>. Until these <u>limitations are addressed</u>, free testosterone by equilibrium dialysis and calculated free testosterone should use <u>reference ranges established by individual laboratories or their specific assay method</u></em></strong></p><p><strong><em></em></strong></p><p><strong><em>*Assays that are <u>standardized are designed to provide accurate results, traceable to “true” value-assigned certified reference materials and gold-standard reference methods</u>. <u>Results obtained using standardized methods can be compared across assays, institutions, populations, and past and future test results, thereby improving diagnosis, treatment, and outcomes of patients</u></em></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>The Need to Harmonize Clinical Laboratory Test Results-----</strong></p><p><strong></strong></p><p><strong><em>Laboratory test results are a critical component of patient care. These values help physicians diagnose disease and are critical to developing clinical guidelines that direct treatment options and are instrumental in ongoing efforts to improve and measure the quality of patient care. <u>Most tests report a numeric value for healthcare providers to interpret and the range of numbers reported for a test for a certain condition may vary depending on the method used</u></em></strong></p><p><strong><em><u></u></em></strong></p><p><strong><em><u>Different test methods, however, may report different numeric values for the same condition</u>. <u>Although these test results may be accurate within the context of its own method, this variation can create confusion for physicians and patients</u>. Clinical laboratory test results need to be <u>harmonized</u> so that healthcare providers and the public receive the <u>same numeric result regardless of the method or instrument used or the setting where it was performed</u></em></strong></p><p></p><p></p><p></p><p></p><p></p><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/cdc-standardized-total-t-and-estradiol-tests-and-soon-to-be-free-testosterone.17329/[/URL]</p><p></p><p><strong><em>*Measuring FT is technically challenging and shows high variability. The CDC clinical standardization program is <u>developing a high throughput method using the gold-standard equilibrium dialysis (ED) procedure with isotope dilution ultra-high-performance liquid chromatography-tandem mass spectrometry (ID-UHPLC-MS/MS)</u></em></strong></p><p></p><p>This has been done now!</p><p></p><p>[USER=3]@Nelson Vergel[/USER] </p><p></p><p>You heard it here first only on Excel (dropping the thread soon)!</p><p></p><p>CDC has developed a new higher-order reference method with high throughput FT ED UHPLC-MS/MS.</p><p></p><p>The method was used to evaluate the agreement between measured and calculated (cFTV).</p><p></p><p>N=45</p><p></p><p>The data in one of the slides show that a majority of the calculated values overestimated FT concentration compared to measured values <strong>(new higher-order reference method with high throughput ED UHPLC-MS/MS)</strong>.</p><p></p><p>The mean bias is roughly 35% and a higher bias (upwards of 60%) was seen in the samples with low FT concentrations.</p><p></p><p></p><p><em><strong>*The CDC ED-UPLC/MS/MS FT high-throughput method shows sufficient accuracy, precision, and sensitivity and is suitable for routine FT measurements in patient care and research settings</strong></em></p><p></p><p><strong><em>*The CDC ED-UPLC/MS/MS FT method can provide more accurate FT estimations compared to cFT by Vermeulen formula</em></strong></p><p></p><p></p><p></p><p></p><p></p><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/cdc-hormone-standardization-program-cdc-host-certified-free-testosterone-procedures-is-coming.25751/[/URL]</p><p></p><p>[ATTACH=full]25106[/ATTACH]</p><p>[ATTACH=full]25105[/ATTACH]</p><p>[ATTACH=full]25107[/ATTACH]</p><p>[ATTACH=full]25108[/ATTACH]</p><p></p><p></p><p></p><p></p><p></p><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/what-to-measure-testosterone-or-free-testosterone.25287/[/URL]</p><p></p><p><em><strong>*The binding of T to SHBG is complex, which results in many different methods that directly measure or calculate free T. Some of these methods do not measure the free fraction of T and some formulae may provide less accurate results [40]</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*Recent evidence suggests that the law of mass action formula which is based on the assumption that two T molecules bind to two binding sites on the SHBG with similar binding affinity may be incorrect. And further argues that the binding of T to SHBG may be a multistep, dynamic process with complex allosteric characteristics [65]. Based on this new model, investigators used a new formula to calculate free T in younger men in the Framingham Heart Study and showed that the newly calculated values were similar to those measured by equilibrium dialysis. They further verified that the calculated free T values had clinical diagnostic validity using data from the European Male Aging Study</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*Currently, the CDC is developing a harmonized method for free T based on calculated free T using revised formulae. This may bring the measurement of free T to a referable standard in clinical laboratories and common reference intervals that all clinicians can use</strong></em></p><p><em><strong></strong></em></p><p><em><strong>*Perhaps the newer formula for calculated free T validated in multiple laboratories [65], will become generally available, correlate with free T by equilibrium dialysis, and demonstrate improved correlation with clinical symptoms and therapeutic responsiveness. If all these prove to be true, then this formula to calculate free T may be a justified replacement for free T measurement by the equilibrium dialysis methodology</strong></em></p><p></p><p></p><p></p><p></p><p>[URL unfurl="true"]https://www.excelmale.com/forum/threads/whats-coming-accurate-measurement-of-total-and-free-testosterone-levels-for-the-diagnosis-of-androgen-disorders.25690/[/URL]</p></blockquote><p></p>
[QUOTE="madman, post: 232024, member: 13851"] With a robust TT 756 ng/dL and normal SHBG 30 nmol/L, you can rest assured that your FT level is healthy. Put money on it if you had your FT tested using Labcorp's TT (LC/MS-MS) with FT (Equilibrium Ultrafiltration) your FT would be near the top-end of the assay reference range 5.00-21.00ng/dL. [URL unfurl="true"]https://www.labcorp.com/tests/070038/testosterone-free-equilibrium-ultrafiltration-with-total-testosterone-lc-ms-ms[/URL] [B][I]post #35[/I][/B] [URL unfurl="true"]https://www.excelmale.com/forum/threads/could-this-be-low-e2.25618/page-2#post-228324[/URL] [B]My reply:[/B] For the time being stick to testing your FT using Equilibrium Dialysis or Ultrafiltration, especially in cases of ALTERED SHBG! Test using the same lab/same assay (most accurate). Compare your blood work using the same lab/same assay (most accurate). Forget using/relying upon the calculated methods in cases of altered SHBG until this S**TSHOW comes to an end which will be soon enough. If you want to use/rely on the calculated methods then go F**KING NUTS! [B][I]*Currently, the CDC is developing a [U]harmonized method for free T based on calculated free T using REVISED FORMULAE[/U]. This may bring the measurement of free T to a referable standard in clinical laboratories and common reference intervals that all clinicians can use[/I][/B] Now, why the F**K would they go and do that? [B]Key Points: [I]* Limitations of using free testosterone by equilibrium dialysis and calculated free testosterone concentrations in practice are the [U]lack of assay standardization, an accuracy-based quality control program, and a harmonized reference range[/U]. Until these [U]limitations are addressed[/U], free testosterone by equilibrium dialysis and calculated free testosterone should use [U]reference ranges established by individual laboratories or their specific assay method[/U] *Assays that are [U]standardized are designed to provide accurate results, traceable to “true” value-assigned certified reference materials and gold-standard reference methods[/U]. [U]Results obtained using standardized methods can be compared across assays, institutions, populations, and past and future test results, thereby improving diagnosis, treatment, and outcomes of patients[/U][/I] The Need to Harmonize Clinical Laboratory Test Results----- [I]Laboratory test results are a critical component of patient care. These values help physicians diagnose disease and are critical to developing clinical guidelines that direct treatment options and are instrumental in ongoing efforts to improve and measure the quality of patient care. [U]Most tests report a numeric value for healthcare providers to interpret and the range of numbers reported for a test for a certain condition may vary depending on the method used Different test methods, however, may report different numeric values for the same condition[/U]. [U]Although these test results may be accurate within the context of its own method, this variation can create confusion for physicians and patients[/U]. Clinical laboratory test results need to be [U]harmonized[/U] so that healthcare providers and the public receive the [U]same numeric result regardless of the method or instrument used or the setting where it was performed[/U][/I][/B] [URL unfurl="true"]https://www.excelmale.com/forum/threads/cdc-standardized-total-t-and-estradiol-tests-and-soon-to-be-free-testosterone.17329/[/URL] [B][I]*Measuring FT is technically challenging and shows high variability. The CDC clinical standardization program is [U]developing a high throughput method using the gold-standard equilibrium dialysis (ED) procedure with isotope dilution ultra-high-performance liquid chromatography-tandem mass spectrometry (ID-UHPLC-MS/MS)[/U][/I][/B] This has been done now! [USER=3]@Nelson Vergel[/USER] You heard it here first only on Excel (dropping the thread soon)! CDC has developed a new higher-order reference method with high throughput FT ED UHPLC-MS/MS. The method was used to evaluate the agreement between measured and calculated (cFTV). N=45 The data in one of the slides show that a majority of the calculated values overestimated FT concentration compared to measured values [B](new higher-order reference method with high throughput ED UHPLC-MS/MS)[/B]. The mean bias is roughly 35% and a higher bias (upwards of 60%) was seen in the samples with low FT concentrations. [I][B]*The CDC ED-UPLC/MS/MS FT high-throughput method shows sufficient accuracy, precision, and sensitivity and is suitable for routine FT measurements in patient care and research settings[/B][/I] [B][I]*The CDC ED-UPLC/MS/MS FT method can provide more accurate FT estimations compared to cFT by Vermeulen formula[/I][/B] [URL unfurl="true"]https://www.excelmale.com/forum/threads/cdc-hormone-standardization-program-cdc-host-certified-free-testosterone-procedures-is-coming.25751/[/URL] [ATTACH type="full" alt="1661957735602.png"]25106[/ATTACH] [ATTACH type="full" alt="1661957735639.png"]25105[/ATTACH] [ATTACH type="full" alt="1661957735666.png"]25107[/ATTACH] [ATTACH type="full" alt="1661957735689.png"]25108[/ATTACH] [URL unfurl="true"]https://www.excelmale.com/forum/threads/what-to-measure-testosterone-or-free-testosterone.25287/[/URL] [I][B]*The binding of T to SHBG is complex, which results in many different methods that directly measure or calculate free T. Some of these methods do not measure the free fraction of T and some formulae may provide less accurate results [40] *Recent evidence suggests that the law of mass action formula which is based on the assumption that two T molecules bind to two binding sites on the SHBG with similar binding affinity may be incorrect. And further argues that the binding of T to SHBG may be a multistep, dynamic process with complex allosteric characteristics [65]. Based on this new model, investigators used a new formula to calculate free T in younger men in the Framingham Heart Study and showed that the newly calculated values were similar to those measured by equilibrium dialysis. They further verified that the calculated free T values had clinical diagnostic validity using data from the European Male Aging Study *Currently, the CDC is developing a harmonized method for free T based on calculated free T using revised formulae. This may bring the measurement of free T to a referable standard in clinical laboratories and common reference intervals that all clinicians can use *Perhaps the newer formula for calculated free T validated in multiple laboratories [65], will become generally available, correlate with free T by equilibrium dialysis, and demonstrate improved correlation with clinical symptoms and therapeutic responsiveness. If all these prove to be true, then this formula to calculate free T may be a justified replacement for free T measurement by the equilibrium dialysis methodology[/B][/I] [URL unfurl="true"]https://www.excelmale.com/forum/threads/whats-coming-accurate-measurement-of-total-and-free-testosterone-levels-for-the-diagnosis-of-androgen-disorders.25690/[/URL] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Blood Test Discussion
Quest Lab values from DiscountedLabs.com just not adding up
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