My Endo results here... Question?

[Raven]

So I got my lab results back today, and the doc
said everything is within normal range..
Mind you this was a walk in clinic, and not an endo specialist.
However I do have a question about the "prolactin level".
Here is exactly how it is written out:


Results                                   Range
---------------------------------------------------------------------
sTSH  =1.73                       0.35 - 5.00 mu/L

LH = 3.                               1 - 10  IU/L

FSH = 2.                             M: 1 - 14 IU/L

Testosterone = 13.5          M:  8.0 - 38.0 nmol/L

Prolactin = 7.                     MALE: < 18 ug/L

Estradiol = 108.                Adult M: 50 - 218 pmol/L


---------------------------------------------------------------------



Am I not reading this right?
Does this not mean Prolactin should be greater than 18 ug/L?

I don't know anything about this..
Any help is much appreciated..
I really dont feel like going back to the clinic and waiting a couple hours to see a doc if I don't need to.. lol
Thanks,  

[NoMoreBoobies]

No...It says your prolactin should be less than 18, so 7 is just fine

[Raven]

No...It says your prolactin should be less than 18, so 7 is just fine

Nevermind, I'm retarded... lol  

[SRK]

So I got my lab results back today, and the doc
said everything is within normal range..
Mind you this was a walk in clinic, and not an endo specialist.
However I do have a question about the "prolactin level".
Here is exactly how it is written out:


Results                                   Range
---------------------------------------------------------------------
sTSH  =1.73                       0.35 - 5.00 mu/L

LH = 3.                               1 - 10  IU/L

FSH = 2.                             M: 1 - 14 IU/L

Testosterone = 13.5          M:  8.0 - 38.0 nmol/L

Prolactin = 7.                     MALE: < 18 ug/L

Estradiol = 108.                Adult M: 50 - 218 pmol/L


---------------------------------------------------------------------



Am I not reading this right?
Does this not mean Prolactin should be greater than 18 ug/L?

I don't know anything about this..
Any help is much appreciated..
I really dont feel like going back to the clinic and waiting a couple hours to see a doc if I don't need to.. lol
Thanks,  

how much did the tests cost u raven...do tell me

[gynosucks1]

your estrodiol levels are high as shit bro

that be not normal for a healthy adult male

[Raven]

your estrodiol levels are high as shit bro

that be not normal for a healthy adult male

How do you figure?
I am well within the normal range... as indicated to the right hand side....
And listed here: http://47xxy.org/Gloss/hormlevel.htm
Please do explain.



applyingthought:

These tests were simply bloodwork done at a lab, and cost me nothing whatsoever.
Covered under good ol OHIP

[hypo]

What time were the bloods drawn at?

[Raven]

What time were the bloods drawn at?

Is there any significance to this?

It was around 12:00 noon.

[hypo]

Yes.

The male hormones work according to a circadian rhythm whereby they are higher in the morning (when they are supposed to be tested than in the afternoon).

You’re lucky your bloods were not drawn any later otherwise you would have completely wasted your money&time.

12pm is a little late and not perfect but luckily not so that as to rubbish the results.

Your testosterone would be a higher in the morning; your estradiol would be very similar as it doesn't tend to change across the day in the same way as the hormones produced by the testicles.

Your estradiol is a little high despite being within the normal range and could come down a bit.

The normal range you have been given goes far to high and is not a reflection of an ideal of healthy status.

Most reference ranges using the pmol/l molecular reference have a maximum of 150pmol/l.

Even then you would not want to be in the top third of that range as the range does not differentiate between a 17yr old and a 90yr old.

Your estradiol maybe high as a result of puberty or other factors.

How old are you?

[allbah]

can I please add that interpretation of endocrine results is not simple. these results are absolutely normal.
Although what was said about hormonal level variation throughout the day is true (with some hormones not all), there are many other factors affect them, for e.g prolactin level goes up with stress, growth hormone is up at night and suppressed by high glucose.......BUT please note that if there was anything wrong with his testosterone or estradiol he would have had either supressed or very high gonadotrophins (LH/FSH) due to what we call feed back mechanism.
Also remember that absolute levels of hormones do not necessarily reflect there activity, some hormones are bound to neutralising proteins in the blood therefore you may have a high TOTAL level of a hormone but the FREE/ACTIVE portion is normal.
Although these hormones are important, you should get also your liver function test and renal function,  certainly unless you have liver cirrhosis or chronic renal failure they would not contribute to gynecomastia. cut down on the marjwana and alcohol ( if you take them) and avoid any drugs that cause gyne.
good luck.

[hypo]

Albah

Quote
if there was anything wrong with his testosterone or estradiol he would have had either supressed or very high gonadotrophins (LH/FSH) due to what we call feed back mechanism.
Unquote

If a man has primary testicular failure, you would expect to see low testosterone coupled with high LH, however if estradiol is high or even high normal LH can be mitigated downwards so a high LH level can appear within the normal range.

With metabolic testosterone deficiency total testosterone is relatively low in comparison to estradiol, LH can often appear as normal despite free testosterone being low as a result of estradiols actions in blocking the androgen receptors.

These examples show why gonadotropins should not be used to determine testosterone deficiency.

Testosterone deficiency should be determined by free testosterone tests if possible, where it is not possible it should be determined by serum testosterone in combination with other blood results one of which should be SHBG ,the protein that typically binds 98% of testosterone in the blood.

LH should only be used to help ascertain the reason for testosterone deficiency.

Quote
Also remember that absolute levels of hormones do not necessarily reflect there activity, some hormones are bound to neutralising proteins in the blood therefore you may have a high TOTAL level of a hormone but the FREE/ACTIVE portion is normal.
Unquote

Yes but equally, if an individual has high SHBG and a normal level of serum testosterone, they could easily be testosterone deficient because of the high binding affinity of SHBG.

Quote
Although these hormones are important, you should get also your liver function test and renal function, certainly unless you have liver cirrhosis or chronic renal failure they would not contribute to gynecomastia. cut down on the marjwana and alcohol ( if you take them) and avoid any drugs that cause gyne.
Unquote

If there are symptoms of renal or hepatic problems then certainly kidney & liver function tests should be performed and even ultrasound or MRIs in certain cases.

That said liver and kidney problems are relatively rare when it comes to gynecomastia and they tend to affect the over 50s.

I should say;

You do not require liver cirrhosis in order to have gynecomastia as a result of liver problems.  All that is required is poor liver function that results in poor estrogen metabolization, but again this is relatively rare.

From Ravens point of view, little of this counts for much.

He does have an estradiol level that isn't particularly healthy and he should have had his SHBG level tested if he was only getting serum testosterone checked.

Excluding estradiol which is in question, the rest of the blood results that have been performed all appear normal.

[Raven]

You’re lucky your bloods were not drawn any later otherwise you would have completely wasted your money&time.

12pm is a little late and not perfect but luckily not so that as to rubbish the results.

How old are you?

The blood is taken in this clinic, and then sent to a lab which I believe is only tested a few days later.
Since I did have to wait a week for this.
So this may of threw my results off then? Is that what you are saying?
Again, this is a free service for Canadian Citizens which is covered under our health plan.

I am 29yrs old.

[hypo]

I am saying that your bloods should ideally have been taken earlier during the day to more accurately measure your hormonal status.

This does not relate to when they are tested by your lab.

But like I said your results for the most part are ok and your testosterone could be expected to be higher if correctly drawn between 9 and 11am.

The only concerns I would have are a) your estradiol level, which whilst not being a huge problem is still not particularly healthy and B) we do not know what your SHBG level is.

How do you feel in yourself?

Do you ever suffer from any of the symptoms below?

Fatigue/lethargy
Poor concentration/action slips
Poor memory
Low libido
Erection difficulties
Excess sweating
Depression
Panic attacks/nervousness

If you do not and you feel very health your SHBG level is probably ok along with your free testosterone level.

In which case you may just consider lowering the estradiol level a little.

[gynosucks1]

How do you figure?
I am well within the normal range... as indicated to the right hand side....
And listed here: http://47xxy.org/Gloss/hormlevel.htm
Please do explain.



applyingthought:

These tests were simply bloodwork done at a lab, and cost me nothing whatsoever.
Covered under good ol OHIP

how do i figure?? cuz most males is about 40-50 who are 15% or lower b/f

my guess is ur a little chunky or not athletic

and that is high est level

mine is 45ish

[allbah]

Hypo, Thank you for the valuable information.
One thing that I am never able to do in medicine is to treat or even interpret blood results without taking good history and performing efficient clinical examination and then come up with clinical problem for which the blood tests are only a guide to the full picture of the problem.

treating the blood test and not the clinical problem can take us to a dark road.
the information I provided was a very simplified honest guidance to Raven. He is clearly not in the medical field and doesn't know about the art of practicing internal medicine.

for eg, if (hypothetically) one is sexually active and fertile, I don't care how low his testosterone is as long as this level is asymptomatic and is not an introduction to a future problem.
Gynecomastia ALONE, if caused by abnormal oestrogen/androgen ration will not require any medical treatment and, if surgery is done, is extremely unlikely to recur because the remaining glandular tissue is minimal.
IF GYNECOMASTIA IS PART OF A WIDER SPECTRUM OF CLINICAL PROBLEM and the hormonal ratio is abnormal, then a cause and a treatment would be required.

HARISSON'S text book of medicine, 16th edition,page 2193 has an algorithm that recommends checking hormones ONLY IF there is clinical evidence of androgen deficiency (tender/very large/ rapidly enlarging breasts, small testes....)
SHBG does not go up and down randomly, there are disease states in which this occurs and they would most likely present clinically, furthermore it binds both testosterone and oestrogen and affect the level of both (although more testosterone).
SHBG binds T4 as well and if it was high, Raven's TSH would have been abnormal and this is not the case.

Having said all the above I feel that a better endocrine screen (one that I would do to my patients) would include hCG, total and free testos and oestrogen, SHBG and oest:testos ratio and as you said at 8:00 am.