My Thoughts on Blood Testing

[DrJMW]

I just was referred to this post. I have a couple of observations to offer.

PARDON THE CAPS. I REALLY LIKE THESE COMMENTS.

Yours is indeed a good, comprehensive panel. However, I have not been drawing DHEA because, IMPO, there is no real value in spending money on this assay. Low DHEA and low testosterone are well correlated. Also, you cannot increase T levels in males through DHEA supplemention, so why monitor same?

I TEND TO AGREE WITH YOU. PART OF THE AGING PROCESS INTERFERS WITH THE CONVERSION OF DHEA TO TESTOSTERONE. THIS STILL A DEBATABLE SUBJECT AMONG ANTI-AGERS. THE ONLY THING ABOUT THE DHEA-S TESTING IS IT IS ONE LINK IN A LONG CHAIN TO THE FABRICATION OF TESTOS. WE ARE ABLE TO RETRACE "UP-THE-LINE" TO SEE WHERE THE DEFICIENCY IS. AGAIN, WE COULD PROBABLY DO WITHOUT THIS TEST.

Next, I just run what is called a "Bioavailable Testosterone". I say this for the readers out there who may see it listed, but not know that is the sum of the Free T and that which is loosely bound to proteins such as albumin. That is where the real bang for the buck comes from.

I TEND TO AGREE WITH THIS AS WELL. PERSONALLY, I THINK THE FREE TESTOS LEVEL IS MOST IMPORTANT, FOLLOWED BY THE BIOAVAILABLE. I REALLY DO LIKE LOOKING AT THE FULL PICTURE (TOTAL TESTOS, FREE TESTOS, BIOAVAILABLE TESTOS, ALBUMIN AND SHBG).

Finally, this is a proper Anti-Aging panel (perhaps with homocycteine assay added), but isn't necessarily what steroid athletes are looking for, as it includes assays which are of no real use to them. For instance, the IGFBP-3 would be a waste in this case.

IT IS IMPORTANT TO KNOW THE IGFBP-3 LEVELS ALONG WITH THE IGF-1. THEY DO NOT ALWAYS CORRELATE. GH DEFICIENCY AND GH RESISTANCE WILL LOOK DIFFERENT GIVEN THE RESULTS OF IGF-1 AND IGFBP-3. INTERESTINGLY, MANY ATHLETES HAVE LOW IGF-1 AND HIGH IGFBP-3.

I would definitely add (for the case of a true HRT work-up) Prolactin and Estradiol (must be specified as a "sensitive" assay for males, aka "Extraction Method" per Quest Diagnostics Nichols Institute). NO hormonal work-up is complete without Estradiol, and this is also an important assay for Anabolic Androgenic Steroids (AAS) athletes as well. And 5-8% of hypogonadism (back to HRT stuff now) is associated with hyperprolactinemia. Elevated levels of same may also provide a marker for a pituitary tumor, as cause of hypogonadism.

I USED TO INCLUDE ESTRADIOL EXTRACTION AND PROLACTIN. ALL OF THE RESULTS (I AHVE SEEN TO DATE) HAVE COME BACK NORMAL PRE-CYCLE. IF PROPERLY MEDICATED, THE ESTRADIOL AND PROLACTIN LEVELS STAY NORMAL OR DECREASE DURING A CYCLE, AS DEMONSTRATED BY BLOOD TEST RESULTS. I JUST DIDN'T FIND THESE TELLING. I SHOULD ADD LH TO THE BASELINE TESTING. IT IS VERY IMPORTANT TO DETERMINE WHY NATURAL TESTOS LEVELS ARE LOW. IT COULD BE A TESTICULAR PROBLEM OR IT COULD BE A PITUITARY PROBLEM OR IT COULD BE LOTS OF STEPS IN BETWEEN.

As prostate cancer is rare in men under the age of fifty, I wouldn't waste money on a PSA in men under the age of forty. Also, heavy androgen supplementation such as Anabolic Androgenic Steroids (AAS) use will definitley boost PSA, especially with all that bouncing around the guys do on their prostates secondary to their wildly increased libido. LOL.

IN SOME PEOPLE, EXOGENOUS TESTOS WILL BOOST DHT. I AM MOST CONCERNED WITH DHT'S EFFECT ON THE PROSTATE. THIS IS PRECAUTIONARY. IT IS ALSO DEBATABLE AS TO WHETHER THIS TEST IS NEEDED OR ACCURATE, BUT IT IS THE BEST WE HAVE FOR NOW. OTHER SIDES OF EXCESSIVE DHT INCLUDE ACNE AND HAIRLOSS (KIND OF LIKE PUTERY ALL OVER AGAIN). PROSTATE PROBLEMS ARISE FROM EXCESSIVE DHT AND LACK OF USE OF THE GLAND.

I think we have to be careful to separate out that which is of value to steroid athletes (as this is what this Forum is about) from the true HRT work-up. We have a hard enough itme getting them to monitor their health while "on", and since most will either elect, or have to, pay for the labs themselves, I don't want the expense to be any greater than it has to be.

I AGREE WITH THE ECONOMICS OF THIS. I KNOW THAT I AM ALWAYS OPEN TO SUGGESTIONS, AND I AM WILLING TO MAKE CHANGES TO MY FORMAT. SO FAR THIS YEAR, I AHVE BEEN PLEASED WITH THIS BLOOD TEST FORMAT. IT REALLY ONLY NEEDS TO BE RUN TWO TIMES AND THEN PERIODCIALLY, MODIFICATIONS DEPENDING ON THE CYCLING AND PROBLEMS FOUND. BOTTOM LINE: IT IS FOOLISH TO PROCEED TO ELECTIVELY USE Anabolic Androgenic Steroids (AAS) AND ANCILLARIES WITHOUT BLOOD TESTING.

 

[SWALE]

DrJMW--It's nice to communicate with a colleague here.

I'm going to simply add a couple of responses to yours, rather than try to paste even more in.

At this time, I see no reason to try to ascertain where any deficiency may be with respect to the cause of hypogonadism, insofar as looking at individual steps downstream. That is to say, beyond whether it is primary or secondary hypogonadism (and the very rare receptor deficiency, of course). When ordering tests, I always ask myself what I am going to do with the results. If DHEA is low, I cannot do anything about it by supplementing DHEA, because all that is going to do is elevate estrogen levels, not raise testosterone. And we cannot (yet!) manipulate individual enzymes within the pathway. So, IMPO, AT THIS TIME (I may change my mind in the future) there is no need to waste the patients' money by ordering tests which provide no useful information. With so many of my patients paying for their testosterone replacement therapy (TRT) out-of-pocket, I jealously protect their wallets.

I think a relience on DHEA is kind of a throw back to when AA'ers were trying to increase T with DHEA. We now know that doesn't work.

While I'm thinking of it, any chance you'll be in Las Vegas at the end of this week for the A4M International Conference? If so, let's hook up.

When you order a Bio T, you also get the Free T and SHBG thrown in. The only way to determine Bio T without specifically ordering it is to use the very rough calculation for it, which gives less accurate results than simply ordering it. Free T and Bio T are well coordinated, by why settle for something less? If you are merely looking for proof that suppleneting androgens, and controlling estrogen, I think that fact is well established.

There is no doubt about it, NO proper testosterone replacement therapy (TRT) workup is complete without Estradiol and Prolactin. Proper administration of testosterone replacement therapy (TRT) absolutley requires management of estrogen. I am now doing some work looking into managing the 2-OH/16-AOHE metabolites of estrogen. In fact, in the first patient I tried this on, a former steroid user now on testosterone replacement therapy (TRT) by me, his years-old hard gyno nodules completely disappered in two weeks! In only one case, to be sure, but that sure opened some eyes wide!

How are you going to monitor and control estrogen without getting labs?

The incidence of elevated PRL is way too high (approaching 5-8%) to ignore it, also. It is a significant cause of hypogonadism. It also signals a possible pituitary tumor when elevated. I've already caught one of these because I was the first to ask for the assay.

My comments regarding IGF-1 and IGFBP-3 were regarding steroid athletes, not an AA workup. I certainly do concur with drawing an IGFBP-3 for AA workups. But if a guy is going to take huge GH dosing for BB'ing anyway, it certainly is not necessary. In any case, there's nothing you can do with the results.

I draw LH up front, but its short half-life and pulsatile production make it almost worthless when only one assay is drawn (as opposed to serial draws). I am really only looking for something really out of whack when I order it. FSH is used on my follow-up labs, as it is a much better indicator of gonadotrophin production as it relates to suppression of the HPTA secondary to TRT.

You really won't see elevated PSA secondary to testosterone replacement therapy (TRT) dosing when administered IM. It may very well accelerate with transdermal delivery systems, because of increased DHT production induced by same, but will stablize to baseline once serum androgen levels have stabilized, too. And this phenomen really only occurs in older men.

If you are drawing a PSA for steroid athletes, what use are the results? You know it is elevated from the AAS, and from the increased sexual activity, but is the guy gong to quit because he has an elevated PSA, when it would be phenomenally rare for a man under the age of forty to get prostate cancer? If you are concerned with elevated DHT levels, then draw that. But again, you can expect that with Anabolic Androgenic Steroids (AAS) use, so the cost of the labwork is unjustified. If he is losing his hair (at a greater pace than he would normally), then switch AAS, or add in some finasteride.

As far as the actual effects of DHT on the prostate, I have learned much through the studies conducted on men with prostate morbidity who engaged in DHT as sole TRT.

As you can see, I am trying to be careful to separate out what we do for testosterone replacement therapy (TRT), and the advice we give steroid athletes.

If you would like to email me at my practice's addy, I would be happy to send you a copy of the report I just wrote for the American Academy of Anti-Aging Medicine. It is a "recipe" for administering testosterone replacement therapy (TRT) for men, and is getting pretty good reviews by the professionals who have seen it thus far.

 

[DrJMW]

I like your comments, and I have adjusted my list of blood tests to reflect your suggested changes. Now, all we need are more athletes getting the blood tests done before starting cycles.

 

[BiggieSwolls]

Again, this is a great thread. I feel very lucky to have both you Doctors posting on the board and helping out our community.

 

[Drveejay11]

Moved here for GOOD reason

 

[ronmolina]

All those test are extremely expensive. What I mean if you did all those test the expenses is up there. Any inexpensive places in Miami you good folks know of to get the testing done?

 

[bigdaddy22]

Excellent thread. I am currently in P.A. school and I feel sometimes like I am able to learn more in some posts here than in class.

 

[MeatWad]

ok, i want to have a blood test done because im SURE i have a testosterone deficieny (i made a thread in the anabolics section explaining why). The only problem is, I need a reason to justify having one done for my parents. Im 19, and im on my parents insurance, so i can just say "hey mom, i think i need some juice, make me an appointment."

so my question is, is there any way to justify having a blood test done (i.e., just to make sure im healthy, something along those lines)

Or what if i simply ask to have a checkup done, and ask the doc while im there to do a blood test, is it something he can just say "ok, ill be right back for your blood test" or do i have to schedule it in advance?

 

[gofins64]

Old therad, but great info

 

[kilsong]

yup