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?

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  • 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.”

    https://www.managedcaremag.com/archives/2015/5/spending-compounded-drugs-goes-sky-high

    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.[4] 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.[7] 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.[8]

    http://menopause.northwestern.edu/content/what-are-concerns-about-custom-compounded-biomedical-hormone-therapy

    Certainly the responses you posted from the compounding pharmacy you contacted about D+Q were vague, excuse-laden, and not at all reassuring.

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      • Danmoderator
      • skipping my funeral
      • dantheman
      • 3 mths ago
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       Free and total, and estradiol/DHEA. The test methodology my provider uses isn't so easily available I think, and at any rate I couldn't judge whether one is better than the other. My provider is a major one, a competitor to Kaiser. Test conditions were the same. The thought about the compounding pharmacy is a good one, however this is one my Eurologist regularly uses with good success. On Dr Zimmer that I posted, if there's any confusion it's my fault and not his. You're quite particular in what you expect, and the fault is in using me for the information conduit. His contact information is right there and talking to him or his clinic directly is recommended, I was simply providing a heads up to this source. 

       

      I think my conclusion from this is that hormone testing should be taken with a grain of salt given the difficulty. My provider lab vis-a-vis LabCorp should not be that different, all else being equal. 

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  • 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....

    Reply Like
      • Danmoderator
      • skipping my funeral
      • dantheman
      • 3 mths ago
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      BobM Bob, thanks! I do two clicks (doc upped me from one as it wasn't doing much). 

      I've been doing it on the upper shoulders outside which is basically hairless. One click on each shoulder, then rub in (using the cap so I don't have to wash my hands) around the upper arms, shoulders, and chest to some degree. Let it dry for 20 minutes to a half hour, then put shirt on. Inner wrist to arm has more hair. Thoughts?

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      • BobM
      • BobM
      • 3 mths ago
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      Dan 

      Hi Dan, I have been doing this (testosterone) for many years. I think using drops of water to rub product in is superior. And the skin thickness / vessel concentration is best on the lower inside arm area. 

      Cheers

      bob

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      • Danmoderator
      • skipping my funeral
      • dantheman
      • 3 mths ago
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      BobM Good points, I'll try that today and let you know how it goes. Thanks so much for the tips. 

      The body builders are really into T therapy of course, to a fault it seems. Anyhow some of them are into testicular application because the skin is supposedly thinner and more receptive to hormone transmission. It requires a different formulation (oil based instead of alcohol). Any thoughts on that score? 

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      • BobM
      • BobM
      • 3 mths ago
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      Dan 

      yes. I applied there for several years. You can expect a lot of shrinkage in the area. Unfortunate side effect. Pretty soon the skin area is reduced. So there is less surface area to rub into. 

      I switched to the inside forearm area and new technique with water drops to rub in. I was able to reduce dosing and still get high readings. The process of rubbing in well over a larger area seemed to work better for me.

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      • Danmoderator
      • skipping my funeral
      • dantheman
      • 3 mths ago
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      BobM A couple more questions if I may lean on your expertise -

      • Did you ever try the shots or under skin tablets? 
      • Are you using the LE recommended levels as your goal? 
      • How long do you let it dry? 
      • Do you use a long sleeve shirt or don't worry about it?
      • Do you do this every day, or take the weekend off as some recommend (to let your body not forget to make it's own)?

      By the way my wife happened to see her HRT doc yesterday, and she also mentioned the inner forearm application as an option. 

      Male HRT is more difficult as there's so much less available information. OTOH the women have more variables to balance. 

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      • BobM
      • BobM
      • 3 mths ago
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      Hi  Dan,

      No shots tried.

      Goal: my naturopathic doc sets it.  LE test upper limit is a reading of 1500. I’ve tested over that a few times. Mostly doc wants to watch prostrate level for large changes PSA total and free. Then  she looks at total. I run 1300-1500.

      prostate testing: be very wary of everyone. Their test methods are 10-50% accurate at best. There is a new urine pee test which is >99% accurate. It is the only meaningful data. You have to find a urologist who will prescribe it. I had to go to the top doc at University of Colorado oncology: Dr David Crawford. Worth the flight.

      Time: I rub in for a minute, it’s then dry. No film. I wear short sleeve. It it’s still white your applying too much.

      i do not skip any days.

      one time I went off completely (PSA scare). Levels plummeted quickly to 300 . I felt really run down. 

      Mine is compounded with DHEA. These levels run very high: 400-600+ vs “std” of 295 max. Doc is just fine with it. 

      Cheers

      bob

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      • Danmoderator
      • skipping my funeral
      • dantheman
      • 3 mths ago
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       Bob,

         Very helpful! Thanks. I dream 1300 - but with your technique I've been using the last day it does seem anecdotally to be working better. 

       

         Prostate: yes very aware of the issues with this test - I've always had a low < 1 reading and never worried about even, even though my father had prostate cancer (supposedly, it was during the time of over use of the test). Great tip on the urine test, I'll check that. 

       

         Rubbing in - OK rub in for a minute - that also corresponds to what my wife's doc is telling her (mine give me no instruction). I'll try that. 

       

         DHEA - good to know. Yes with oral supplementation my DHEA goes up very quickly. I'll keep it in mind not to worry much about higher levels there. 

       

      Dan

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      • BobM
      • BobM
      • 3 mths ago
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      Dan 

      min talking with my doc yesterday, she advised the reason your generally told to put it on the inside thigh or shoulders (instead of forearms) is to avoid possible contact with women who may be pregnant or sensitive to the testosterone. 

      Reply Like 1
    • JohnnyAdamsmoderator
    • Mission: Slow and Ultimately Reverse Biological Aging and Age Related Decline for More Years of Healthy Living
    • JohnnyAdams
    • 3 mths ago
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    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.  

    Feedback Inhibition

    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.  


     

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      • Danmoderator
      • skipping my funeral
      • dantheman
      • 2 mths ago
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      JohnnyAdams Thanks Johnny, I just caught post. I did talk to an endocrinologist who turned out was against replacement therapy at any age. Previously he had experience with young body builders who took testosterone (large dosing I gathered), and then later had trouble with having children. From this he concluded it was due to the testosterone treatments they did earlier, but while that's a natural conclusion it's not a given that testosterone was the culprit. Body building is an activity we're not designed for and those folks do all sorts of extreme things to get those muscles. Physicians know that the muscles are hard on your cardiovascular, they could as well be hard on your reproductive system. Without data showing cause and effect we don't know. 

      His reasoning was also faulty because I'm done having children, he didn't seem to understand any value in it simply for addressing aging. Finally he pointed out what is the result of doing this - taking it forever? I appreciated the unintentional reference to living forever, but my response was "well are my hormones ever coming back on their own?" So this Endo is a skeptic and did everything he could to get me to stop and presumably accept 'normal' age declines. However as I didn't budge he finally admitted that frankly they don't really know much about hormones, but at least he'd like me to consider going for a few years and then taking some time off. I didn't go back to him since his M.O. was to get me to quit, but otherwise I think he's an excellent Endo. 

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  • 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. 

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