Reading Blood Work

By: Will Brink

One topic that seems to be a never-ending source of confusion is blood, or more precisely, understanding blood work and which tests to get and why. It never fails to amaze me that the vast majority of bodybuilders and other athletes have no issue spending literally thousands of dollars on supplements (some of which have virtually no science behind them to justify their use) and gym memberships each year, but won't spend a penny on blood tests to see what's really going on with their hormones and other indicators of health (e.g., cholesterol, liver function, etc.).

This is odd considering the fact that it's those very hormones that are ultimately responsible for whether or not your hard work in the gym is a waste of time (read busting your ass and getting no place fast) or productive. Let me be as clear as possible here: if your blood chemistry is off, meaning your hormone levels are sub par, you can eat all the supplements you want, follow any fancy new routine you want, and eat all you want, and you will be spinning your wheels with little to no results!

Depending on how out of whack your hormones are, you will get less then optimal results from your hard work or virtually no results at all. Conversely, the person with naturally optimal levels of hormones, or the person that has optimized their hormone levels via external assistance (more on that later) is going to make the progress they expect from their training, nutrition, and supplement use.

Now, explaining everything there is to know about blood work, hormones, etc., is far beyond the scope of this article. What I hope to do is give people a primer, using my own recent blood tests as examples, so people understand the importance of regular blood work and will follow up by learning more about the topic via additional readings, talking to a doctor, surfing the net, and so on.

Most bodybuilders know about the major anabolic and catabolic hormones, such as testosterone, Insulin-like growth factor-1, GH, cortisol, etc. There are however other tests that give an overall picture that should be considered (e.g., estradiol, thyroid hormones, etc.) and not all hormones can be tested for easily by a single blood draw, such as GH, which does not last long enough in the blood and is released in a pulsatile fashion, making it difficult to test for unless you are hooked up for multiple blood draws throughout the day.

Reading Blood Tests 101

Many people are under the impression that blood tests are difficult to read and must be in some secret coded language only doctors can possibly understand. Nothing could be further from the truth. The trick is not in reading them per se but interpreting them. Interpreting a blood test, that is understanding the relevance of the results, is where the doctor's education may come in and where years of research can be spent.

This does not mean however that even the average person can't read a blood test and derive some very useful information regarding the state of their health, hormone levels, and so on. It's not uncommon at all for a person to spot something of concern on a blood test a doctor either didn't notice or didn't feel was a concern (such as a low "normal" testosterone level) where the bodybuilder would be concerned (being you can't build no **** muscle without adequate testosterone!).

Labs have a reference range for anything tested, such as testosterone, cholesterol, and so on. The test always has that range with the results of your test next to it, and it's easy enough to read. For example: normal testosterone levels range from a low of 300ng/dl to a high of 1200ng/dl*. A testosterone level between those numbers (mine was 520) is considered "normal." Free (unbound) testosterone has a low/high range of 8.7pg/ml - 25pg/ml. Mine was 18.3 which would be about mid "normal."

So, it's quite easy to read a blood test. Again, the challenge is understanding why a person has say low testosterone and what to do about it, such as run additional tests, consider hormone replacement therapy (HRT) and so on. So, reading them is easy, interpreting them is where the difficulty comes in and doctors are often as guilty as lay people in this respect. A perfect example; the many people who fall in the low "normal" range of some hormone. You will often see some poor bastard who is just a few points above the lowest possible "normal" level of testosterone, but most doctors won't treat a person if they are low normal, even when the person is exhibiting symptoms of lacking testosterone.

A smart doctor will know that low normal testosterone levels, though technically "normal," really sucks for adding new muscle, keeping body fat down, libido, mental function, and so on. Though technically sub-clinical, these low "normal" levels should be treated and the data is quite clear that men will greatly benefit from such treatments, often seeing an increase in libido, reduced depression, reduction in cholesterol levels, reductions in bodyfat, and improved muscle mass. Even when some doctors are aware that sub clinical levels of testosterone should be addressed (via HRT), they often won't due to fear of liability.

There are other areas where sub clinical (low normal) levels of hormones should be treated, such as sub clinical levels of thyroid hormones T3 and T4 for example. Of course there can be levels of some hormone that can be too high (versus too low) yet still be technically in the normal range. For example, most of the medical profession refuses to understand the role estrogen - in particular estradiol - plays in a man's physiology. To the majority of the medical profession, estradiol is a "woman's" hormone and refuse to treat men (via an estrogen lowering drug or other modality) when high estrogen levels in men can cause a long list of undesirable effects, from gyno (bitch tits), to increases in bodyfat, to a loss of libido, etc.

Recent data also points to estradiol being correlated to prostate cancer and other ailments best avoided.** So, don't think doctors have all the answers after viewing a blood test. They don't. The best combination is an open-minded progressive doctor who works with a patient who has a general understanding of how to read their own blood tests. A partnership, so to speak, between doctor and patient. This segways us into a comment regarding (some) doctors and your blood tests. Always ask for a copy of your blood work versus simply taking the doctor's word for it with a sweeping "your blood work looks fine" that they often use.

It's very odd to note that some doctors will refuse to give a person a copy of their own blood work! I have no idea why they feel they have the right to do that, but they don't. Any doctor that refuses to give a person a copy of their own blood work is no doctor you want to work with.

My Own Test Results...

Recently, I had over 80 different tests done on my blood, which I do at least once per year, and I consider it money very well spent. In most states you can simply walk into a lab and have your blood drawn and then check off on an order form which tests you want done. Some states may require a doctor to request the tests on your behalf. Some times you can get insurance to pay for it. However, some companies have packages they put together where you can save a considerable amount of money.

I used the Life Extension Foundation to have my tests done as they have good prices and an extensive list of tests many medical professionals are often unaware of or don't bother with***.

I had the major hormones of importance checked:

Testosterone
Free testosterone
IGF-1 Estradiol
DHEA/DHEA-s
Full thyroid panel
I also had a full cardiovascular risk profile done, which included:

Total cholesterol
LDL
HDL
Triglycerides
C-reactive protein
Homocysteine
I had the major liver function tests done: alkaline phosphatase, GGT, SGOT, and SGPT, as well as a PSA test to make sure my prostate was OK.

Finally, I had the major kidney function tests done: creatinine, BUN, and the creatnine/BUN ratio. As mentioned above, there was actually over 80 tests done (man they took a lot of blood out of me!) but those are the major tests of interest to readers and will give you a good idea of what should be looked at.

My results were as follows:

Testosterone: 520ng/dl (normal range 300 - 1200)
Free testosterone: 18.3pg/ml (normal range 8.7 - 25)
IGF-1: 102ng/ml (normal range 109-284)
Estradiol: 22pg/ml (normal range 5 - 53 for adult male)
DHEA-s: 410ug/dl (normal range 120 - 520)
Thyroid panel
T4: 5.5ug/dl (normal range 4.5 - 12 )
T3: 3.1pg/ml (normal range 2.3 - 4.2)
TSH: 3.743uIU/ml (0.350 - 5.500)
Total cholesterol: 262mg/dl (normal healthy range 100 - 199)
LDL fraction: 167mg/dl (normal range 0 - 99)
HDL fraction: 54mg/dl (normal range 40 - 59)
Triglycerides: 204mg/dl (normal range 0 - 149)
C-reactive protein: 0.75 mg/l (> 2 increased risk of MI and stroke)
Homocysteine: 6.3umol/L (normal range 6.3 - 15)
Alkaline phosphatase: 62IU/L (Normal range (25 - 150
GGT: 15IU/L (normal range 0 - 65)
SGOT: 28IU/L (normal range 0 - 40)
SGPT: 24IU/L (normal range 0-40)
PSA: 0.6ng/ml (normal 0.0 - 4.0)
Creatinine: 1.0mg/dl (normal 0.5 - 1.5)
BUN: 19mg/dl (normal range 5 - 26)
Creatinine/BUN ratio: 19 (normal 8 - 27)

Comments On My Blood Work

As I stated above, reading a blood test is one thing, interpreting the results is another. For example, the reader will note my total cholesterol (and triglycerides) were above what is considered normal, presenting a possible increased risk of cardiovascular disease (CVD). However, I had not fasted for the test, which always leads to higher numbers in blood lipids (which is why they tell you to fast prior to blood work).

Regardless, my total cholesterol tends to run about 220 anyway, which is 20 points above what is recommend. Does that worry me? Not at all. Total cholesterol levels are poorly correlated to CVD, I have an exceptionally high HDL level (giving me a favorable total cholesterol/HDL ratio), very low homocysteine levels, low C-reactive protein levels, high normal DHEA levels, and no family history of CVD. Thus my real CVD risk is quite low. Speaking of DHEA, the reason I have such favorable DHEA levels is I take 25mg per day of DHEA. Prior tests showed I was actually low "normal" in DHEA for my age group, so I adjusted it upward via a DHEA supplement. How would I have ever known I was low in DHEA without a blood test? I wouldn't!

My testosterone and free T levels are in pretty good shape, but could be better. Thyroid could also be better. In fact, several prior tests showed I had sub clinical hypothyroid (low normal t3 and t4 with high TSH) which was treated with Armour Thyroid. However, seeing these latest results shows that although my thyroid levels have improved, they could be far better, thus, due to these latest tests I know I need to increase my dose of thyroid medication to get into the high normal range.

Low thyroid hormone levels means a person will have a sub optimal metabolism for protein synthesis, keeping bodyfat to a minimum, among the many essential functions the thyroid hormones play in human metabolism. Again, only blood tests will tell a person where they stand. Conversely, I have known many bodybuilders who took large amounts of thyroid meds in hopes of shedding bodyfat pre contest, only to shrivel up like a raison as their hard earned muscle mass was catabolized due to the huge doses of thyroid meds. How does a bodybuilder tweak thyroid levels to optimize fat loss without losing hard earned muscle? Blood tests! Bodybuilders and other athletes spend thousands of dollars on drugs, but often won't spend a penny on blood tests…

Finally, you may notice one real bummer in my blood tests, which are my IGF-1 levels. They suck! IGF-1, which is considered a reflection of GH levels (with some debate) have been low for me for years and I have no explanation for it. IGF-1 levels respond to total calorie intakes and total protein intakes, neither of which I lack. It's one area of my blood work that remains a bit of a mystery but I am looking into the problem.

I don't seem to suffer outward signs of a lack of IGF-1, and the cost of GH replacement therapy is very expensive and not without potential risks, so I don't consider it an option at this time. GH HRT may or may not increase my IGF-1 levels, though it normally does increase IGF-1 levels. Everything else looks in good shape. How does your blood look? Do you know?

Optimizing Hormones Levels

There are some hormones that we can be altered via diet, supplements, and or drugs, and there are some we have little direct control over. As you can see from my own tests, I am in pretty good shape, but not all is perfect. By knowing what's going on with my blood, I get a great deal of insight into what's going on with my body in general, and can make decisions from there.

The discussion and comments on my own tests is a the proverbial tip of the iceberg regarding the many potential variables that effect hormone levels, treatment options, effects of diet, supps, and training, etc., and it's simply too extensive a topic to cover in this article. It should also be noted that genetics play a large part in the equation regarding hormone levels and other factors.

So what would be an optimal level of the hormones mentioned above and how does one achieve it? The optimal hormone levels for adding muscle mass, minimizing bodyfat, and having a superior metabolism in general, would have high normal testosterone levels (total T, 800-1200, with free T 20-25), high normal IGF-1 (250-300), DHEA levels in the 400 - 500 range, low normal estradiol levels**** (below 25), high normal thyroid levels (T3, 3.5 - 4.5, T4, 8 - 12), with favorable blood lipids and CVD risk factors (e.g., C-reactive protein, etc), and normal kidney and liver functions. Of course the above recommendations do not take into account many variables, such as genetic individuality and other possible factors, as well as other tests that can be done.

The above recommended hormone levels and other variables can be achieved with diet, supplements, proper training, and when needed, HRT or other drugs. As mentioned, genetics plays a major role here. Some people simply have higher or lower levels of various hormones then others. At the same time, even simple changes can effect some hormones. For example, one high level Olympic sprinter I worked with had fairly low testosterone levels. On examination of his diet, it was found he was following a high carb low fat diet, which sucks for testosterone levels*****. By altering his diet, we were able to increase his testosterone levels by over 30%.

Steroids & Other Drugs

Finally, what of steroids and other drugs? Steroids will of course have profound effects on the above discussion. Injecting say 500-1000mg per week of Sustanon (a testosterone blend) will shoot total and free testosterone levels far above the high normal range, and will have all sorts of additional effects on things like estradiol (will go up), cholesterol levels, etc, etc. The person will also put on a considerable amount of lean bodymass on such a regimen, but potential side effects may occur that will have to be dealt with.

The addition of other steroids, GH, insulin, anti estrogens, etc, etc, further complicates things and adds a new level of potential issues that are beyond the scope of this article. Suffice it to say: (a) this article is generally directed at people not using large doses of steroids and other drugs (though low dose HRT is often needed for some people to optimize their metabolism) and (b) people that are using steroids and other drugs that bring them far above normal lab values need to have regular blood work done for obvious reasons, such as seeing if the drugs are having a negative impact on liver function, cholesterol levels, etc. If a person is using the above example of 500mg per week of Sustanon, there is no real reason to test for Testosterone levels now is there?

Conclusion

This article is designed to be a down and dirty primer and introduction to understanding the value of regular blood work with some strategies and pointers for optimizing hormones and other things that negatively or positively impact your health and ability to add lean body mass and minimize bodyfat levels. It's not intended as an exhaustive review of the topic or a guide to take matters into your own hands without the guidance of your doctor.

It is intended to give the reader a solid foundation they can work from and make bodybuilders and other athletes realize they are throwing away literally thousands of dollars each year on supplements, drugs, etc., not to mention a great deal of wasted time, if their hormones are sub optimal. See you in the gym!