Test Reference Range Alanine aminotransferase (ALT, SGPT)
Levels are extremely increased in cases of liver cell necrosis of any cause, right heart failure, acute anoxia, extensive trauma, or left heart failure. A slightly high level may indicate cirrhosis, obstructive jaundice, liver tumors, extensive myocardial infarction, myositis, muscular dystrophy, fatty liver, chronic alcohol abuse, or severe pancreatitis. Levels will by low in cases of pyridoxal phosphate deficiency
Female 7-30 U/liter Male 10-55 U/liter Albumin
There is no naturally occurring hyperalbuminemia. Any condition that results in the decrease of plasma water will increase the concentration of all plasma proteins, including albumin. Low concentrations of blood albumin may be due to acute and chronic inflammation, decreased synthesis by the liver, increased loss via body surfaces, increased catabolism, or increased blood volume. *albumin is the principal oncotically active component of plasma. As the major plasma protein, albumin acts as a nitrogen pool. Its role in transporting bilirubin, bile acids, metal ions, and drugs will be markedly affected by variations in concentrations.
3.1-4.3 g/dl Alkaline phosphatase (adult)
Origins of the major phosphatases are liver, bone, intestine, endometrium, and lung. Ingestion of a meal increases the intestinal isoenzyme of alp in serum, especially in individuals who are blood type o or b and who are Lewis-positive secretors. Increased levels of alp may indicate increased bone metabolism (during healing of fracture, primary and secondary hyperparathyroidism, osteomalacia, or juvenile rickets). May also indicate bone disease, renal disease, or liver disease. Low levels may indicate hypothyroidism, scurvy, gross anemia, vitamin b12 deficiency or nutritional deficiency of zinc or magnesium.
Female 30-100 U/liter Male 45-115 U/liter Androstenedione (adult)
Androstenedione is a major precursor in the biosynthesis of androgens and estrogens. It is produced in adrenals and gonads and serves as prohormone for testosterone and estrone. The test is useful in conjunction with other tests in the evaluation and management of androgen disorders
50-250 ng/dl Aspartate aminotransferase (AST, SGOT)
Increased levels may indicate liver cell necrosis or injury of any cause, including cholestatic and obstructive jaundice, chronic hepatitis, or drug-induced injury to liver. May also be associated with hepatic metastases and hepatoma, necrosis or trauma to heart or skeletal muscle, inflammatory disease of heart or skeletal muscle, heart failure, Forbes’s disease, heat stroke, hypothyroidism, intestinal obstruction, lactate acidosis, or toxic shock syndrome. Also distinguishes neonatal hepatitis from biliary atresia.
Female 9-25 U/liter Male 10-40 U/liter Bilirubin, direct
High serum blood levels are associated with intrahepatic and extrahepatic biliary tree obstruction, hepatocellular damage, cholestasis, Dubin-Johnson syndrome, or rotor’s syndrome.
0.0-0.4 mg/dl Bilirubin, total
High serum levels may indicate hepatocellular damage (inflammatory, toxic, neoplastic), intrahepatic and extrahepatic biliary tree obstruction, hemolytic diseases, fructose intolerance, hypothyroidism or neonatal physiological jaundice
0.0-1.0 mg/dl Calcium
High blood calcium levels may indicate primary and tertiary hyperparathyroidism, malignant disease with bone involvement (in particular metastatic carcinoma of the breast, lung, kidney, multiple myeloma, lymphomas, and leukemia), vitamin d intoxication, milk-alkali syndrome, Paget’s disease with immobilization, thyrotoxicosis, acromegaly, diuretic phase of acute tubular necrosis or dehydration. Low levels of calcium may indicate hypoparathyroidism; vitamin d deficiency, chronic renal failure, magnesium deficiency, prolonged anticonvulsant therapy, acute pancreatitis, anterior pituitary hypofunction, hypoalbuminemia, or inadequate nutrition.
8.5-10.5 mg/dl Carbon dioxide content, total
High levels may indicate respiratory acidosis caused by poor gas exchange or depression of respiratory center; generalized respiratory disease; metabolic acidosis (after severe vomiting in pyloric stenosis, hypokalemic states, or excessive alkali intake). Low levels may indicate compensated respiratory alkalosis, metabolic acidosis in diabetes mellitus, renal glomerular or tubular failure, renal tubular acidosis and intestinal loss of alkali with coexisting increase in c1 and normal anion gap
24-30 mmol/liter Chloride
High chloride levels may be attributed to dehydration, renal tubular acidosis, acute renal failure, diabetes insipidus, metabolic acidosis associated with prolonged diarrhea with loss of nahco3, respiratory alkalosis, and some cases of primary hyperparathyroidism. Low serum chloride levels may be due to excessive sweating, prolonged vomiting from any cause or gastric suction, persistent gastric secretion, salt-losing nephritis, aldosteronism, potassium depletion associated with alkalosis, respiratory acidosis
100-108 mmol/liter Cholesterol
High total cholesterol levels may indicate familial or polygenic hyperlipoproteinemia types IIa and IIb, hyperlipidemia, hyperlipoproteinemias secondary to hepatocellular disease, intra- and extrahepatic cholestasis, chronic renal failure, malignant neoplasms of pancreas and prostate, hypothyroidism, gout, ischemic heart disease, pregnancy, diabetes, alcoholism, analbuminemia, dysglobulinemia, anorexia nervosa, idiopathic hypercalcemia, acute intermittent porphyria, or isolated hgh deficiency. Low levels may be associated with lipoprotein deficiency, hepatocellular necrosis, malignant neoplasm of liver, hyperthyroidism, malabsorption, malnutrition, megaloblastic anemias, chronic obstructive lung disease, mental retardation, rheumatoid arthritis, or intestinal lymphangiectasia. *secondary disorders that elevate cholesterol levels should be ruled out prior to initiating therapy with cholesterol-lowering drugs. *factors that have variable effects on cholesterol levels in different people include posture before and at time of blood sampling, a recent meal, emotional stress, and menstrual cycle.
Desirable < 200 mg / dl Borderline high 200-239 mg/dl High > 239 mg/dl Creatinine
High serum or plasma levels may indicate renal function impairment, both acute and chronic; active acromegaly and gigantism, hyperthyroidism, and meat meals. Creatine supplements can increase creatinine. It is always good to calculate your eGFR to make sure it is not under 60: https://nkdep.nih.gov/lab-evaluation/…culators.shtml
0.6-1.5 mg/dl Dehydroepiandrosterone (DHEA) sulfate (adult)
Decreased levels may be associated with increased age in men & women, hyperlipidemia, psychosis, or psoriasis. Weakly androgenic
Male 10-619 µg/dl Female Premenopausal 12-535 µg/dl Postmenopausal 30-260 µg/dl Estradiol (ultra sensitive)
Estradiol is the most active of endogenous estrogens. The test is of value, together with gonadotropins, in evaluating menstrual and fertility problems in adult females. Measurement is also useful in the evaluation of gynecomastia or feminization states due to estrogen or producing tumors.
Female Menstruating Follicular phase 50-145 pg/ml Midcycle peak 112-443 pg/ml Luteal phase 50-241 pg/ml Postmenopausal <59 pg / ml Male < 50 pg / ml Follicle-stimulating hormone (FSH)
In hypogonadism, FSH and LH levels lower than normal for the patient’s age indicate hypothalamic or pituitary problems; higher levels indicate a primary gonadal defect
Female Menstruating Follicular phase 3.0-20.0 U/liter Ovulatory phase 9.0-26.0 U/liter Luteal phase 1.0-12.0 U/liter Postmenopausal 18.0-153.0 U/liter Male 1.0-12.0 U/liter Globulin High levels may be associated with chronic hepatitis, plasma cell dyscrasias/ lymphoproliferative disorders, cirrhosis, chronic liver diseases, chronic infections or certain autoimmune disorders. Low levels may indicate immune deficiency or suppression or lymphoproliferative disorder. Decreases in all fractions may be seen in bulk loss of proteins into the gut. 2.6-4.1 g/dl Glucose, fasting
Serum glucose levels may be high due to diabetes mellitus, strenuous exercise, increased epinephrine, pancreatic disease or an endocrine disorder. A high serum level may also be related to acute myocardial infarction or severe angina, chronic liver disease, or chronic renal disease.
70-110 mg/dl (gamma)-Glutamyltransferase (GGT)
Very high levels can be associated with obstructive liver disease and posthepatic obstruction. Moderately high levels may indicate liver disease (inflammation, cirrhosis, space-occupying lesions), infectious mononucleosis, renal transplant, hyperthyroidism, myotonic dystrophy, diabetes mellitus, pancreatitis, or alcohol-induced liver disease. Low GGT levels will indicate hypothyroidism. *useful marker for pancreatic cancer, prostatic cancer, and hepatoma because levels reflect remission and recurrence.
Male 1-94 U/liter Female 1-70 U/liter Growth hormone (resting)
Secretion of GH is episodic and pulsatile; highest values occur during periods of deepest sleep. Ability to secrete GH in response to a conventional challenge declines with age. Random levels of GH provide little diagnostic information; GH secretion is best assessed during tests that stimulate or suppress release. Patients with GH-producing pituitary disorders often release GH in response to TRH or GnRH; and patients with suspected GH deficiencies have subnormal responses to stimulation tests (i.e. GH stimulation test after arginine, insulin, l-dopa, glucagon, propanolol and insulin tolerance test.)
2-5 ng/ml Hemoglobin A1C
Glycated hemoglobin concentration appears to reflect the mean blood glucose concentration over the previous 4-8 wks. This test, while not useful for the diagnosis of diabetes mellitus, has been shown to be useful in monitoring its long-term control. Glycated hemoglobins are increased as a reflection of hyperglycemia during the lifespan of erythrocytes
3.8-6.4% High-density lipoprotein cholesterol, as major risk factor
Epidemiological studies demonstrate the inverse association between HDL-c levels and the incidence and prevalence of coronary heart disease (CHD). It is suggested that for every 5 mg/dl decrease in HDL-c below the mean, the risk of CHD increases 25%. Another approach in assessing CHD risk is to calculate the ratio of HDL-c to either LDL-c or total cholesterol. The following primary disease states can lead to secondary decrease in HDL-c: uncontrolled diabetes, premature coronary heart disease, hepatocellular disorders, cholestasis, nephrotic syndrome, and chronic renal failure.
above 40 mg/dl men
above 50 mg/dl women
Decreased serum levels indicate inadequately treated type I diabetes mellitus. High serum levels may indicate insulin overdose, insulin resistance syndromes, or endogenous hyperinsulinemia
2-20 U/ml Lactate dehydrogenase (LDH)
Extremely high levels may indicate megaloblastic and pernicious anemia, extensive carcinomatosis, viral hepatitis, shock, hypoxia or extreme hyperthermia. Very high levels are associated with cirrhosis, obstructive jaundice, renal diseases, neoplastic diseases, skeletomuscular diseases, or congestive heart failure. Mildly high levels are associated with any cellular injury that results in loss of cytoplasm, myocardial or pulmonary infarction, leukemias, hemolytic anemias, hepatitis (nonviral), sickle cell disease, lymphoma, renal infarction, or acute pancreatitis.
110-210 U/liter Lipoprotein(a) 0-30 mg/dl Low-density lipoprotein cholesterol
LDL encompasses all of the lipoproteins with density greater than 1.006 kg/l and less than or equal to 1.063 kg/l. High levels may indicate primary hyperlipoproteinemia types IIa and IIb; tendon and tuberous xanthomas, corneal arcus, and premature coronary heart disease. The following diseases can lead to secondary elevation of LDL-c: hyperlipoproteinemia secondary to hypothyroidism, nephrotic syndrome, hepatic obstruction, hepatic disease, pregnancy, anorexia nervosa, diabetes, chronic renal failure, and Cushing’s syndrome.
Desirable < 130
Borderline high risk 130-159 mg/dl High risk greater than or equal to 160 mg/dl Iron
High serum levels may indicate pernicious, aplastic, and hemolytic anemias; hemochromatosis, acute leukemia, lead poisoning, acute hepatitis, vitamin b6 deficiency, excessive iron supplementation/therapy, repeated transfusions, or nephritis. Low serum iron levels may indicate iron-deficiency anemia, remission of acute and chronic infection, carcinoma, nephrosis, hypothyroidism, or postoperative state. *symptoms of iron poisoning include abdominal pain, vomiting, bloody diarrhea, cyanosis, lethargy, and convulsions. Levels may vary widely for an individual within the same day or from day to day.
45-180 ug/dL (MALES FEMALES). Luteinizing hormone (LH)
Test used to determine the preovulatory LH surge; also provides an integrated picture of LH secretion throughout the day. Shows pituitary or hypothalamic impairment or overproduction
Female Menstruating Follicular phase 2.0-15.0 Ovulatory phase 22-105 Luteal phase 0.6-19 Postmenopausal 16-64 Male 2.0-12.0 Magnesium
Mg plays a vital role in glucose metabolism by facilitating the formation of muscle and liver glycogen from blood-borne glucose. Also participates as a cofactor in the breakdown of glucose, fatty acids, and amino acids during energy metabolism. High serum levels may indicate dehydration, renal insufficiency, uncontrolled diabetes mellitus, adrenocortical insufficiency, Addison’s disease, hypothyroidism or lupus erythematosus. Phytate, fatty acids, and an excess of phosphate impair mg absorption. Symptoms of deficiency usually do not occur until serum levels are above 1 meq / liter
1.4-2.0 meq/liter Phosphorus, inorganic (adult)
Serum phosphorus concentrations have a circadian rhythm (highest level in late morning, lowest in evening) and are subject to rapid change secondary to environmental factors such as diet (carbohydrate), phosphate-binding antacids, and fluctuations in growth hormone, insulin, and renal function. High levels may indicate osteolytic metastatic bone tumors, myelogenous leukemia, milk-alkali syndrome, vitamin d intoxication, healing fractures, renal failure, hypoparathyroidism, pseudohypoparathyroidism, diabetes mellitus with ketosis, acromegaly, portal cirrhosis, pulmonary embolism, lactic acidosis or respiratory acidosis.
2.6-4.5 mg/dl Potassium
High potassium levels are associated with reduced renal excretion of potassium or redistribution of potassium in the body (i.e. Massive hemolysis, severe tissue damage, severe acute starvation-anorexia nervosa, hyperkinetic activity, malignant hyperpyrexia following anesthesia, hyperkalemic periodic paralysis, and dehydration).
3.4-4.8 mmol/liter Progesterone
The diagnostic value of this test lies in its detection of ovulation and in the evaluation of the function of the corpus luteum. Serial sampling during the menstrual cycle is required. During menopause, levels drop to 0
Female Follicular phase > 1 ng / ml Midluteal phase 3-20 ng/ml Male < 1 ng / ml Prolactin
May help assess Prolactin reserve and abnormal Prolactin secretion by the pituitary. May indicate pituitary tumors.
Female Premenopausal 0-20 ng/ml Postmenopausal 0-15 ng/ml Male 0-15 ng/ml Prostate-specific antigen (PSA)
PSA is prostate-tissue specific, not prostate-cancer specific. Used for early detection of the recurrence of prostatic cancer. The test is of great value as a marker in the follow-up of patients at high risk for disease progression. PSA values increase with age.
Female 0 Male less than 40 years of age 0.0-2.0 ng/ml greater than or equal to 40 yr old 0.0-4.0 ng/ml Prostate-specific antigen (PSA), free, in males 45-75 yr old, with PSA values between 4 and 20 ng/ml above 25% associated with benign prostatic hyperplasia Protein, total
High blood levels may be associated with anabolic steroid use, androgens, corticosteroids, coritcotropin, epinephrine, insulin, progesterone, or thyroid preparations. Severe protein deficiency, chronic liver disease, malabsorption syndrome, and malnutrition may also lead to abnormal levels. Serum total protein decreases in the third trimester of pregnancy.
6.0-8.0 g/dl Sodium
High serum levels are associated with water loss in excess of salt through skin, lungs, GI tract, and kidneys. Also may indicate increased renal sodium conservation in hyperaldosteronism, Cushing’s syndrome or disease, inadequate water intake because of inadequate thirst mechanism, dehydration, or excessive saline therapy. Low sodium levels may indicate low sodium intake, sodium losses due to vomiting, diarrhea, excessive sweating with adequate water intake and inadequate salt replacement, diuretics abuse, or salt-losing nephropathy
135-145 mmol/liter Somatomedin C (Insulin-like growth factor I)
Blood concentrations of IGF-1 are constant during the day and after eating. In acromegaly, the test may serve as an indicator of the severity of the disease; serial determinations may be used to monitor efficacy of treatment. In dwarfism IGF-1 may be used to determine the response to GH therapy. Concentrations of IGF-1 rise during the first year of life, reaching the highest values in preadolescent or early adolescent years. Normal values tend to decline progressively until age 50
16-24 yr 182-780 ng/ml 25-39 yr 114-492 ng/ml 40-54 yr 90-360 ng/ml > 54 yr 71-290 ng/ml Testosterone, total (morning sample)
This test is a measure of total circulating testosterone, both protein bound and free. In adult men, serum levels peak in the early morning, decreasing 25% to the evening minimum. Levels increase after exercise and decrease after immobilization and after glucose load. Progressive decreases begin after age 50
Female 6-86 ng/dl Male 270-1070 ng/dl Testosterone, unbound (morning sample)
Free (nonprotein-bound) testosterone is independent of changes in concentrations of the principal testosterone transport protein, sex hormone-binding globulin.
Female 20-40 yr 0.6-3.1 pg/ml 41-60 yr 0.4-2.5 pg/ml 61-80 yr 0.2-2.0 pg/ml Male 20-40 yr 15.0-40.0 pg/ml 41-60 yr 13.0-35.0 pg/ml 61-80 yr 12.0-28.0 pg/ml Thyroid-stimulating hormone (TSH)
First-line test for hyper- and hypothyroidism. Test is considered by some to be the preferred screening test for evaluation of thyrometabolic states. Moderately high TSH is often found in euthyroid patients during treatment of hyperthyroidism.
0.5-5.0 U/ml Thyroxine, total (T4)
Used in conjunction with other tests to measure thryoid function. T4 testing is frequently used when TSH levels are abnormally high or low. In hypothyroidism, total serum t4 falls before t3. High serum levels may represent hyperthyroidism.
4.5-10.9 g/dl Transferrin
Transferrin is the major plasma transport protein for iron. High serum levels may indicate iron deficiency (high levels often precede the appearance of anemia by days to months). Serum ferritin levels fall with iron deficiency and with generalized malnutrition but remain normal in the presence of inflammation and iron deficiency
191-365 mg/dl Triglycerides (fasting)
Increased triglyceride levels indicate hyperlipoproteinemia types I, IIb, III, IV, and V due to familial or sporadic endogenous hypertriglyceridemia. The following primary disease states or conditions can lead to secondary elevation of triglycerides: obesity, impaired glucose tolerance, viral hepatitis, alcoholism, alcoholic cirrhosis, biliary cirrhosis, acute and chronic pancreatitis, extrahepatic biliary obstruction, nephrotic syndrome, chronic renal failure, essential hypertension, acute myocardial infarction, chronic ischemic heart disease, cerebral thrombosis, hypothyroidism, diabetes mellitus, gout, pregnancy, glycogen storage diseases types I, II, III, and IV, down syndrome, respiratory distress syndrome, Werner’s syndrome, anorexia nervosa, or idiopathic hypercalcemia. Low levels of triglycerides may indicate chronic obstructive lung disease, brain infarction, hyperthyroidism, hyperparathyroidism, lactosuria, malnutrition, malabsorption syndrome, intestinal lymphangiectasia or end-stage parenchymal liver disease.
40-150 mg/dl Triiodothyronine, total (T3)
Used in conjunction with other tests to measure thyroid function. High serum levels may indicate hyperthyroidism while low levels may indicate hypothyroidism. At least 80% of circulating T3 is derived from monodeiodination of T4 in peripheral tissues. Free T3 and free T4 can also be of great value in thyroid work-ups. T3 is 4 to 5 times more potent in biological systems than T4.
60-181 ng/dl Urea nitrogen (BUN) (adult)
High serum blood levels may indicate impaired kidney function associated with an increase with age or protein content of diet.
8-25 mg/dl Uric acid
High serum levels may indicate gout, renal failure, leukemia, lymphoma, psoriasis, polycythemia, multiple myeloma, kidney disease, and or chronic lead nephropathy. Associated with hyperlipidemia, obesity, hypertension, arteriosclerosis, diabetes mellitus, hypoparathyroidism, acromegaly, and liver disease.
Male 3.6-8.5 mg/dl Female 2.3-6.6 mg/dl Differential blood count Reference Range Neutrophils 45-75% Bands 0-5% Lymphocytes 16-46% Monocytes 4-11% Eosinophils 0-8% Basophils 0-3% Erythrocyte count
Red Blood Cell count; filled with hemoglobin and specialized for carrying O2 and CO2 (adult)
Male 4.50-5.30 X 106/mm3 Female 4.10-5.10 X 106/mm3 Ferritin
Surplus iron is stored as Ferritin, primarily in the liver
Male 30-300 ng/ml Female 10-200 ng/ml Folate (folic acid)
Water soluble vitamin involved with amino acid metabolism & transfer of single-carbon units in nucleic acid
Normal 3.1-17.5 ng/ml Borderline deficient 2.2-3.0 ng/ml Deficient < 2 ng / ml Excessive above 17.5 ng/ml Hematocrit (adult)
% of Red Blood Cells present in total blood
Male 37.0-49.0 Female 36.0-46.0 Hemoglobin (adult)
Oxygen-carrying compound of blood. Numerical value of hemoglobin present in Red Blood Cells
Male 13.0-18.0 g/dl Female 12.0-16.0 g/dl Iron
Constituent of hemoglobin (transport of oxygen in blood) and enzymes involved in energy metabolism
Ferritin should also be measured in those undergoing phlebotomies or blood donation to ensure it is not low.
30-160 g/dl Leukocyte count (WBC)
White Blood Cell (WBC); Central to the immune system that defends against infection
4.5-11.0X103/mm3 Mean corpuscular hemoglobin (MCH)
Value is calculated from hemoglobin and erythrocyte count. MCH= Erc÷Hb
25.0-35.0 pg/cell Mean corpuscular hemoglobin concentration (MCHC)
Mean cell hemoglobin concentration is calculated from Hb and hematocrit (Hct)
31.0-37.0 g/dl Mean corpuscular volume (MCV) (adult)
Mean cell volume may not be reliable when a large number of abnormal erythroctes or a dimorphic population of erythrocytes is present. It may also be calculated from the hematocrit and erythrocyte count
Male 78-100 m3 Female 78-102 m3 Platelet count
Helps mediate the blood clotting that prevents loss of blood after injury
150-350X103/mm3 Platelet, mean volume 6.4-11.0 m3
Proper monitoring of men on testosterone replacement therapy has been dictated by several medical guidelines groups. However, most of them fall short in guiding doctors on what to do if different key variables are not optimal. The following list includes all important blood tests and health variables for men before they are prescribed testosterone and while on testosterone replacement therapy.
The following panels can be obtained on DiscountedLabs.com, the most affordable online lab test company (No doctor visit required. Prescription provided. Most US cities except the following states: NY, NJ, NH, MA and RI- No labs in VT,ME and HI)
Pre- TRT Male Hormone / Wellness Panel
Testosterone replacement therapy- Target Blood Test Limits
Hematocrit under 53 (donate blood if equal or over 53. High hematocrit (large amount of red blood cells) makes your blood thick which is not good for your cardiovascular health)
PSA under 3 (4 is max since doctors will not prescribe TRT at this number)
Estradiol (ultrasensitive) between 20-50 pg/mL or higher in men on TRT
Blood pressure under 135/85 (high blood pressure can make you feel winded, increase cardiovascular risks and affect kidneys)
Estimated Glomerular (eGFR) (kidney function) over 60 ( keep blood pressure under control and avoid supplements that may load your kidneys)
Liver enzymes not elevated over 20 percent of top value of reference range. (Exercise can increase ALT and AST. Testosterone in gels, injections, pellets etc does not increase liver function. Be careful with supplements!)
TSH under 2.5 (higher numbers can point at low thyroid function, which causes a lot of the symptoms of low testosterone)
Total Testosterone over 500 ng/dL (many men feel better above 600-700 ng/dL)
Free Testosterone equal or above 2 percent of total (lower percentage means your sex hormone binding globulin is high and grasping more testosterone).
If donating blood to bring hematocrit down, ferritin never under 30 ng/mL or micrograms/liter (Donating blood more frequently than every 3 months can decrease ferritin which can cause fatigue).
Free T3 (if hypothyroid and on treatment) in the upper quartile of range. (depending on range it can be 3.7- 4.2 pg/mL)
HDL over 40 mg/dL (low levels of good cholesterol can affect cardiovascular health- Higher T doses can decrease HDL)
For more information on how to manage these variables and other testosterone related potential side effects, visit: Testosterone Side Effect Management Table
OPTIMUM REQUIRED LAB WORK (Preferred but not mandatory)
1 ——- Estradiol- sensitive via LC/MS test (not EIA!) [Quest Labs code 30289]
(Labcorp code: 140244) (baseline, week 6 or 8, month 6)
GOAL: 20-50 pg/mL
2 ——- Testosterone, Free and Total (baseline, week 6-8, month 6, then yearly)
GOAL: Total testosterone over 500 ng/mL and free T 2 percent or more of total T.
3 ——- DHEAs (baseline, month 6, month 12 (if supplementing))
4 ——- Comprehensive Metabolic Panel w/EGFR (baseline, week 6-8, month 6 and then once a year)
GOAL: Normal CBC including liver enzyme elevations under 20 percent and eGFR over 60
5 ——- CBC w/ diff/PLT (baselines, week 6-8, month 6 and then once or twice per year)
GOAL: Normal CBC
6 ——- Lipid profile (fasting sample) (baselines, month 6, then once per year unless LDL is high and/or HDL is low)
GOAL: Normal lipids
7 ——- T3, free (for those with low thyroid symptoms)
GOAL: Upper quartile free T3
8 ——- T4, free (for those with low thyroid symptoms)
Goal: Normal free T4
9 ——- TSH (baseline, month 6, yearly after that depending on value and treatment)
GOAL: TSH under 2.5
10 ——– Prostatic Specific Antigen (PSA) (Baseline before testosterone treatment, 6-8 weeks after and then yearly)
GOAL: PSA under 3
11——– LH and FSH (for men not on testosterone yet)- Used to diagnosed primary or secondary hypogonadism. Do not waste money testing your LH and FSH if you are on testosterone since they will be undetectable.
For those with excessive fatigue: Saliva Cortisol + DHEA (4 specimens during one day) (you can wait for after 6 weeks on TRT). Ferritin is also a test that can be considered.
GOAL: Normal cortisol graph and values along with proper cortisol/DHEA ratios
Vitamin D (25 (OH)D test)- Most people have low vitamin D, so spending money on this may be optional. Taking 5000 IU per day brings blood levels up to desired range in most people.
Folate and Vitamin B-12- Low only if you suffer from malnutrition or malabsorption.
Lab test results mean little unless health information is provided. Here is a sample health questionnaire that could be filled at baselines, week 6 or 8 and then every 6 months to assess progress in quality of life.
ADAM questionnaire about symptoms of low testosterone
(Androgen Deficiency in the Aging Male)
This basic questionnaire can be very useful for men to describe the kind and severity of their low testosterone symptoms.
1. Do you have a decrease in libido (sex drive)? Yes No
2. Do you have a lack of energy? Yes No
3. Do you have a decrease in strength and/or endurance? Yes No
4. Have you lost height? Yes No
5. Have you noticed a decreased “enjoyment of life” Yes No
6. Are you sad and/or grumpy? Yes No
7. Are your erections less strong? Yes No
8. Have you noticed a recent deterioration in your ability to play sports? Yes No
9. Are you falling asleep after dinner? Yes No
10. Has there been a recent deterioration in your work performance? Yes No
If you answered Yes to number 1 or 7 or if you answer Yes to more than 3 questions, you may have low Testosterone.
What is your IIEF erectile function score?
Posting blood test results without comprehensive quality of life information may not get you the best quality of input from members of this site.To save time and make your questions clearer, please review this list. You can copy and paste it on a post and add your answers if you wish. This will ensure that you get the best quality input from members.
HEALTH AND QUALITY OF LIFE INFORMATION:
Do you have small children?
Do you still want to have children?
Have you lost weight in the past 6 month? If yes, how many pounds?
Have you gained weight in past 6 months? If yes, how many pounds?
Has your body tone changed in the past 6 months (harder, softer)?
When was your last complete physical examination?
What were the results of that exam?
(FOR OVER 40) Did you have your prostate examined by digital rectal exam?
(FOR OVER 40) Did you have your PSA checked?
If so, what was it?
Are you taking testosterone now?
If answer to above question is NO, have you taken testosterone in the past? How long and when did you last stop?
Do you urinate alright (you fully void)?
How many times do you get up at night to urinate ?
Does it hurt when you urinate?
Is there any blood in your urine?
Have you had prostatitis (prostate/urinary infections) in the past?
Describe any acne history:
Did you have gynecomastia (increased breast tissue swelling) when young?
Do you have cold intolerance?
Do you bruise easily?
Do you have:
Decreased sexual potency (erection quality). If so, is this causing stress in your relationship?
Decreased sex drive
Do you have morning erections? _____ If yes, how many times per week (estimate)?
Do you feel your testicles are smaller than they used to be?
Generalized muscle aches and pains
Previous heart attack
Previous clotting issues
Sensitive or swollen nipples?
Can you feel any lumps around your nipples?
Are you losing your hair?
Have you ever taken Propecia or Proscar (finasteride) for hair loss or prostate inflammation or Accutane for acne?
Have you had a traumatic head injury?
Have you taken pain killers (opiates) for several months?
Have you ever been diagnosed with sleep apnea via a sleep study? If yes, do you use a CPAP machine?
Do you take frequent naps?
Do you feel refreshed when you wake up in the morning?
Average hours of sleep per night:
Do you usually go to bed after 10 pm ?
DIET AND EXERCISE
Tell us about your diet (The more details, the better)
Do you exercise? If yes, what type and how frequently?
Do you feel that you procrastinate a lot and do not have enough mental focus to finish projects?
Are you experiencing a lot of stress lately? For how long and why?
MEDICATIONS AND SUPPLEMENTS
Do you take any prescription medications or medications bought on the internet or black market?
If so, please list, and give dosages:
What supplements do you take (vitamins, minerals, neutraceuticals, etc.)? List all (with amounts or dosages) each day.
QUESTIONS FOR STEROID USERS ONLY
How many times have you been on a steroid cycle (if any)?
How long ago was your first steroid cycle (if any)?
How long was your break before starting this cycle?
Did you have swollen or painful nipples BEFORE you ever used steroids (for men who have used anabolics steroids- AAS)?
Have you needed to donate blood or get a therapeutic phlebotomy due to high hematocrit (red blood cell volume)?
Describe your past usage, if any, of hCG, Nolvadex, Clomid, Arimidex or finasteride:
Have you ever had any problems (side effects) with any of the medications mentioned in the last question If so, please describe:
Did you use a post-cycle therapy (PCT) program after stopping the cycle (s)? If yes, please describe:
Did you get your total and free testosterone tested after PCT?
More information on blood tests: Click here
Before undergoing testosterone replacement therapy (TRT), it’s vital to obtain a number of blood tests. The main blood tests to measure are total and free testosterone, hematocrit, PSA, estradiol, HDL cholesterol and others. Pre-treatment testing provides doctors with baseline values to diagnose hypogonadism (low testosterone) and asses overall health. Baseline tests are also conducted during TRT as well, ensuring that doctors can adjust TRT dose and catch side effects before they become an issue.
But do you know why these tests are needed or what they mean? Below, you’ll find some of the main blood tests that have been shown to be affected by TRT, so doctors measure them before and during therapy to prevent or manage side effects:
What Is Creatinine and Creatinine Clearance?
Creatinine is a waste product that is produced continuously during normal muscle breakdown. The kidneys filter creatinine from the blood into the urine, and reabsorb almost none of it.
The amount of blood the kidneys can make creatinine-free each minute is called the creatinine clearance. Creatinine clearance in a healthy young person is about 125 milliliters per minute — meaning each minute, that person’s kidneys clear 125 mL of blood free of creatinine. The GFR can vary depending on age, sex, and size. Generally, the creatinine clearance is a good estimation of the glomerular filtration rate.
Measuring Creatinine Clearance and Renal Function
Doctors use creatinine and creatinine clearance tests to check renal function (kidney function). Testing the rate of creatinine clearance shows the kidneys’ ability to filter the blood. As renal function declines, creatinine clearance also goes down.
There are two main ways doctors use creatinine tests to measure kidney function:
Creatinine clearance can be precisely determined by measuring the amount of creatinine present in a sample of urine collected over 24 hours. This method requires a person to urinate exclusively in a plastic jug for one day, then bring it in for testing. Although the urine creatinine measurement method is inconvenient, it may be necessary to diagnose some kidney conditions.
GFR can be estimated using a single blood level of creatinine, which your doctor enters into a formula. Different formulas are available, which take into account age, sex, and sometimes weightand ethnicity. The higher the blood creatinine level, the lower the estimated GFR and creatinine clearance.
For practical reasons, the blood test estimation method for GFR is used far more often than the 24-hour urine collection test for creatinine clearance.
A low GFR or creatinine clearance demonstrates kidney disease. The decline in kidney function can be either acute (sudden, often reversible) or chronic (long-term and irreversible). Repeated GFR or creatinine clearance measurements over time can identify kidney disease as acute or chronic.
Kidney function and creatinine clearance naturally decline with age. Fortunately, the kidneys have a huge reserve capacity. Most people can lose well over half their renal function without symptoms or significant problems.
Doctors determine the severity of chronic kidney disease with a staging system that uses GFR:
Stage 1: GFR 90 or greater (normal kidney function)
Stage 2: GFR 60-90 (mild decline in kidney function)
Stage 3: GFR 30-59 (moderate decline in kidney function)
Stage 4: GFR 15-29 (severe decline in kidney function)
Stage 5: GFR less than 15 (kidney failure, usually requiring dialysis)
People over age 60 may have an apparently normal creatinine blood level, but still have a low GFR and creatinine clearance. The 24-hour urine collection method, or one of the GFR estimation formulas, can more accurately identify the decline in kidney function.
How Do I Know If I Have Kidney Disease?
Blood pressure . Your health care provider will devise a plan, which may include diet changes and medications, to keep your blood pressure as close to normal as possible. Target blood pressure is defined as less than 130/80.
Blood electrolytes. When the kidneys are not working correctly, you can develop high potassium and low calcium, phosphorus, bicarbonate, which can affect your heart’s conduction system and cause muscle aches and other complications.
Urine protein or albumin in the urine. Albumin is the main protein in the blood. When the kidneys become damaged, the holes in the filtering system of your kidneys become enlarged, allowing protein to leak into the urine. In the early stages of kidney damage, only small amounts of albumin (microalbuminuria) are found. This test is very important for people with diabetesbecause at this early stage of kidney damage, further deterioration can often be prevented by diet, exercise, and medications.
GFR (glomerular filtration rate). This is a measure of how well the kidneys are filtering blood. An estimate of your “filtering rate” is determined by a blood test called a blood creatinine test, which measures the amount of creatinine — a waste product — in your blood. This test, along with your age, body size, and gender, provides an estimate of your GFR. The GFR, or “filtering rate,” helps confirm normal or low kidney function. A score of 90 or above is normal; a score below 15 indicates kidney damage that will require dialysisor a kidney transplant. Another commonly used test to estimate GFR is a creatinine clearance. This test measures the creatinine in the blood and urine to determine kidney function.
Your health care provider may also refer you to a kidney specialist, called a nephrologist, for more specialized testing. A kidney biopsy may also be performed. During a kidney biopsy a small amount of kidney tissue is removed for microscopic exam to pinpoint the cause of kidney damage and plan treatment.
How Can I Prevent Kidney Disease?
The key to prevention or delay of severe kidney disease is early detection and aggressive intervention — while there’s still time to slow down the progression to kidney failure. Medical care with early intervention can change the course of chronic kidney disease and help prevent the need for dialysis or a kidney transplant.
Diabetes and high blood pressure account for two thirds of all cases of chronic kidney disease. By aggressively managing diabetes and high blood pressure with diet, exercise, and medications, you may be able to prevent kidney failure and help keep as much kidney function as possible.
Know Your Risks for Kidney Disease
Since diabetes and high blood pressure put you at risk of kidney disease, know where you stand with these risks. Do you have diabetes or high blood pressure? If so, are they under control?
If you can, find out if diabetes, hypertension, or kidney disease runs in your family. Certain ethnic groups, such as African-Americans, Hispanics, Pacific Islanders, and Native Americans are at higher risk of chronic kidney disease, as are senior citizens.
Get Tested Regularly
At your next checkup, and at least within the next year if you haven’t had these tests done:
Ask for a urine test to see if you have excess protein, glucose, or blood in the urine.
Ask for a blood pressure reading, to see if your blood pressure is elevated.
Ask for a fasting blood glucose test, to see if you have too much glucose (sugar) in your blood. Another blood test that can be used to determine diabetes is a hemoglobin A1C which will indicate your average blood glucose level over the past two to three months
Ask for a creatinine test. This blood test measures the amount of waste from muscle activity. When the kidneys are not working properly, the creatinine rises.
If any of these tests are abnormal, your health care provider will need to do other tests to more clearly define the problem.
If you have diabetes, work with your health care provider to keep your blood sugar levels under the best possible control. A program of diet, regular exercise, glucose monitoring, andmedicationsto control blood sugars and protect kidney function can help.
Medications for Kidney Disease
High blood pressure may be both a cause and a result of kidney disease. Your health care provider may prescribe a blood pressure drug for your kidney disease, such as an angiotensin-converting enzyme (ACE) inhibitor, such as captopril(Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), or ramipril (Altace), or an angiotensin receptor blocker (ARB), such as azilsartan (Edarbi), eprosartan (Teveten), irbesartan (Avapro), losartan (Cozaar), olmesartan (Benicar), and valsartan (Diovan). Along with controlling blood pressure, these drugs may reduce the amount of protein in your urine, which may also help your kidneys over time.
Drugs are excreted through the kidneys, so you’ll need to consult with your health care provider before taking any medications — including over-the-counter drugs. You may be told to avoid NSAIDs, such as ibuprofen (Motrin,Advil) andnaproxen (Aleve) and COX-II inhibitors, like celecoxib(Celebrex), which are possible contributors to kidney disease. Always discuss any alternative or herbal treatments with your doctor before trying them.
Pyelonephritis (infection of kidney pelvis): Bacteria may infect the kidney, usually causing back pain and fever. A spread of bacteria from an untreated bladder infection is the most common cause of pyelonephritis.
Glomerulonephritis: An overactive immune system may attack the kidney, causing inflammation and some damage. Blood and protein in the urine are common problems that occur with glomerulonephritis. It can also result in kidney failure.
Kidney stones (nephrolithiasis): Minerals in urine form crystals (stones), which may grow large enough to block urine flow. It’s considered one of the most painful conditions. Most kidney stones pass on their own but some are too large and need to be treated.
Nephrotic syndrome: Damage to the kidneys causes them to spill large amounts of protein into the urine. Leg swelling (edema) may be a symptom.
Polycystic kidney disease: A genetic condition resulting in large cysts in both kidneys that impair their function.
Acute renal failure (kidney failure): A sudden worsening in kidney function. Dehydration, a blockage in the urinary tract, or kidney damage can cause acute renal failure, which may be reversible.
Chronic renal failure: A permanent partial loss of kidney function. Diabetes and high blood pressure are the most common causes.
End stage renal disease (ESRD): Complete loss of kidney function, usually due to progressive chronic kidney disease. People with ESRD require regular dialysis for survival.
Papillary necrosis: Severe damage to the kidneys can cause chunks of kidney tissue to break off internally and clog the kidneys. If untreated, the resulting damage can lead to total kidney failure.
Diabetic nephropathy: High blood sugar from diabetes progressively damages the kidneys, eventually causing chronic kidney disease. Protein in the urine (nephrotic syndrome) may also result.
Hypertensive nephropathy: Kidney damage caused by high blood pressure. Chronic renal failure may eventually result.
Kidney cancer: Renal cell carcinoma is the most common cancer affecting the kidney. Smoking is the most common cause of kidney cancer.
Interstitial nephritis: Inflammation of the connective tissue inside the kidney, often causing acute renal failure. Allergic reactions and drug side effects are the usual causes.
Minimal change disease: A form of nephrotic syndrome in which kidney cells look almost normal under the microscope. The disease can cause significant leg swelling (edema). Steroids are used to treat minimal change disease.
Nephrogenic diabetes insipidus: The kidneys lose the ability to concentrate the urine, usually due to a drug reaction. Although it’s rarely dangerous, diabetes insipidus causes constant thirst and frequent urination.
Renal cyst: A benign hollowed-out space in the kidney. Isolated kidney cysts occur in many normal people and almost never impair kidney function.
Urinalysis: A routine test of the urine by a machine and often by a person looking through a microscope. Urinalysis can help detect infections, inflammation, microscopic bleeding, and kidney damage.
Kidney ultrasound: A probe placed on the skin reflects sound waves off the kidneys, creating images on a screen. Ultrasound can reveal blockages in urine flow, stones, cysts, or suspicious masses in the kidneys.
Computed tomography (CT scan): A CT scanner takes a series of X-rays and a computer creates detailed images of the kidneys.
Magnetic resonance imaging (MRI scan): A scanner uses radio waves in a magnetic field to make high-resolution images of the kidneys.
Urine and blood cultures: If an infection is suspected, cultures of the blood and urine may identify the bacteria responsible. This can help target antibiotic therapy.
Ureteroscopy: An endoscope (flexible tube with a camera on its end) is passed through the urethra into the bladder and ureters. Ureteroscopy generally cannot reach the kidneys themselves, but can help treat conditions that also affect the ureters.
Kidney biopsy: Using a needle inserted into the back, a small piece of kidney tissue is removed. Examining the kidney tissue under a microscope may help diagnose a kidney problem.
This panel is designed to measure the health and recovery of the Hypothalamic-Pituitary-Testicular Axis (HPTA) after attempting to normalize it spontaneously or with the use of Post-Cycle Therapy (PCT) with hCG, clomiphene and/or tamoxifen. PCT is prescribed by some physicians for men who stop testosterone replacement therapy (TRT) or Anabolic-Androgenic Steroids (AAS).
Testosterone replacement therapy and anabolic steroids can lead to HPTA (Hypothalamic-Pituitary-Testicular Axis- shown in figure below) dysfunction. Supplemental testosterone can inhibit the release of the body’s own testosterone production through negative feedback inhibition on LH levels. This feedback inhibition also results in suppression of FSH levels, leading to suppression of sperm production (spermatogenesis).
It is suggested that this panel be done no sooner than 4 weeks after PCT cessation and in a fasting state (morning time)
– Sensitive Estradiol (E2) by Liquid Chromatography/Mass Spectrometry (LC/MS assay used to more accurately measure estradiol in men)
– Total and Free Testosterone [ Free T: direct analog/radioimmunoassay (RIA); Total T:electrochemiluminescence immunoassay (ECLIA) ]
– Luteinizing Hormone (LH) (Responsible for activating Leydig testicular cells to produce your own testosterone). This hormone is shut down by testosterone replacement or AAS.
– Follicle Stimulating Hormone (FSH) (Responsible for activating Sertoli testicular cells to produce sperm). This hormone is shut down by testosterone replacement or AAS.
– CBC – Complete Blood Count (Includes hematocrit)
– CMP – Comprehensive Metabolic Panel (Includes liver and kidney function, glucose and electrolytes)
BUY POST PCT PANEL
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It’s been 18 years since the FDA approved sildenafil to treat men suffering from erectile dysfunction (ED). Under the well-known brand name Viagra, this “little blue pill” has grown to hold almost half of sexual dysfunction market share.
But, sildenafil wasn’t originally intended to help men with ED. Many have forgotten that before it was associated with a re-invigorated love life, sildenafil was a life-saving drug for people experiencing cardiovascular problems.
cGMP and PDE5 inhibitors
The groundbreaking discovery of nitric oxide (NO) in 1986 was the launch point for a novel innovation in drug discoveries. NO is a potent vasodilator that relaxes blood vessels and encourages blood flow (1).
Researchers found that NO is a critical mediator for several physiological systems that regulate blood pressure, prevent the development of atherosclerosis, and maintain penis erection. Because NO has such an incredible vasodilatory effect, it’s considered one of the most essential modulators of blood pressure.
NO accomplishes this by the formation of a substance called cyclic guanosine monophosphate (cGMP). The enzyme responsible for stopping cGMP is called phosphodiesterase enzyme 5 (PDE-5). This enzyme is always observed at high levels in patients experiencing conditions like heart failure or ventricular hypertrophy.
The discovery of PDE-5 inhibitors like sildenafil opened up a whole new approach to dealing with circulatory problems. Sildenafil provided a effective way to both restore and maintain healthy circulation, especially in people suffering from cardiovascular disease (2).
Pfizer develops a heart drug with an unusual side-effect
By the early 90s drug giant Pfizer had completed several trials of sildenafil citrate as a treatment for angina with little evidence that it was a sufficiently effective option. But, included in data collected from volunteers was anecdotal evidence that they were experiencing increased erections for several days after taking the drug.
Pfizer decided to go ahead with pilot studies with patients experiencing erectile dysfunction. In 1996 Pfizer acquired a US patent for sildenafil citrate and by March 1998 it was FDA approved to treat ED and pharmacists began dispensing it under the brand name Viagra.
ED is a common sexual disorder affecting millions of men worldwide. Over half the population over 40 years old experience some degree of ED. Some of the risk factors for ED are:
- Sedentary lifestyle
- Alcohol consumption
- Excessive stress
Among the most common treatment options that are available, PDE-5 inhibitors have become the most preferred by physicians for increasing blood flow and relaxing muscles for improved erections (3).
There were worries about safety
In 2000, research was presented by Dr. Sanjay Kaul at the 49th annual Scientific Session of the American College of Cardiology that suggested that there were 522 Viagra-related deaths in the first year the drug entered the market. While not explicitly blaming sildenafil the doctor was quoted by WebMd as saying, “Data appears to suggest that there’s a relatively high number of deaths and adverse cardiovascular events associated with the use of Viagra.” He also clarified that he was not implying any cause-and-effect relationship.
According to research PDE-5 inhibitors can treat more than ED
The clinical use of PDE-5 inhibitors has now come full circle. Although the original trials failed to demonstrate efficacy for the treatment of angina, hypertension, and other cardiovascular conditions, more recent studies have concluded otherwise. Due to the multiple cellular processes involving PDEs, inhibitors have found new applications in the treatment of some medical conditions (7).
Sildenafil for pulmonary hypertension
Sildenafil will help cases of pulmonary arterial hypertension (8); a lung disorder resulting from the narrowing of arteries (pulmonary arteries) that carry blood from the heart to the lungs. This narrowing causes abnormally high blood pressure in the pulmonary arteries that strains the right ventricle of the heart and causes it to expand. If it continues long enough the right ventricle will lose the ability to pump sufficient blood to the lungs, possibly leading to heart failure. Sildenafil is marketed under the brand name Revatio to treat pulmonary hypertension.
Benefits extend to diabetics
Sildenafil has been shown to reduce diabetes-induced oxidative stress and even improve insulin sensitivity to prevent type 2 diabetes (9). According to research in the Journal of Clinical Endocrinology and Metabolism, sildenafil can not only treat ED but will prevent type 2 diabetes in patients experiencing pre-diabetes, while it reduces the risk of kidney and heart disease.
It raises serum testosterone levels
20 patients at an average age of 55 years were given the PDE-5 inhibitor Tadalafil over a 12-month study period. Researchers observed sustained improvement in the men’s sexual function after one year. Tadalafil administration was associated with increased testosterone and reduced estrogen levels. The theory is that chronic exposure to tadalafil might improve the hormonal profile that regulates erectile function (10).
Can effectively treat prostate enlargement
Benign prostatic hyperplasia or BPH (prostate enlargement) and ED are not only linked by similar risk factors like age and cardiovascular disease but also at a molecular level. According to studies, PDE-5 inhibitors are a practical treatment option to relieve moderate to severe urinary symptoms of BPH (11).
PDE-5 inhibitors and premature ejaculation
Premature ejaculation (PE), while not a physically harmful condition, causes psychological distress in men who suffer it. A recent study (12) looked at whether sildenafil could increase the time to ejaculation and reduce the time needed to become erect again. The study concluded that sildenafil used alone wasn’t better than a placebo or combination treatment to treat PD.
The importance of an erectile dysfunction panel
An ED panel is a laboratory investigation looking at the possible hormonal causes of a patient’s ED. While an ED panel isn’t necessary for everyone experiencing erectile problems, it’s still a good idea.
An ED panel will determine your levels of:
- Total and Free Testosterone levels
- Sensitive Estradiol
- Free T3
- Free T4
An imbalance in any of these hormones could cause low libido/ ED. Before you consider medication to treat your ED, you should first consider investigating if there is another medical issue that may need to be addressed.
1) Musicki B, Champion HC, Becker RE, Liu T, Kramer MF, Burnett AL. Erection capability is potentiated by long- term sildenafil treatment: role of blood flow-induced endothelial nitric-oxide synthase phosphorylation. Mol Pharmacol.(2005)
2) Chester AH, O’Neil GS, Moncada S, Tadjkarimi S, Yacoub MH. Low basal and stimulated release of nitric oxide in atherosclerotic epicardial coronary arteries. Lancet. (1990)
3) Olsson AM, Speakman MJ, Dinsmore WW, et al. Silde- nafil citrate (Viagra) is effective and well tolerated for treating erectile dysfunction of psychogenic or mixed aetiology. International Journal of Clinical Practice. (2000)
4) Steers W, Guay AT, Leriche A, et al. Assessment of the efficacy and safety of Viagra (sildenafil citrate) in men with erectile dysfunction during long-term treatment. Int J Impot Res. (2001)
5) Porst H, Giuliano F, Glina S, et al. Evaluation of the efficacy and safety of once-a-day dosing of tadalafil 5 mg and 10 mg in the treatment of erectile dysfunction: results of a multicenter, randomized, double-blind, pla- cebo controlled trial. Eur Urol. (2006)
6) Brock G, Nehra A, Lipshultz LI, et al. Safety and efficacy of vardenafil for the treatment of erectile dysfunction after radical retropubic prostatectomy. J Urol. (2003)
7) Kukreja RC. Cardiovascular protection with sildenafil following chronic inhibition of nitric oxide synthase. Br J Pharmacol. (2007)
8) Galie N, Ghofrani HA, Torbicki A, et al. Sildenafil citrate therapy for pulmonary arterial hypertension. N Engl J Med.(2005).
9) Milani E, Nikfar S, Khorasani R, Zamani MJ, Abdollahi M.Reduction of diabetes-induced oxidative stress by phos- phodiesterase inhibitors in rats. Comp Biochem Physiol C Toxicol Pharmacol. (2005)
10) Greco EA, Pili M, Bruzziches R, Corona G, Spera A, Aversa A. Testosterone:estradiol ratio changes associated with long-term tadalafil administration: a pilot study. J Sex Med. (2006)
11) Uckert S, Oelke M, Stief CG, Andersson KE, Jonas U, Hedlund P. Immunohistochemical distribution of cAMP- and cGMP-phosphodiesterase (PDE) isoenzymes in the human prostate. Eur Urol. (2006)
12) Atan A, Basar MM, Tuncel A, Ferhat M, Agras K, Tekdo- gan U. Comparison of efficacy of sildenafil-only, silde- nafil plus topical EMLA cream, and topical EMLA-cream- only in treatment of premature ejaculation. Urology. (2006)
Basic Semen Analysis
Basic semen analysis is also known as a sperm count test. A semen analysis measures the viability and health of male sperm. Semen is the bodily fluid that contains sperm (and other sugars and proteins) that is released during ejaculation.
Semen analysis is used to measure three major sperm health factors:
- Quantity of sperm
- Shape of the sperm cells
- Sperm motility (movement of the sperm)
Doctors will often order two or three separate sperm analyses to get an accurate idea of sperm health. Sperm counts may vary on a daily basis, so these tests should be performed at least seven days apart over the course of eight to twelve weeks. Your doctor should use the average of the sperm analysis results to determine your fertility level.
How Ejaculation Affects Semen Analysis
Certain factors can result in an inaccurate semen analysis. The most critical is ejaculating less than three days before the test. Providing a semen sample less than three days after the last ejaculation will result in both a lower semen volume and total sperm count (1).
The testicles continually produce sperm cells which are stored in the epididymis; a long tubular structure that exists for this purpose. Ejaculation empties the epididymis, and it can take two to three days for new sperm to refill it.
This issue doesn’t mean that abstaining for a longer period is better – sperm cells only last about three weeks before dying and breaking down in the body. Ideally, a man should abstain from ejaculation for between three and five days for the most accurate results.
Since the concentration of cystatin C in the blood will not change due to infection or inflammation and isn’t affected by body weight, drugs or diet – cystatin C level could be a more reliable indicator of kidney health than creatinine (2).
Testing for cystatin may also be useful to detect kidney disease early when the affected person isn’t experiencing many (if any) symptoms, and other test results are normal.
What is Cystatin C?
Cystatin C is a protein found in almost all the cells in the body. Cystatin C helps to regulate the activity of enzymes needed to break down bigger molecules both inside of and around those cells (3).
Cystatin C level in the blood can be measured to determine how well the kidneys are functioning (3). The kidneys, liver, and spleen all work to filter the blood and excrete any waste substances as urine. This filtration process happens in a microscopic structure in the kidneys; the glomerulus (4). Each kidney contains approximately one-million glomeruli that function as tiny sieves to extract waste. The glomerular filtration rate (GFR) rate is a measure of how well the glomeruli are filtering blood (4).