Page 2 - Lab Test Education

On February 6, 2014, the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services Office for Civil Rights (HHS OCR) issued a final rule amending the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to provide individuals the right to access test reports directly from laboratories subject to HIPAA. The goal of the final rule is to provide individuals with a greater ability to access their health information, empowering them to take a more active role in managing their health and healthcare. Under the final rule, HIPAA-covered labs must: Disclose lab test results to individuals, in most cases, within 30 days of a request for such information. Labs are not required to disclose results to an individual if the individual did not request disclosure. Comply with an individual's request to have the lab transmit a copy of Protected Health Information (PHI) to another person or entity appropriately designated by the individual. Verify the identity and authority of any person requesting access to lab test results as a personal representative of the individual. If the lab cannot verify the identity and authority, it may not release the test report. Disclose test reports that the lab maintains even if the test report was created before the effective date of the final rules. Subject to a narrow limitation, disclose test reports to the individual upon request even if the lab test is considered "sensitive," i.e., tests for sexually transmitted disease, pregnancy test, etc... Allow individuals to make requests for test reports directly to the lab and not require the individual to make the request to the healthcare provider. Charge only the reasonable, cost-based copy fee permitted under the HIPAA Privacy Rule. HIPAA covered labs may not charge fees for verification, documentation, liability insurance, maintaining systems and other similar activities. Revise their Notice of Privacy Practices by October 6, 2014 to inform individuals of their right to access PHI directly from HIPAA covered labs, include a brief description of how to exercise this right, and remove any contrary statements from the existing notice. Ordering providers are not required to update their privacy notices. Not withhold an individual's PHI because the individual has not paid the lab for services provided. The Final Rule also explains what is not required: With respect to employment-related testing, the CLIA regulations do not apply to the employer or entity that performs substance abuse testing for the purpose of employment screening where the results are merely used to determine compliance with conditions of employment. CLIA labs that are not subject to HIPAA have discretion to provide individuals with direct access to lab test reports, subject to any applicable state laws that may limit access. The final rule does not require labs to interpret test reports for individuals, although labs may provide additional education material regarding the test results if they choose to do so.

While it's becoming commonplace for patients to see the results of lab work electronically, a new University of Michigan study suggests that many people may not be able to understand what those numbers mean. Research conducted by a team at the U-M schools of Public Health and Medicine found that people with low comprehension of numerical concepts—or numeracy—and low literacy skills were less than half as likely to understand whether a result was inside or outside the reference ranges. They also were less able to use the data to decide whether or not to call their doctor. As more medical professionals and facilities have adopted electronic health record keeping, increasing numbers of patients can see their test results outside of a doctor's visit. One goal of giving patients access to the data is to help them become partners in managing their own care, said Brian Zikmund-Fisher, associate professor of health behavior and health education at the U-M School of Public Health. "We can spend all the money we want making sure that patients have access to their test results, but it won't matter if they don't know what to do with them," he said. "The problem is, many people can't imagine that giving someone an accurate number isn't enough, even if it is in complex format." Source

Table of Contents What is Uric Acid? Why Should I Monitor My Uric Acid Levels? What Drives Uric Acid Formation? What To Know About the Uric Acid Serum Test   References What is Uric Acid? Uric acid is a byproduct of the body breaking down purines (compounds that provide essential building blocks for synthesizing DNA and RNA) in food. After the purines are broken down, uric acid travels to the kidneys through the bloodstream, where it is filtered and expelled from the body via urination. High uric acid levels in one’s blood could be an indicator or cause of more serious health conditions like gout. Why Should I Monitor My Uric Acid Levels? A high concentration of uric acid is called hyperuricemia. This blood test value indicates that the body is either producing too much uric acid while breaking down purines or that the kidneys cannot properly filter the correct amount of uric acid out of the body. You may undergo a Uric Acid (Serum) test before or after certain types of chemotherapy, as rapid destruction of cancerous cells or significant weight loss can increase uric acid levels in the bloodstream. High uric acid levels can lead to gout, a painful form of arthritis characterized by uric acid crystallizing in the joints, skin, and other tissues. This crystallization process can also lead to the formation and deposition of kidney stones. An unusually low uric acid level is called hypouricemia. While it is typically asymptomatic, affected individuals might be at greater risk of acute kidney injury. Deficiencies in zinc, iron, or molybdenum can result in hypouricemia. Molybdenum cofactor deficiency is a serious medical condition characterized by declining brain function. Molybdenum plays a critical role in purine degradation, so a deficiency can significantly reduce the amount of uric acid the body can produce. What Drives Uric Acid Formation? There are many potential causes of higher-than-normal levels of uric acid. Diet can be a huge factor in the development of uric acid if one consumes too many purine-rich foods and beverages. A major driver of uric acid excess is high levels of fructose consumption. Levels of sugar consumption across the globe have dramatically increased over the past century, in tandem with rates of obesity and diabetes. Individuals with diabetes may develop high uric acid levels if their bodies cannot produce enough insulin. Since insulin is used to help sugars enter the body’s cells, the inability to process that sugar can lead to a buildup of uric acid and many other serious health complications. Intaking too much high-fructose corn syrup or table sugar, even in non-diabetic individuals, can result in elevated uric acid levels in the bloodstream. However, sugary sweets are not the only possible culprit. Many foods, such as liver, game meat, certain seafood, gravy, dried beans, and peas, contain a high concentration of purines, rendering them able to function as a driver in the formation of excess uric acid. Other potential causes could be high alcohol consumption, chemotherapy-related side effects, rapid weight loss, psoriasis, or even certain prescription medications. Finally, high uric acid can result from renal failure when the kidneys do not function properly and excretion is reduced. What To Know About the Uric Acid Serum Test A Uric Acid (Serum) test measures the concentration of uric acid in the liquid part of the blood, otherwise known as the serum. Alternative tests can measure the amount of uric acid in one’s urine. It is important for the patient not to eat or drink anything for four hours before the test, as not properly fasting can interfere with the results. Additionally, certain medications can impact test results, so a health care provider will be sure to inform their patient what medicines they should and should not take before testing. A healthy range of uric acid in the blood is between 3.5 and 7.2 milligrams per deciliter (mg/dL). While potential first steps to lowering excessive uric acid levels are reducing sugar and urine intake and exercising regularly, treatments are available for individuals who cannot bring down uric acid concentration through lifestyle choices alone. Allopurinol and febuxostat are two medications that help reduce the body's production of uric acid. There are also drugs such as probenecid designed to help improve kidney efficiency in expelling uric acid from the body. Monitoring your uric acid concentration is imperative in preventing gout and/or kidney stones. For an accurate and affordable measurement of uric acid levels, consider ordering a Uric Acid (Serum) test from discountedlabs.com. Seek testing or medical attention if you are experiencing hyperuricemia symptoms such as joint pain, swelling, or redness, as these could be indicators of gout attacks. References   Bardin, T., & Richette, P. (2014): Definition of hyperuricemia and gouty conditions Choi, H. K., Liu, S., & Curhan, G. (2005): Intake of purine-rich foods, protein, and dairy products and relationship to serum levels of uric acid Drum, D. E., Goldman, P. A., & Jankowski, C. B. (1981): Elevation of serum uric acid as a clue to alcohol abuse Hahn K, Kanbay M, Lanaspa MA, Johnson RJ, Ejaz AA (2017): Serum uric acid and acute kidney injury: A mini review Johnson, R. J., Nakagawa, T., Sanchez-Lozada, L. G., Shafiu, M., Sundaram, S., Le, M., … & Lanaspa, M. A. (2013): Sugar, uric acid, and the etiology of diabetes and obesity  

  Welcome to a new era in personalized healthcare, where understanding the intricacies of our bodies is more achievable than ever. Lab tests play a crucial role in this journey, serving as the compass that guides us through the landscape of our health. The question then becomes: among the myriad of lab panels available, how do you find the one that aligns with your health aspirations? Let's explore this question with insights from Nelson Vergel, founder of DiscountedLabs.com, as he illuminates the path in his informative YouTube video.   Understanding the Video's Purpose In his enlightening video on DiscountedLabs.com, Nelson Vergel seeks to simplify the often perplexing task of comparing lab panels. For those new to the concept, lab panels are collections of various lab tests packaged together for convenience and cost-effectiveness. This approach to health testing makes preventative care more accessible and affordable for everyone. Your Journey Begins: Navigating DiscountedLabs.com Your first step in this health exploration is a visit to DiscountedLabs.com and clicking on the Lab Panels tab. Here, you'll discover an array of lab panels, each crafted to cater to different health concerns and goals. It's important to get acquainted with the options and what they offer to make a well-informed choice. Step-by-Step: How to Compare Lab Panels Let's go through the comparison process as Nelson demonstrates it in the video: Choose Your Lab Panel: Start by selecting a lab panel that catches your interest. For example, consider the "Bodybuilder Lab Test Panel Comprehensive." The Comparison Tool: The "Compare" button is your key to understanding differences. It helps you discern which panels can be juxtaposed for a better evaluation. Broadening Your Comparison: Don't limit yourself to just one panel. For a more rounded view, select other panels you wish to compare, like "Complete Hormone and Wellness Panel for Men" and "Hormone Panel for Men on TRT Comprehensive." See the Difference: Click "Compare Panels" to view a detailed table comparing the panels' names, pricing, and the specific lab tests included in each. Empowered Choices for Better Health This method of comparison equips you with the knowledge to make choices that best suit your health goals. Here's what you gain from this comparison: Budget-Friendly Options: Find the panel that fits your budget without compromising quality. Test Details: Gain clarity on which tests are included in each panel. Personalized Health Tracking: Tailor your health monitoring to your unique needs and aspirations. Your Voice Matters Nelson Vergel values your feedback and ideas. If you have suggestions for new panels or improvements, the team at DiscountedLabs.com is eager to hear from you. Your engagement ensures the platform continues to evolve and cater to diverse health needs. A Note of Thanks As the video concludes, Vergel extends heartfelt thanks to the community and hints at future enhancements on the website. It's this dedication to continual improvement that cements DiscountedLabs.com as a trusted ally in your health journey. Are you ready to embark on this path? Visit DiscountedLabs.com and leverage the insights from Nelson Vergel's video. With these resources, you're well-equipped to navigate your health journey with confidence and clarity.

In a world where healthcare costs are continually rising, DiscountedLabs.com emerges as a beacon of affordability and convenience. We've been in operation for over eight years, offering the most competitively priced lab tests in the U.S. Our service design is tailored to ensure simplicity, confidentiality, and reliability from the moment you place an order to when you receive your results. Here's a closer look at why DiscountedLabs.com should be your go-to platform for lab testing needs. Affordable Lab Testing At DiscountedLabs.com, we pride ourselves on providing the most affordable lab tests available in the U.S. Our pricing structure is transparent with no hidden costs. A nominal lab draw fee of $8 is added to your order, ensuring you get quality service without any surprise charges. No Doctor Visit Necessary Seamless Prescription Process We simplify the process of obtaining lab tests by eliminating the need for a doctor's visit. Our in-house doctor provides a prescription at no extra cost to you, making the process seamless and hassle-free. Private and Confidential Your privacy is our priority. We ensure that your lab test results are private and confidential. Adhering to HIPAA compliance, we employ robust measures to protect your privacy throughout the process. Wide Reach Across the U.S. We extend our services to most U.S. states, boasting over 1,900 lab locations nationwide. This extensive network makes it convenient for you to find a lab nearby, reducing the time and effort required to get tested. Order Validity and No Rush Our process is designed with your convenience in mind. Orders are valid for a substantial period of six months (180 days), allowing you ample time to visit the lab at your convenience. There's no need to rush; your order will remain valid, providing flexibility to fit testing into your schedule. Easy Ordering Process With a simple menu and a 24/7 ordering process, obtaining the lab tests you need has never been easier. Post-order, you'll receive a lab requisition form within minutes, enabling a swift process without any waiting time. FDA Approved Blood Tests Accurate Hormone Testing We offer a wide range of FDA approved blood tests, ensuring accuracy and reliability in the results you receive. Our hormone testing is conducted via sensitive LC/MS assays, avoiding less accurate testing methods, and ensuring precise results. Educational Resources We believe in empowering you with the knowledge to understand and interpret your lab test results. Our blog page hosts a variety of educational videos and articles, while we also provide resources for clinical care and consumer forums on our Resources Page. This educational content can be a valuable tool in discussing your lab results with your physician. Tailored Blood Test Panels Understanding that different individuals have different needs, we've curated blood test panels catering to various requirements. This tailored approach allows for a more targeted and insightful testing process. Periodic Discount Coupons and More We value our customers and continually strive to provide added benefits. Periodic discount coupons are emailed to our patrons, ensuring affordability over time. Our commitment extends beyond just testing, as we endeavor to provide a comprehensive and enriching user experience. Conclusion: DiscountedLabs.com is more than just a lab testing service. We are a dedicated partner in your healthcare journey, providing affordable, convenient, and reliable lab testing services. Our vast network, coupled with a customer-centric approach, makes us a preferred choice for many. Explore our website, avail the benefits, and take a proactive step towards better health.

Table of Contents Impact of Lipids on Cardiovascular Health The concept of ideal cardiovascular health Blood lipids and atherosclerosis How does atherosclerosis develop? How to Prevent Atherosclerosis The importance of timing when it comes to lowering cholesterol levels Some people naturally have low cholesterol levels How physicians can help when it comes to lowering cholesterol levels Assessing blood lipids throughout life is vital for achieving ideal health The role of educational institutions in achieving optimal blood lipid levels Conclusions Impact of Lipids on Cardiovascular Health Maintaining a safe level of blood lipids help to lower the risk of developing a dangerous cardiovascular disease at some point during adulthood. Cardiovascular diseases tend to kill millions of people worldwide and they are preventable if individuals maintain optimal health throughout their lives. A cardiovascular disease implies that something is wrong with the heart or the blood vessels. Some good examples of cardiovascular diseases include coronary artery disease, myocardial infarction, angina, hypertension, and atherosclerosis. This article summarizes the impact of blood lipid test on cardiovascular health and what you can do to lower the risk of developing cardiovascular disease at some point in the future. The concept of ideal cardiovascular health The American Heart Association (AHA) has defined the ideal cardiovascular health using 7 parameters which can be monitored independently. AHA has also created a specific list of behaviors and habits people can put into practice to have a healthier lifestyle and lower their risk of developing cardiovascular diseases. For example, having the untreated total cholesterol level below 200 mg/dL, having a blood pressure of less than 120/80 mm Hg and a glucose concentration of less than 100 mg/dL can help you prevent most heart-related problems. Unfortunately, less than 5% of people take these parameters into account and maintain optimal health throughout adulthood. The goal of AHA is to help physicians educate their patients and assist them in making better decisions when it comes to influencing the lipids in their blood. This involves making lifestyle changes such as engaging in regular exercise, reducing the intake of saturated fats and avoiding smoking. Blood lipids and atherosclerosis It has been discovered that low-density lipoproteins (LDL cholesterol, aka bad cholesterol) play a vital role in the development and progression of atherosclerosis. Atherosclerosis is one of the most dangerous cardiovascular diseases out there. It is characterized by a narrowing of the blood vessels as a result of plaque buildup. Plaque is a waxy substance which develops inside blood vessels and arteries. This substance makes the blood vessels narrower and the speed of circulating blood will increase. Atherosclerosis develops over a period of decades and it progresses as a result of an unhealthy lifestyle. When too much plaque builds up in certain vessels, this can cause a rupture which might lead to stroke or a heart attack. How does atherosclerosis develop? Studies show that nearly 90% of all the LDL particles travel around the body through plasma. Some of these LDL particles get trapped in the walls of veins and arteries and they start to create a buildup. It has been discovered that the progression of atherosclerosis is directly related to the absolute plasma LDL levels in the body. As LDL particles circulate through veins and arteries, more of them become trapped by the plaque buildup and cause lager blockages. The atherosclerotic plaque burden can be determined by 2 factors - the amount of exposure to LDL particles and the concentration of low-density lipoproteins and other particles similar to them. It is possible to quantify this burden by multiplying a person’s age by the LDL concentration in the bloodstream. Of course, this gives only an estimate as only complex laboratory investigations can offer a more accurate reading of blood lipids. When the individual is young, the risk of a major cardiovascular event is small as plaque buildup is still in its infancy. However, poor lifestyle choices combined with advanced age can lead to a major deposit of plaque on blood veins and arteries. This can lead to something called thrombus which can block a blood vessel entirely. When this happens, several health conditions can appear such as unstable angina, myocardial infarction (heart attack) or even death. To better understand this concept, let’s look at a real-life example. The incidence of myocardial infarction among people who are 40 years old is about 1% in the United States. That means that one in 100 people might have a heart attack when they reach 40. If we consider that the mean level of LDL-C (which is a form of cholesterol) for these people is 125 mg/dL then this means that the total plaque burden can amount to 40 years x 125 mg/dL = 5,000 mg-years. This is the point when atherosclerotic plaque buildup can significantly increase the risk of developing myocardial infarction or heart attack.   BUY A CHOLESTEROL PANEL   How to Prevent Atherosclerosis Keeping blood lipids at normal level throughout life is one of the best ways to prevent cardiovascular diseases. This means that fewer LDL particles are trapped in the walls of veins and arteries and the exposure to bad cholesterol is limited. Preventing atherosclerosis lead experts to suggest 2 types of approach - primordial prevention and primary prevention. Primordial prevention focuses on minimizing blood lipid levels throughout childhood and adolescence when most of the mean cholesterol levels are inherited from parents. Primary prevention focuses on lifestyle and diet changes, which can reduce the number of lipids in the bloodstream and prevent plaque buildup. Specialists suggest that an optimal level of blood lipids would be 80 mg/dl for LDL - C and less than 200 mg/dl for total plasma cholesterol levels. Achieving these levels and maintaining them throughout adulthood can significantly lower the risk of developing myocardial infarction, even for people who are well over their 40s. It's also important to note that some people can retain more LDL particles than others, so there are no "one-size fits all" when it comes to plaque buildup and preventing it. The importance of timing when it comes to lowering cholesterol levels As mentioned earlier, atherosclerosis tends to develop over time and it is strongly influenced by a poor diet and a sedentary lifestyle. Young adults in their twenties might not experience plaque buildup or any symptoms associated with it, but this doesn’t mean that atherosclerosis might not affect them. That’s why any strategy to lower cholesterol levels should be implemented as early as possible and not wait until plaque has already developed a substantial thickness in arteries and veins. In other words, it’s easier to reduce the LDL-C levels from 120 to 80 mg/dl when a person is in his 20s and prevent major cardiovascular events such as stroke or heart attacks in comparison with a person who is 50 years old. Remember that the total plaque burden is cumulative, so the senior might have a great amount of plaque developed in his circulatory system, which needs to be approached carefully. Plaque building in veins and arteries is not something that can be stopped altogether. It slowly develops starting from childhood and invasive procedures can detect signs of atherosclerosis beginning in early adulthood. However, it might take decades until plaque develops at a massive rate and starts causing problems. With that being said, something can be done to slow down the process of developing plaque. For example, engaging in physical exercises regularly, quitting smoking and eating lots of vegetables can significantly reduce the risk of developing cardiovascular diseases. Some people naturally have low cholesterol levels There are numerous genetic variants which indicate that some people are less predisposed to developing plaque than others. This is similar to being involved in cholesterol-reducing therapy throughout the entire life. These individuals have a slower rate of progression when it comes to plaque buildup, and they are less predisposed to cardiovascular diseases. However, this doesn’t mean that people with naturally low cholesterol levels shouldn’t worry about plaque buildup at all. They should also engage in preventative measures to slow down the progression of atherosclerosis, even if they already have a lower risk in comparison with other people. How physicians can help when it comes to lowering cholesterol levels It is commonly accepted that exercise can lower the levels of LDL-C and decreasing the risk of developing cardiovascular disease. This is true, but specialists discovered that diet could have a larger impact when it comes to cholesterol levels. For example, reducing the intake of saturated fats has been linked with lower levels of LDL-C in the plasma. As a result, a smaller concentration of LDL particles limits the development and progression of atherosclerosis. If this is maintained for decades, the individual in question might never experience a heart attack or a stroke. However, studies show that replacing saturated fats with carbohydrates can lower LDL-C levels in the plasma but increase triglyceride levels. Having high triglyceride levels is a risk factor for heart problems, so it’s not a viable option. Further studies offer a better approach - replacing saturated fats with unsaturated fats and protein. This doesn't only lower the LDL-C levels, but also keeps the triglyceride levels at a minimum and prevents a whole suite of cardiovascular problems. On top of that, researchers have found out that a diet rich in fibers can also help in reducing LDL-C levels and lowering the risk for heart disease. People should consume nuts, plant-based protein, plant phytosterols, and polyunsaturated fats to achieve these benefits. By following such a healthy diet for years, patients can help to reduce the plaque buildup acquired in childhood or adolescence and enjoy a healthier and longer life. For some people who are not able to maintain optimal blood lipid levels through diet alone, doctors also recommend taking statin drugs. Small doses of 10mg or 20mg of atorvastatin or ezetimibe can help certain individuals achieve ideal levels of LDL-C in their blood and prevent major cardiovascular events such as myocardial infarction or strokes. Assessing blood lipids throughout life is vital for achieving ideal health Measuring blood lipids regularly is paramount for people of all ages, even children. Experts recommend taking a blood lipid test once every 3 years to assess the levels of triglycerides, LDL-C and other lipoproteins in the body. Parents might also want to test the lipids levels at birth, when the child is 2 years old, 10 years old, 14 years old and finally, when he reaches 18 years of age. This helps to monitor the inherited plaque burden and see if the adolescent has high cholesterol levels. Based on these results, physicians can recommend lifestyle changes and dietary adjustments to reduce the levels of LDL-C in the blood. These preventative measures help the individual avoid major cardiovascular events when he is 40 years old or older. If the young patient is constantly assessed and his/her blood lipids are optimal, the doctor might recommend continuing with the prescribed diet. The patient should return for a blood test once every 3 years to see if the lipids are below the optimal threshold. In some cases when the blood lipids level increased, the doctor might recommend lipid-lowering therapy. Noninvasive imaging might be used in high-risk individuals to determine the amount of plaque buildup in the blood veins and arteries. If plaque is discovered, the patient can be reassessed to determine if he or she is a good candidate for lipid-lowering therapy. In most cases, patients with high-risk factors such as a family history of cardiac events will benefit from this type of therapy to slow down the rapid progression of atherosclerosis. If plaque is not discovered in the bloodstream, then the patient doesn’t need lipid-lowering therapy. The role of educational institutions in achieving optimal blood lipid levels It is true that healthcare resources are finite and people should do their best to take care of their health and avoid being a burden on the healthcare industry. Irresponsible behavior, which involves eating a lot of junk food, smoking cigarettes and drinking excessive amounts of alcohol, can put a serious strain on healthcare providers. One way to alleviate this problem and achieve optimal blood lipid levels is by educating people about cardiovascular diseases from an early age. This can be done if educational institutions such as schools and colleges put an emphasis on blood lipid levels and how to prevent atherosclerosis. Lessons should be taught on how to reduce LDL-C levels, how to engage in regular exercise and what foods are healthier for the heart and circulatory system. On top of that, numerous people, especially teenagers, smoke cigarettes regularly. This bad habit can significantly contribute to the levels of lipids in the blood, not to mention that cigarettes can cause a host of cancers. Schools, high-schools and colleges should make a priority to help adolescents quit smoking and remain cigarette-free for the rest of their lives. By adopting such preventative measures, not only that a large portion of the US population will be healthier, but healthcare costs will also be reduced. The saved money can be redirected to finding cures for cancers or developing new drugs and medicines for diseases that have recently appeared. The educational system might also need to emphasize proper nutrition and offering healthy meals to children and adolescents in primary schools and high schools. Junk foods such as pizza and burgers should be replaced with healthier varieties such as salads, lean protein and nutritious snacks, which include Greek yogurt and nuts. Putting an accent on healthier meals help in reducing the amount of plaque buildup throughout the early stages of life. As a result, these young adults are less predisposed to develop cardiovascular diseases later on in life. Furthermore, they will become health-conscious parents who will also educate their children on how to become better and healthier individuals! Conclusions This article has established that LDL particles are directly responsible for developing atherosclerosis, which can lead to major cardiovascular events. The LDL concentration in the blood combined with the exposure to such particles create the overall risk of heart disease and it can be quantified using both invasive and noninvasive medical procedures. A healthy diet low in saturated fats and rich in fibers and protein can help to reduce the LDL-C levels in the bloodstream. Couple this healthy diet with a regular exercise regimen and individuals can significantly reduce the atherosclerosis progression throughout their lifetimes.

Testosterone Replacement Therapy (TRT) has changed the lives of many men around the world.  Like any therapy, it can have great benefits if properly managed but negative side effects if not monitored.  This article will briefly and simply review the different TRT tests that most physicians use to monitor your progress while minimizing potential side effects.   Table of Contents How to Know if You Need TRT Follow Up Lab Tests After Starting TRT Avoiding or Lowering High Hematocrit on TRT Avoiding Low Ferritin and Iron Monitoring the PSA Test on Testosterone Monitoring Estradiol Test on Testosterone Avoiding High Blood Pressure and Water Retention on TRT Monitoring Kidney Function Avoiding High Liver Enzymes Monitoring Thyroid Tests Maintaining Good HDL Levels on TRT Prolactin in Men with Low Testosterone: The Forgotten Hormone Where to Buy Your Own TRT Tests: How to Know if You Need TRT The first thing doctors actually measure before you get on testosterone replacement is your total and free testosterone blood levels to find out if you have low testosterone. They will also ask you a few questions to see if you have low testosterone or hypogonadal symptoms. They include low sex drive, erectile dysfunction, fatigue, low mood, and issues with cognitive capacity and function. So, testosterone replacement therapy includes anything to increase testosterone levels with either injections or creams, gels, pellets, oral, nasal, and other TRT options. Follow Up Lab Tests After Starting TRT Once you get on testosterone replacement, your doctor will have you come back either at week six or eight to run another blood test to see if your dosage needs to be adjusted and/or you may require other medications to monitor or to modulate or change levels like estradiol, hematocrit, etc. The first one obviously is testosterone total and free. You come back at week six or eight, and your total testosterone is not over 500 nanograms per deciliter, your doctor will probably choose to increase your dosage or your frequency of injections in the case of injections. Free testosterone is usually around 2% of total or higher. If you have lower than 2%, your doctor will probably focus on any issues related to high sex hormone binding globulin (SHBG), which is a protein that binds to testosterone and does not free it up for action. Avoiding or Lowering High Hematocrit on TRT Hematocrit is the proportion of red blood cells in the blood. Testosterone tends to increase red blood cells.  Some men don't have that issue, but most men at least have a two to a three-point increase in hematocrit after starting TRT. Hematocrit increases a lot more in men on TRT who have sleep apnea and in smokers since these two can cause oxygen starvation.  High hematocrit can increase the viscosity of the blood and may cause cardiovascular issues. So, the magic number to go for is a hematocrit of 53 or below. When you're getting close to 53, you have to basically donate blood or go for what we call a therapeutic phlebotomy to bring down the red blood cell amount in the blood. And that's very important because as hematocrit goes up, your blood becomes more and more viscous, and your cardiovascular system gets compromised.  It's also very important not to let it go too high because above 52, most blood centers would not accept you as a donor, so you would have to require a special prescription for a therapeutic phlebotomy from your doctor for the blood centers to take your blood and dispose of it later. Keep in mind that donating more frequently than every three months may decrease your ferritin and iron stores considerably, which can cause fatigue and other issues. Here are some hematocrit lab panels, or you can buy them as part of the CBC panel. Avoiding Low Ferritin and Iron When your hematocrit is over 53, and you donate blood frequently than every three months, you can deplete your iron stores which makes you tired, depressed, and with no libido. Blood donations should not be happening that frequently because you'll lose iron. Some doctors will test your iron and your ferritin, and if you have low levels, they will put you on an iron supplement. Discounted Labs sells a blood donation panel that is designed to inform you if you can safely donate blood. Monitoring the PSA Test on Testosterone High PSA, prostate-specific antigen, is the only contraindication for testosterone replacement therapy if it is 4 or above. Obviously, physicians get very concerned that a man with higher PSA may have prostatic cancer, although it could be caused by an infection of your prostate (prostatitis) that could be easily treatable with an antibiotic. So, all high PSA tests do not mean you have cancer, but it could mean that you could have a treatable prostatic infection.  Your doctor may prescribe antibiotics and retest your PSA after your antibiotic cycle is finished.  He or she may need to refer you to a urologist if your high PSA test does not come down.  But if you do have a PSA of four or higher, you are not going to be allowed to use testosterone replacement unless your doctor can actually prove that it's an infection that will eventually be treated so that your PSA can come down. Monitoring Estradiol Test on Testosterone Estradiol (E2) is a very important hormone for men. We need it because estradiol is actually linked to bone health, cognitive functioning, cardiovascular health, even sex drive, and decreased fat mass. Having very low estradiol of under 20 pg/mL is actually not good for you since it can decrease bone density and cause other issues. Having very high estradiol in relation to your testosterone blood level may also have some consequences.  Several studies have different opinions and conclusions on what high estradiol means. About 0.3 to 0.4% of testosterone gets converted into estradiol by the aromatase enzyme. So obviously, the body increases the amount of estradiol as your testosterone goes up. There's nothing wrong with that. Estradiol balances testosterone to keep a better lipid (cholesterol) profile and to keep healthy sperm counts, just to name a few benefits. But what level of estradiol in men is too high? For example, if you have a testosterone level after you start TRT of 700 nanograms per deciliter, obviously, your estradiol is going to be higher than when before you started TRT. Is that cause for concern? Most men on testosterone replacement therapy do not need to take medications to lower estradiol. Estrogen blocker medications like anastrozole (Arimidex) are being overprescribed by many TRT clinics.  Men with a history of gynecomastia or breast enlargement may have issues with gynecomastia again if your estradiol's over 50 pg/ml, but in most studies where men with gynecomastia were followed, a lot of those men had low testosterone while they had high estradiol. A large study in adolescent boys showed that most of the ones with gynecomastia also had high IGF-1.  Some studies have shown that the ratio of testosterone to estradiol is really the important factor to monitor, with ratios over 12 being needed for healthy sperm production in men. But the management of estradiol in men is a very controversial topic as there is not a lot of agreement in the field.  Some doctors insist on keeping an E2 level of 20 to 40 picograms per milliliter no matter how high testosterone levels reach. We have learned in the past three years that the old immunoassay-based estradiol test tends to overestimate estradiol in men. Two studies have shown that the real estradiol value is better tested with a liquid chromatography-mass spectrometry sensitive estradiol assay. So, make sure that if your doctor is going to check your estradiol, you're using the right LC/MS E2 test. Discounted Labs offers several lab panels that contain sensitive estradiol.  Another concern of high estradiol is that some men feel that water retention is an issue, although that has not been proven by any studies. Most men with TRT-related water retention assume that their estradiol is high but fail to get it tested. Avoiding High Blood Pressure and Water Retention on TRT Some men on testosterone replacement therapy tend to have increased blood pressure related to water retention. There are some central nervous system effects that increase blood pressure and heart rate. These men can gain considerable weight during the first weeks of TRT.  Most lose most of that weight after a few weeks of therapy.  Some studies have shown that testosterone may decrease sodium excretion by the kidneys, which makes the body retain water to keep that sodium diluted. Ways to improve blood pressure are to lose weight, take a blood pressure medication, exercise, and decrease excessive sodium intake. Many men assume that their estradiol is high when they experience water retention. That assumption has not proven to be correct. Monitoring Kidney Function The estimated glomerular filtration rate, or eGFR, is a way to measure your kidney function. It's part of what we call a CMP blood test panel, and we are aiming at an eGFR over 60. Anything below that is indicative of a slowdown in the way your kidneys are filtrating toxins from your body. TRT does not really cause a decrease in eGFR. However, a lot of men taking creatine, exercising heavily, or eating very high protein intake tend to probably have artificial increases in creatine that decrease eGFR. You can Google eGFR formula and see how that's calculated. Avoiding High Liver Enzymes Current testosterone replacement therapy options have not been shown to increase liver enzymes; only the old oral forms of TRT used to cause that problem. However, doctors obviously follow it up. A very important distinction to make is that men that are exercising heavily with weights at the gym may artificially  increase in AST and ALT that has nothing to do with toxicity to the liver. Monitoring Thyroid Tests TSH, thyroid stimulating hormone, is also something else that most doctors follow up, although some actually do not. Low thyroid function (hypothyroidism or high TSH) may have the same symptoms as low testosterone. TRT medical guidelines groups around the world recommend different schedules for monitoring men on TRT, and a few of them agree with each other. Rarely do any guidelines mention thyroid function monitoring in men on TRT. TSH levels above 2.5 may indicate that you have hypothyroidism. If you have high TSH, doctors usually tend to use a comprehensive thyroid panel that includes free T3 and free T4, along with antibodies, to see if you have an autoimmune disease like Hashimoto's that may be inducing hypothyroidism. Maintaining Good HDL Levels on TRT High-density lipoprotein or HDL is another one of the variables most affected by testosterone replacement, especially at higher doses. When I say higher doses, anybody using 200 milligrams of testosterone replacement per week — cypionate or enanthate — tend to have a lowering of HDL. Low HDL has been shown to cause cardiovascular issues, so your doctor will always follow your lipids. Testosterone replacement has not really been shown to increase LDL, and there are some studies that show that TRT improves triglyceride blood levels because testosterone tends to improve the way the body metabolizes carbohydrates. There's very little we can do to increase HDL besides aerobic exercise, losing weight, decreasing TRT dose, and taking a supplement. Niacin supplementation is one of the ways to increase HDL, but some people get flushing of the skin and face. Last but not least, the use of anastrozole, an estradiol blocker, can also decrease HDL since estradiol is known to protect HDL levels. Prolactin in Men with Low Testosterone: The Forgotten Hormone Prolactin is not a hormone that is usually measured at TRT baseline or even at follow-up unless you have severe erectile dysfunction, even with good levels of testosterone. Men that have low testosterone at baseline, and I mean low testosterone, very low — under 150 nanograms per deciliter — are probably the best candidates to get a prolactin test. It is a hormone that women and men produce – obviously, women that are lactating produce it at higher concentrations in their bodies because it helps lactation. It also has some other benefits; otherwise, men would not have it. Prolactin has some immune-enhancing benefits and some cardiovascular benefits that are starting to show up in studies. So, prolactin is not an evil hormone, but it can, at higher concentrations, cause erectile dysfunction. The reason for high prolactin could be a benign tumor called pituitary adenoma (diagnosed by MRI), which can be producing a lot of pituitary output for prolactin, and that could actually impair your testosterone replacement therapy benefits. So, it's a hormone that is hardly looked at unless you are a man that has very low testosterone blood levels at baseline or do not respond well (unresponsive erectile dysfunction) after eight weeks or ten weeks of testosterone replacement therapy and/or you are having high prolactin symptoms, like lactation. That's actually a very rare symptom that actually occurs in men with pituitary adenomas. Where to Buy Your Own TRT Tests: DiscountedLabs.com provides very low-cost blood testing in most US states. You don't need to see a doctor because the company has in-house physicians that provide a prescription. After ordering your lab test online, you receive an email with the lab request form that you take to the closest lab near you. Once you go to a lab and get your blood drawn, you receive an email with your results within five to seven business days, depending on the blood test. For more information, visit DiscountedLabs.com   Visit ExcelMale.com to download Nelson's latest book: Beyond Testosterone   Click here for TRT Resources

Table of Contents Lab Test Results Turn-Around Time How to Locate a Lab Near You What Lab Tests Require Fasting? Stay Hydrated Before Lab Test Best Time of Day to Get Lab Test Done Taking your Medications Before Lab Tests Important Information for those on Hormone Replacement Therapy and Your Lab Tests Why DiscountedLabs.com? After you buy your lab tests online with Discounted Labs, there are things you should do to get ready for your blood draw at the nearest lab near you.  Here are a few considerations to know so that your lab test results are accurate. Lab Test Results Turn-Around Time All lab test orders are processed Monday to Friday 9 am-5 pm Central Time. Results for commonly ordered tests are typically available within 3 business days after collection at a patient service center. Specialized tests based on LC/MS assay could take 5 to 7 business days to get results.   How to Locate a Lab Near You After receiving and printing your lab requisition form, please take it into any Quest location along with a photo ID.  Quest Diagnostics lab centers are typically open during business hours Mon-Friday,. with some locations open Saturdays. No appointment is necessary, but you can schedule an appointment. Scheduling an appointment may save wait time if the lab is busy. No additional charges will be required. Find a lab near you.   What Lab Tests Require Fasting? Fasting is usually recommended for common tests like glucose and lipid profiles. Some physicians prefer that testosterone testing be done before breakfast since food may temporarily decrease the blood level of testosterone. If you ordered a lipid (cholesterol) panel or a testosterone blood test (and are not currently on testosterone replacement therapy), it is recommended that you fast for at least 8 hours before getting your blood drawn in the morning at the location you choose. The following panels required fasting: 12 hours - CMP (14), Lipid Panels, Renal Function Panel 8 to 10 hours - Insulin, Cardio IQ Advanced Lipid Panel, CBC ( Glucose), GGT 6 to 8 hours - B12, Folate, magnesium, Homocysteine   Stay Hydrated Before Lab Test Hydration is of the utmost importance. Drink extra water for 24 hours prior to your draw, and try refrain from drinking alcohol for 24 hours prior to collection. Dehydration decreases blood volume that could result in higher lab test values.   Best Time of Day to Get Lab Test Done Depending on your current treatment and your doctor's reason for testing, there may be an optimal time of day at which the test should be completed. Be sure to follow your doctor's instructions for your laboratory tests. Having labs taken early morning is recommended for the following tests: ACTH Glucose Plasma PTH Testosterone (if not on TRT)   Taking your Medications Before Lab Tests Take your medications prior to your appointment. However, if you have diabetes and are on oral medications or insulin, check with your doctor whether to take these medications. See below for special instructions for hormone replacement medications.   Important Information for those on Hormone Replacement Therapy and Your Lab Tests If you are on hormone replacement of any type, please be sure to have your labs drawn BEFORE your hormone cream application or hours before your next testosterone injection.   For more information: Fasting Labs and Blood Tests - Everything You Need to Know Testosterone Tests: Should They Be Done After Fasting? Factors that Can Affect the Accuracy of Your Blood Test Results Biotin May Interfere With Hormone Blood Tests   Why DiscountedLabs.com? We Have the Most Affordable Lab Tests Available in the U.S. No Doctor Visit is Required. Our In-House Doctor Provides Prescription at No extra Cost to You. We Serve Several U.S. States. No Hidden Costs. A $8 Lab Draw Fee is Added to Your Order. Our Blood Tests are FDA Approved. We are HIPAA Compliant. We Protect Your Privacy. Your Order Good for 90 Days. You Do Not Have to Rush to the Lab. Over 1,900 Lab Locations Around the United States. No Appointment Needed. Walk-ins Welcomed. Your Blood Test Results are Delivered by Email. We Provide Hormone Testing Via Sensitive Assays. We Have Created Blood Test Panels Applied to Different Needs. Discount Coupons Emailed Periodically. Educational Videos and Articles are Provided in Our Blog Page.