Need Some Help on Lab Work

[ZenFitness]

So I call my new doc today to discuss adding some blood work to the order he gave me. I'm already on TRT and he was just going to test total T and estradiol.

I then discovered that he doesn't include free T as he "doesn't go by free testosterone ". That's fine and dandy for him but not for me... my old doc included it without question. However, I discovered that insurance will cover whatever tests I want, so I can add away on my LabCorp order.

So here are the tests I'm thinking I want... please keep in mind that I've been on TRT for a year and have up-to-date (as of a month ago) total T numbers, estradiol (not sensitive), LH/FSH (even though they are suppressed) and PSA. I tested prolactin way back when before TRT but it's been a while.

The new tests I want are all from LabCorp:

Total and Free Testosterone
Estradiol (sensitive)
SHBG
DHEA
DHT
Prolactin
Progesterone (free and total)
Cortisol
Red blood cell count (I think this is CBC?)


Apart from the Total and Free T, none of the tests above have ever been run for me. My thought is to try and keep a baseline of these numbers 3 - 4 times a year (or at least whenever blood work is done). Other blood work I get from my GP once a year (thyroid, cholesterol, vitamin D, etc.).

My questions are there any tests I should add to the list above, and is the red blood cell count the CBC test?

Thanks!!

[ZenFitness]

Just saw that a post below mine was concerning lab work with a response from GD, so I took from there and updated the list as follows:

Testosterone (Total and Free)
Cortisol
Sensitive Estradiol
SHBG
DHEA
DHT
Prolactin
Progesterone (Total and Free)
Metabolic Panel, Comprehensive
Complete Blood Count (CBC) With Differential
Insulin-like Growth Factor 1 (IGF-1)

I realize some of these are extra from what was on GD's list, but I've never been tested for any of this stuff. I just had a cholesterol test for private disability insurance, so I'm not adding the lipid panel.

So, ignoring the questions from my first post, here is my updated set of questions:

1. Should the CBC be with Differential? LabCorp offers with or without.
2. Is it worthwhile testing progesterone?

Thanks again!

[HRTstudent]

you don't want to test DHEA, just DHEA-sulfate. DHEA varies widely and a single measure is of little to no practical value.

is it worthwhile to test progesterone? I would say no, unless you are trying to manipulate it somehow. what would you do with a proesterone number?...

and make the cortisol a saliva, not blood/serum.

[ZenFitness]

Thanks HRT, that is helpful. I will drop the progesterone... I was just curious as it is mentioned in the hCG sticky. Since the world is my oyster here on blood tests, I'm trying to get all I can.

Out of curiosity, why would a saliva cortisol test be better over a blood test? My main goal for testing cortisol is that I know it has a large effect on the body plus my sister has Cushings Disease from a pituitary tumor and thus runs very high cortisol. I've never been tested for it. Would doing both a blood and saliva be beneficial here?

Thanks again, I really appreciate the input.

[ZenFitness]

One more question in addition to the cortisol question - is DHT worth testing?

EDIT - it looks like it: Interpretation of Free Testosterone, Estrogen, and Total Testosterone Blood Tests

Just curious on the blood vs saliva cortisol test at this point, thx again everyone.

[kelkel]

Yes for DHT, always good to know where you're at.
With saliva you can give samples throughout the day for an overall better assessment.

Remember we all seem to like our free T numbers but a lot of docs, Crisler included, never test for it. They only worry about total T.

[Faster]

I hope you have good results, I Just did all of these tests

[HRTstudent]

Is DHT worth testing? It depends, do you have symptoms of too high or low? What would you do with that information?... If you never had it checked then sure, I would get it looked at.

Same with free testosterone . I don't check free testosterone anymore. Heck, I didn't even get T checked on my last couple blood labs. No point since it wouldn't provide any useful information at this point.

blood cortisol is notoriously inaccurate. my current doctor has mentioned some of his patients who have frank genetic adrenal diseases and the blood cortisol labs show them to be fine. but saliva cortisol gives him a better, more accurate picture. I have seen time and time again where good doctors strictly test cortisol via saliva. I've never seen a reputable dr who tests cortisol via blood. These are just my observations of course.

[ZenFitness]

Thanks guys. Test is in a week... it's nice to have a doc that lets me write my own blood work order

[gymfu]

Check your lipids as well.

[BallSak]

is it worthwhile to test progesterone? I would say no, unless you are trying to manipulate it somehow. what would you do with a proesterone number?...

Your progesterone number can be useful if you have difficulty sleeping. If your prog levels are low chances are you don't sleep very well and by bumping up your prog with pregnenolone or directly with bio identical progesterone, it could make a world of difference in your sleep. This has been my experience. I can actually say I sleep pretty good now...after 6 years of sleeplessness...

[thisAngelBites]

Just curious on the blood vs saliva cortisol test at this point, thx again everyone.

It's not that blood cortisol is somehow not reliable - it is, but one cortisol reading doesn't tell you much unless you are dealing with Addison's or Cushing's in which case your early morning or midnight cortisol levels will be frankly high or frankly low.

Salivary testing is more useful outside those extremes as they typically require four or five samples, taken over the course of a day, where you then get information about the diurnal nature of your cortisol production (whether you follow the standard daily rhythm of having the highest reading in the morning, and decreasing on a curve through the day to the lowest reading at midnight). Deviations from this pattern can cause symptoms and just having one sample doesn't tell you anything about that, plus it would require for or five venipunctures.

They're now using salivary cortisol tests more and more in medicine. I presume this was motivated by the fact that it's a pain to get a midnight blood draw to diagnose Cushing's unless you're an inpatient in a hospital. Because of this, there have been some studies done comparing midnight blood serum cortisol levels to salivary levels and they actually correlate pretty well. So salivary will be good because if you indeed have Cushing's it will show up there, but it will also be informative if you have some less extreme issues.

[ZenFitness]

Thanks for the response. I'm going in for blood work on Thursday - if I specify a cortisol salivary test, will they want multiple samples throughout the day?

[thisAngelBites]

I've never heard of anyone doing a one-off salivary cortisol, but I don't know for sure. If you want to more specific you could ask for a salivary cortisol curve test. That would be (most likely) four measurements of saliva, that you would sample at approximately 8am, noon, 4pm and 11pm-midnight.

Just an FYI: if you choose to do the samples on a weekend or something, be sure not to take any kind of nap or sleep during the day as that will cause your cortisol to rise rather unnaturally, and give you skewed results. I was completely fatigued when I took my first cortisol curve, and it was ruined because I was so tired I took a 10 min power nap without realising it would affect the test.