Understanding blood work

[Sundownz239]

Hey guys, I don't really know how to start this off, but I'm having a really hard time reading my lab results; more so trying to find what levels I SHOULD be at. All sources say different things and I havent had any kuck makingsense of the resukts as a whole. I know there's relationships between cholesterol and testosterone, and free test and total test with shbg etc but if someone more knowledgeable could help guide me through this I would really appreciate it. I'm going to post picture of my lab results and hopefully someone can make sense of it.

Thanks in advance,
Manny

 

[Sundownz239]

Results

 

[FunkOdyssey]

You have a high total testosterone and low free testosterone. Free testosterone is what determines whether you have symptoms of hypogonadism or not. Although it is not provided in your labs, you must have a very high SHBG value in order to have such a low free testosterone with a total of 987 ng/dL.

If I were you I would want lab results for SHBG and I would test free testosterone directly with equilibrium dialysis, which is the most accurate test available. I think the direct measurement is important here to confirm that free testosterone is truly low in the presence of such a high total testosterone value.

 

[Vince]

Hey guys, I don't really know how to start this off, but I'm having a really hard time reading my lab results; more so trying to find what levels I SHOULD be at. All sources say different things and I havent had any kuck makingsense of the resukts as a whole. I know there's relationships between cholesterol and testosterone, and free test and total test with shbg etc but if someone more knowledgeable could help guide me through this I would really appreciate it. I'm going to post picture of my lab results and hopefully someone can make sense of it.

Thanks in advance,
Manny

You can see your name. I would delete that second post and start over.

 

[Systemlord]

I'm having a really hard time reading my lab results; more so trying to find what levels I SHOULD be at.

You want your free testosterone levels at the highest quartile of the normal ranges.

One thing is for sure, you'll need a total testosterone levels well 1000> to benefit from high free testosterone, and I'm sure it will be challenge to find a sick care doctor that is knowledgeable enough to allow it.

I know there's relationships between cholesterol and testosterone

Cholesterol is the build blocks of testosterone, and people on statins, if the dosage is excessive, can cause testosterone.

 

[Sundownz239]

You can see your name. I would delete that second post and start over.

I know, I appreciate the concern but I don't really care lol

 

[Sundownz239]

You have a high total testosterone and low free testosterone. Free testosterone is what determines whether you have symptoms of hypogonadism or not. Although it is not provided in your labs, you must have a very high SHBG value in order to have such a low free testosterone with a total of 987 ng/dL.

If I were you I would want lab results for SHBG and I would test free testosterone directly with equilibrium dialysis, which is the most accurate test available. I think the direct measurement is important here to confirm that free testosterone is truly low in the presence of such a high total testosterone value.

So more lab tests for shbg? And I heard you're supposed to test between 2 different days and in the morning like 10 a.m. I went at the end of a work day in the afternoon and they just pulled the blood that one day. Would that have any effect on the levels?

 

[Sundownz239]

Hey guys, I don't really know how to start this off, but I'm having a really hard time reading my lab results; more so trying to find what levels I SHOULD be at. All sources say different things and I havent had any kuck makingsense of the resukts as a whole. I know there's relationships between cholesterol and testosterone, and free test and total test with shbg etc but if someone more knowledgeable could help guide me through this I would really appreciate it. I'm going to post picture of my lab results and hopefully someone can make sense of it.

Thanks in advance,
Manny

Also I want to point out I'm not on anything and I just started working out, have been consistently doing it for about 2 months now. I'm not on any supplements or even protein shakes I just eat pretty healthy and lift.

 

[madman]

Hey guys, I don't really know how to start this off, but I'm having a really hard time reading my lab results; more so trying to find what levels I SHOULD be at. All sources say different things and I havent had any kuck makingsense of the resukts as a whole. I know there's relationships between cholesterol and testosterone, and free test and total test with shbg etc but if someone more knowledgeable could help guide me through this I would really appreciate it. I'm going to post picture of my lab results and hopefully someone can make sense of it.

Thanks in advance,
Manny

You are missing some critical blood markers such as testing Free Testosterone using an accurate assay (ED or UF), SHBG, and LH/FSH.

Your TT was tested using the most accurate assay (LC/MS-MS).

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

When it comes to testing FT it is critical to use an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best), especially in cases of altered SHBG.

Keep in mind that men can have what would be considered healthy/higher-end TT and still have subpar FT due to high SHBG.


When Binding Proteins Interfere With Immunoassays

WHAT CAN BE DONE TO ENSURE ACCURATE LABORATORY RESULTS FOR THESE PATIENTS?

There are several strategies that both clinical and laboratory teams can take to ensure accurate measurements for patients with abnormal levels of binding proteins. Initially, if laboratory measurements do not agree with the clinical presentation of the patient, the analyte-specific binding globulin can be measured to rule out bias due to abnormal concentrations of binding proteins. If possible, the sample can be analyzed by the gold standard method, LC-MS/MS, which removes binding proteins by precipitation or, in the case of FREE HORMONE measurements, physically separates the bound from the free fraction via EQUILIBRIUM DIALYSIS or ULTRACENTRIFUGATION.

If measurement by LC-MS/MS is not feasible, the clinical and laboratory teams can collaborate to define appropriate reference intervals for specific patient populations.




If anything you should have ordered this test through Nelson's discounted labs:
Testosterone, Total, LC/MS and Free (Equilibrium Dialysis)

When it comes to testing FT any one of these would suffice:


Labcorp

1. 500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | Labcorp
Methodology: Testosterone: high-pressure liquid chromatography (HPLC)/tandem mass spectrometry; free testosterone: equilibrium dialysis


2. 070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp
Methodology: Free: equilibrium ultrafiltration; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)


Quest Diagnostics

3. Testosterone, Total, LC/MS, and Free (Equilibrium Dialysis)
Methodology: Free: equilibrium dialysis; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)




Another thing that stands out is you did not have your bloodwork done in a fasted state in the early am.

You never fasted and had blood drawn in the early afternoon at 2:10 pm.

Natural endogenous testosterone secretion is pulsatile and diurnal (24 hr circadian rhythm).

Testing should be done in a fasted state between 7-10 am as we want to test at peak.

*Testosterone levels decline after a meal or glucose

I would go for bloodwork between 7-8 am.

Blood work should never be done in the late afternoon/early evening when levels will be lower as nadir (lowest point) would be around 6-8 pm.

Fluctuations from peak--->trough would be around 20-25%.


Improving Diagnostic Accuracy and Treatment Decisions in Men with Hypogonadism

What led you to have your hormones checked as you never stated that you might be experiencing symptoms of low T?

Would not jump to any conclusions until you have your FT tested using an accurate assay!

 

[Systemlord]

I went at the end of a work day in the afternoon and they just pulled the blood that one day. Would that have any effect on the levels?

This was a complete waste of a test, because you testosterone levels are highest in the mornings (before 10 a.m.) and lowest at night time.

 

[madman]

Hey guys, I don't really know how to start this off, but I'm having a really hard time reading my lab results; more so trying to find what levels I SHOULD be at. All sources say different things and I havent had any kuck makingsense of the resukts as a whole. I know there's relationships between cholesterol and testosterone, and free test and total test with shbg etc but if someone more knowledgeable could help guide me through this I would really appreciate it. I'm going to post picture of my lab results and hopefully someone can make sense of it.

Thanks in advance,
Manny

What's Coming? Accurate measurement of total and free testosterone levels for the diagnosis of androgen disorders

Accurate measurement of total and free testosterone levels for the diagnosis of androgen disorders (7/2022) Ezgi Caliskan Guzelce, MD, Clinical/ Research Fellow, Francesca Galbiati, MD, Fellow, Anna L. Goldman, MD, Assistant Professor of Medicine, Arijeet K. Gattu, MD, Fellow, Shehzad Basaria...

www.excelmale.com

 

[Sundownz239]

You are missing some critical blood markers such as testing Free Testosterone using an accurate assay (ED or UF), SHBG, and LH/FSH.

Your TT was tested using the most accurate assay (LC/MS-MS).

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

When it comes to testing FT it is critical to use an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best), especially in cases of altered SHBG.

Keep in mind that men can have what would be considered healthy/higher-end TT and still have subpar FT due to high SHBG.


When Binding Proteins Interfere With Immunoassays

WHAT CAN BE DONE TO ENSURE ACCURATE LABORATORY RESULTS FOR THESE PATIENTS?

There are several strategies that both clinical and laboratory teams can take to ensure accurate measurements for patients with abnormal levels of binding proteins. Initially, if laboratory measurements do not agree with the clinical presentation of the patient, the analyte-specific binding globulin can be measured to rule out bias due to abnormal concentrations of binding proteins. If possible, the sample can be analyzed by the gold standard method, LC-MS/MS, which removes binding proteins by precipitation or, in the case of FREE HORMONE measurements, physically separates the bound from the free fraction via EQUILIBRIUM DIALYSIS or ULTRACENTRIFUGATION.

If measurement by LC-MS/MS is not feasible, the clinical and laboratory teams can collaborate to define appropriate reference intervals for specific patient populations.




If anything you should have ordered this test through Nelson's discounted labs:
Testosterone, Total, LC/MS and Free (Equilibrium Dialysis)

When it comes to testing FT any one of these would suffice:


Labcorp

1. 500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | Labcorp
Methodology: Testosterone: high-pressure liquid chromatography (HPLC)/tandem mass spectrometry; free testosterone: equilibrium dialysis


2. 070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp
Methodology: Free: equilibrium ultrafiltration; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)


Quest Diagnostics

3. Testosterone, Total, LC/MS, and Free (Equilibrium Dialysis)
Methodology: Free: equilibrium dialysis; total: liquid chromatography/tandem mass spectrometry (LC/MS-MS)




Another thing that stands out is you did not have your bloodwork done in a fasted state in the early am.

You never fasted and had blood drawn in the early afternoon at 2:10 pm.

View attachment 24965


Natural endogenous testosterone secretion is pulsatile and diurnal (24 hr circadian rhythm).

Testing should be done in a fasted state between 7-10 am as we want to test at peak.

*Testosterone levels decline after a meal or glucose

I would go for bloodwork between 7-8 am.

Blood work should never be done in the late afternoon/early evening when levels will be lower as nadir (lowest point) would be around 6-8 pm.

Fluctuations from peak--->trough would be around 20-25%.


Improving Diagnostic Accuracy and Treatment Decisions in Men with Hypogonadism

View attachment 24961
View attachment 24962
View attachment 24963
View attachment 24964


What led you to have your hormones checked as you never stated that you might be experiencing symptoms of low T?

Would not jump to any conclusions until you have your FT tested using an accurate assay!

Slight Gyno left over from puberty lollllll the doctor is the one who ordered the blood work I was asking him to give me raloxifene.