Test results question(s)

[nicktheory]

Apologies for the prolix note. There are two succint questions at the bottom. Feel free to skip and scroll down.

I've been at odds with several doctors who say my scores are too normal to have hypogonadism, despite gynecomastia, osteoporsis and some other physical and behavioral chracteristics of hypogonadism (and even KS, which makes my conservative and skeptical docs almost laugh when I raise the possibility.)

Anyway, about three months ago I had a case of shingles (trust me you don't want that) and the doc (an osteopath; not my usual one; I was out of town) in the follow up ran some tests for T, after my casual inquries about the gyne/hypogonadism link.

Well, I finally got those test results -- T- 383 and Free T 45. He says he will give me a hypogonadism diagnosis, if I want, so I can get a genetist to test for KS and also to re-raise the possibility of hypogonadism with my endocrinologist.

But -- and here is the question(s) -- I recall that the test was done at 3 p.m. and I don't recall if I fasted; in fact, I doubt I did. So, does this invalidate the test completely? And even if it does, is it normal to have a 9 a.m. to 3 p.m. T swing from 474 to 383. I can only imagine what it is at 11 p.m., which probably explains that the only time I want sex is in the a.m., which is a drag for the wife.

So, invalidation and the intraday swings. Thoughts?

[brm]

i'm no doc and hypo could certainly reply more wisely. 1°) You should precise what the unit is. If free T is 45pg/ml, this figure seems to me very far from any possible case of Hypogonadism. My free test is around 11 and the max bracket value o f my lab is 40. So what's the unit?  2°) I had a consultation with an endo 2 days ago. She told me that the hormonal blood tests were better and more meaningful if made in the first hours of YOUR day, except maybe for cortisol. That is, if you're a daytime worker, you should get your test 1,2 or 3 hours max after getting up in  the morning. 3°) Fast is now regarded as irrelevant  with hormonal bloodtests. It means your 383 value is relevant. 4°)The fall from 474 from 383 is not so steep as you may think. it may be put at the door of the natural variations of the very sensitive hormonal levels. What is more important is: have the 2 tests been done in the same lab? The methods of extraction may vary. If not, you should calculate the relative position of each value inside the bracket of each lab, then compare.

[nicktheory]

I think hypo has written me off as an undiagnosable.

1) Anyway,  the normal range, according to my lab, for free T is 34-194, so a 45 is in range but on the low end. And I am talking pg/ML. You sure you're not looking at your SHBG and NMOL/L, which has 7-50 as a rreference range? If not then one of us has a really whacky lab giving out reference ranges.

2. Thanks for the info on (not) fasting.

3. Maybe you are right about daily drops from 478 to 383, and then presumaly to under 300 by bedtime, all being normal. But it sure doesn't feel normal to me. Sure the morning boner/pisshardon syndrome is common and we have them throughout our lives. But now it is the only time I feel that way is right when I wake up. And even then, it's not like what it used to be. Alas.

[Hypo-is-here]

Come on Nick I didn’t write you off.  I put a lot of effort into trying to help last time we spoke;

http://www.gynecomastia.org/cgi-bin/gyne_yabb/YaBB.cgi?board=1;action=display;num=1137003711;start=4#4


The results you have posted on this occasion are different from those that you showed me last time.

Very different in fact from a testosterone point of view.

But what I would say is hormonal pathology needs to be taken between 9 and 11am as your bodies natural circadian hormonal rhythm makes a big difference when it comes to hormone levels and the reference ranges are geared around this time frame.

So I would say that you would need to have your blood taken again to gain an accurate idea of what is going on.

Please understand that what I was doing the last time we spoke was explain how complicated these matters are and detail the differing possibilities for your situation and state what your options might be.  

It is FAR too easy to jump to conclusions and make wrong assumptions that lead you down blind medical alleys.  I was trying to put you in the picture so you could avoid doing such, trying to do that for your benefit.

I am not saying that there is not something wrong.  There could well be something wrong.  

All I am trying to do is ensure that you do not prematurely attach a condition to your symptoms and waste enormous time and effort in one specific area only to find out at a latter date to your cost that the problem lies elsewhere.

I can’t remember whether I gave you details for endocrinologists in the past.  Hey whether I did or whether I didn’t I have provided them now- they are in your other thread.  

I see you want to see a geneticist regarding the possibility of KS.  Well endocrinologists can test for KS or they can put you in contact with someone who can- so you should find those contact details useful.

P.S

I can only try and help you make sense of what is going on and try to advise as a lay person or try and put you in contact with medical people who can help.  

Believe me I have been trying.

[brm]

Exact converse by my data. They say 42 - 139 inpmol/l and 12 - 40 in pg/ml. And I take it from 2 different labs... Strange
You're a happy man. Good old morning bars in my pants are now an old memory. And i'm in my early 40's.

[nicktheory]

EXTREMELY STRANGE. I use Quest Diagnostics, major lab in the U.S., who are you using. Our normal ranges should not be converse, as you put it. Are you sure were talking the right metrics?

[nicktheory]

Hypo, you have been very helpful; my comments were tongue in cheek. Fully understand what you say ...

[Hypo-is-here]

Bare in mind that not only are there different molecular reference ranges within which hormones are measured.

e.g


Total testosterone is commonly measured in nmol/l, ng/dl and ng/ml. Estradiol in pg/ml and pmol/l.

But also each lab can differ in measureing within the same molecular reference range thanks to the way they callibrate there specific equipement the type of assay/test methodology they are using.

Also what each lab deems as the correct normal reference range, this too can simply differ lab to lab.  And can differ from country to country, for instance The Society of Endocrinology in the UK has a very different idea of what is normal that the AACE does in the US.

It is always a bad idea to try and compare one labs results with another due to the differences mentioned.

What you can do if needs be is calculate what your hormone test results and reference ranges equate to in differing molecular ranges.  That way the link between test result and reference range remains.

e.g

Total testosterone 14nmol/l reference range 10-29nmol/l typically seen in Europe.

Would equates to;

Total testosterone 404ng/dl, reference range 288-836ng/dl.

Estradiol 221pmol/l reference range upto 150pmol/l

Would equates to;

Estradiol 63.7pg/ml, reference range upto 43.3pg/ml

[brm]

Yes, hypo, provided that the interpolation process should be linear,...which we're not sure of. But I do apply this method indeed.  Its validity may be much more dubious when your figure falls in outside the reference ranges of the lab.

[Hypo-is-here]

The relative difference between test results and reference ranges are maintained exactly when choosing to convert and view hormones in different ranges in this manner.

That doesn't mean to say that the test results are accurate, in that once a test result is above a callibrated reference range there can be the possibility of error.

It also doesn't mean that you can compare your result to that of someone else in the differing scale even if they have a range similar to your own.

It is just a useful tool for converting these factors to ranges more easily understood by the individual.  

So for instance if you are from the US and you can relate to ng/dl but not to the nmol/l more widely used in Europe, you can show what the result and range is in more understandable language.  

It isn't something that adds or removes credance to the test results.  It doesn't make a poor assay more reliable/accurate, but it doesn't make it any less reliable/accurate either.

At least is my understanding on the matter.