It’s in the Blood: When it Rains it Pours

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It’s in the Blood: When it Rains it Pours

The recent article Paleo and Testosterone spiked a huge comment response regarding the intricacies of nutrition, training, lifestyle, supplements and hormones.  The subject of hormones has been one that I have been in bed with for quite some time, especially low or dysfunctional hormones. It has become more and more understood to me that the endocrine system controls all. Another alarming fact is that more hormone-related illnesses and associated problems are rampant in today’s populations, affecting everyone from children to the elderly.

The subject of hormones is a massive, all inclusive one that would best be addressed in multiple posts/chapters. The information at times can be as tricky as trying to figure out a foreign subway system. So the intention of this and future posts is to break this stuff down so we all can master the subject matter at hand as best we can. From what has been stated recently, one can teach male hormones in 44 minutes, but it takes 200+ hours to teach female hormones. Therefore, things can get complicated fast, but hang in there; there is hope!

Many people in the comment section immediately wanted to play doctor and questioned specific symptoms and began dreaded self-diagnosis procedures. Many also questioned immediate fixes such as HRT/TRT/Creams and supplements. I believe that in order to fix a problem we should find out if there even is one at all. (The next logical step is, of course, what is causing the problem?)

The Truth is in the Blood:

Most things in today’s modern age can really only efficiently run with an occasional diagnostic check, and the human body is no different. Getting blood work can actually determine if a problem is just in the head or actually in the body. In my opinion, it is one of the first steps needed to conclude if everything is working correctly and if a suspected problem is “real.” Usually the need for bloodwork starts with the expression of a symptom or symptoms (such as low libido or inability to lose weight after all “methods” have been exhausted or random mood swings) and then involves “light” research. By this I mean you Google and/or ask friends.

After these two steps many people choose the wrong one, which is to either treat the problem themselves or let a friend or doctor treat them(neither of whom has any idea on the subject.) This faux step can result in really bad consequences or reactions and is one that I would not advise. First thing’s first: we need to see this working on a cellular level.

Blood Work:

Note to the reader: Blood work is a tool used to find out what could be going on, on the inside. It is not just a good idea for all things hormonal but overall health really. Blood work can be confusing, but it doesn’t have to be. What are really confusing, though, are the actual systems involved. The blood work is just numbers, ranges and abbreviations. The confusion stems from the questions:

-         Why is the system under/over regulating?

-         What is going wrong with a said hormone?

This is also a starter list, a basic that you can go in and ask for to provide you with a better idea of what is going down under the hood. It would be difficult to get into exact ranges for exact individuals and particular problems. Unfortunately, discussing variations in ranges (high or low) can be way too complex and is outside the topic of this particular article.

Wo(Men): Differently similar:

I also have to break up the topics based on gender. Men and women need different tests at a point, and as unfortunate as this may sound, men can get a lot of information from one blood test, while women on the other, sad hand need typically 3 tests drawn during their 28 day cycle. This is because levels change (or should change) throughout the month. In no way am I saying that women are unstable…..but their hormone levels may be. (But that’s why we love you!) Only a short panel is needed for those in menopause.

Paging Doctor Idiot:

Also please don’t think for a second that your doctor, OBGYN or Endo has a clue on what’s going on with your hormones. I have a lot of experience with medical “professionals,” from a range of places including small town visit-you-at-home-doctors to the almighty UCLA medical center/staff, and I haven’t found one that has given me a solid or good answer to certain questions. I have found more correct information from Strength Coaches. My only purpose for seeing a doctor is to have someone certified enough to put the needle in my arm and draw out my precious red liquid and get it tested. Other than that we don’t speak anymore. You can get the results and then review with your current physician, but I would get 2-3 opinions on the matter from anyone who has experience in the field such as a functional medicine practitioner/doctor, Endo or naturopath.

Signs and Symptoms:

It should be noted that you don’t need to have signs or symptoms to warrant a blood test. You can get one just to take a timed picture of what is going on at the moment and be evaluated, because even though you feel good now, there may in fact be something wrong. Typically there is a list of symptoms associated with hormone disorders/dysfunctions. Here are the common male and female symptoms:

Males:

(Not all may be included or present in a single individual)

Effects of low testosterone in men may include:

From a BioSignature standpoint I would also include: Excessive fat in particular areas on the body are associated with specific hormone imbalances. You don’t have fat thighs because of calories in vs. calories out, hormones control everything.

Females:

Effects of low/high estrogen levels in women may include: (not all are present in any individual)

  • Hot flashes
  • Poor libido
  • Infertility
  • Loss of, irregular, or failure to develop, menstruation
  • Loss of body hair
  • Loss of bone mass (osteoporosis)
  • Heart disease
  • Sleep disturbances
  • Symptoms of urinary bladder discomfort like frequency, urgency, frequent infections, lack of lubrication, discharge
  • Shrinking of breasts
  • Loss of or nonexistent sense of smell
  • Irritability
  • PMS
  • Menopause discomfort
  • Fatigue
  • Anxiety/ depression

Again, from a BioSignature standpoint, fat deposits located in particular areas also indicate hormonal problems.

In my opinion, having three or more symptoms warrants concern. Having all is not recommended.

So once you decide to do blood work, all you need to do is make an appointment. Again, don’t think your doctor is going to request the right tests either. You should go in prepared with a list of possible suggestions/demands. Remember, this is not meant to be a complete list but more or less a starter kit (and a damn good one) to see what may be happening. Also, ask your doc ahead of time how you should prepare for the test(fasted or not, etc.) Don’t make my mistake and fast for 20ish hours, drink three cups of coffee and one cup of water, and expect to not pass the funk out. It’s a lot of blood to draw usually. Good info: when you pass out they have to stop the drawing and have you sit, eat a cookie and wait….to draw again. Not good.

Three Paces, Then DRAW!!:

Testing for Males:

-         Complete Blood Count (white blood cell count, hemoglobin, hematocrit, platelet count)

-         Complete Thyroid Panel (TSH, Free T3, Free T4, TPO)

-         Complete Lipid Panel: (Total cholesterol, triglycerides, LDL, HDL, VLDL)

-         Adrenal Panel: (Cortisol, DHEA, DHEAS)

-         Complete Metabolic Panel: (Electrolytes, Comprehensive Kidney and Liver Function, Fasting Glucose)

-         Complete Hormonal Panel: (Total Testosterone, Free Testosterone, Estradiol, GH stimulation tests, IGH-1, SHBG)

-         Renal Function Panel: (BUN, Creatinine)

 

Other Important Tests/Readings:

-         Specific C-Reactive Protein

-         Homocysteine

-         PSA (Prostate specific antigen)

-         Calcium

-         Vitamin D

-         Red blood cell magnesium

-         Zinc

 

Note:

Regarding Cortisol testing, blood work may not be the best route to follow. Word on the street is it needs to be taken multiple times during the day to provide any value. Saliva test for this is recommended over blood work.

Also, men: Don’t settle for one blood test. It’s best to draw again in about a month or sooner, then compare and contrast.

 

Testing for Females:

-         Complete Blood Count (white blood cell count, hemoglobin, hematocrit, platelet count)

-         Complete Thyroid Panel (TSH, Free T3, Free T4, TPO)

-         Complete Lipid Panel: (Total cholesterol, triglycerides, LDL, HDL, VLDL)

-         Adrenal Panel: (Cortisol, DHEA, DHEAS)

-         Complete Metabolic Panel: (Electrolytes, Comprehensive Kidney and Liver Function, Fasting Glucose)

-         Complete Hormonal Panel: (Estradiol, Progesterone, Total Testosterone, Free Testosterone, GH stimulation tests, IGF-1, SHBG, FSH, LH)

-         Renal Function Panel: (BUN, Creatinine)

-         Immune Panel: (CBC, T and B lymphocytes)

 

Other Important Tests/Readings:

-         Specific C-Reactive Protein

-         Homocysteine

-         Calcium

-         Vitamin D

-         Red blood cell magnesium

-         Iron

-         Ferritin

-         Melatonin

-         Zinc

 

Note: Same rules apply for cortisol testing. Also, ladies, progesterone tests should be run on days 18-24 of your cycle.

“Not My Blood!! Not My Blood!!”

So they have it, they read you the results, said you’re fine (or didn’t) but for what should YOU be looking? Well, the above mentioned symptoms are somewhat good indications that something isn’t exactly right but not necessarily wrong. The blood work will shed light on confirming or hinting that same conclusion. Usually you will get a “range.” The range is deduced by the “standard American.” It should be known by now that the “standard American” isn’t exactly a healthy one, hence why he is at the hospital in the first place. With blood work really three things will happen:

1)    You are outside (way low or way high) of “the range.”

2)    You are “within range” but your tests show you to be closer to low or closer too high.

3)    You are in the middle.

If you’re good; great! Stay being a bad azz.

If your tests come back with an unfavorable or undesired result further investigation is needed, not into “What can I take to fix it?” but two more important questions:

“What is wrong?”

and

“What is causing the problem?”

Possible answers to these questions will be addressed in the next post. Please stay tuned, and in the spirit of Breaking Dawn, go draw some blood…..then get impregnated by a werewolf (spoiler!?).

 

_____________________________________________________________________________________________________

Chris Espinosa is Head Trainer and Paleo Nutrition Coach at Crossfit Simi Valley [crossfitsimi.com].  He also holds a B.A. in Creative Writing from California State University, Northridge.  Certified recently as a Charles Poliquin BioSignature Modulation Practitioner, he has become a huge advocate of BioSignature Modulation and Poliquin Training and Principles. As of now he works off the webspace happyhealthysexystrong.com. He is another one of those who has had his coaching, business, nutrition and general life changed (saved) by Robb Wolf. Feel free to contact Chris through: chris@crossfitsimi.com or happyhealthysexystrong.com.

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  1. Yvonne
    November 23, 2011 at 3:52 am

    Does the women’s panel stay the same for menopausal or perimenopausal women? I am not exactly sure where I am since I had a partial hysterectomy 3 1/2 years ago. But have have had some symptoms and I am 53 years old. Note, the most recent bout of hot flashes stopped after a few weeks of Paleo eating…

    • Chris
      November 23, 2011 at 6:18 am

      You could go with the same recommendations for male – 1 or 2 blood test just to see where things are at the moment – but getting 3 drawn to get a full look wont hurt.

    • Tim Gerstmar, ND
      November 23, 2011 at 9:01 pm

      Yvonne,
      Did you have your ovaries removed? I’m assuming not as you don’t mention much in the way of symptoms. But it’s possible. If you have ovaries I would recommend having your LH and FSH tested which will tell you if you are in menopause or not.

      It is possible you are still cycling and if so more extensive testing has to be done, if not, it gets much easier.

      Hope that is helpful.

      Best,
      Tim Gerstmar, ND

      • Yvonne
        November 25, 2011 at 7:36 am

        Still have ovaries, thanks for the info.

  2. Ashley North
    November 23, 2011 at 6:01 am

    Hey, it’s ‘Squatchy’ from the podcast! Too cool.:)

    This blog post couldn’t have come at a better time, I’m getting my blood drawn and tested by my OB next Tuesday. My menstrual cycle has not yet regulated since having my first son almost 2 years and four months ago. I also stopped nursing almost a year ago so it should have returned by now. Last month my OB put me on Provera, and that gave me a period on the 10th day of taking that stuff. Kinda freaked me out how it works like that, but I’m desperate to normalize everything down there because we want to have another baby. Well, my period hasn’t returned after that episode last month, so I’m definitely now in the “What is wrong” and “What is causing the problem” camp.
    So, just to clarify, should I just write down that entire list you provided and hand it over to my OB to make sure she provides me with all those answers when my blood results come back?? Would she normally test my blood for all of those things or just one or two things when she is looking for a reason that I’m not getting a regular period? I just want to handle this situation appropriately because otherwise I have no idea what I’m talking about.:)
    Thanks, ‘Squatchy’! Great post, informative, but not boring like some of Robb’s. :)

    • Tim Gerstmar, ND
      November 23, 2011 at 10:53 am

      Hi Ashley,
      Unless you have an integrative or very out of the box OB/Gyn they will NOT run all of those tests for you.

      From the list above, most will run something like:
      1. Complete blood count
      2. Comprehensive metabolic panel – but maybe not
      3. TSH
      4. Estradiol, Progesterone, LH, FSH
      5. Ferritin – but maybe not

      If they’re a conventional doc they’re probably going to look at you like you’re crazy if you present this list to them, so just be prepared, and they’re probably going to say no to most of it, so just be aware. From the conventional insurance based system it’s difficult to justify all of this testing for a “simple” case of amenorrhea (lack of period) and a doctor can get dropped from insurance for “overutilization of services” (read ordering too many lab tests) which jeopardizes their ability to make a living.

      While I can’t say what’s going on for you. I would definitely make sure they screen your thyroid and iron levels. I have had a lot of great success with amenorrhea using the adaptogenic herbs that Robb has talked about in the past such as Siberian ginseng, rhodiola, ashwaganda, etc.

      Best,
      Tim Gerstmar, ND

      • Ashley North
        November 23, 2011 at 11:21 am

        Thanks-great advice! Good insight too. Now I feel a bit more prepared for my appointment next week. Thank you, thank you.

        • Chris
          November 23, 2011 at 3:31 pm

          Hey Ashley!
          Thanks for the very kind review. Turns out though there are 2 Chris’s on the website – badazz squatchy and lil ol’ me – 2 different brothers from different mothers ;)

          Some people consider your situation “normal” – though these same people also have hormonal disturbances. There is a lot going on pre-intra-and post babies now a days. There is a whole host of reasons for this and I expect an outside circumstance/factor is involved. But that response falls outside the scope of what I can return in this reply. I will be writing about that for the next post, possible answers to those questions.

          Tim is very spot on. Going in with this list of demands can piss off the “establishment.” I didnt care, I wanted answers BUT I also did this in sections and through different doctors. I went to my regular then an Endo then a Uro and another Endo. Costed me a pretty penny but I found out what was wrong.

          We (BioSig Practitioners) have seen lack of periods in certain circumstances such as fitness bunnies post competition as well as other athletes and normal ladies balancing hormones. I worked with a girl who hadnt had one in 3 months and after a consult she got hers in a week.

          Your Dr. probably would not test all of these, look at you like your crazy and recommend you down the line. But talk to your Doc like you are concerned and would like to check these levels to get a complete picture. There are other routes you can take as well. Again time is right, iron will be important but others like zinc and magnesium will also be important. I would have to consult with you further to steer you in a better direction.

          Please let me know if you have further questions.

          • Tim Gerstmar, ND
            November 23, 2011 at 9:09 pm

            I agree with Chris. You have to know what you want and be willing to stick with it until you get it, and that may mean going outside the regular system. And it probably means paying out of pocket for at least some things.

            I didn’t mean to imply that only iron and thyroid are important. As Chris said earlier, men are simple (the ladies know that!) but women are very complicated “under the hood”. It’s just that I would start with thyroid and iron as well as estrogen and progesterone levels. If you are very lean then that’s a place to look as well. If you are burned out that’s important to take into account.

            If you can get your OB/Gyn to look at your FSH, LH, progesterone, estrogen, CBC, TSH, thyroid antibodies (please if you can push for one thing, get this done), and ferritin, you will have a good start.

            Best,
            Tim Gerstmar, ND

          • Squatchy
            November 24, 2011 at 1:20 am

            Haha, yeah wish I could take credit for it, but all I did was put it on the site :)

          • Ashley North
            November 25, 2011 at 6:48 am

            Thank you for all this info!
            I wouldn’t consider myself a fitness bunny, I only workout 3-4 times a week, around 30 minutes a pop. I’m not skinny, I’m 5′ 6″ish and 134ish pounds. I was actually skinnier, more burned out, and eating a ‘healthy’ SAD diet when I got pregnant with my first child. Now I eat Primal/Paleo, workout smarter, and my body comp is curvier and more balanced looking. I have a ton more energy too! I did have a c-section (my son was upside down when I went into labor). Do you think my scar tissue underneath might have something to do with my lack of period? Or would you still assume a hormone imbalance??
            I really appreciate you all taking the time to help me out on this. I really would like to get this fixed.

  3. John
    November 23, 2011 at 9:27 am

    Re: “I have a lot of experience with medical “professionals,” from a range of places including small town visit-you-at-home-doctors to the almighty UCLA medical center/staff, and I haven’t found one that has given me a solid or good answer to certain questions.”

    You say you can’t get a solid or good answer to certain questions from doctors – what are these questions? Are you getting “solid or good answers” to other questions?

    Re: “I have found more correct information from Strength Coaches.”

    This begs the question, how do you evaluate the correctness of the answers given by doctors vs strength coaches? What are you comparing the answers against to determine correctness? What are the limits to your method of evaluation? And finally, are the strength coaches giving you “more correct” information, or are they giving you information that is “more correct” because it falls within your limits of evaluation?

    • Sean
      November 23, 2011 at 2:54 pm

      I agree, John, and I would go even further and openly call bullshit on this whole post. What I love about Robb (in a totally non-sexual way) is that he’s got the science nailed down yet he’s not at all arrogant or unwilling to expand his knowledge.

      But then Chris is planning to supply possible answers in his next post so we should all be waiting with bated breath.

      • Chris
        November 23, 2011 at 3:59 pm

        Where is the arrogance amigo? I was giving out a warning based on personal insight and experience. I didnt say anything super elitist or that the entire world wide medical community has its head up its ass – just that Coaches like Robb have helped me way more than my own Doc. Looking through this website, I would say I am not the only one who would say that.
        I am more than willing to expand knowledge and be the first to fully claim “I know not all.” That is why I read up to 6 hours a day on a whole host of topics for many sources. This article was reviewed by Coach Wolf. My apologies if it rubbed you the wrong way. Not intention to piss off only inform.

        • Danny
          November 23, 2011 at 11:59 pm

          Chris,

          I just want to say that the two comments above, attacking your posts, are unfounded. For one thing I have heard Robb, on many occasions, say that certain medical professionals are not good at treating certain things (e.g. Dr. Oz). Anyone who has had any experience with complex medical problems (even ones that are not severe) while trying to get solid information and/or treatment from conventional docs knows exactly what you are talking about. I look forward to hearing the rest of what you have to say on the subject.

          -Danny

    • Chris
      November 23, 2011 at 3:54 pm

      Hey John,

      I didnt take your post to be as angry as Seans below but let me try to give you a correct response.

      I have had my own 10 year struggle with this particular issue. So it’s near and dear to my heart. The post was already getting super long so I was unable to put in a bunch of disclaimers about how this is “my” particular experience regarding sentences like the ones you quoted. With the above 1st comment, that’s all that is; my experience. I showed up to UCLA one day with a Total test of 234 and an E total of 52. My Dr (at the time) looked me square in the eye and said “you’re fine.” (Really?!?!)(I was 22 at the time).
      Later I went to several Endos and received similar answers and not one of them could answer my questions at the time (why do I feel this way? Why no sex drive? Why arent I leaner? Why cant I put on muscle? Why do I cry during Bounty commercials? Etc.) They ran no further tests and to quote one Endo “It will all balance out eventually.”

      The question you ask is a solid one and unfortunately I just couldn’t go into all those details in this particular post. The difference is the Drs told me basically “nothing we can do, it should get better eventually, you’re still growing, good luck.” The strength coaches (ie Robb and Poliquin, Ripp, Berardi, Meadows) Said “nope, something is wrong, look here. Then here. And over there.” They didn’t have solid answers but they gave me direction. That is life saving and life changing.

      Robb and Poliquin in specific, have been life changing and saving. The entire course on BioSig is hormones. I evaluated correctness based on the SC (strength coaches) actually giving me a direction and a suggestion and getting a Positive result from the interaction and course/methods. There are no limits. It was all science-y thinking: hypotheses (problem) – experiment (test)- solution (result).

      Ocassionally I received good general information through Drs but when I sat down with Poliquin and a BioSig Practitioner I was given a reason, to-do list and more importantly answers and solutions. After 10 years, this meant a significant amount to me “personally.” Sorry if this post offends anyone in the medical community – as that is not the purpose. I took stabs but everything is based off of personal experience and history. I hope this helps clarify.

  4. Amy B.
    November 23, 2011 at 9:31 am

    Thanks for a great post, Chris!

    This is a very good primer on all this stuff. You’re right — seems like people are getting more and more interested in having these tests done because we know “something’s wrong,” but we’re not sure quite what, and it’s a shame to pay big money for lots of supplements when we’re just shooting in the dark and not really sure of what the underlying issue is.

    I had/have a monstrous case of estrogen dominance. Well, it’s not so much excessive estrogen as it is ridiculously low progesterone (pregnenolone steal, I suspect). Like you said – testing is a good way to find out if these kinds of things are “all in our heads” or if there is genuinely something wonky going on inside us. It was a great relief to know that my problems are due to an actual imbalance, and that there are things I can do to correct it. I went about a year with irregular periods, horrible mood swings and some awful depression before it “occurred” to me that maybe there was something chemically/hormonally wrong and it wasn’t just “the way I’m wired.”

    You’re also spot-on when you talked about the ranges on these tests. Falling into the “normal” range doesn’t mean all that much if you still have signs & symptoms of an imbalance. “Normal” is by no means OPTIMAL. Maybe someone falls into the normal range but they still feel awful, and for their individual biochemistry, they’d feel like a million bucks if they were boosted a little higher, or taken a little lower. And like you said – let’s not forget that the “normal” ranges are usually defined by the population of people getting tested by those labs — and chances are, most of the people getting tested are getting tested for a reason and are probably NOT functioning optimally. :)

    The hormonal pathways are so complicated, and even when we identify *what* is wrong, it can be a lot harder to pinpoint *why.* But testing is so helpful and gives people a way out of the darkness, for lack of a better term.

    • Chris
      November 23, 2011 at 4:04 pm

      Thank you very much Amy!

      It is a shame. It is even worse if the supplement only fuels the problem or is even unable to be used (such as bad digestive issues and/or poor absorption).

      Good for you on figuring out something is up. All too often I hear “but I thought this was just normal?!?!” Have you corrected your problem or sought treatment?

      Thank you again for the response :)

      • Amy B.
        November 28, 2011 at 2:50 pm

        I’m working with an ND, but it’s been slow going. Even after having a ton of hormone tests, it’s still hard to pinpoint exactly what’s going on. Things are definitely getting better; it’s just taking longer than I wish it would. *Sigh.* Patience, grasshopper!

        I’m on exactly the things Robb has recommended in past podcasts (and that you’ve mentioned too): di-indolmethane, calc-d-glucarate, and phosphorylated serine. Trying my best to manage my stress levels and dial in the diet, too. Every little bit helps. At this point, I think my biggest issue is that I don’t sleep anywhere near enough. Working on that too.

        I’m getting a master’s in nutrition with an eye toward becoming a holistic practitioner myself, so on a good day, I can be objective and actually see all this as a very valuable learning experience. Having been through it, I’ll be that much better able to empathize with future clients – and HELP them.

        • Chris
          November 29, 2011 at 2:57 pm

          Email me and I can talk more about what is going on with you, if youre interested.

  5. Kevin
    November 23, 2011 at 1:47 pm

    I’m very interested in getting my testosterone checked, so this is a helpful post for me. Can anyone give some more specifics? Where and how can one go about getting these tests? Can I just call a lab? Or does a physician have to refer me? I’m interested in doing this but don’t know where to find a place to have it done. What should I be Googling? And how much would all this cost? Does insurance typically cover it?

    • Chris
      November 23, 2011 at 4:13 pm

      Hey Kevin,

      People are already sending me emails about testing. I was going to cover it later because the subject of hormones can be massive (which is why Coach and I are covering it in several posts).

      Where: regular Dr can get them as well as an Endo or there are even blood work type clinics that will run whatever tests. The problem is that some places (like TRT/HRT) will draw and then want to give you drugs to counter-act. I do not recommend immediately jumping on an approach like that.

      How: Ask, make an appointment, get poked. You should be able to call a lab. No reference needed (this may depend on location) out here in Cali we freely distribute weed so getting blood drawn isnt thatt hard either. Insurance may cover some of it. I did my 1st tests with out it. If you see someone outside your insurance it will be out of pocket. Your dr may refer you to see an Endo. Google quest dianostics. It can get expensive but which costs more – going thru life with low test? or getting the problem consulted and corrected? (If there is one of course)

    • Tim Gerstmar, ND
      November 23, 2011 at 9:21 pm

      Kevin,
      Typically you need to get a doctor to sign off on lab tests, you cannot call a lab and order tests yourself.

      There are some companies who will order lab tests for you, I believe Direct Labs and Life Extension Foundation will order lab tests if you can’t find a doctor who will order the tests you’d like (you can also Google it, I’m sure there are others, these will all be out of pocket). If you go that route I do urge you to get a competent health professional you trust involved to help you interpret your lab tests and guide treatment.

      As for doctors I’d have a talk with your family doc and see what their comfort levels are. Most general practice docs are not going to be comfortable with test replacement therapy which will be the only therapy they are aware of to raise low test unless they are integrative or out of the box. This is changing as pharma is beginning to advertise – have you seen the “low T syndrome” commercials? Oh and the FDA watches test prescriptions fairly aggressively as it is a controlled substance after all (*rolls eyes*), and many docs are leary about giving out too many prescriptions as it can trigger an investigation and the possibility of getting their license pulled.

      If your doc is not comfortable and they take you seriously they will probably kick you up to an endocrinologist, and they are all over the place. Many will not advise treatment unless you are pathologically low in test (outside the reference range), as many docs won’t treat thyroid unless it is outside the pathologic range.

      You might do a search for an ‘anti-aging’ doc who will run all the tests for you but will also probably aggressively recommend replacement therapies. And it will most likely be out of pocket.

      I hope this was helpful. And please don’t take anything I’ve said to mean that I push test replacement, I don’t. It is at the end of the list of treatments I recommend for low T, but is definitely appropriate for some people.

      Best,
      Tim Gerstmar, ND

  6. Janknitz
    November 23, 2011 at 1:48 pm

    Women like me with PCOS (polycystic ovarian syndrome) and insulin resistance may have very elevated Testosterone levels. Metabolic correction with a low carb/paleo/primal diet helps enormously.

  7. Dan Pope
    November 23, 2011 at 4:43 pm

    Great post Chris. Its tough to find good health information out there and specifically self powering information so that people have an idea of what they want before they reach the doctor. Thanks!

    strengthfoodlife.blogspot.com

  8. Sean Knox
    November 23, 2011 at 5:28 pm

    Hope this is discussed more in the next post, but just because you’re square within the lab ranges doesn’t mean that you are “good.” Lab ranges are actually reference ranges, and they’re determine based on average values tested in the lab.

    Just because you’re within the lab reference ranges doesn’t mean that it’s a functional/healthy value.

    • Chris
      November 23, 2011 at 7:12 pm

      Sean K –
      I totally agree. Really good way of putting that as it is hard to say that. Reference ranges sounds best – but it is individual to some extent. There is a broad range in which the blood number can fall but high/low/middle doesnt mean anything until several other factors are considered – which is why I left most of that topic out – this is just a scratch on the surface of what you could/should ask for when under the idea that you may have an existing condition or would “just like to know.” I intend on making this a long-ish series about different hormonal topics.

  9. Tim O'Neill
    November 25, 2011 at 2:55 am

    Great post – lots of food for thought!

    If this is something that might be answered in the follow on posts, please disregard this question.

    I’m 33 year old male having been off & on paleo over the last two years. At this stage I have been paleo (well 90%) the last six months! I don’t have any off the above symptoms but would like to get some tests done to see my ranges / bloodmarkers.

    Just of the phone with my GP, who has told me the price for the above testing would come home a little over €1000. Which is a little out of my price range, is there any of the tests you would have done as a priorty or one better than an other???

    Thanks in advance,

    Keep up the job work – knowledge is power!

    Tim

    • Chris
      November 25, 2011 at 8:37 am

      Hot damn Tim!

      I have actually heard of similar complaints about testing in EU. If no symptoms are present or felt and you just want a snap shot I would recommend just getting a standard hormonal profile – metabolic profile -adrenal profile (IMO) with the inclusion of Vitamin D – Zinc – and red blood cell mag. If youre from UK, you are guaranteed to be Vitamin D deficient. If you workout you have that same guarantee for zinc but blood work never hurts (except the initial poke of the needle, and maybe your pocket book ;)

      • Tim
        November 25, 2011 at 1:12 pm

        Hey Chris,

        Thanks for taking time out to reply!

        Not to far off with your guess – just across the pond from the UK in Ireland! Yeah Vit D is a serious issue but some what counteracting that issue with a 4000iu capsule per day but I’m sure nothing beats the real thing!

        Zinc is a new one on me, I race triathlon so will have that looked at! To get the ball rolling I’m booked in to see the doc Monday morning for some blood tests relating to testosterone levels & will discuss the other tests you have highlighted!

        Price of testing is crazy!

        Tanks once again,

        Tim

  10. Jim Purdy
    November 25, 2011 at 12:16 pm

    YOU SAID:
    “My only purpose for seeing a doctor is to have someone certified enough to put the needle in my arm and draw out my precious red liquid and get it tested. Other than that we don’t speak anymore.”

    My feelings exactly.

  11. hal | www.questorganic.com
    November 25, 2011 at 11:19 pm

    i agree the hormonal issue is very complicated, but how do we account for quantitative trends in hormonal signaling. ie if i’m insulin resistant, and you are not, is the difference in how we respond quantitatively to insulin? Ie, I am 20% less reponsive than you? Or is it qualitatively different, eg I am evoking a different pathway altogether?

  12. Jim
    November 26, 2011 at 11:32 am

    I am glad the topic of TRT is being discussed by more people. Some doctors know it well, many others have no experience with it. For men, males doctors seem more comfortable with testicular exams and frank discussions.

    I have been on TRT for 5 years now. Ideally one finds the reasons for the low T before beginning but for some the causes are unknown. Ultimately I am in charge of my own health and the decisions I make to maintain and improve it.

    As a related note, a number of men who have take prescription hair loss drugs are now on TRT, including myself.

  13. Rich
    November 28, 2011 at 9:31 am

    If you look in your medical chart for some of these values, they may be presented in this format: http://i40.tinypic.com/2aan72d.jpg

    Note the Chem-7/SMA-7, Liver Enzymes (better known in the medical community as LFTs), CBC, Arterial Blood Gas (ABGs) may not all appear right next to each other as in the image, but may be displayed in different places.

    Also, if you are just getting your BUN and serum creatinine tested for renal function it will be covered in your complete metabolic panel. Check out the Chem-7/SMA-7 in the image again. BUN is your BUN. Cr is your serum creatinine.

  14. Beth
    November 30, 2011 at 6:16 pm

    This post is very informative. I’m very interested in reading your future posts on hormones. I recently pushed my doctor into ordering me several of these blood tests (p.s. she looked at me like I was crazy, but I didn’t care). I was feeling very lethargic, had very low libido, had trouble losing weight, and got crazy pms, bouts of depression, and anxiety. I also had persistent psoriasis and couldn’t sleep through the night without having to pee every 3 hours. Clearly, something was not functioning properly in my body. Even after living the paleo lifestyle for 2 months, my weight barely budged and my energy levels were very low. I had a thyroid panel, lipid panel, and my testosterone checked. My doctor said that testing other hormone levels would be pointless because I am on the pill (Yasmin to be exact).

    Turns out I have an underactive thyroid and very low testosterone. And, apparently, the very little bit of testosterone I do have is not being absorbed properly (thanks to my birth control?). So, my doctor quickly prescribed the generic form of Synthroid for the low thyroid and topical testosterone cream for the low testosterone. I also got a steroid solution for the psoriasis (good news: my psoriasis has gone into hybernation as a result). My energy levels have skyrocketed (I think due to the thyroid medication). However, I am really sceptical about using the testosterone cream. I applied it for about 2 weeks with no apparent effect. I still have very low sex drive. I’m also afraid that it may have side effects (other than the obvious hair growth and potential aggression) that remain to be seen. What would you recommend to treat low testosterone levels in women? Do you agree with my doctors treatment? Also, what are the dangers of using testosterone cream? I’d love to hear your thoughts. Thanks!!

    • Chris
      December 4, 2011 at 7:15 am

      Hey Beth,

      Thanks for the response.

      Im going to go into recommendations for treatment of low and high numbers in articles to come I hope. Typically low test in women can be caused by Estrogen stealing the testosterone during a conversion.
      Do I agree with the treatment? Personally? No. Medications do have their place but they arent looking for a cause they are only looking to sell medical treatment through medications. If I walked in with low t levels my doc would hardly explore WHY I have low t and just give me something for the low t (watch Bigger, Faster, Stronger if you want an example). But what if I walked in with low t and was on Birth control? Could that cause low t? Probably.
      Dangers typically revolve around the body getting used to not having to work for to produce it. It can cause a natrual shut down of your bodys was of producing t. Aggression and testosterone are actually a misconception, testosterone is a feel good hormone. THe aggression actually comes from Estrogen levels rising and falling. Ever had bad PMS? As Poliquin jokes, PMS stands for: Pre Murder Syndrome. Stay tuned and hopefully I can answer your questions. If not just ask :)

  15. W
    December 13, 2011 at 6:24 am

    Rob,
    Purely for the sake of sating my curiosity, do you have a reference for the length of times it takes to explain male/female hormone systems?

    Thanks!
    -W

  16. Tim
    December 16, 2011 at 5:01 pm

    So I missed this post but just had a basic blood done and ended up with a 438 total at 44 years old.

    My doc says it is normal and thus nothing needs to be done. I, personally, think that is low for a 44 year old since the range is for teens to folks in their 80s and I am 90 points above pathological?

    Any advice?

    Thanks from Chicago,

    Tim

  17. John
    January 7, 2012 at 10:14 pm

    Does anyone know if part 2 of tis article was ever published? A link would be greatly appreciated :-)

    • Anondson
      January 14, 2012 at 11:22 pm

      I’m also looking for part 2? It’s not clear it ever was published . . .

  18. John
    October 3, 2012 at 9:57 am

    So I had my doc send over a list of tests for me to get at Quest Diagnostics who are a fairly large diagnostic testing facility with offices all over the place…interesting that they had not idea what GH stimulation tests & IGH-1 were or what do to for them?

  19. jms1123
    November 25, 2012 at 2:59 pm

    So what is working best for psoriasis – I have been reading this site for hours and can’t seem to find a solid answer

  20. Sarhalsyd
    October 4, 2013 at 9:42 am

    So….I’ve been living the Paleo lifestyle for about 3 months…love it and was feeling tons of energy and way less symptoms of estrogen dominance. I wasn’t loosing any weight even though I need to loose at least 100 pnds. I know I have low progesterone (blood work and history of it) and figured that was why the pounds weren’t coming off. So I purchased a natural progesterone cream and started using it. Period wasn’t as heavy but all the other symptoms of estrogen dominance I had before starting Paleo came back. I stopped the progesterone cream but still feel like crap. Have I really screwed things up? What do I do?

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