Post: #1

I'm planning to get my first blood work done. I'm 29yo. What else should i check for besides testosterone? What vitamins, minerals, hormones?

Post: #2

I'm the same age and interested as well. Late 20's and early 30's definately seems like the right time to start taking this seriously but I'll admit that I have no idea which basket of tests is money well spent at my age, especially for paying out of pocket.

MikeCF dropped some good info on the thread below . It really got me thinking about getting my T-levels and CBC checked.

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Post: #3

This seems like a good option if you're paying out of pocket.

http://www.privatemdlabs.com/lp/diagnost...tests.php#

Post: #4

I had some bloods run after some chest pain last year (check for troponin), doc just said I might as well check out things of interest.
Vitamin D, Iron studies, a general chemistry one that tests for liver and kidney. Haemotology can be interesting but may be of little use. T levels your doc may want you to go see an endocrinologist, T is notoriously hard to quantify; the same sample sent to different labs will yield vastly different results so its something they test for a reason, not just out of curiosity. If you feel lethargic, never horny etc tell them but they'll tell you to eat better, sleep more, stress less and lift heavy things unless you only have one ball or something. If you have any family history of a disease see if there's any tests that may be predictors. Don't venture into hypochondriac territory though

Also, no idea how much any of this costs because socialism...

Post: #5

It would probably be good to get your thyroid function tested, and maybe iron levels.

Post: #6

I have recently started having routine testing done and plan on continuing with quarterly assays. I am still tinkering with the exact panel that I plan to have run each time (vs what I plan to have run on an annual basis), but I can give a general overview of what I've personally tested so far for myself... for what that's worth.

Note: my choices are very probably overly exhaustive and most people can get away with much less (especially if you are planning for these to be simple screening tests.)

Let me briefly discuss one other quick point before discussing the labs. Where/how do you get tested?

Where to Get Tested

In certain states in the US, you can seek out a lab called Private MD Labs and pick and choose what labs you'd like assayed. Note: this service is only available in certain states, so you may have to travel a bit to have this done... or plan a mini-vacation around it. For those considering TRT; I believe their "female hormone panel" is a good starting place for a basket of labs that will cover most important things you will be wanting to look for.

Outside of the US in many countries, I can imagine that having certain labs drawn is simply as easy as just showing up and literally asking for certain things to be drawn. The 2 main points I'd remember in these scenarios would be:
-pay attention to sterility (have them open all blood draw equipment fresh and in front of you)
-pay attention to units (you will want to keep these consistent so you can accurately track changes without having to deal with complicated conversions)

Another option you have is to find a friendly/cooperative doc who is willing to Rx certain labs for you. This is a really great option because this is your best chance at having insurance cover the cost of many of the labs as the doctor can provide documentation of them being "medically necessary" and hence they will be paid for by your insurance carrier. Finding a friendly/willing doc can prove to be a challenge (i.e. similar in difficulty to finding a doc who is good at/willing to Rx TRT.) I would suggest doing some research ahead of time into what type of practice the doctor runs. Usually family docs are a little more agreeable to these types of scenarios as compared to other specialists ... usually. I'd even suggest going as far as calling up the practice and chatting with one of the nurses and/or medical assistants just to get a feel for if you think your requests may be honored. Again, you may need to prepare yourself for some trial & error with this strategy.

I should mention that the latter strategy (of finding a good/willing doc) is probably the best option ... especially if you find a doctor who is at the same time skillful/knowledgable, because now you have an expert consultant to help you interpret the findings and guide you further. Although, YMMV with many docs depending on their training and practice style.

How Testing is Done

I suggest you get your test done early in the morning; and that you have it done after having fasted for approx 12 hours. Some of the assays will require a morning draw and some will require prior fasting ... so this will address both of those issues.

Have your labs drawn at the same time/state every time. For example, having your blood tests drawn on the first Monday of every 3rd month at 8am after a 12-hour fast and full night of sleep will make trending your values much more meaningful over time.

In the US if you have an Rx for your labs you can schedule a time over the internet with one of the big lab testing companies (i.e. LabCorp, Quest, etc.) much the same way you would book a time slot for any sort of appointment. Usually early in the morning it is quite slow, and you can get in and get out rather quickly.

Try to drink plenty of water the day before to make sure you will be hydrated and that you will have nice juicy veins to stick. The phlebotomist (and your pain threshold) will thank you. Wear a shirt that has sleeves that are easily rollable all the way up to your upper arm so you can make the blood draw process even quicker & more efficient for all.

On to the labs ... I'll try to break them down by category.

[It is important to mention a disclaimer that the following advice is simply for educational/recreational purposes and does not constitute or substitute for actual medical advice given to you by your licensed healthcare provider. You should always seek out the guidance of a licensed and trained doctor for your own specific healthcare needs/issues.]

Sex Hormones

-Total Testosterone
-Free Testosterone
-Estradiol
-LH
-FSH
-PSA

Those are the main ones. Some additional ones that may be beneficial:
-SHBG
-DHT (the hormone responsible for the development of male pattern baldness)
-Pregnenolone (a precursor to important hormones such as Testosterone)
-Prolactin
-Progesterone
-Androstenedione
-Estrone

While not really sex hormones, the following two might be of interest to some guys who may be considering HGH therapy.
-IGF-1
-IGF-Binding Protein

The tricky thing about Insulin Growth Factor assays are that a one-time draw is not truly ideal as IGF has a very cyclical presence in the serum throughout the day. A more accurate assay may be a test that requires draws at 5 different times during the day and/or also a more complicated stimulation type test to assess proper functioning of feedback loops and signaling pathways. All that being said, a single time draw can still give you some information; but as with all of these labs you really have to be careful in how you interpret them.

Adrenal Hormones

-Cortisol
-DHEA-S

Cortisol is the catabolic analog to testosterone, one of your major anabolic hormones. Finding and keeping a balance between these two can be very key to your well-being. Cortisol will be elevated in high stress states and fatigue states. Chronically elevated cortisol can make it difficult to put on muscle mass, and may even be contributing to some unwanted muscle breakdown.

As far as the assay for cortisol goes, it follows a similar principle to that of IGF in that cortisol levels are highly cyclical throughout the day. A better test might actually be a 24-hour urine collection ... something to keep in mind.

Thyroid Hormones

-TSH
-Total T3
-Free T3
-T4
-Free T4
-Reverse T3
-Thyroid Peroxidase Antibody

That is a very comprehensive thyroid panel and should tell you most everything you need to know about your thyroid function. A more basic/intro level approach may be to simply have the standard "Thyroid Panel" done which will prove to be more than sufficient for most guys.

Lipid Panel

-Total Cholesterol
-Triglycerides
-HDL
-LDL
-VLDL

It is good to keep a track of these factors as they may have impact on your cardiac health. These would definitely be recc'd for guys that have a strong family history of heart disease and/or high cholesterol in the family.

Vitamins/Minerals

This is a grab bag category that includes a mixture of different tests.

-Vitamin D, 25-OH (think of this as more of a hormone as opposed to a vitamin ... very important and easy to take care of)
-Vitamin B12
-Methylmalonic Acid
-Folate
-Vitamin A
-Vitamin E
-Nicotinamide
-Nicotinic Acid

-Coenzyme Q10
-Homocysteine
-C-reactive protein

-Phosphorus
-Magnesium
-Copper
-Zinc
-Selenium

Glucose Homeostasis

Keeping your blood sugar in check is VERY important to your overall long term health.

-Glucose (this will be a fasting glucose if you follow the guidelines of always getting your blood test in the morning after a 12-hr fast)
-Hemoglobin A1C (this will be a measure of how well your blood sugar has been controlled over the past few months)
-Insulin

Blood Cells

-Hematocrit
-MCV
-Platelets
-WBC

You can simply request a "CBC" to get these tests done.

Metabolic function

-BUN
-Creatnine
-Na
-K
-Cl
-CO2

You can simply request a "basic metabolic panel" to get these tests done. They will give you insight into your kidney function, among other things.

Liver function

-AST
-ALT
-Total Protein
-Albumin
-Total Bilirubin
-Direct Bilirubin
-Alkaline Phosphatase

These will give you insight into how you have been treating your liver. Might be very useful to those guys who have been hitting the bottle hard and provide them some data to help them curb some of those habits.

You can simply request "Liver Function Panel" to get these tests done.

Iron Studies

-Serum Iron
-Iron Saturation
-TIBC
-UIBC
-Ferritin
-Transferrin

Other Comments

The above is likely too exhaustive of a list; but it is definitely comprehensive.

If you are considering or are already on TRT; then some of the above tests are basically mandatory.

I would argue to those that are supplementing vitamins/minerals that unless you are checking your levels, you might not have much clue as to whether your efforts are benefitting you most efficiently (...or even at all.)

For instance, you may be taking 2,000 units of Vit D daily ... but your actual serum level is still sub-therapeutic and perhaps you should be taking 5,000 or 10,000 units daily instead. Or maybe you are taking 50mg of Zinc supplements every day and spending a decent amount of $$ every month buying the pills through your online vendor ... only to find that your levels are way above normal and you are most likely urinating out most of the exogenous supplementation that you are spending good money on every month.

It is also worth mentioning that collecting the data is a TOTALLY different ballgame than interpreting the data and figuring out what interventions to make based upon the data. Some may argue, that collecting the data without knowing what it means or how to act upon it might actually be pretty useless/possibly detrimental. (For example, if you know there is no way you could afford or legitimately obtain or personally consider using TRT ... then it probably doesn't make any sense to check your T levels.)

For most of the tests, a trend of the values is more valuable than just a single number in time. You want to make sure that value is real and not the result of a statistical error or a lab calibration problem or just a one-off random occurrence.

Post: #7

^--- good post sthesia. One tip to find a HRT friendly doc is to call the compounding pharmacies in your area and ask them for a recommendation for a good endocrinologist. They'll know who is sending TRT business their way and will gladly refer you.

Post: #8

As a 29 year old man, most health guidelines wouldn't even recommend any blood testing. It's not necessary.

Having said that, it's not unreasonable either. But I wouldn't over do it. The more tests one does, the more likely something will return 'outside of normal limits'. This could easily lead to more (unnecessary) tests and maybe even unnecessary treatment. This is currently a big problem with the practice of medicine especially in the USA.

I would keep it simple:

Complete Blood Count
Creatinine (kidney function marker)
Liver Panel (ALT, AST, Bilirubin)
Hemoglobin A1c (considered a better test for diabetes than previous fasting glucose; over 7% means you have diabetes needing treatment)
Fasting Lipids
TSH (screen for thyroid disease; if normal, no further tests needed)

HIV Screen, Urine for Chlamydia Antigen

Troponin is used to diagnosis a heart attack (and a few other conditions). You don't need it.

Iron deficiency is rare in men.

Testosterone screening and testing has been a successful play by drug companies. If you're young and healthy, you don' t need it.

Sthesia's panel is too exhaustive IMO and will lead to more tests to explain all those results that were slightly outside of normal limits. You will be left wondering why you got the original test in the first place. If all those blood tests don't make you anemic, certainly doing it every 3 months will in due course

PSA: Super controversial even testing in a man that's 50. You don't need it. Just think if it's abnormal...then what?...a rectal exam by the GP to feel your prostate, perhaps an ultrasound probe next all because a stupid test you didn't need was performed.

Bottom line, if you're young and healthy keep the testing to a minimum if anything at all. Aside from a few basic things, SCREENING blood work offers little value. Tests of any kind (blood, imaging etc) are useful when someone is unhealthy with actual SYMPTOMS needing explaining. That's when it's been shown to be of value.

Post: #9

Got my test results back today. Total testosterone is 929, Free T is 136.

I'm 36 and in perfect health. Looks like I can put off testosterone supplements for awhile.

Now I'm just waiting for the STD results.

Post: #10

To those that are more knowledgeable than me, can you give your thoughts on my results and any supplementation you would recommend?

I got these done a few weeks ago, I'm early 30s, 5'11 and 165lbs. It seems my Vitamin D, White Blood Cells, and potentially Testosterone are low? Any and all comments welcome...

Quote:Sex Hormones

-Total Testosterone: 564
-Free Testosterone: 101.7
-Free Testosterone %: 1.8%
-SHBG: 38

Thyroid Hormones

-TSH: 2.10
-Total T3: 81
-Free T4: 1.25

Lipid Panel

-Total Cholesterol: 184
-Triglycerides: 70
-HDL: 66
-LDL: 104
-VLDL: 14

Vitamins/Minerals

-Vitamin D, 25-OH: 33 (pretty low?)

Glucose Homeostasis

-Glucose: 81 or 89, can't tell which result
-Hemoglobin A1C: 4.4

Blood Cells

-Hematocrit: 41.9
-MCV: 93
-Platelets: 178
-WBC: 4.3 (this is pretty low?)
-RBC: 4.53
-Hemoglobin: 13.9

Metabolic function

-BUN: 18.8
-Creatnine: 0.8
-Na: 139
-K: 4.1
-Cl: 102
-CO2: 28

Liver function

-AST: 25
-ALT: 27
-Total Protein: 6.6
-Albumin: 4.8
-Total Bilirubin: 0.9
-Alkaline Phosphatase: 59
-Globulin: 4.8

Other

-Urine PH: 7.0

Post: #11

Test is good. 564 is right around average. Even most TRT anti-aging clinics wouldn't prescribe you test until you're below 500.

Vitamin D should be around 50. If you're not getting sunshine, get some Vitamin D pills.

WBC could be low due to a simple cold or minor infection in your body.

I'm surprised your liver counts are so good, as you drink a lot.

That's some really good blood work, man. Your HDL to lipid ratio is good. Your fasting glucose is good.

Other than taking some Vitamin D or getting some sun, looks good to me.

Post: #12

(02-24-2014 02:45 PM)slubu Wrote:  can you give your thoughts on my results and any supplementation you would recommend

Providing the lab's references ranges (for some labs) can be helpful as an absolute individual value can be misleading, especially when units are omitted.

For example:
Total Testosterone: 375 [300-1200]

is pretty different from

Total Testosterone 375 [110-625]

Different lab companies report different ranges based on units and their specific calibration/assay methods. For most basic lab tests like CBC (aka Blood Cells) or Basic Metabolic Panel (Metabolic Function) the units and ranges are pretty standard. But for things like testosterone or some other specialized hormones; references ranges are sometimes reportedly differently by different labs and this can affect interpretation.

That being said, I can try to provide some insight on your values making some assumptions as to usual reference ranges I've commonly seen.

Sex Hormones
-Total Test is not bad. Its around average.
-Curious to know reference range on Free T; as the range I've commonly seen previously is 8-25 for normal values. Your lab is likely using different units/ranges than I've seen.
-Try to incorporate some of the following to try to naturally raise your T levels (in case you're not already doing): get better sleep; do more heavy compound lifts (squats, DL, bench, OHP); ensure you are getting enough healthy saturated fats in your diet (aka precursors/building blocks of sex hormones)

There are some good resources out there regarding boosting natural T levels. I think D&P had a post; GLL; Thumotic; Art of Manliness. Lmk if you have trouble finding.

Thyroid Hormones
-look great; very balanced; euthyroid (aka normal thyroid function ... neither overactive; nor underactive)

Lipid Panel
-also looks great
-LDL is maybe a touch elevated; but honestly I would not be concerned (especially if you don't have a strong family history of heart disease)
-in fact, your HDL number is so great, that its actually a protective risk factor AGAINST you developing heart disease ... your number is so high that it adjusts your risk of developing heart disease even lower

Vitamins
-yup, your Vit D is low (again, I'd be interested to see ref range)
-I would consider starting Vit D supplementation at 5000 units daily
-elevating your Vit D levels can actually help boost T levels as well
-after starting Vit D supps; I would plan to re-check levels maybe 3-6 months down the road to see if you need more/less/same
-note: your levels may also be down in the winter time due to you not getting enough sun ... however, you may also just be low year-round. In fact, Vit D deficiency is the most common Vitamin deficiency and most everyone would probably benefit from supplementation in general.

Glucose Homeostasis
-assuming you had your labs drawn after fasting; the glucose looks fine
-plus your HbA1C is great which indicates that your insulin metabolism is really dialed in and your blood sugar has been well controlled over the past few weeks/months

Your blood cells, metabolic function, and liver function all look fine. Nothing to do there. It actually takes quite a significant amount of chronic alcohol intake to see significant elevation in your liver enzymes (specifically the AST and ALT.)



All in all, things look pretty good. As long as you're feeling pretty good otherwise, maybe just add in some Vit D supplementation for now and go from there. If you're not already incorporating some behaviors/habits to help naturally boost your T further, then maybe I'd consider doing those as well.

Consider getting Zinc tested next time. This will help you decide whether Zinc supplementation, which can help boost T, is indicated/will have any benefit for you.

At 5'11" 165lbs, I'm assuming you are at a pretty decent body fat percentage. If excessive or stubborn body fat ever becomes an issue; you can consider having Estradiol checked in future blood work as elevated Estradiol can be associated with difficult to shed body fat.

One other suggestion I'd make is to start tracking your values; even if doing something as simple as making an excel spreadsheet. You will find value in being able to track your values over time and it will help you to determine whether changes you make in your diet, habits, supplementation actually make a change. It will also help you dial in supplementation dosages.

Post: #13

For someone that wakes up exhausted on a regular basis with low energy all day, what should they be looking to test?

Post: #14

I've been feeling fatigued and more sluggish than usual so I made an appointment and got my blood work checked about 4 weeks ago. Doctor's nurse called with results and said it's all fine and haven't heard anything since.

I'm just learning how all this works and what to look for and take seriously, so I would appreciate any experienced eyes giving any feedback.

Total Cholesterol and HDL may be a bit high but nothing serious from what I've read. My concerns are WBC count and absolute counts for Lymphocytes, Granulocytes, and Monocytes. I'm not sick, but I just always feel at like 70%, mostly since I can remember. Last STD/HIV test was clear. I always assumed it was severe allergies and sleep related but wondering if there could be more to it.

I'm 30, 5'11" and 182lbs

Post: #15

(02-24-2014 02:50 PM)MikeCF Wrote:  Test is good. 564 is right around average. Even most TRT anti-aging clinics wouldn't prescribe you test until you're below 500.

Vitamin D should be around 50. If you're not getting sunshine, get some Vitamin D pills.

WBC could be low due to a simple cold or minor infection in your body.

I'm surprised your liver counts are so good, as you drink a lot.

That's some really good blood work, man. Your HDL to lipid ratio is good. Your fasting glucose is good.

Other than taking some Vitamin D or getting some sun, looks good to me.

Actually, in general a cold or other infection would produce an elevated WBC count, not a depressed one. High WBC counts are a red flag for infections and cancers. Atypically low WBC counts could be the result of very specific infections that target the bone marrow in particular, some cancers, autoimmune disorders, etc. With that said, if your WBC count is merely on the lower end of the normal range that's nothing to worry about.