Blood Work: You have Questions, I have Answers.

[Dr. Joel Nathan]

Ask Your Lab Work Questions Here.
This Virtual Office on RxMuscle.com is open.

I am an Internal Medicine Physician who has is certified in Age Management. Age Management has implications for those of any age. This field includes optimization of diet, exercise and hormone replacement, if necessary.

My focus is utilizing lab tests to guide appropriate medical care. If your doc says your labs are normal, it may be that your values are "normal" for a person of your age. In the opinion of the age management field this is unacceptable for optimum health. I optimize my patients to the levels of at least a 35 year old.

I make my patients accountable to improve their health status. Patients see their improvement both physically and emotionally. In addition, objective improvements in lab values they can be compared over time.

My answers will be for education only, I can interpret your lab tests for you. I may have to ask some additional questions before giving a knowledgeable answer, but all questions will be anwered in detail.

The final execution of any changes in your health care regimen as determined by your blood work would be done by your teaming up with a physician, like me, who is skilled in Age Management with experience in prescribing appropriate diet, exercise and when necessary, hormone optimization.

Joel Nathan, MD
New York, NY 10028

[Lee Penman]

Okay...here's a starter for you...WBC - 6.9, RBC- 4.84.
Platelet count - 263
MPV -10.9
Total Neutrophils - 63.9
Total Lymphocytes -27.7
Monocytes - 6.7
Eosinophils - 1.3
Basophils -0.4

Any indicators of internal inflammation e.g ulcer, muscle injury

[Dr. Joel Nathan]

The following is for educational information only. Please check with your physician before making changes in your current medical regimen.

Your blood count values are well within normal range. You show no signs of inflammation based on this. To get a fuller picture of any muscle injury, your doc may want to order a creatine phospho kinase level (elevated levels show evidence of muscle breakdown) or get a cardio-C Reactive protein, which is a sign of inflammation in general.

Why do you think you may have an ulcer?

Joel

Okay...here's a starter for you...WBC - 6.9, RBC- 4.84.
Platelet count - 263
MPV -10.9
Total Neutrophils - 63.9
Total Lymphocytes -27.7
Monocytes - 6.7
Eosinophils - 1.3
Basophils -0.4

Any indicators of internal inflammation e.g ulcer, muscle injury

[Lee Penman]

Abdominal pain, acid production, symptoms increase on eating certain foods - especially meat/fish. General 'raw' feeling in abdominal area around naval. Plus, slight improvement on taking Cimetedrine. My regular doc. said it was an abdominal pull but that was almost 7 weeks ago.

[Dr. Joel Nathan]

Abdominal pain, acid production, symptoms increase on eating certain foods - especially meat/fish. General 'raw' feeling in abdominal area around naval. Plus, slight improvement on taking Cimetedrine. My regular doc. said it was an abdominal pull but that was almost 7 weeks ago.
If I had these symptoms, and I'd been on Cimetidine for at least 4 weeks and the pain was still there, I would call my doc for more advice.
Thanks for your question. Joel

[apex23]

This is a good add on to this site!!!

[wolfpack6906]

So I am going to go get some blood work done. I would like to know what the normal ranges are for a male adult in his early thirties off cycle and what is the ranges on cycle (low to dangerous). The test being done are CBC with differantial/platelet, Estradiol, IGF--1, Testosterone free and total

[Dr. Joel Nathan]

So I am going to go get some blood work done. I would like to know what the normal ranges are for a male adult in his early thirties off cycle and what is the ranges on cycle (low to dangerous). The test being done are CBC with differantial/platelet, Estradiol, IGF--1, Testosterone free and total

The following is for educational purposes only. Please check with your doc for specifics in your case.

I love the Age Management field. It is very gratifying to see someone really take off health wise with markedly improved physical as well improved mood. I answer questions here and make recommendations that are customized to you.

For a general screening, I'd get a physical exam too. Get a base line for prostate, testes size, any pre-existing gynecomastia or any other health problem.

For screeing labs, consider: PSA, AST, ALT, Bilirubin total and direct, CBC with platelets and differential, Free and Total Testosterone, DHT, Estradiol, (IGF-1 and IGF-BP3 - these are GH markers), lipid profile, fasting Blood Sugar, Hemoglobin A1C, Urine Analysis. When you get the tests back, let me know, so I can educate you.

Please PM me with your physical exam findings, lab results, age, current meds, allergies, family history of diabetes or lipid issues and the type of diet you're on & exercise program you're on and current level of fitness. This way you don't have have to share personal info with others. Honestly, it is not a simple answer to say what is right for you without this info. I can then customize a response based on the findings.

I base my answers on facts and then when suggesting possible answers, it is done in a medically sound manner. I would stongly support you getting a physician to follow you.

Regards,
Joel

And again this is for educational value only, your doc will advise you on what he thinks is in your best interest.

[Anthony]

Hi Dr. Nathan -

Glad to have you on the site. I have results from a mini-screening (not a full blood test). All is normal (well they say body fat is too low - ha) except for HDL. HDL is below the threshold for measurement, under 15. Total cholesterol is 101.

All the typical reccomendations for raising HDL are pretty well covered for me -(exercise, lose fat, cut smoking and drinking, cut trans fatty acids, eat lots of fiber) I'm taking have plenty of niacin as well (75 mg/day).

This is just 3 weeks into my first "real" AAS run with test. I've used a few runs of OTC AAS previously. I will have a complete blood test done in about a week.

- For the AAS using athelete, how can I raise HDL?
- What is the outcome of having too low HDL?

Thanks

[Dr. Joel Nathan]

Hi Dr. Nathan -

Glad to have you on the site. I have results from a mini-screening (not a full blood test). All is normal (well they say body fat is too low - ha) except for HDL. HDL is below the threshold for measurement, under 15. Total cholesterol is 101.

All the typical reccomendations for raising HDL are pretty well covered for me -(exercise, lose fat, cut smoking and drinking, cut trans fatty acids, eat lots of fiber) I'm taking have plenty of niacin as well (75 mg/day).

This is just 3 weeks into my first "real" AAS run with test. I've used a few runs of OTC AAS previously. I will have a complete blood test done in about a week.

- For the AAS using athelete, how can I raise HDL?
- What is the outcome of having too low HDL?

Thanks

Anthony,
You bring up a very important point. If someone decides to use anabolic androgenic steroids (AAS), it's important to be aware of side effects and to help minimize them. Check your liver function tests about every 3 months when on AAS and if you drink alcohol, do so in moderation. Keep your liver healthy.

Anabolic androgenic steroids (AAS) reduce HDL cholesterol.

Reduced levels of HDL Cholesterol are associated with an increased risk of coronary heart disease. Both the cholesterol level and the prevalence of coronary heart disease are influenced by enviornmental factors, including diet.

How to Keep HDL's High When on AAS:

1. Exercise: Here's just one way to do cardio to keep HDL high, it's not the only way, but here's what I do. Low volume high intensity exercise, specifically 4-6 repeated 30sec bouts of all-out effort interspersed w/4min recovery time in between. Total time involved is 17-26min/session.

2. Medication: One lipid lowering drug, Crestor (rosuvstatin calcium) is particularly suited to raising HDL cholesterol. If you do take Crestor, take it at bedtime. That's when the body makes cholesterol so it will be best to have the drug at a high concentration at this time.

In addition, statins, like Crestor, lower enzyme coQ-10. This is found as an energy source in mitochondria. Heart muscle is rich in mitochondria and coQ-10. Consider a dose of 100mg twice a day.

3. Lower your homocysteine level. Homocysteine is increased when you exercise and do not have appropriate nutritional support. Patients at high risk for cardiovascular disease should be strongly advised to be sure to get enough folic acid and vitamins B-6 and B-12 in their diet. They should eat fruits and green, leafy vegetables daily.

4. Lower your Cardio c-Reactive Protein. Another maker, cardio-c-reactive protein (c-CRP) is a sign of inflammation and is a cardiac risk factor. Therefore, if your doc recommends it, one baby aspirin a day (81mg) will help. Sometimes people need to take more than 81mg a day, but please check with your doc first.

5. More methodology is in the pipeline:

It is likely that the modulation of HDL function and its concentrations in serum will significantly impact future approaches to the management of cardiovascular disease.

What's amazing to me is what else will we be able to modulate in the future?

As always, the info I give is for educational purposes only, please check with your doc on what's appropriate for you.

Regards,
Joel

[DR.BB]

Doc,
Thanks for the info on this thread. You mentioned C-Reactive Protein in your post. My doc commented that I was "inflammed" but also said it was not a major concern. I'll talk w/him again in a couple weeks, but can you shed some light on C-Reactive Protein (My labs indicate 8.3 on a 0-4.9 mg/L scale). My doc did not recommed it, but I take aspirin just in case. Is this among the tests that heavy weight trainers would see elevated? Should I take special precautions?

[Dr. Joel Nathan]

Doc,
Thanks for the info on this thread. You mentioned C-Reactive Protein in your post. My doc commented that I was "inflammed" but also said it was not a major concern. I'll talk w/him again in a couple weeks, but can you shed some light on C-Reactive Protein (My labs indicate 8.3 on a 0-4.9 mg/L scale). My doc did not recommed it, but I take aspirin just in case. Is this among the tests that heavy weight trainers would see elevated? Should I take special precautions?

Dr. BB,

C-REACTIVE PROTEIN and Cardio-CRP are two different tests. The Normal range for C-Reactive Protein is 6.8-820 μg/dl (68-8200 μg/L [CF: 10; SMI: 10 μg/L]). C-REACTIVE PROTEIN is elevated in inflammatory states such as Rheumatoid arthritis, rheumatic fever, inflammatory bowel disease, bacterial infections, myocardial infarction, oral contraceptives, pregnancy third trimester (acute phase reactant), inflammatory and neoplastic diseases.


What I was talking originally about was:


HIGH SENSITIVITY (hs-CRP, cardio-CRP) This is a cardiac risk marker. It is increased in patients with silent atherosclerosis years before a cardiovascular event and is independent of cholesterol level and other lipoproteins. It can be used to help stratify cardiac risk.


Interpretation of results:*

Cardio-CRP result (mg/L)Risk
≤0.6Lowest risk
0.7-1.1Low risk
1.2-1.9Moderate risk
2.0-3.8High risk
3.9-4.9Highest risk
≥5.0Results may be confounded by acute inflammatory disease. If clinically indicated, a repeat test should be performed in 2 or more weeks.
*The above values are from Ferri: Ferri's Clinical Advisor 2009, 1st ed.

As an Age Management doc, the theory is that ageing is actually inflammation. Free Radicals in the environment (pollution) or that occur during exercise, shoot off electrons. These electrons hit our cell walls (arteries for instance) and our DNA.

For primary prevention of inflammation due to free radicals use antioxidants. The antioxidants flow though us and take the hit for us when those electrons start shooting off.

Once inflammation is there, some docs recommend taking a baby aspirin (81 mg). This will reduce cardio-CRP. If after a 6 week stint on 81 mg of Aspirin, the cardio-CRP is still elevated, some docs would suggest going higher.

The above information is for educational purposes only. Please consult your doc regarding what is appropriate for you. The use of low dose aspirin is not appropriate for everyone.


Regards,
Joel

[Anthony]

Anthony,
You bring up a very important point. If someone decides to use anabolic androgenic steroids (AAS), it's important to be aware of side effects and to help minimize them. Check your liver function tests about every 3 months when on AAS and if you drink alcohol, do so in moderation. Keep your liver healthy.

Anabolic androgenic steroids (AAS) reduce HDL cholesterol.

Reduced levels of HDL Cholesterol are associated with an increased risk of coronary heart disease. Both the cholesterol level and the prevalence of coronary heart disease are influenced by enviornmental factors, including diet.

How to Keep HDL's High When on AAS:

1. Exercise: Here's just one way to do cardio to keep HDL high, it's not the only way, but here's what I do. Low volume high intensity exercise, specifically 4-6 repeated 30sec bouts of all-out effort interspersed w/4min recovery time in between. Total time involved is 17-26min/session.

2. Medication: One lipid lowering drug, Crestor (rosuvstatin calcium) is particularly suited to raising HDL cholesterol. If you do take Crestor, take it at bedtime. That's when the body makes cholesterol so it will be best to have the drug at a high concentration at this time.

In addition, statins, like Crestor, lower enzyme coQ-10. This is found as an energy source in mitochondria. Heart muscle is rich in mitochondria and coQ-10. Consider a dose of 100mg twice a day.

3. Lower your homocysteine level. Homocysteine is increased when you exercise and do not have appropriate nutritional support. Patients at high risk for cardiovascular disease should be strongly advised to be sure to get enough folic acid and vitamins B-6 and B-12 in their diet. They should eat fruits and green, leafy vegetables daily.

4. Lower your Cardio c-Reactive Protein. Another maker, cardio-c-reactive protein (c-CRP) is a sign of inflammation and is a cardiac risk factor. Therefore, if your doc recommends it, one baby aspirin a day (81mg) will help. Sometimes people need to take more than 81mg a day, but please check with your doc first.

5. More methodology is in the pipeline:

It is likely that the modulation of HDL function and its concentrations in serum will significantly impact future approaches to the management of cardiovascular disease.

What's amazing to me is what else will we be able to modulate in the future?

As always, the info I give is for educational purposes only, please check with your doc on what's appropriate for you.

Regards,
Joel


Hi Dr J -

Got my full blood test results back - what do you think?

(everything else is normal)
ALT 68 (0-55) -> liver stress from orals? (winstrol)
HDL 16 (>39) -> already discussed
BUN/Creat Ratio 30 (8-27) (BUN and creat are in normal range) -> expected on high protein diet?
IGF-1 78 (117-329) -> ??? I'm not taking GH of IGF-1, but I'm not aware that anything I'm taking would reduce IGF-1...

TSH and total test are way off normal, but I kinda know what is going on there :D

thanks!

[Dr. Joel Nathan]

Hi Dr J -

Got my full blood test results back - what do you think?

(everything else is normal)
ALT 68 (0-55) -> liver stress from orals? (winstrol)
HDL 16 (>39) -> already discussed
BUN/Creat Ratio 30 (8-27) (BUN and creat are in normal range) -> expected on high protein diet?
IGF-1 78 (117-329) -> ??? I'm not taking GH of IGF-1, but I'm not aware that anything I'm taking would reduce IGF-1...

TSH and total test are way off normal, but I kinda know what is going on there :D

thanks!

Anthony,
The GH level is pulsatile, you may have gotten a reading when you were at a low point in concentration. Usually exaogenous testosterone will increase IGF-1. If you're doing cardio this will raise IGF-1.

Ask your doc for a repeat, fasting IGF-1 in about 6 weeks. See if it increases.

The above is for educational use only. Check with your own doc to see what is appropriate for you.

Regards,
Joel

[heavyiron]

Would you comment on my bilirubin please and anything else you see. I would like to know how to mitigate these values.

PHOSPHATE, SERUM 2.3 LO REF. RANGE 2.5-4.5 MG/DL

BILIRUBIN, TOTAL 1.9 HI REF. RANGE 0.2-1.2 MG/DL-this is typical for me over the last 11 years.

BILIRUBIN, DIRECT 0.3 HI REF. RANGE 0-0.2 MG/DL

AST (SGOT) 43 HI REF. RANGE 10-40 U/L

HDL CHOLESTEROL 36 LO REF. RANGE MORE THAN 40 MG/DL-my LDL was 81.

I had been on aas 4 months when the draw was taken.

Thank you!

[Dr. Joel Nathan]

Would you comment on my bilirubin please and anything else you see. I would like to know how to mitigate these values.

PHOSPHATE, SERUM 2.3 LO REF. RANGE 2.5-4.5 MG/DL

BILIRUBIN, TOTAL 1.9 HI REF. RANGE 0.2-1.2 MG/DL-this is typical for me over the last 11 years.

BILIRUBIN, DIRECT 0.3 HI REF. RANGE 0-0.2 MG/DL

AST (SGOT) 43 HI REF. RANGE 10-40 U/L

HDL CHOLESTEROL 36 LO REF. RANGE MORE THAN 40 MG/DL-my LDL was 81.

I had been on aas 4 months when the draw was taken.

Thank you!

For educational purposes only, I bring up the following points. Please check with your doc for what is best for you.

Your liver function tests are slightly up. Things to take under consideration in a situation like this would be to stop alcohol and any tylenol intake until levels are back to normal. Consider a recheck in 6 weeks.

If one's urine turns dark coca-cola in color and/or stools become very iight, check values sooner. A hepatitis screen would be helpful (A, B & C).

Have your doc re-evaluate how much AAS you're taking and on what schedule. Decreasing dose by 25% and rechecking values in 6 weeks would be helpful.

As far as the HDL, that is answered in a previous post on this thread. You may want to ask your doc about the medication Crestor, that would increase HDL cholesterol. However, by decreasing your AAS, your HDL should rise. Make sure you have a full lipid panel drawn next time.

Have your phosphorus rechecked next time. Low phosphorus is fairly common in hospitalized patients. If you did not have a recent hospitalization, just get this rechecked with the rest of your labs, also get your vitamin D and calcium levels checked.

Regards,
joel

[BigJD69]

Hey Doc, I have been seeing an Endocronologist for my high blood pressure, high cholesterol and now Type2- Diabetes. She increased my Pravacol for my high cholesterol, from 40 to 80mgs. I am also on Glucophage(1500mg) a day and Byetta 10mcgs twice a day. My question to you is that my CPK levels came back last week at 3000. My Endo. told me to stop the Pravacol for a week and to retest, which I will be doing tomorrow. She seems to think it is from the Pravacol. Is it true that subQ injections(Byetta) could also raise CPKLevels??

[indianamonster1986]

Question for you. I have bloodwork done this Wednesday for my job. It was supposed to be a month from now and i was gonna stop taking my gear, but it was moved up. Now I am taking liver support, kidney support, EFA, Hawthorne, Forshkoli, Co-q10, and livercure. I started the cycle four weeks ago and have been taking these supps since I started. Will these help my blood work look somewhat normal lol?

[heavyiron]

For educational purposes only, I bring up the following points. Please check with your doc for what is best for you.

Your liver function tests are slightly up. Things to take under consideration in a situation like this would be to stop alcohol and any tylenol intake until levels are back to normal. Consider a recheck in 6 weeks.

If one's urine turns dark coca-cola in color and/or stools become very iight, check values sooner. A hepatitis screen would be helpful (A, B & C).

Have your doc re-evaluate how much AAS you're taking and on what schedule. Decreasing dose by 25% and rechecking values in 6 weeks would be helpful.

As far as the HDL, that is answered in a previous post on this thread. You may want to ask your doc about the medication Crestor, that would increase HDL cholesterol. However, by decreasing your AAS, your HDL should rise. Make sure you have a full lipid panel drawn next time.

Have your phosphorus rechecked next time. Low phosphorus is fairly common in hospitalized patients. If you did not have a recent hospitalization, just get this rechecked with the rest of your labs, also get your vitamin D and calcium levels checked.

Regards,
joel
Thank you for the quick reply, I really appreciate your insight. I drink a little but will stop until my next test. I use 81mg of asprin daily. Is that ok? Or will it put additional stress on my liver.

My urine is light to normal and stools are normal.

My Testosterone dose was quite low during the draw, around 250mg weekly. I was up quite a bit higher a month earlier.

I only posted problem values but my lipids were as follows;

HDL-36
LDL-81
Triglycerides-67
Cholesterol-130 mg/dl
Chol/HDL Ratio- 3.6

Calcium Serum-9.5mg/dl

I was not hospitalized.

Thoughts?

btw, for educational purposes of course =)

[indianamonster1986]

Also been drinking electrolyte drink during my workout.

[indianamonster1986]

My bp and pluse are pretty good as I just got them checked 4 days ago. Taking test suspension, sustanon, and parabolin. stopped teh anadrol as soon as I found out about the blood test as I know it increases red blood cells

[Dr. Joel Nathan]

Hey Doc, I have been seeing an Endocronologist for my high blood pressure, high cholesterol and now Type2- Diabetes. She increased my Pravacol for my high cholesterol, from 40 to 80mgs. I am also on Glucophage(1500mg) a day and Byetta 10mcgs twice a day. My question to you is that my CPK levels came back last week at 3000. My Endo. told me to stop the Pravacol for a week and to retest, which I will be doing tomorrow. She seems to think it is from the Pravacol. Is it true that subQ injections(Byetta) could also raise CPKLevels??


The following is for educational purposes only. Always follow your physician’s directives.

Your CPK level needs to be addressed by your doc.

Here is some general info:

PRAVACHOL (Pravastatin Sodium)


It is suggested to erform LFTs before therapy, before dose increases, and if clinically indicated. Risk of myopathy, myalgia, and rhabdomyolysis. D/C if AST or ALT ≥3x. If elevated CPK levels occur, or if myopathy diagnosed or suspected. Less effective with homozygous familial hypercholesterolemia. Closely monitor with heavy alcohol use, recent history or signs of hepatic disease, or renal dysfunction.

ADVERSE REACTIONS

Rash, NV, diarrhea, headache, chest pain, influenza, abdominal pain, dizziness, increases ALT, AST, CPK.

DRUG INTERACTIONS

Risk of myopathy with fibrates, niacin, cyclosporine, erythromycin. Increased levels with gemfibrozil, itraconazole. Avoid fibrates unless benefit outweighs drug combination risk. Decreased levels with concomitant cholestyramine/colestipol; take 1 hr before or 4 hrs after resins. Caution with drugs that diminish levels or activity of steroid hormones (eg, ketoconazole, spironolactone, cimetidine).

MONITORING

Monitor for signs/symptoms of active liver disease, rhabdomyolysis with acute renal failure, myoglobinuria, myopathies. Monitor CPK and LFTs periodically, and lipid levels every 4 weeks to evaluate response.

PATIENT COUNSELING

Advise to report signs/symptoms of unexplained muscle pain, tenderness, or weakness, particularly with malaise or fever. Recommend standard cholesterol-lowering diet prior to and during treatment. Educate about pregnancy/nursing risks. Counsel to take with/without food.
______

Regarding the BYETTA® (exenatide) injection, please consult your doc about this.

Regards,
Joel

[Dr. Joel Nathan]

Question for you. I have bloodwork done this Wednesday for my job. It was supposed to be a month from now and i was gonna stop taking my gear, but it was moved up. Now I am taking liver support, kidney support, EFA, Hawthorne, Forshkoli, Co-q10, and livercure. I started the cycle four weeks ago and have been taking these supps since I started. Will these help my blood work look somewhat normal lol?

This answer is for educational purposes only.

The appropriate monitoring of blood work is very important. If your liver shows any signs of damage, it's better to know now than later.

[Dr. Joel Nathan]

My bp and pluse are pretty good as I just got them checked 4 days ago. Taking test suspension, sustanon, and parabolin. stopped teh anadrol as soon as I found out about the blood test as I know it increases red blood cells

The lipids look good. Your HDL (could be better) will improve with decreased use of AAS.

[killercuda426]

vo2max hi i have a couple questions for you? do you know what lupus anti coagulant anti cardiolipin antibody thromboembolic diseas is? well i take a babby asprin every morning for it so i dont get a clott.i went to my doctor and asked him if i can take hormonal anabolic supplement and he wont answer me because he said nobdy should take them so im trying to find out if i take something is it going to be safe. i asked him again to put aside of what he thought of them and give me a answer and he said no nobody belongs taking them do you think it will be allright to take them thanks bob

[Dr. Joel Nathan]

vo2max hi i have a couple questions for you? do you know what lupus anti coagulant anti cardiolipin antibody thromboembolic diseas is? well i take a babby asprin every morning for it so i dont get a clott.i went to my doctor and asked him if i can take hormonal anabolic supplement and he wont answer me because he said nobdy should take them so im trying to find out if i take something is it going to be safe. i asked him again to put aside of what he thought of them and give me a answer and he said no nobody belongs taking them do you think it will be allright to take them thanks bob

Dear Bob,
I did some research on the web last night. Unfortunate news about AAS and people with coagulation disorders. It's dangerous to be on AAS for you because they can increase your chances for coagulation. This can lead to many things including, stroke. Also AAS increase the viscosity of blood by increasing your blood count. When people are monitored on AAS, a blood count is part of the follow up. Some men need to intermittantly donate a pint of blood if high blood cell count occurs.

I suggest you see an "Age Management" spcecialist in your area who knows about HRT and can suggest possible alternatives. It would really take a physical and going through your history and labs in detail that would help in finding ways to help you reach your bodybuilding goals that would be safe and effective. Keep on your search and see that doc.

Regards.
Joel

[killercuda426]

vo2max thank you for your help,ill keep trying to find a doctor for HRT but they dont realy wont to help beause my test level was at 341 i told them i had 2 back surgerys and im tired all the time and everything else that goes alone with it.i will keep looking thank s bob

[Jack of All]

Hematocrit.
How high is too high for hematocrit levels? My bloodwork is consistently around 49% hematocrit. I try to give blood but my iron is always too high. How high does hematocrit need to be before a Dr. would prescribe a phlebotomy.

[Dr. Joel Nathan]

Hematocrit.
How high is too high for hematocrit levels? My bloodwork is consistently around 49% hematocrit. I try to give blood but my iron is always too high. How high does hematocrit need to be before a Dr. would prescribe a phlebotomy.

For educational purposes only:

If a hematocrit is above 51-52% one should consider donating 1 pint of blood.

Ask your doc what he feels is best for your health.

[Manavs]

Dr. Nathan,

I was reading that for emergency room patients who have edema that one procedure is to administer a 25% albumin solution intravenously.

are there any over the counter products that can effectively increase serum albumin levels effectively enough to see similar results?

[Dr. Joel Nathan]

Over-the-Counter products for vascular volume expansion are just that. They are nutriceuticals so they are not FDA tested.

To increase albumin in blood, do it the old fashion way, eat a clean diet that includes the appropriate amounts of protein, carbs and fat. Possibly a multivitamin or phytonutrient to help your metabolism use the nutrition you eat would help. For a phytonutrient with science backing check out drnathanjuiceplus.com (http://www.drnathanjuiceplus.com) .

Regards,
Joel

[vnfitness]

Hi Dr

I just got my blood work result today. Now I am very confused that my total testosterone is at low level 291, free test little high out of range and estradiol at normal range 20. Currently I am on 250mg/wk of test enanthate (self medicated TRT) and please let me know how my total test is at that low.
Thanks in advance

[Diabetic Muscle]

Had my test tested. It came back 389. Isn't that a little low for being 26?
Thanks for any help.

[Dr. Joel Nathan]

Hi Dr

I just got my blood work result today. Now I am very confused that my total testosterone is at low level 291, free test little high out of range and estradiol at normal range 20. Currently I am on 250mg/wk of test enanthate (self medicated TRT) and please let me know how my total test is at that low.
Thanks in advance

For educational purposes only, I propose the following issues:

The timing of your blood test could be the reason for the low T -total. If you caught it at he trough, just prior to your dose (which is the appropriate time to test), your value is low, but it would be higher just after dosing.

If your T-total was 291 @ 1-2 days post dosing it is unusually low. If this case, I'd question the potency of your T-enanthate.

In any case, recheck of Free and Total Testosterone, estradiol, PSA and DHT all done just prior to the next Testosterone dosing is indicated. A retest would be scheduled in 6-8 weeks from your last labs.

Let me know by PM or on the public board when you get your next results.
It would also be important to check you lipid panel as well as your complete blood count on your next tesing too. This is because AAS cause increases in blood count, decreased HDL cholesterol and increased DHT all which need addressing.

Why not just have an Age Management doc who knows HRT follow you and if your labs are low, you can get prescription Testosterone and use your insurance? The doc can also address any action needed on the HDL cholesterol, DHT or estradiol and PSA.

Regards,
Joel

[Dr. Joel Nathan]

Had my test tested. It came back 389. Isn't that a little low for being 26?
Thanks for any help.

Was that free or total T?
What was the timing of your blood work? It should have been done just prior to your next dose.
What AAS and dose are you on?
You can respond here or PM me.

Regards,
Joel

[BigJD69]

Doc, have my results for my Test Levels:
Estradiol, Ultra-Sensitive=12
FSH= 4.9
LH= 2.3
Total Test= 272
Free Test%= 1.5
Free Test= 41.5(L)
My Doc says that my total Test is low normal and is suprised that my FSH and LH aren't lower. She is going to send me for an M.R.I. for my pituitary, she suspects that it will be fine. After that she says we will talk about TRT. What is your opinion on these results and her statements.
Thanks Doc

[Dr. Joel Nathan]

Had my test tested. It came back 389. Isn't that a little low for being 26?
Thanks for any help.

By the way, it's the free Testosterone that counts. The total testosterone is partiallly bound by steroid binding globulins.

Questions come to mind such as :
1. Did you do post cycle therapy post last use of AAS.
2. Which AAS and for how long did you use it for.
3. Your general health.
4. How well is your DM being treated?
5. Are you on insulin?

Before responding, please read my PM to you.

Regards,
Joel

[Dr. Joel Nathan]

Doc, have my results for my Test Levels:
Estradiol, Ultra-Sensitive=12
FSH= 4.9
LH= 2.3
Total Test= 272
Free Test%= 1.5
Free Test= 41.5(L)
My Doc says that my total Test is low normal and is suprised that my FSH and LH aren't lower. She is going to send me for an M.R.I. for my pituitary, she suspects that it will be fine. After that she says we will talk about TRT. What is your opinion on these results and her statements.
Thanks Doc
Please see my PM

[jbruno7272]

Hello Doctor, I had blood work done and one of the categories was RBC Morph and my red cell morph was abnormal,polychrome 1+ and Spherocytes 1+. I have no idea what this means and the NP I saw was supposed to consult a Dr. and neglected to do so. I would appreciate your insight. Thank you.

[Dr. Joel Nathan]

Hereditary spherocytosis is an abnormality of the erythrocyte membrane. So to keep it simple, it means that you have a slight amount of blood cells that may get trapped in the spleen leading to anemia. You need to ask your doc exactly how this applies in your case.

Polychromasia just means you are making a lot of new red blood cells. Your body is sensing that you have anemia. Again, your doc needs to tell you how this applies to your case.

Regards,
Joel

[gman]

I am an HRT patient on a regimen of 200mg of test cyp once a week, 500iu hcg on day 5 and 6, and .5mg of arimidex 3x a week.

My first blood test (taken on morning of test shot, before the shot) 8 weeks in showed:

Total test: 987 (241-827)
Free Test: 37.6 (6.8-21.5)
SHBG: 12 (13-71)
IGF-1: 254 (94-252) [Dr thought I was taking HGH on my own! lol]
Estradiol: 28 (0-53)

I had other tests, but not posting them here.

My question is:

A few people have told me my body is not happy with this, my SHBG is low, so my body is "dumping" test all day. They think I should either cut the test back to 100-150mg a week, or at least split the dose into 2 shots a week of 100mg each.

I am not sure what low SHBG means. I thought it was good to have it low so that the test could stay free and do its thing.

I am so confused.

[Dr. Joel Nathan]

I am an HRT patient on a regimen of 200mg of test cyp once a week, 500iu hcg on day 5 and 6, and .5mg of arimidex 3x a week.

My first blood test (taken on morning of test shot, before the shot) 8 weeks in showed:

Total test: 987 (241-827)
Free Test: 37.6 (6.8-21.5)
SHBG: 12 (13-71)
IGF-1: 254 (94-252) [Dr thought I was taking HGH on my own! lol]
Estradiol: 28 (0-53)

I had other tests, but not posting them here.

My question is:

A few people have told me my body is not happy with this, my SHBG is low, so my body is "dumping" test all day. They think I should either cut the test back to 100-150mg a week, or at least split the dose into 2 shots a week of 100mg each.

I am not sure what low SHBG means. I thought it was good to have it low so that the test could stay free and do its thing.

I am so confused.

Answered for educational purposes only. Your physician must be the person you use for personal health plan.

Wiith respect to SBG - it's good to have lower SBG. By having lower SBG you have more Free Testosterone. It's the free testosterone that helps with the sarcopenia that it treats in age management.

[Sunshine]

Thanks for sharing your time and expertise.
I have been on thyroid hormone replacment for >10 yrs (Hashimotos, along with celia and Raynauds.) I have felt great after seeing an endo about 3-4 years ago who started me on a combo of Synthroid and Armour, the Armour at an apparently relatively high dose as he felt I had developed a resistance of some sort. A year ago in an effort to consolidate MD's I had all my labs run by my primary doc. With my labs done a couple weeks ago she wants to halve my dosage because TSH is low. Free T3 and Free T are within ranges. (Values below) I am very hesitant to do this as I have learned that TSH is essentially meaningless when exogenous hormone is being administered. The free levels are important, to my understanding.
TSH .009 (.45-4.5)
Free T4 1.63 (.61-1.76)
Free T3 2.8 (2.3-4.2)
Your opinion?

Also, in urinalysis specific gravity is abnormal, WBC esterase is 3+, and WBC are 6-10 (0-5). This was also the case last year, a culture was run, nothing grew, and I have no signs/symptoms of a UTI. Should I be concerned?

Lastly, I am 35 years old and use the NuvaRing for birth control. To get sex hormones tested accurately, I'm assuming I would have to be off that? Any idea for how long?

Thanks very much!

[Dr. Joel Nathan]

Thanks for sharing your time and expertise.
I have been on thyroid hormone replacment for >10 yrs (Hashimotos, along with celia and Raynauds.) I have felt great after seeing an endo about 3-4 years ago who started me on a combo of Synthroid and Armour, the Armour at an apparently relatively high dose as he felt I had developed a resistance of some sort. A year ago in an effort to consolidate MD's I had all my labs run by my primary doc. With my labs done a couple weeks ago she wants to halve my dosage because TSH is low. Free T3 and Free T are within ranges. (Values below) I am very hesitant to do this as I have learned that TSH is essentially meaningless when exogenous hormone is being administered. The free levels are important, to my understanding.
TSH .009 (.45-4.5)
Free T4 1.63 (.61-1.76)
Free T3 2.8 (2.3-4.2)
Your opinion?

Also, in urinalysis specific gravity is abnormal, WBC esterase is 3+, and WBC are 6-10 (0-5). This was also the case last year, a culture was run, nothing grew, and I have no signs/symptoms of a UTI. Should I be concerned?

Lastly, I am 35 years old and use the NuvaRing for birth control. To get sex hormones tested accurately, I'm assuming I would have to be off that? Any idea for how long?

Thanks very much!

My answers are for educational purposes only and I do not make medication recommendations. Medications and their dosing are the responsibility of your physician.

Your thyroid, UTI and contraceptive questions would be answered best by your endocrinologist and/gynecologist.

Regards,
Joel

[Dr. Joel Nathan]

Please post your questions under a new thread.
Thank you.