Which Tests To Ask For

[Michael McAlister]

I am 67. I am active doing cardio at the gym every day and weight training one body part a day. 5-10 and staying steady at 250 lbs. I take 5 pills a day for blood pressure, one for triglycerides, two for diabeties. I hope I am moving in the right direction to get off all these pills. We'll see after tomorrow.

I have been on TRT for 9 months and am now on cruise control, sort of. I am going in for a blood draw in the morning and I am wondering which tests to ask for. I am asking for Total T, Free T, E-2 (sensitive), and Hematocrit. The Dr has been watching my lipids and esp the Trig since before I started the TRT. What other tests should I be asking for, if any?

If I get nice numbers from this draw, I am going to go for the HCG. The Dr won't help me with this so I am going to go for the free offer that is posted above. My libido is way up but my erections are very disappointing. It's a Cat on a Hot Tin Roof kind of feeling--wanting it but can't get it (up). I've ordered Cialis.

He also will not help with a theraputic blood draw. Red Cross won't help me, either, since I had Hep B decades ago. I am looking into a study going on regarding Hep B and they will pay me for a pint if I qualify. That will take care of the elevated hematocrit, which is what I suspect we will find with this blood work.

Any advice you can give me will be greatly appreciated.
Seems like there is always something blocking me from what I am trying to do (mostly my doctor) and it gets frustrating.

 

[Tom Larabee]

Michael,

The Gold Standard is below for Blood Tests when on TRT, read through it and if you have your baselines numbers it would be good to see those also.

Blood Tests Required for Testosterone Replacement Therapy

After ensuring PSA is under 4, then these tests can be performed before starting testosterone to establish baseline

OPTIMUM REQUIRED LAB WORK

1 ------- CAH Panel 6B (Comprehensive Screen) (10299X)
2 ------- Estradiol [4021X](13- 54 pg/mL) (ultrasensitive)
3 ------- Testosterone, Free, Bio/Total (LC/MS/MS) Code: 14966X
4 ------- DHEAs
5 ------- Comprehensive Metabolic Panel w/EGFR
6 ------- CBC w/ diff/PLT
7 ------- Lipid profile
8------- T3, Free
9------- T4, Free
10------- Ultrasensitive TSH
11------- LH, FSH

For follow up, LH and FSH are not needed since testosterone replacement shuts their production down. If thyroid tests are good at baseline they may not need to be repeated at follow up. Lipids tests only once or twice a year depending on patient metabolic issues. CBC includes hematocrit, one of the main variables to watch for on TRT at least for the first 6 months to a year. PSA could be added to 6 month follow up specially if over 2 at baseline.

 

[Vettester Chris]

Here's a post I made in the BW forum regarding some needed follow up labs ... Some are repeats of Tom's, others could be included if you wanted to get the gamut.

Total Testosterone Serum
Free & Bio Testosterone
SHBG
Estradiol (E2) Sensitive
Prolactin
DHT
Cortisol (4x Saliva Panel) ...
... ACTH (not always needed, but it will portrait the feedback loop productivity with the adrenals, and help if certain diseases are in question i.e., Addison's, Cushing's,)
... Aldosterone (Again, probably not on the 'standard' follow up requisition list, but something to consider if adrenal issues persists, and other variables like High BP is a factor, i.e., ruling out Conn Syndrome)
DHEA
Thyroid Panel ...
... -TSH, Free T4, Free T3, Reverse T3, Thyroid Antibodies (TPO, TgAb for Hashis and Graves)
Iron (Serum, TIBC & Saturation % if possible)
Ferritin
CBC w/Diff
Comprehensive Metabolic Panel
Lipid Panel
PSA
IGF-1
Vitamin D3 (essential with the effective management of SHBG, and much more!)
Vitamin B12

 

[a_crossfitter]

Hmm. Does anyone have the Labcorp codes that these tests would correspond to?

 

[Vettester Chris]

I don't, but I've used privatemdlabs.com, which runs their requisitions through Labcorp. You might look on their site for additional information. Also, they won't have the saliva cortisol, you will have to get that through a place like ZRT or Canary Club.

 

[Nelson Vergel]

Required Work Up Before and After Initiation of Testosterone Replacement
Unless you have money or a great insurance, I would not spend money on IGF-1 (it goes up with TRT anyway, you can test if you wish after you start TRT), prolactin (unless your T comes back at below 200 ng/dL), a full thyroid panel (unless you suspect hypo or hyperthyrodism), ACTH adrenal testing (unless you are too tired and suspect adrenal insufficiency), Vit D (most of us are deficient), and B-12 (rare to have a deficiency unless you are not eating enough vegetables and not taking a multivitamin). But if you have money, go ahead with as much testing as you can!