How do you determine GH Deficiency?

[Hemochromatosis]

How do you determine GH Deficiency?

I present with Hemochromatosis a genetic iron overload disorder that has fouled anterior lobe signaling of my pituitary I have been on TRT for 3 months, feel better and have other noticeable improvements in adjacent areas that I will document in separate posts.

I have had my IGF-1 tested twice since I read that IGF-1 is a key indicator of GH deficiency, results as follows:

12/10/08 Value: 157 Range: 86-220 ng/mL
01/15/09 Value: 154 Range: 86-220 ng/mL

I have also had Quest test for GH levels and they come back with some very confusing results that seem to be worthless, as follows:
-------------------
GROWTH HORMONE Value 0.1 Range <=10.0 ng/mL

Because of a pulsatile secretion pattern, random (unstimulated) GH levels are frequently undetectable in normal children and adults and are not reliable for the diagnosis of GH deficiency. Regarding suppression tests, failure to suppress GH diagnostic of acromegaly.

Typical (GH) response in healthy subjects:

Using the glucose tolerance (GH Suppression) test, acromegaly would be ruled out if the patients GH level is <1.0 ng/mL

Using the GH stimulation test, the following results would rule out GH deficiency.

Adults (> or = 20 Years):
Insulin hypoglycemia > or = 5.1 ng/mL
Arginine/GHRH > or 4.1 ng/mL

Pediatric (< 20 years):
All stimulation tests > or = 10.0 ng/mL
-------------------
What I ascertain from the GH results is nothing. Is there something hidden in the code?

I also read IgfBP1 is usually also tested to determine GH deficiency.

WHAT IS EXACTLY REQUIRED TO DETERMINE IF I AM GH DEFICIENT BEYOND A REASONABLE DOUBT?

[JanSz]

How do you determine GH Deficiency?

I present with Hemochromatosis a genetic iron overload disorder that has fouled anterior lobe signaling of my pituitary I have been on TRT for 3 months, feel better and have other noticeable improvements in adjacent areas that I will document in separate posts.

I have had my IGF-1 tested twice since I read that IGF-1 is a key indicator of GH deficiency, results as follows:

12/10/08 Value: 157 Range: 86-220 ng/mL
01/15/09 Value: 154 Range: 86-220 ng/mL

I have also had Quest test for GH levels and they come back with some very confusing results that seem to be worthless, as follows:
-------------------
GROWTH HORMONE Value 0.1 Range <=10.0 ng/mL

Because of a pulsatile secretion pattern, random (unstimulated) GH levels are frequently undetectable in normal children and adults and are not reliable for the diagnosis of GH deficiency. Regarding suppression tests, failure to suppress GH diagnostic of acromegaly.

Typical (GH) response in healthy subjects:

Using the glucose tolerance (GH Suppression) test, acromegaly would be ruled out if the patients GH level is <1.0 ng/mL

Using the GH stimulation test, the following results would rule out GH deficiency.

Adults (> or = 20 Years):
Insulin hypoglycemia > or = 5.1 ng/mL
Arginine/GHRH > or 4.1 ng/mL

Pediatric (< 20 years):
All stimulation tests > or = 10.0 ng/mL
-------------------
What I ascertain from the GH results is nothing. Is there something hidden in the code?

I also read IgfBP1 is usually also tested to determine GH deficiency.

WHAT IS EXACTLY REQUIRED TO DETERMINE IF I AM GH DEFICIENT BEYOND A REASONABLE DOUBT?

Post #130
http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-4.html

Thierry Hertoghe, MD

PC01d - Adult Growth Deficiences Treatments
$20.00 Purchase Conference: A4M Orlando 2007
Speaker: Thierry Hertoghe, MD
Date/Time: April 26, 2007
------------------------------------------
Post #107

Growth Hormone
per Tierry Hertoghe MD Hormone Solution
supplementation required when
IGF-1<150mcg/L
IGFBP-3>4000mcg/L=4mg/L
---------------------------------------------------------------------

[Hemochromatosis]

IGF-1<150mcg/L
IGFBP-3>4000mcg/L=4mg/L

Are there optimal values and what about any other relevant testing.

I have an appointment iwth my D.O. next Monday, who while prescribes T without tracking E2 until I told him, is terrified about administering GH or Arimidex, etc...

I know I am GH deficient I am just trying to satisfy my primary and insurance requirements.

Any help is appreciated, I only have a few days.

[Wise Guy]

Hemo

Did you have those tests done at quest?

If so, they are age adjusted ranges for your age. They are NOT ideal.

What is your age?

You want to shoot for the upper 1/3 levels of a healthy 25 year old man. At quest, this is typically 126 - 386. The upper level would be over 300.

Now, if you tested in at 270 or something, that probably wouldn't warrent replacement due to benefits versus cost/effectiveness ratio.

However, your at half of where you need to be. So you would definitely qualify IMO.

My IGF-1 levels test out at about where you are. I want to be on GHRT in the near future.

[Hemochromatosis]

Thanks JanSz, I have been on many a board/forum and do try to search before asking, thanks for the time saver.

Are there optimal values and are the ranges referenced valid.

As mentioned, I have Hemochromatosis, the Fe range often referenced by labs are destructive. I have seen some Fe ranges as high as 800+ which would trash the beta cells into oblivion.

Are the IGF-1, IgfBP1, and stimulation test the go to labs as comprehensive and conclusive?

[Wise Guy]

I
I have an appointment iwth my D.O. next Monday, who while prescribes T without tracking E2 until I told him, is terrified about administering GH or Arimidex, etc...

.

It is unlikely you will have any long term significant success in GHRT, or any new advances in HRT in the future as long as you stay with this Dr.

[JanSz]

Thanks JanSz, I have been on many a board/forum and do try to search before asking, thanks for the time saver.

Are there optimal values and are the ranges referenced valid.

As mentioned, I have Hemochromatosis, the Fe range often referenced by labs are destructive. I have seen some Fe ranges as high as 800+ which would trash the beta cells into oblivion.

Are the IGF-1, IgfBP1, and stimulation test the go to labs as comprehensive and conclusive?

You have also said:

"My knowledge on Atril Fibrillation and Hemochromatosis is extensive."

Sorry that you had to learn it the hard way,
but please share with us your knowledge.

crazycew here
http://musclechatroom.com/forum/showpost.php?p=31114&postcount=20

had his hematocrit raised from good to bad levels after aplying Androgel.
------
Hematocrit-43.5%(37-49)
Hematocrit-55.9%(37-49)-----------------! ! ! !---(12/18/2008 labs)
------

He have no other choice, he have to raise his BAT level,
among rather numerous other items,
but his case requires more knowledge.
Any advice, pointers, proper tests to follow, please post on his thread, thank you.
.
.

[medgerton]

How do you determine GH Deficiency?

I present with Hemochromatosis a genetic iron overload disorder that has fouled anterior lobe signaling of my pituitary I have been on TRT for 3 months, feel better and have other noticeable improvements in adjacent areas that I will document in separate posts.

I have had my IGF-1 tested twice since I read that IGF-1 is a key indicator of GH deficiency, results as follows:

12/10/08 Value: 157 Range: 86-220 ng/mL
01/15/09 Value: 154 Range: 86-220 ng/mL

I have also had Quest test for GH levels and they come back with some very confusing results that seem to be worthless, as follows:
-------------------
GROWTH HORMONE Value 0.1 Range <=10.0 ng/mL

Because of a pulsatile secretion pattern, random (unstimulated) GH levels are frequently undetectable in normal children and adults and are not reliable for the diagnosis of GH deficiency. Regarding suppression tests, failure to suppress GH diagnostic of acromegaly.

Typical (GH) response in healthy subjects:

Using the glucose tolerance (GH Suppression) test, acromegaly would be ruled out if the patients GH level is <1.0 ng/mL

Using the GH stimulation test, the following results would rule out GH deficiency.

Adults (> or = 20 Years):
Insulin hypoglycemia > or = 5.1 ng/mL
Arginine/GHRH > or 4.1 ng/mL

Pediatric (< 20 years):
All stimulation tests > or = 10.0 ng/mL
-------------------
What I ascertain from the GH results is nothing. Is there something hidden in the code?

I also read IgfBP1 is usually also tested to determine GH deficiency.

WHAT IS EXACTLY REQUIRED TO DETERMINE IF I AM GH DEFICIENT BEYOND A REASONABLE DOUBT?

Here are the blood tests my doctor ordered for HGH testing:

IGF-1
IGFBP3
Fasting Insulin

My values were

233 range 91-246
5.3 range 3.4 -6.9
6 range 2-25

My doctor said no need for GH therapy.

[Wise Guy]

Here are the blood tests my doctor ordered for HGH testing:

IGF-1
IGFBP3
Fasting Insulin

My values were

233 range 91-246
5.3 range 3.4 -6.9
6 range 2-25

My doctor said no need for GH therapy.

Medg,

Where did you get those tests done.

If they are at Quest, those are probably age adjusted ranges.

[medgerton]

Medg,

Where did you get those tests done.

If they are at Quest, those are probably age adjusted ranges.

They are Quest and I know that the IGF-1 range is age adjusted. The youthful range goes up to 382 for a 19 - 30 yr old. Although the 31 - 40 range only goes to 255. From where I sit 31 seems young.

IGFBP3 for 21 - 30 yr old range is 3.4 - 7.8

[chilln]

Because of a pulsatile secretion pattern, random (unstimulated) GH levels are frequently undetectable in normal children and adults and are not reliable for the diagnosis of GH deficiency.

Depends on which lab is doing the tests - some have good gear and can measure practically anything, some are shocking.

###

The answer to your question is Rheins 24hr urinary GH testing.

Here's Dr Crisler's comment:
http://musclechatroom.com/forum/showthread.php?t=2492&highlight=crisler+rheins

All this inaccurate IGF-1 and IGFBP-3 stuff can take a back seat. Measure GH, cut the guess work.

If you want to measure serum IGF-1, then measure serum IGF-1, because serum IGF-1 is relatively stable.

If you want to measure serum IGFBP-3, then measure serum IGFBP-3, because serum IGFBP-3 is relatively stable.

If you want to measure serum GH, then measure urinary GH, because GH is pulsatile, and the urinary test from Rheins is now highly accurate.

Alternatively, pay a university to hook you up to an auto-serum-sampler which samples every 5 minutes, and hopefully they'll pay for the test results.

###

We've moved on from measuring daytime IGF-1 and daytime IGFBP-3 in order to hopefully measure the overnight GH release pulse which happened up to 12 hours earlier.

[Hemochromatosis]

Wow, it is refreshing to see such an active board that stays focused in a man cave way on the issues. I appreciate all of the comments and will proceed in an educated way.

I am 44 years old so I suspect Quest made ae range adjustments and I am just guessing but I would suspect I need 2 iu's per day, to be confirmed.

The real ***** is how convention seems to be more of an impedance than facilitator. I have to almost demand labs. Yes, I want my PSA monitored monthly for the first 12 months, call it overkill, but guess what I am footing the $850 per month BCBS premium not to mention office visit $25, deductible I believe is still $1500, and a share in the med %.

I have been wanting to work with a D.O. because he is local and definitely more progressive than entrenched MD's. With emphasis, they process everything through insurance and since I had a major event of a stroke 4 years ago I am concerned to just drop the policy and pay as I go, which alternatives such as Dr. Chrisler or the doctors from other reputable networks who give you a receipt and code and tell you to go process your claims.

In as much, there really is not that much of a cost load. I really wish I had the diagnostic equipment myself and I am willing to spend the money. My concern is the catastrophic.

Additionally, I set up my Testosterone Cyp with McKessen as required by BCBS. They require it to be sent to my doctors office. I can not have it redirected to a pharmacy and with my travel and extended stays it makes it a pain in the ass. Not to mention they take me right down to the last injection before they agree to refill it. That makes me uncomfortable in the event we have a hurricane, some other force majure or a homeland issue.

Ideally I want a years supply rolling on a FIFO. The sticking point is labs and access to diagnostics. I swear I almost have to plead my case with printouts and bout after bout of convincing. My life is on the line wrestle ever single time I go to an appointment.

It scares me when they "play" with HRT. The sexy Big Pharm rep shows up says Testim for the world. Next thing you know there is testim replacement paper on every exam table and the guy is off to the races peddling gels. I asked if he tracked E2 and I got a blank stare until I showed the white paper. Why am I having to educate the D.O.'s and MD's and why aren't they embracing the science anymore? Is there oath a legally enforceable creed?

I have trained since age 6 as a competitive wrestler in Ohio. I get it. I understand diet, I was weight room supervisor at Florida State. I am being damaged by ignorance and greed and apathy and I am pissed, which means E2 is probably about at 40!

Anyhow I am done, Monday he accepts my terms or I just keep him around for a runny nose as needed.

[chilln]

Wow, it is refreshing to see such an active board that stays focused in a man cave way on the issues. I appreciate all of the comments and will proceed in an educated way.

I am 44 years old so I suspect Quest made ae range adjustments and I am just guessing but I would suspect I need 2 iu's per day, to be confirmed.

The real ***** is how convention seems to be more of an impedance than facilitator. I have to almost demand labs. Yes, I want my PSA monitored monthly for the first 12 months, call it overkill, but guess what I am footing the $850 per month BCBS premium not to mention office visit $25, deductible I believe is still $1500, and a share in the med %.

I have been wanting to work with a D.O. because he is local and definitely more progressive than entrenched MD's. With emphasis, they process everything through insurance and since I had a major event of a stroke 4 years ago I am concerned to just drop the policy and pay as I go, which alternatives such as Dr. Chrisler or the doctors from other reputable networks who give you a receipt and code and tell you to go process your claims.

In as much, there really is not that much of a cost load. I really wish I had the diagnostic equipment myself and I am willing to spend the money. My concern is the catastrophic.

Additionally, I set up my Testosterone Cyp with McKessen as required by BCBS. They require it to be sent to my doctors office. I can not have it redirected to a pharmacy and with my travel and extended stays it makes it a pain in the ass. Not to mention they take me right down to the last injection before they agree to refill it. That makes me uncomfortable in the event we have a hurricane, some other force majure or a homeland issue.

Ideally I want a years supply rolling on a FIFO. The sticking point is labs and access to diagnostics. I swear I almost have to plead my case with printouts and bout after bout of convincing. My life is on the line wrestle ever single time I go to an appointment.

It scares me when they "play" with HRT. The sexy Big Pharm rep shows up says Testim for the world. Next thing you know there is testim replacement paper on every exam table and the guy is off to the races peddling gels. I asked if he tracked E2 and I got a blank stare until I showed the white paper. Why am I having to educate the D.O.'s and MD's and why aren't they embracing the science anymore? Is there oath a legally enforceable creed?

I have trained since age 6 as a competitive wrestler in Ohio. I get it. I understand diet, I was weight room supervisor at Florida State. I am being damaged by ignorance and greed and apathy and I am pissed, which means E2 is probably about at 40!

Anyhow I am done, Monday he accepts my terms or I just keep him around for a runny nose as needed.


You can always do what some of us have done, and purchase a year's supply of testosterone via another doc, pay full price without a reimbursement - and you have your 52 week FIFO buffer. I recognize this may cause financial stress, but it resolves the problem.

Then continue to get the rest of your testosterone the normal way, with less emotional stress.

###

You can always do what some of us have done, and go to one doc for the "smarts" and travel far to meet him/her, and pay through the nose, and then go back to your local medical professional adviser for repeat prescriptions.

Local medical professional advisers seem to be able to regurgitate repeat prescriptions indefinitely.

I definitely do not recommend ever getting your local medical professional adviser offside, so that you can continue to get those repeat prescriptions (after you find your "smarts" doc).

###

You can find a "smarts" medical professional adviser by googling for:
a) holistic medical center
b) anti aging

Even though a lot of these medical professional advisers don't have all the tricks worked out, they'll buy into your suggestions for testing and monitoring new supps.

###

In the end you either pay lots, or you lose lots of time filling in claim forms and justifications.

If you believe you're exempt, then that must be a nice place to live - but none of us have been to that place, so if you do get there, then please send us all a postcard.

[Hemochromatosis]

You can always do what some of us have done, and purchase a year's supply of testosterone via another doc, pay full price without a reimbursement - and you have your 52 week FIFO buffer. I recognize this may cause financial stress, but it resolves the problem.

Then continue to get the rest of your testosterone the normal way, with less emotional stress.

###

You can always do what some of us have done, and go to one doc for the "smarts" and travel far to meet him/her, and pay through the nose, and then go back to your local medical professional adviser for repeat prescriptions.

Local medical professional advisers seem to be able to regurgitate repeat prescriptions indefinitely.

I definitely do not recommend ever getting your local medical professional adviser offside, so that you can continue to get those repeat prescriptions (after you find your "smarts" doc).

###

You can find a "smarts" medical professional adviser by googling for:
a) holistic medical center
b) anti aging

Even though a lot of these medical professional advisers don't have all the tricks worked out, they'll buy into your suggestions for testing and monitoring new supps.

###

In the end you either pay lots, or you lose lots of time filling in claim forms and justifications.

If you believe you're exempt, then that must be a nice place to live - but none of us have been to that place, so if you do get there, then please send us all a postcard.

LOL, thanks! No I don't think I am exempt, but I will still send you postcards :001_tt2:

Anyhow, all great advise and already realized. My issue revolves around keeping a policy I pay too much for because more than likey no one will insure me due to my history. If I can get catastrophic and drop the rest and out of pocket for HRT, I am totally alright and in a financial place to maintain. It's feeling bound to policy that just inflated 35% within the last week, which I pay out of pocket, not to include office visits, deductibles, etc but I can't use it to the fullest.

As mentioned, and as you have provided the alternative, being bound to BCBS requiring McKesson to send my T to my doctors office is a non starter I travel way too much and for extended periods. I think Dr. John and company needs to relocate to Orlando or better yet Cocoa Beach!

Lansing and Grand Rapids in the winter? The thought of flying into that makes me want to grow man boobs and drink lots of soy milk! :willy_nilly:

[Wise Guy]

Lansing and Grand Rapids in the winter? The thought of flying into that makes me want to grow man boobs and drink lots of soy milk! :willy_nilly:

I've lived here my whole life, and probably still spend more time outdoors than most who live in California.

Just dress for it and you will be fine.

[rick055]

WHAT IS EXACTLY REQUIRED TO DETERMINE IF I AM GH DEFICIENT BEYOND A REASONABLE DOUBT?

"beyond reasonable doubt" is legal terminology, not medical.

Nothing in medicine is certain, and symptoms/signs can be more probative than ink on paper.

[Hemochromatosis]

You have also said:

"My knowledge on Atril Fibrillation and Hemochromatosis is extensive."

Sorry that you had to learn it the hard way,
but please share with us your knowledge.

crazycew here
http://musclechatroom.com/forum/showpost.php?p=31114&postcount=20

had his hematocrit raised from good to bad levels after aplying Androgel.
------
Hematocrit-43.5%(37-49)
Hematocrit-55.9%(37-49)-----------------! ! ! !---(12/18/2008 labs)
------

He have no other choice, he have to raise his BAT level,
among rather numerous other items,
but his case requires more knowledge.
Any advice, pointers, proper tests to follow, please post on his thread, thank you.
.
.

Janz, what was the date of the first hematocrit? I have to be over 45 in order to receive a phlebotomy. Yes, Testosterone therapy can increase hematocrit, keeping in mind you are looking at a red cell blood packing. In people with arrhythmia it is crucial to monitor since coagulation and stroke is a big issue.

For me since I have the iron overload disorder, hemochromatosis, the number one genetic disorder in America, I am required to give blood often. However, if I did not have Hemochromatosis and had an arrhythmia I would give blood every 56 days as the Red Cross states on their web site is allowable for individuals that do not have other health issues, mostly blood related.

You can calculate from hematocrit or hemoglobin since there is a relation between the two. hematocrit is 3 times more than hemoglobin. My hematologist wants me over a hematocrit of 45 before I give blood or a hemoglobin of 15 an my Fe (ferritin the transport protein for iron at 15 or more), this varies by individual. For me to determine my Fe value I had to intentionally drive myself into an anemic state, which feel like a low grade nausea, sweats, brain fog, light headed, lasts for about 2-3 days.

The referenced person may also be taking other supplements to stimulate red blood cells, which should be reassessed by his/her primary. My course for me would be to give a pint and mitigate red cell pack by simply removeing it.

I am sure there is someone from Big Pharm who has a happy pill just not my first line of approach.

[Hemochromatosis]

"beyond reasonable doubt" is legal terminology, not medical.

Nothing in medicine is certain, and symptoms/signs can be more probative than ink on paper.


Thanks Rick, I wouldn't have known that since I have lived in that environment for 25 years. Maybe you can contribute instead of criticize, hmmm?

If you want to exhibit your need to be my redaction team let me know and I'll put you in contact with my publisher or maybe your proclivity for law would be better received when you get back with me after you have your JD and are on a BAR somewhere, otherwise either contribute or leave me alone.

What is most amusing is how labs and dosing and much related to medicine in general is measured and quantitative, objective and defined. In fact, comparatively, medicine is many times more objective that the law, which is nothing more than a perversion of justice.

[Hemochromatosis]

I've lived here my whole life, and probably still spend more time outdoors than most who live in California.

Just dress for it and you will be fine.

I grew up in an East side suburb of Cleveland called Euclid (I know the jokes are coming), had a brother who went to Ferris State, and an Uncle who owned a marina in Bay City, vacationed in Mio in the UP.

If your idea of fun is a 1 foot thick goose down jacket that looks like you just made a lunar landing then I guess so. I remember the winter of 78. Great home made apple cider by the keg in Big Rapids. There actually was a time you could drink direct from the Ausable river, good times, great canoeing and better strawberries.

[Wise Guy]

I grew up in an East side suburb of Cleveland called Euclid (I know the jokes are coming), had a brother who went to Ferris State, and an Uncle who owned a marina in Bay City, vacationed in Mio in the UP.

If your idea of fun is a 1 foot thick goose down jacket that looks like you just made a lunar landing then I guess so. I remember the winter of 78. Great home made apple cider by the keg in Big Rapids. There actually was a time you could drink direct from the Ausable river, good times, great canoeing and better strawberries.

I snowboard, pretty hardcore, I would say from January till March its a huge part of my life in winter in Michigan.

I usually spend my whole weekend either on day long or weekend long snowboarding trips. Although I am injured now and cannot do so.

So winter isn't that big of a deal to me.

It takes a certain testicular fortitude to handle midwest winters

We are a tough breed