New Labs This Week...

[Investmentbanker]

Well, I am back to square one again. My DO decided she wasnt comfortable prescribing danazol. Here are the new labs from Monday this week. Jan, Chillin, anyone, you guys notice anything? First, the blood was drawn at 2:00 in the afternoon. Everyone of my recent blood testosterone tests have been drawn at 8:00 and were all in the upper 800s, lower 900s. I know my SHBG is high but the last reading was 68 when my total T was 964 in December. Any thoughts would be appreciated. My DO says everything is in range. Thanks.

Total Testosterone 592 ng/dL (241 - 827)
Free Testosterone 12.7 pg/mL (8.7 - 25.1)
SHBG 56 nmol/l (13 - 71)
DHEA 475 ng/dL (146 - 827)

TSH 2.231 uIU/mL (.450 - 4.50)
Free T3 3.4 pg/mL (2.3 - 4.2)
Free T4 1.39 ng/dL (.61 - 1.76)

[JanSz]

Well, I am back to square one again. My DO decided she wasnt comfortable prescribing danazol. Here are the new labs from Monday this week. Jan, Chillin, anyone, you guys notice anything? First, the blood was drawn at 2:00 in the afternoon. Everyone of my recent blood testosterone tests have been drawn at 8:00 and were all in the upper 800s, lower 900s. I know my SHBG is high but the last reading was 68 when my total T was 964 in December. Any thoughts would be appreciated. My DO says everything is in range. Thanks.

Total Testosterone 592 ng/dL (241 - 827)
Free Testosterone 12.7 pg/mL (8.7 - 25.1)
SHBG 56 nmol/l (13 - 71)
DHEA 475 ng/dL (146 - 827)

TSH 2.231 uIU/mL (.450 - 4.50)
Free T3 3.4 pg/mL (2.3 - 4.2)
Free T4 1.39 ng/dL (.61 - 1.76)

Other than getting back on Danazol...............

Wild goose chase...........

http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=3105&query=danazol&hiword=DANAZOLS%20danazol%20

Plasma fatty acid profiles in benign breast disorders.

Management of cyclical breast pain.

Management of the painful and nodular breast.

Using danazol, bromocriptine or evening primrose oil a clinically useful improvement in pain can be anticipated in 77% of patients with cyclical mastalgia and 44% with non-cyclical mastalgia.
================================================== =
Lichten EM. Efficacy of Danazol® in the treatment of hormonal migraine. J Reproduct Med. 1991
http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=4773&query=danazol&hiword=DANAZOLS%20danazol%20
================================================== ===


I suggest that you do:
Essential & Metabolic Fatty Acids Analysis (EMFA)

Pay attention to GLA and other imbalances.

I suspect that there may be connection between high SHBG and Fatty Acids, more so with one of them, GLA.
-----------------------------------

You should do fatty acid analysis anyhow, so you will not loose much by doing this test.

[JanSz]

http://en.wikipedia.org/wiki/Sex_hormone_binding_globulin

Conditions with high or low levels
Conditions with low SHBG include polycystic ovary syndrome, diabetes, and hypothyroidism. Conditions with high SHBG include pregnancy, hyperthyroidism, and anorexia nervosa. There has recently been research to link high SHBG levels with breast and testicular cancer as well.

================================================== =======

high fiber diets boost SHBG
================================================== =======

SHBG was less influenced by body mass index than IGFBP-1. [2005]

insulin-like growth factor binding globulin-1 (IGFBP-1)

insulin levels were significantly negatively associated with SHBG

[Investmentbanker]

Jan, where do I go to do this? If it is an imbalance will the test results suggest what I do to correct it? Thank you for your help.




Other than getting back on Danazol...............

Wild goose chase...........

http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=3105&query=danazol&hiword=DANAZOLS%20danazol%20

Plasma fatty acid profiles in benign breast disorders.

Management of cyclical breast pain.

Management of the painful and nodular breast.

Using danazol, bromocriptine or evening primrose oil a clinically useful improvement in pain can be anticipated in 77% of patients with cyclical mastalgia and 44% with non-cyclical mastalgia.
================================================== =
Lichten EM. Efficacy of Danazol® in the treatment of hormonal migraine. J Reproduct Med. 1991
http://search.lef.org/cgi-src-bin/MsmGo.exe?grab_id=0&page_id=4773&query=danazol&hiword=DANAZOLS%20danazol%20
================================================== ===


I suggest that you do:
Essential & Metabolic Fatty Acids Analysis (EMFA)

Pay attention to GLA and other imbalances.

I suspect that there may be connection between high SHBG and Fatty Acids, more so with one of them, GLA.
-----------------------------------

You should do fatty acid analysis anyhow, so you will not loose much by doing this test.

[hardasnails1973]

Jan, where do I go to do this? If it is an imbalance will the test results suggest what I do to correct it? Thank you for your help.



]

Upon our conversation I mentioned that these areas nutritonal and lifestyle are needs to be explored as well.

[JanSz]

Jan, where do I go to do this? If it is an imbalance will the test results suggest what I do to correct it? Thank you for your help.

http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-2.html

I put the answer on the bottom of post #44
.
.

[Wise Guy]

No estrogen test?

[Investmentbanker]

I have always been relatively low E2. Was at 11 last time I checked through LabCorp Ultrasensative E@ Test


No estrogen test?

Jan, Thank you for the info. I have contacted them and requested the information. FYI, I ordered danazol on my own. Will be trying it and monitoring my labs on my own while I am looking for a new Doc. I know people say dont self treat but damn, I really dont have a choice at this point. The medicine and follow up labs at LabCorp are a lot cheaper than continuing to travel to see drs who say they are open to new treatments but then "are not comfortable" with anything I bring in. Geez!!

[JanSz]

I have always been relatively low E2. Was at 11 last time I checked through LabCorp Ultrasensative E@ Test



Jan, Thank you for the info. I have contacted them and requested the information. FYI, I ordered danazol on my own. Will be trying it and monitoring my labs on my own while I am looking for a new Doc. I know people say dont self treat but damn, I really dont have a choice at this point. The medicine and follow up labs at LabCorp are a lot cheaper than continuing to travel to see drs who say they are open to new treatments but then "are not comfortable" with anything I bring in. Geez!!

LEF.org sells blood tests, their Estradiol test is suspect.
but check and compare prices, look at my post #101

http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-4.html

.
/

[00slotiv]

I have always been relatively low E2. Was at 11 last time I checked through LabCorp Ultrasensative E@ Test



Jan, Thank you for the info. I have contacted them and requested the information. FYI, I ordered danazol on my own. Will be trying it and monitoring my labs on my own while I am looking for a new Doc. I know people say dont self treat but damn, I really dont have a choice at this point. The medicine and follow up labs at LabCorp are a lot cheaper than continuing to travel to see drs who say they are open to new treatments but then "are not comfortable" with anything I bring in. Geez!!

Rejoice! I just got almost a week's worth of results back that would put me at around 20...for the whole week! Needless to say the Anastrozole needs to go down again and JanSz I am working on it. Erections are plentiful but I'd like to increase it X7.

Bob

Bob

[chilln]

The medicine and follow up labs at LabCorp are a lot cheaper than continuing to travel to see drs who say they are open to new treatments but then "are not comfortable" with anything I bring in.

I suspect you provide hard copies of medical research papers, to your medical professional adviser, to help him/her understand that your suggestion is based on documented studies.

Have you tried searching for an "anti-aging" medical professional adviser, or have you tried searching for a "holistic medicine clinic" in your area ?

[Investmentbanker]

I tried that with the last one, had a hard copy of a study following danazol treatment of men for several years...still wasnt good enough for her. Even offered to pay for her to consult with Shippen. She would not do it...I will try what you suggest. Surely, in a city as big as Dallas, there has to be at least one anti aging doctor that will let me give it a go.



I suspect you provide hard copies of medical research papers, to your medical professional adviser, to help him/her understand that your suggestion is based on documented studies.

Have you tried searching for an "anti-aging" medical professional adviser, or have you tried searching for a "holistic medicine clinic" in your area ?

[chilln]

I tried that with the last one, had a hard copy of a study following danazol treatment of men for several years...still wasnt good enough for her. Even offered to pay for her to consult with Shippen. She would not do it...I will try what you suggest. Surely, in a city as big as Dallas, there has to be at least one anti aging doctor that will let me give it a go.

That's enough effort wasted on this individual. Not all medical profesional advisers want to deal with anti-aging. It's too new, it's long term. Not good for quick profits when you have to wait 100 years to prove irrefutably to the dummies in the regulatory authorities, that people really do live longer when their hormones remain more youthful and more balanced for longer.

a) anti-aging
b) holistic medicine clinic <-- one with MD doctors

these are the terms I use to find new medical professional advisers.

[chilln]

FYI, I ordered danazol on my own. Will be trying it and monitoring my labs on my own while I am looking for a new Doc.

Before you take danazol, please get your bioavailable testosterone measured.

Ie: if your SHBG is continually high, then the usual "rule-of-thumb" that bioavailable testosterone follows total testosterone - does not apply. And the usual "rule-of-thumb" that free testosterone follows total testosterone - also does not apply.

The only reason most of us can get away with blabbing on about total testosterone is because our bioavailable and free testosterone values follow a similar trend to our total testosterone. And that's because our SHBG behaves typically / normally.

Once that relationship is broken (eg: continually high SHBG), thereafter total testosterone is no longer an indicator of bioavailable testosterone levels.

Hence you need to do the bioavailable testosterone testing.

If you confirm that danazol is somehow restoring your hormone balance, then you can probably switch to blabbing on about total testosterone too - but not until after you confirm that danazol is somehow restoring your hormone balance, via (at least) using bioavailable testosterone measurements.

Ie: if after taking a short course of danazil, you decide to post your total testosterone results, and if you ask us to compare those to your "before danazol" results, then the comparison is mostly meaningless - because it's the bioavailable testosterone which makes us tick - not the total testosterone.

We can only reliably compare apples with apples. Once you mess with SHBG, we can't compare total testosterone before and after results.

[JanSz]

Before you take danazol, please get your bioavailable testosterone measured.

Ie: if your SHBG is continually high, then the usual "rule-of-thumb" that bioavailable testosterone follows total testosterone - does not apply. And the usual "rule-of-thumb" that free testosterone follows total testosterone - also does not apply.

The only reason most of us can get away with blabbing on about total testosterone is because our bioavailable and free testosterone values follow a similar trend to our total testosterone. And that's because our SHBG behaves typically / normally.

Once that relationship is broken (eg: continually high SHBG), thereafter total testosterone is no longer an indicator of bioavailable testosterone levels.

Hence you need to do the bioavailable testosterone testing.

If you confirm that danazol is somehow restoring your hormone balance, then you can probably switch to blabbing on about total testosterone too - but not until after you confirm that danazol is somehow restoring your hormone balance, via (at least) using bioavailable testosterone measurements.

Ie: if after taking a short course of danazil, you decide to post your total testosterone results, and if you ask us to compare those to your "before danazol" results, then the comparison is mostly meaningless - because it's the bioavailable testosterone which makes us tick - not the total testosterone.

We can only reliably compare apples with apples. Once you mess with SHBG, we can't compare total testosterone before and after results.

chilln,
do you have some idea of how to treat
BioAvailabletestosterone results
of those who's SHBG is high (over 30 I think)?
Investmentbanker's-SHBG=56 nmol/l

I am refering to this discussion:
http://musclechatroom.com/forum/showthread.php?t=2527

With high SHBG the BioAvailable testosterone results may come with close to 200% error.

Someone comming back from Quest, having BAT=500 (good) may actually have 250(bad).

[Investmentbanker]

Do you know any service online that works with Quest? I currently use privatemdlabs and they only work with Labcorp. When I completed the bioavaliable testosterone calculator it estimated a free t level of 8.75 ng/dL and bioavailable level of 219 ng/dL.

Look I really dont know what you are talking about 2x bio but I know something is not right. For a doctor to misrepresent and tell me she is open to the latest treatments and then not be is what I have a problem with. I am going to try and locate a doctor per Chillin's suggestion but it is getting very frustrating.




chilln,
do you have some idea of how to treat
BioAvailabletestosterone results
of those who's SHBG is high (over 30 I think)?
Investmentbanker's-SHBG=56 nmol/l

I am refering to this discussion:
http://musclechatroom.com/forum/showthread.php?t=2527

With high SHBG the BioAvailable testosterone results may come with close to 200% error.

Someone comming back from Quest, having BAT=500 (good) may actually have 250(bad).

[chilln]

I am refering to this discussion:
http://musclechatroom.com/forum/showthread.php?t=2527

With high SHBG the BioAvailable testosterone results may come with close to 200% error.

Someone comming back from Quest, having BAT=500 (good) may actually have 250(bad).

That's not a correct assessment of the Quest calc accuracy.

The Quest test 14966X "Testosterone calculated Free, Bioavailable and Total" uses calcs for bioavailable testosterone which take the measured SHBG and the measured albumin into consideration.

Quest haven't published their algorithm, but I doubt it's any one of the algorithms referenced in that discussion.

I wasn't referring to any Quest test in that discussion, even if you were.

The pertinent info item which Quest mentions in Quests Diagnostic Manual "Endocrinology Test Selection and Interpretation" is as follows:

"Measurement of bioavailable or weakly bound testosterone can be performed using an ammonium sulfate precipitation method, or the levels can be calculated based on measurement of aSHBG and albumin in addition to total testosterone. The former methods shows very good correlation with the bioavailable testoserone levels obtained by calculation using SHBG and albumin."

The Quest lab test 14966X doesn't require age as an input because the issue of SHBG and albumin variations are taken into account by direct measurement of albumin and SHBG (which are also included in the test results). The problems with age related variations were only a problem for those algorithms which only considered total testosterone and SHBG as inputs. Not Quest's algorithm.

While it's true that Quest's mechanism for measuring total testosterone in test 14966X doesn't use LC/MS/MS, The same Quest Diagnostic Manual addresses this, and states that the LC/MS/MS mechanism is most useful for low levels of total testosterone, while the method used to measure total testosterone in 14966X (ie: ICMA) is adequate for high levels of total testosterone.

Since Investmentbanker is in the high total testosteorne category, therefore the Quest test 14966X is applicable and relevent and sufficiently accurate to make before and after comparisons.

####

Please remember that I am specifically recommending this test to Investmentbanker, in order to help him and his medical professional adviser make before and after comparisons of danazol's effectiveness.

I am not recommending this test to anyone to make any absolute judgments re the efficacy of danazol.

[JanSz]

Do you know any service online that works with Quest? I currently use privatemdlabs and they only work with Labcorp. When I completed the bioavaliable testosterone calculator it estimated a free t level of 8.75 ng/dL and bioavailable level of 219 ng/dL.

Look I really dont know what you are talking about 2x bio but I know something is not right. For a doctor to misrepresent and tell me she is open to the latest treatments and then not be is what I have a problem with. I am going to try and locate a doctor per Chillin's suggestion but it is getting very frustrating.

In the thread that I mentioned previously:
http://musclechatroom.com/forum/showthread.php?t=2527

There is research being discussesd.
That research is very important but rather confusing (to me) in at least two way.
They use use words "BioAvailableTestosterone" (actually BT) when they actually mean FreeTestosterone.
They use "old men" and "young men" when they actually mean men with low SHBG and men with high SHBG.

At least this is my take.

Now, our choices when doing blood analysis are mostly

Quest--(BAT & FreeT calculated)
LabCorP--(BAT & FreeT found by assays)

Each lab have also other similar tests available.

Confussion abound.

It helps if one is praying men.


It sounds as men with SHBG<=30 do not have to worry much
But there is a doubt raised about accuracy of results when SHBG is higher.

I doubt any doctor is familiar with much of those nuances.
We could definitey use a good contact at Quest or LabCorp or both, and have them explan current state of know-how and technology.

The best single person can do when following progress of their theraphy is stick with one lab and one test and hope for the best.
===================================

There is a little doubt about quality of basic tests, TT, SHBG, Albumin.
So you will know if Danazol is helping in lowering SHBG, which is your main goal.
.


.
/

[chilln]

When I completed the bioavaliable testosterone calculator it estimated a free t level of 8.75 ng/dL and bioavailable level of 219 ng/dL.


Sorry but there are no online calculators worthy of use.

A bioavailable T calculator would only work if the inputs were at a minimum:

.....a) total testosterone - measured accurately

.....b) albumin - measured accurately

.....c) SHBG - measured accurately

.....d) include empirical adjustments to the output, and those empirical adjustments were obtained by many comparisons with ammonium sulfate precipitation of directly measured bioavailable T (same as Quest's calcs). This input should be automatically included in the chart, you don't enter it. It costs a ton of money to develop this empirical adjustment, and no-one is going to give it away for free.

Its not enough to try to calc bioavailable T from any fewer than all four of these inputs.

Quest's test 14966X uses calculations which use all four of these inputs. Therefore Quest's test 14966X is reasonable.

The online calculators are a joke.

[Investmentbanker]

Oh, I did not realize that I needed ........d) below. I had the other three. Do you think it will be enough to keep up with these three and E2 after starting Danazol or are there more things to watch as well?

I may just bite the bullet and fly up north and see either Shippen or Dr. J. I am not sure how Dr. J feels about danazol, which is one of the reasons I am hesitant to see him. On the other hand, Shippen is VERY expensive.

Do you know what Dr. J thinks about using danazol? Perhaps he may come across this thread and post himself. I am very reluctant to begin any type of testosterone treatment with high natural total t but dont really know any other alternative outside of danazol. It is certainly a catch 22.



Sorry but there are no online calculators worthy of use.

A bioavailable T calculator would only work if the inputs were at a minimum:

.....a) total testosterone - measured accurately

.....b) albumin - measured accurately

.....c) SHBG - measured accurately

.....d) include empirical adjustments to the output, and those empirical adjustments were obtained by many comparisons with ammonium sulfate precipitation of directly measured bioavailable T (same as Quest's calcs). This input should be automatically included in the chart, you don't enter it. It costs a ton of money to develop this empirical adjustment, and no-one is going to give it away for free.

Its not enough to try to calc bioavailable T from any fewer than all four of these inputs.

Quest's test 14966X uses calculations which use all four of these inputs. Therefore Quest's test 14966X is reasonable.

The online calculators are a joke.

[JanSz]

Oh, I did not realize that I needed ........d) below. I had the other three. Do you think it will be enough to keep up with these three and E2 after starting Danazol or are there more things to watch as well?

I may just bite the bullet and fly up north and see either Shippen or Dr. J. I am not sure how Dr. J feels about danazol, which is one of the reasons I am hesitant to see him. On the other hand, Shippen is VERY expensive.

Do you know what Dr. J thinks about using danazol? Perhaps he may come across this thread and post himself. I am very reluctant to begin any type of testosterone treatment with high natural total t but dont really know any other alternative outside of danazol. It is certainly a catch 22.

You have been subjected to number of theoretical opinions.
Those opinions are important but you may as well forget about them, at least for a while.

Your priority is to find a doctor who is comfortable with getting you on a program of lowering your SHBG.

Other than Danazol I suggest that you do Essential and Fatty Acid Analysis (RBC).
I suspect that you may find some irregularities there, specially around Omega-6 and Delta-6 and Delta-5 Desaturases
The test is not expensive, may give you some additional clues.


To find FreeT, get TT + SHBG plus chart, not perfect but close enough.
.
/

[medgerton]

Oh, I did not realize that I needed ........d) below. I had the other three. Do you think it will be enough to keep up with these three and E2 after starting Danazol or are there more things to watch as well?

I may just bite the bullet and fly up north and see either Shippen or Dr. J. I am not sure how Dr. J feels about danazol, which is one of the reasons I am hesitant to see him. On the other hand, Shippen is VERY expensive.

Do you know what Dr. J thinks about using danazol? Perhaps he may come across this thread and post himself. I am very reluctant to begin any type of testosterone treatment with high natural total t but dont really know any other alternative outside of danazol. It is certainly a catch 22.


Bite the bullet. Dr. John initial consult is $300 and he talks to you for more than an hour. This is cheap. I know there is travel cost but in the scheme of things this visit is well worth the cost. You will have confidence that the answers you are getting are from the best in the business. This alone will make you feel better!

[Investmentbanker]

I was just checking Labcorp tests and notice that they DO offer a bioavailable testosterone test. This is something new because in December it was not offered. I will get this test done before I start the danazol, along with E2, LH, FSH, and SHBG. I hate experimenting on myself but I am going to give it a go....

[chilln]

I was just checking Labcorp tests and notice that they DO offer a bioavailable testosterone test. This is something new because in December it was not offered. I will get this test done before I start the danazol, along with E2, LH, FSH, and SHBG. I hate experimenting on myself but I am going to give it a go....


Well spotted!

I've read Labcorp's write-up, ie:
https://www.labcorp.com/datasets/labcorp/html/chapter/mono/sr016000.htm

I'll announce it on the board (credit will go to you of course).

[Investmentbanker]

Chilln, Jan, Han...I have a question for you all. Today I went to the office of the Urologist I saw when I was 22 and inquired about getting the test results that were ran then. Believe it or not they actually had the tests. After listening to all of my symptoms the ONLY tests he ran were Total T and Prolactin. I have never checked prolactin but wanted to post the results to see what you think. Keep in mind this was done in August 1997 but my Total Test is almost identical to what it has been recently.

Total Testosterone 918 ng/dL (241-827)
Prolactin 15.24 ng/mL (1.6 - 18.77)

What do you all think? It is in range but seems kind of high. The only note on the page is "Normal" and the Drs. initials. This is the man who gave me prescription yohimbine (spelling) and told me it was performance anxiety.

[chilln]

Chilln, Jan, Han...I have a question for you all. Today I went to the office of the Urologist I saw when I was 22 and inquired about getting the test results that were ran then. Believe it or not they actually had the tests. After listening to all of my symptoms the ONLY tests he ran were Total T and Prolactin. I have never checked prolactin but wanted to post the results to see what you think. Keep in mind this was done in August 1997 but my Total Test is almost identical to what it has been recently.

Total Testosterone 918 ng/dL (241-827)
Prolactin 15.24 ng/mL (1.6 - 18.77)

What do you all think? It is in range but seems kind of high. The only note on the page is "Normal" and the Drs. initials. This is the man who gave me prescription yohimbine (spelling) and told me it was performance anxiety.


High prolactin is a problem if it comes with gyno (man boobs) and / or high E2.

How are your nipples ?

[Investmentbanker]

Chilln - I guess they are fine??? I am sure I would know it if something was not right, they look normal to me. No hard spots or anything like that.

So, I should not worry about the prolactin thing then and concentrate primarily on the SHBG? The Danazol will be here on Thursday. I am going to Labcorp before I start and measure Total T, Bio T, SHBG, Albumin, LH/FSH, E2. Is there any others I should get before starting it? Thanks.




High prolactin is a problem if it comes with gyno (man boobs) and / or high E2.

How are your nipples ?

[chilln]

Chilln - I guess they are fine??? I am sure I would know it if something was not right, they look normal to me. No hard spots or anything like that.

So, I should not worry about the prolactin thing then and concentrate primarily on the SHBG? The Danazol will be here on Thursday. I am going to Labcorp before I start and measure Total T, Bio T, SHBG, Albumin, LH/FSH, E2. Is there any others I should get before starting it? Thanks.

Don't need serum LH or FSH. These are pulsatile hormones. You don't know if you caught them during a pulse, or during a low-point between pulses.

The rest are fine. I'm all for frequent testing of only a few metrics at a time, with dose modification / optimization after each test - then stick to your amended schedule until the next test.

So stick with these tests for now, and add others as you learn how your body adapts to the danazol.