New labs…what’s your take?

[GWJ]

Hi guys. I need some insight on my current blood work. This blood work is without testerone therapy. My endo told all is ok, and wants to recheck my blood in 3 months. I’m calling B.S. on his diagnosis. He only had a little issue with the Estradiol (he said to recheck it in 3 months).

VITAMIN B12 575 R 200-1100
UREA NITROGEN 23 R 7-25
CREATININE .85 R .78-1.34
eGFR >60 R >=60
CALCIUM 9.8 R 8.6-10.2
SODIUM 143 R 135-146
POTASSIUM 4.2 R 3.5-5.1
CO2 30 R 21-33
CHLORIDE 102 R 98-110
PROTEIN 7 R 6.2-8.3
ALBUMIN 4.6 R 3.6-5.1
GLOBULIN 2.4 R 2.1-3.7
A/G RATIO 1.9 R 1.0-2.1
BILIRUBIN 0.6 R 0.2-1.2
ALKALINE 45 R 40-115
AST 8 R 10-40 (LOW)
ALT 25 R 9-40
TESTOSTERONE 176 R 250-1100 (LOW)
% FREE TESTO 2.08 R 1.5-2.2 %
TESTOSTERONE FREE 36.6 R 35-155
IGF-1 172 R 86-220
ESTRADIOL FREE .72 R <0R= .45 (HIGH)
ESTRADIOL % FREE 2.39 R 1.25-1.85 % (HIGH)
ESTRADIOL 30 R A1C 8 R <7 (HIGH)
THYROXINE-FREE 1.0 R .8-1.8
PSA .5 R TSH 3.23 R .40-4.50
LH 3.5 R 1.5-9.3
FSH 2.6 R 1.6-8.0

Thanks for any input!

[DrMariano2]

@GWJ 963 wrote:

VITAMIN B12 575 R 200-1100
TESTOSTERONE 176 R 250-1100 (LOW)
IGF-1 172 R 86-220
ESTRADIOL 30 R <OR=29 (HIGH)
A1C 8 R <7 (HIGH)
THYROXINE-FREE 1.0 R .8-1.8
TSH 3.23 R .40-4.50

These are the ones which stick out for me.

The interpretation is fairly self-evident for most of them.

Blood glucose seems to be missing, as is a fasting insulin.

Generally, when one fat soluble vitamin is low, the other ones are low also. And generally, this means a person has too little animal-source saturated fat and possibly protein in the diet.

Nervous system deterioration tends to occur when B12 is half-way in the reference range – around 550. To be safe, I prefer much higher levels than 550.

IGF-1, as a measure of growth hormone, varies in interpretation. To an anti-aging doctor, growth hormone replacement may occur at a level under 250 for IGF-1. However, I tend to only consider growth hormone replacement only after optimizing everything else, and then only if IGF-1 is much lower than 250 – the exact level depends on the patient.

Note that even the American Medical Association recognizes that low testosterone predicts early death in men.

[GWJ]

Thanks for the reply, Dr…the blood glucose was 140 fasting ( I’m working real heard to lower my numbers, with 60 min. on the treadmill, 5 days a week). The funny thing about the low saturated fat is I’m on a low carb diet, and it all I eat is meat. Dr. M I can’t remember the last time I had a good sense of well being. I have no drive in life, and I was a real go getter, back in the day. I have mood swings, and some times I’m depressed, so I’m not sure why is going on. I haven’t had morning wood in about 10 years, and I’m 45. I can take one to two naps a day. My endro told me the reason my T was low and my E was high was maybe I had a tumor, and it was converting my T into E but he wanted to do a recheck in 3 more month. I think he’s done! Well as you can see I’m a mess, any help would be much appreciated! By the way I live in Hollister, ca.

[hardasnails1973]

@GWJ 975 wrote:

Thanks for the reply, Dr…the blood glucose was 140 fasting ( I’m working real heard to lower my numbers, with 60 min. on the treadmill, 5 days a week). The funny thing about the low saturated fat is I’m on a low carb diet, and it all I eat is meat. Dr. M I can’t remember the last time I had a good sense of well being. I have no drive in life, and I was a real go getter, back in the day. I have mood swings, and some times I’m depressed, so I’m not sure why is going on. I haven’t had morning wood in about 10 years, and I’m 45. I can take one to two naps a day. My endro told me the reason my T was low and my E was high was maybe I had a tumor, and it was converting my T into E but he wanted to do a recheck in 3 more month. I think he’s done! Well as you can see I’m a mess, any help would be much appreciated! By the way I live in Hollister, ca.

After looking at these results I would like to see further evaluation on VAP, more indept thyroid testing as well as cortisol saliva testing to rule out adrenal insufficiency.

Note
B-12 serums even in mid range will result in a b-12 tissue deficiency.
When tested FIA 5000 people with as high as 700 on the serum were b-12 deficient. When this was addressed symptoms started to improve dramatically.

One would look into potential insulin imbalances by examining VAP profile.
At this point HRT should be highly considered because you are not 25 anymore and the idea of a restart is out of the question. A lot of your symptoms reflect low adrenal out put which I commonly see on a daily basis. When hormones, nutrition, mental well being (through counseling, reconnecting with your spirituality, medication) and lifestyles are corrected there is greater chance of recovering ones wellness.

[GWJ]

Thanks, hardasnail.
I’m going to try to set up an appointment with Dr. M.

[JanSz]

@DrMariano 965 wrote:

These are the ones which stick out for me.

The interpretation is fairly self-evident for most of them.

Blood glucose seems to be missing, as is a fasting insulin.

Generally, when one fat soluble vitamin is low, the other ones are low also. And generally, this means a person has too little animal-source saturated fat and possibly protein in the diet.

Nervous system deterioration tends to occur when B12 is half-way in the reference range – around 550. To be safe, I prefer much higher levels than 550.

IGF-1, as a measure of growth hormone, varies in interpretation. To an anti-aging doctor, growth hormone replacement may occur at a level under 250 for IGF-1. However, I tend to only consider growth hormone replacement only after optimizing everything else, and then only if IGF-1 is much lower than 250 – the exact level depends on the patient.

Note that even the American Medical Association recognizes that low testosterone predicts early death in men.

It is common to rely on IGF-1 when evaluating GH level and/or evaluating need for GH supplementation.

Yesterday I listened to Mark Gordon, MD presentation:
http://www.prolibraries.com/a4m/?select=session&sessionID=2046
Adult Growth Hormone Deficiencies Treatment

He relays on IGFBP-3

Any comments?

I was not able to figure out recommended ranges,
do you happen to have your own preferences for this indicator?

======================================================

Slide #68
Approx 95% of IGF-1 and IGF-II are bound to IGFBP-3
which makes this protein the major carrier of IGFs in plasma.
A principal function of IGFBP-3 is to extend half-life iof IGF’s from 8 minutes to hours.
The serum level of IGFBP-3 appears to be a constant over 24hrs and the protein was found to be GH dependent, which makes detection of IGFBP-3 very usefull in the evaluation of GH secretion.
A single BP-3 measurement correlate significantly with the logarithm of the integrated spontaneous GH secretions.

/

[DrMariano2]

@JanSz 987 wrote:

It is common to rely on IGF-1 when evaluating GH level and/or evaluating need for GH supplementation.

Yesterday I listened to Mark Gordon, MD presentation:
http://www.prolibraries.com/a4m/?select=session&sessionID=2046
Adult Growth Hormone Deficiencies Treatment

He relays on IGFBP-3

Any comments?

I was not able to figure out recommended ranges,
do you happen to have your own preferences for this indicator?

======================================================

Slide #68
Approx 95% of IGF-1 and IGF-II are bound to IGFBP-3
which makes this protein the major carrier of IGFs in plasma.
A principal function of IGFBP-3 is to extend half-life iof IGF’s from 8 minutes to hours.
The serum level of IGFBP-3 appears to be a constant over 24hrs and the protein was found to be GH dependent, which makes detection of IGFBP-3 very usefull in the evaluation of GH secretion.
A single BP-3 measurement correlate significantly with the logarithm of the integrated spontaneous GH secretions.

/

Obtaining IGFBP-3 helps determine Free IGF-1, which some practitioners then use to decide whether or not growth hormone is needed.

I think this unnecessarily complicates decision making.

This is like arguments for using Free Testosterone and SHBG to determine testosterone replacement. I prefer total testosterone.

The Endocrine Society uses Total Testosterone to make clinical decisions regarding hypogonadism and testosterone replacement. I agree. This makes decision making simple.

The Endocrine Society uses IGF-1 to determine the need for Adult Hormone Replacement Therapy. I also agree. It makes it so simple.

The only decision point for a physician is what IGF-1 level constitutes growth hormone deficiency. Luckily, this is a decision to be clinically made by each individual physician – leaving much flexibility – which I always like. The Endocrine Society has no hard set level for IGF-1.

With so many factors to take into account – I have to consider hundreds of variables when assessing a patient – anything which makes things simpler and clear is fully welcome.

Since IGF-1 is the standard used by the world’s largest body of endocrinologists, and since it fits my own views, I couldn’t be happier to use it and to avoid fixing what is not broken.

Also, from a medico-legal view, simple is also better and complying with a standard when it works is also better.

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