Dr. Shippen's book and low T and differences in Ranges

[deanwelsh]

I am a 48 year old male. Married. 3 daughters ages 6, 8 and ten. I have all the physical symptoms of Low T.

Labcorp said my 'Testosterone, Free, Direct is 12.5 pg/mL. Their range (or, 'reference interval') is: 6.8 pg/ml - 21.5 pg/ml.

My brother is in family practice. He has been an MD for about 25 years. When I told him I was in the range regarding my free testosterone, he said, "What is your score?"

Me, "12.5 pg/ml".

His jaw about hit the floor. He exclaimed, "That sounds LOW to me!"

So, I did some research on the net.

^^National Institutes of Health (a US gov't site) considers "a free testosterone level below 65 pg/mL can provide supportive evidence for testosterone treatment.

^^"The lower limit of normal free testosterone is 50 pg/ml - measured by equilibrium dialysis according to the Endocrine Society."

^^Questdiagnostics.com had this for a 'Free T range: 18-69 year old: 46 - 224 pg/ml'

^^"...a free testosterone level below 64 pg/mL defines the minimum critera for diagnosing late-onset hypogonadism."

So, according to the four above EXCELLENT references, I would be low. VERY LOW. It is like Labcorp is giving me a false positive. So, today I had my medical records from my Internist sent to an endocrinologist. I will visit with her in about two weeks.

What to make of this wide difference between Labcorp's range -- and the ranges of the other references? I made sure (as best as I could) that I was comparing 'apples to apples' ie. pg/ml units to pg/ml units. Why such a large difference in range?

Would you be concerned regarding Low T if you free, direct testosterone score was 12.5?

I bought a used copy of Dr. Shippen's book, "The Testosterone Syndrome" but I find his numbers to be confusing because he never tells the reader if he is dealing with FREE testosterone or TOTAL testosterone. Is the reader to ASSUME that Dr. Shippen is ALWAYS referring to TOTAL testosterone UNLESS the reader is specifically told otherwise? No where in the index of that book could I find any of the following words:

Free

Direct

Biological Available

Thank you in advance for all your help!

Dean

 

[THE-DET-OAK]

I have not had the opportunity to read his book. He is a very good source of info.

I personally believe blood work is one thing, but symptoms are another and far more important. Trying to put T ranges into an average for the general public is like our daily values for our nutritional intake, they don't mean much to most people

Technically a doctor does not even have to give you a lab test to prescribe testosterone, he can do it based on your Health History and physical evaluation.

My point is they both have value, but neither are the end all. If you have every symptom @ 48, its pretty clear to me that you have a testosterone deficiency.

Hope this helps

 

[deanwelsh]

I have not had the opportunity to read his book. He is a very good source of info.

^^^It is very readable. Again, I guess one is suppose to believe when he uses numbers that he is addressing total T, as he never refers to a 'free' or 'direct' or 'BAT' T. I'm still hoping somebody can answer that one for me.

I personally believe blood work is one thing, but symptoms are another and far more important. Trying to put T ranges into an average for the general public is like our daily values for our nutritional intake, they don't mean much to most people

^^^I agree with what you wrote above. I'm problematic in that over the last 7 years I have been diagnosed and treated for bipolar 2 (the 'light' version) and ADD. Sometimes I wonder if I would have been treated for Low T first, if the other labels would have been slapped on me. Now that I take a 'ton' of head-meds, the endo dr might need me to go off of them to see what is really going on with my hormones. I don't know. I'm just frustrated. I have taught elementary PE for the last 24 years. Last year I had to take 12 weeks off (FMLA) due to fatigue and depression.

Technically a doctor does not even have to give you a lab test to prescribe testosterone, he can do it based on your Health History and physical evaluation.

My point is they both have value, but neither are the end all. If you have every symptom @ 48, its pretty clear to me that you have a testosterone deficiency.

^^^Do you mean 48 pg/ml's of FREE/Direct test? Again, I have to try to make sure that I am comparing 'apples to apples'. There are many different units of measurement that are used. I read somewhere that they are trying to standardize that to take some of the confusion out of things.

^^^Where did you come up with the '48'? My free/direct test is a measly 12.5. The excellent sources I quoted in my first post show that this is no where CLOSE to the BOTTOM end of their ranges (ie. 50 pg/mls).

^^^Labcorp's range seems to be an anomaly since it is no where in the ball park compared to the other's ranges.

^^^Last night I read this, and just thought, "Yep. I bet that is me..." Here is what I read:

"Every week I see men in my office who come in with classic symptoms and test results for Low T, but whose physicians have either dismissed their complaints or misinterpreted the test results ("That's strange - you have all the symptoms of Low T, but this report says your testosterone levels are normal. I guess that is not it.").

pg XiV
Abraham Morgentaler, MD - Associate Clinical Professor, Harvard Medical School

"Testosterone for Life" copyright 2009 (parenthesis's in the original)

^^^I imagine this is what my Internist did with me. He saw the Lapcorp report. It states that my measly 12.5 is within their range (6.8 - 21.5 pg/mL). So, he immediately ruled out Low T.

^^^Again, for reasons unknown to me, Labcorp's range for free/direct T seem to be an anomaly when compared with the other ranges. In all the other ranges I am VERY, VERY low. With Labcorp's range -- I am fine. Hence my seeing an Endocrine doc soon. I signed a form at my Internist's office to have my medical records sent to the endocrine doc. Hopefully she can get the right DX, so I can get the right TX.

^^^I have adequate insurance. Is treating this stuff expensive? My brother said shots work and they are the cheapest way to go.

^^^I'm telling you I sure do not feel or perform fine - cognitively or sexually (and I am always achy throughout my body and feel no/low energy EVEN with Ritalin in my bloodstream for my ADD - 40mg per day of that stuff).

^^^Thank you for your reply.

^^^Can a person change the font color - so that when I quote with in a thread, it is easier to tell who said what?

^^^Thanks again - Dean

^^^PS: underneath this window there is a spot called "Trackback: Send Trackbacks to" -- what is that all about? Thanks again.