The vagaries of lab testing
I've done hormone testing in two labs; LabCorp and my health care provider which has it's own in-house test lab. It was distressing to see my LabCorp numbers continue to drop after starting compounded Testosterone, down to the bottom end of the range. However, while I've only done one test at my provider, that number is right in the middle of the range for 19-60 year olds (e.g., basically fine). It's difficult to compare the numbers directly because they are in two units, SI and imperial, and I haven't gotten the conversion figured out. Anecdotally the T compounded cream appears to be having a beneficial affect and certainly doesn't seem to have made me feel worse, only better.
Some thoughts I have about this
- I understand hormones in particular are difficult to test given they appear in such minute quantities
- There are confounding factors such as other supplements - Biotin in particular is known to alter hormone tests, artificially elevating T for example. I take the LE 2 daily which has biotin, but in much smaller amounts than are mentioned in this context
- Obvious difference in units and 'expected' ranges, and the provider test was done only once (I have to get my provider to submit a test for me which takes some effort)
Thoughts? Also any thoughts on compounded testosterone. There is a video on you from a MD claiming that some guys just don't absorb through the skin. He also claims there is no loss of hormones from aging, it's just that people are different. Has anybody had compounded hormones that don't absorb?
Here is Oxford University Press' SI Conversion Calculator. Does that clear things up? Also, are you looking at free or total T on each test? And are they using similar testing methodologies? (You can find these for? LabCorp by Googling the test code if it isn't on your lab report).
Are you testing under the same conditions (time of day, fasting)?
Without asking you to name your healthcare provider, are you talking about a major institution like Kaiser, or are you talking about your personal physician's office? If it's the latter, they may just be amateurs — or worse, if they're also the providers of your compounded T.
As far as anybody having compounded hormones that don't absorb: well, the compounding pharmacy industry is a mess, as we learned in painful detail after the New England Compounding Center meningitis outbreak. Quality control at compounding pharmacies continues to be an issue:
[Michael Carome, MD, director of research at the FDA watchdog agency Public Citizen] says the [the 2013 Drug Quality and Security Act (DQSA), which was passed in response to the NECC disaster] did not go far enough in controlling compounded drugs and there are serious safety and quality issues. ...Carome says only 52 facilities have registered as outsourcing pharmacies [compounding pharmacies that manufacture and distribute large volumes of standard dose compounds], but his group believes that is a just a fraction of the number that are operating (Congress choose to make registration voluntary, notes Ball). Forty-three have been inspected, which has resulted in 42 receiving citations for deficiencies in their manufacturing practices. A dozen compounders have received warning letters. [Warning letters are official FDA documents and a Big Deal, not friendly notes of concern]. “There can be a significant lag of 8 to 10 months between an inspection and a warning letter so more may be in the works.”
Custom-compounding pharmacies have not been closely regulated by FDA. There have been no requirements to test for efficacy, safety, quality, purity, or potency; to provide product information about proven benefits and risks; or to give proof of batch-to-batch consistency. Dosing and purity can vary substantially from batch to batch. In 2003, FDA examined 29 compounded pharmaceuticals and found that a third failed a standard quality test and nine had fewer active ingredients than the prescription. In 2012, MORE magazine sent 12 filled prescriptions of Tri-Est with progesterone to Flora Research Laboratories in Grants Pass, Oregon, which specializes in natural products research. Compared with the prescription labels, lower quantities of estriol were present. In 10 out of 12, estrone and estradiol had different doses than prescribed (58.4%-272.5% of estrone and 95.9%-259% of estradiol), with inadequate doses of progesterone in 11 out of 12 (60%-80%), potentially increasing the risk of endometrial cancer.
Compounding pharmacies have traditionally fallen under the jurisdiction of state regulators. To date, only 188 out of 7,500 US compounding pharmacies have accreditation by the Pharmacy Compounding Accreditation Board, which requires compliance with strict regulations and periodic renewal (pcab.org lists accredited pharmacies). All drug producers are expected to follow federal Good Manufacturing Practice regulations, but compounded products are not well monitored for these standards.
Certainly the responses you posted from the compounding pharmacy you contacted about D+Q were vague, excuse-laden, and not at all reassuring.
Hi Dan, method and location of application affects absorption in my experience. Try this:
apply to inside of forearm where there is less hair (elbow to wrist area). Split one click onto both forearms. Rub in lightly with some drops of water until it’s gone. Repeat 3x per day. I do this right after a hot shower or warm water on the arms to get skin more looking.
As your testing shows max levels, cut back to two clicks daily.
Other areas I tried were not as effective.
Interesting side effect: more hair started growing on my arms in the application area after 4-5 months....
Age Reversal Network Friends,
I don't know anything about your personal situations and physician oversight, and not dispensing medical advice. These are ideas that I use in my own self-directed age management program.
Early on (circa 1999) I got into physical trouble with large amounts of testosterone and other mega doses of nutritional supplements and pharmaceuticals.
A classic example of what follows is testosterone hormones in general. I will only take testosterone if diagnosed as deficient by a highly qualified endocrinologist – definitely not one who had minimal training in "age management/anti-aging medicine", such as a few courses or weekend seminar. Hormone actions are complex. Same goes for any hormone.
Homeostasis is where a body’s mechanisms go into action to achieve a stable, often preset state.
When augmenting a substance (often “natural”), you may get a boost in biological measures, and feel great -- at first. You may even want to write a glowing testimonial about the product that’s causing it. Then homeostasis begins and the body may compensate by reducing its own production, seeking to achieve the previously set level.
Eventually the body can become dependent, so if the external source is stopped you are now deficient, and dependent on the external source -- very possibly with feelings like weakness, illness, emotional upset or depression, and other really bad things because you’re now deficient. It takes a long time to get back to where you originally were – if ever.
Update: I found a new physician who is experienced in this. Turns out my previous dose was that you'd give to a woman! No wonder it wasn't working. Also, there is a compound that can be added to the cream which keeps your body naturally producing testosterone. So you can have your cake and eat it too. Fortunately my dose was so small it probably didn't materially affect my natural production.