Roge
Heightfidence and faceonality
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Hey guys,
Here is a complete guide to bloodwork, mostly oriented on male health and testosterone.
I’ve broken this down into general categories, to allow you a better idea of how each test is related to the overall whole picture.
• Androgens/Hormone Category:
Testosterone + Free Testosterone: Gives us an idea about your testosterone ‘split’ is: i.e. some men have an adequate supply of TOTAL testosterone, but very low free T levels. Other men may have an average total level, but very high free levels. Given free testosterone is the only bioavailable form able to exert cellular effects across the body, having a higher free T in my opinion is more valuable. If you are in the camp of men who have a high total testosterone, but low free T, the usual culprit is SHBG or albumin. The good news is we have a number of high quality supplements at our disposal to reduce SHBG if it’s binding up all of your valuable testosterone - boron at 3-5mg/day being the easiest, most available and cheapest starting point.
E2 (Estradiol): good to check E2, as men who have higher bodyfat % levels tend to have higher levels of aromatase (the enzyme that converts testosterone into estrogen). E2 also has a strong negative feedback level on the HPT axis, and this is the reason SERMs like clomiphene work well - they block E2 reaching estrogen receptors in the brain, hence the body is ‘tricked’ into thinking testosterone is low, so the brain will bump up LH/FSH signalling, and, in turn, testosterone will increase. If you are getting your blood tested for the first time, have a higher BF level, and E2 is high, this might be a strong reason why your testosterone is low. I’ve seen a lot of guys increase their testosterone level 10-40% just by dropping fat and reducing that negative feedback load on their HPT axis.
LH/FSH: the gonadotropins responsible for testicular activation of the HPT axis. Checking where these are gives us an idea if there are any issues with the hypothalamus or pituitary not releasing enough ‘signalling’. Can also help in the diagnosis of primary/secondary hypogonadism.
SHBG + Albumin: Total testosterone is bound by these 2 proteins, strongly to SHBG and more weakly to albumin. These can be high in men with good total testosterone levels and very low free T levels - i.e. it is all ‘bound’ up, as mentioned above.
Prolactin: gives us an idea about your pituitary gland health: abnormal prolactin levels may be caused by tumours on the pituitary gland. If left untreated, these can cause infertility in women and loss of sexual function in men. In men, high prolactin can cause decreased sex drive, difficulty in getting an erection, breast tenderness or enlargement and in very rare cases breast milk production
Cortisol: plays a role in controlling blood sugar levels, memory and blood pressure (salt/water balance) - good to add in to see that your cortisol is indeed following its usual circadian rhythm.
Vitamin D: bone health, calcium control
ACTH: Adrenocorticotropic hormone (ACTH) is a hormone produced in the anterior, or front, pituitary gland in the brain. The function of ACTH is to regulate levels of the steroid hormone cortisol, which is released from the adrenal gland.
DHEA-S + Pregnenolone: neurosteroids that can be affected by TRT. For some men, this is not an issue at all, other men find supplementing these neurosteroids can be the ‘missing piece’ to TRT and find a lot of cognitive function restoration.
DHT: If you are finding significant hair loss or have a receding hairline on TRT, checking how much DHT is in your blood is a great option. 5-alpha-reductase is the enzyme responsible for converting testosterone to DHT, and DHT is a killer of hair follicles (if you’re genetically predisposed too). For men on topical testosterone, this is of particular import, as the 5AR enzyme is found in high prevalence in skin tissue.
IGF-1/GH: can show any deficiencies in your body’s ability to promote normal bone/tissue growth. Deficiencies here along with low testosterone can be indicative of a central cause of hypogonadism (pituitary gland level).
• Heart Health Category:
C-Reactive Protein: CRP is a blood test marker for inflammation in the body. CRP is produced in the liver and its level is measured by testing the blood. Recent studies have found a link between high levels of CRP and cardiovascular complications (stroke, heart disease, CAD). Ensuring this is low is critical for long-term heart health on TRT (or even naturally).
Cholesterol + Triglycerides + HDL + LDL (sometimes VLDL): *Cholesterol* is the precursor to testosterone production, so can be low if you are on a very low-fat diet (for example in the middle of an aggressive cut). This is why extreme bodybuilding dieting crashes testosterone in most cases. *Triglycerides* are a type of fat in the blood - keeping this within reference range lowers heart disease risk. *HDL* shuttles cholesterol back to the liver, whereas *LDL* delivers it away from the liver and can lead to plaque accumulation in peripheral arteries. Testosterone is known to reduce HDL and raise LDL, and anabolic steroids do this to an even more extreme degree. Checking your HDL levels is probably the most important here, and there are definitely supplements you can take to raise it in the event that it is low - for brevity, will leave that for another post (or the comments if interested). Sometimes, (esp. for guys on heavy cycles) if your LDL is extremely high, it is worth doing a VLDL test to break the LDL value down in subfractions - to identify the subfractions of your LDL value based on the size, density, and/or electrical charge, and give a better idea about your true risk of heart disease and coronary artery atherosclerosis.
Apolipoprotein A1 / B + ratio: Apo B is a primary component of LDL, and this ratio is a very powerful predictor of heart disease risk. This is one of my non-negotiables on any bloodwork from clients.
Homocysteine: Higher than normal levels of homocysteine have also been linked to an increased risk for the development of blood clots, heart attack, and stroke. Good to include this one too.
• Kidney Health Category:
Kidney Function Tests: a lot is covered here, but the most important will be *urea*, *creatinine* and *eGFR*. Making sure your kidney is filtering your blood at healthy levels gives a good indication that they are working well. This is more a concern for guys pushing heavy amounts of nephrotoxic drugs (particularly boldenone/tren) than it is for guys on TRT, but still good to know that your kidneys are healthy. What’s important here too is keeping your blood pressure low - that will reduce stress on your kidneys over time. 120/80 is the gold standard, do everything you can to keep it there on TRT, and if you cannot naturally, don’t feel ashamed to use an ARB or blood pressure medication.
Keeping a healthy BP level will directly add years to your life, and this has been proven in almost all longitudinal studies ever performed.
If eGFR + Creatinine are out of range; Cystatin C: Cystatin C is a protein which is filtered through the kidneys. Increased Cystatin C levels typically indicate that the kidney's glomerular filtration rate is impaired, and is a good indicator of how bad the damage is to your kidneys. Note: this isn’t needed in 99% of men on TRT, and I will usually only recommend this if other kidney values are significantly awry.
• Liver Health:
Liver Function Test (LFTs): Gives a good indication of liver health (AST, ALT, Bilirubin, GGT, Total Protein). Important to see how ‘hard’ your liver is working, and shows any damage (enzymatic or otherwise). Testosterone esters are also cleaved off by the liver, so it is important to check this pathway is properly functioning, especially for all of us on injectable esters.
• Thyroid Health:
TSH/FT3/FT4/Reverse T3: gives us an idea about your thyroid function, and whether you are normal/underactive/overactive. T3 + Reverse T3 are important to check, as T3 is the active form of thyroid hormone in that it influences many body processes, in particular the regulation of metabolism (bodybuilders who have just finished a prep cycle with very low calories…you hear me?)
• Prostate Health:
PSA: measures a protein that is produced by the prostate gland, and can be (although, definitely not always) indicative of prostate cancer.
• General Testing Category:
Full Blood Count: a lot is covered here, but the most important will be looking at your red blood cell morphology/physiology. TRT can increase production of red blood cells, and Haematocrit (Hct) will be vital to check here. Hct is the % of your blood that is made up by red blood cells. Guys pushing 55%+ Hct will be at greater risk of clotting. Keeping your blood thin will be vital for longevity and keeping your heart healthy. Donating blood is always an option if you cannot manage your blood thickness.
Vit B12: General health, DNA health, blood + nerve cell health
Creatine Kinase: for the guys who train hard and are turning over large amounts of muscle, CK is a good value to check (will likely be high) - but good to know how far above range you are.
Iron Studies: Iron is an essential component of haemoglobin, and in some men, TRT can raise iron levels in the blood. Checking this is a way to ensure completeness.
Fasting Glucose + HbA1c: gives a good idea about your insulin sensitivity and risk of diabetes + how well your body is managing its glycemic load (glycemic control).
Zinc: Zinc is an important mineral required for a number of bodily functions involving energy and metabolism. Zinc is necessary for a strong immune system, normal growth, cell reproduction and the healing of wounds.
There you have it guys! If you have any blood tests that you think I missed, feel free to share them below.
Thanks so much!
Here is a complete guide to bloodwork, mostly oriented on male health and testosterone.
I’ve broken this down into general categories, to allow you a better idea of how each test is related to the overall whole picture.
Its one of many many threads that I can release, lmk if you are interested.
Or maybe its dnr + cope + kys so I dont waste my time on them more.
Or maybe its dnr + cope + kys so I dont waste my time on them more.
• Androgens/Hormone Category:
Testosterone + Free Testosterone: Gives us an idea about your testosterone ‘split’ is: i.e. some men have an adequate supply of TOTAL testosterone, but very low free T levels. Other men may have an average total level, but very high free levels. Given free testosterone is the only bioavailable form able to exert cellular effects across the body, having a higher free T in my opinion is more valuable. If you are in the camp of men who have a high total testosterone, but low free T, the usual culprit is SHBG or albumin. The good news is we have a number of high quality supplements at our disposal to reduce SHBG if it’s binding up all of your valuable testosterone - boron at 3-5mg/day being the easiest, most available and cheapest starting point.
E2 (Estradiol): good to check E2, as men who have higher bodyfat % levels tend to have higher levels of aromatase (the enzyme that converts testosterone into estrogen). E2 also has a strong negative feedback level on the HPT axis, and this is the reason SERMs like clomiphene work well - they block E2 reaching estrogen receptors in the brain, hence the body is ‘tricked’ into thinking testosterone is low, so the brain will bump up LH/FSH signalling, and, in turn, testosterone will increase. If you are getting your blood tested for the first time, have a higher BF level, and E2 is high, this might be a strong reason why your testosterone is low. I’ve seen a lot of guys increase their testosterone level 10-40% just by dropping fat and reducing that negative feedback load on their HPT axis.
LH/FSH: the gonadotropins responsible for testicular activation of the HPT axis. Checking where these are gives us an idea if there are any issues with the hypothalamus or pituitary not releasing enough ‘signalling’. Can also help in the diagnosis of primary/secondary hypogonadism.
SHBG + Albumin: Total testosterone is bound by these 2 proteins, strongly to SHBG and more weakly to albumin. These can be high in men with good total testosterone levels and very low free T levels - i.e. it is all ‘bound’ up, as mentioned above.
Prolactin: gives us an idea about your pituitary gland health: abnormal prolactin levels may be caused by tumours on the pituitary gland. If left untreated, these can cause infertility in women and loss of sexual function in men. In men, high prolactin can cause decreased sex drive, difficulty in getting an erection, breast tenderness or enlargement and in very rare cases breast milk production
Cortisol: plays a role in controlling blood sugar levels, memory and blood pressure (salt/water balance) - good to add in to see that your cortisol is indeed following its usual circadian rhythm.
Vitamin D: bone health, calcium control
ACTH: Adrenocorticotropic hormone (ACTH) is a hormone produced in the anterior, or front, pituitary gland in the brain. The function of ACTH is to regulate levels of the steroid hormone cortisol, which is released from the adrenal gland.
DHEA-S + Pregnenolone: neurosteroids that can be affected by TRT. For some men, this is not an issue at all, other men find supplementing these neurosteroids can be the ‘missing piece’ to TRT and find a lot of cognitive function restoration.
DHT: If you are finding significant hair loss or have a receding hairline on TRT, checking how much DHT is in your blood is a great option. 5-alpha-reductase is the enzyme responsible for converting testosterone to DHT, and DHT is a killer of hair follicles (if you’re genetically predisposed too). For men on topical testosterone, this is of particular import, as the 5AR enzyme is found in high prevalence in skin tissue.
IGF-1/GH: can show any deficiencies in your body’s ability to promote normal bone/tissue growth. Deficiencies here along with low testosterone can be indicative of a central cause of hypogonadism (pituitary gland level).
• Heart Health Category:
C-Reactive Protein: CRP is a blood test marker for inflammation in the body. CRP is produced in the liver and its level is measured by testing the blood. Recent studies have found a link between high levels of CRP and cardiovascular complications (stroke, heart disease, CAD). Ensuring this is low is critical for long-term heart health on TRT (or even naturally).
Cholesterol + Triglycerides + HDL + LDL (sometimes VLDL): *Cholesterol* is the precursor to testosterone production, so can be low if you are on a very low-fat diet (for example in the middle of an aggressive cut). This is why extreme bodybuilding dieting crashes testosterone in most cases. *Triglycerides* are a type of fat in the blood - keeping this within reference range lowers heart disease risk. *HDL* shuttles cholesterol back to the liver, whereas *LDL* delivers it away from the liver and can lead to plaque accumulation in peripheral arteries. Testosterone is known to reduce HDL and raise LDL, and anabolic steroids do this to an even more extreme degree. Checking your HDL levels is probably the most important here, and there are definitely supplements you can take to raise it in the event that it is low - for brevity, will leave that for another post (or the comments if interested). Sometimes, (esp. for guys on heavy cycles) if your LDL is extremely high, it is worth doing a VLDL test to break the LDL value down in subfractions - to identify the subfractions of your LDL value based on the size, density, and/or electrical charge, and give a better idea about your true risk of heart disease and coronary artery atherosclerosis.
Apolipoprotein A1 / B + ratio: Apo B is a primary component of LDL, and this ratio is a very powerful predictor of heart disease risk. This is one of my non-negotiables on any bloodwork from clients.
Homocysteine: Higher than normal levels of homocysteine have also been linked to an increased risk for the development of blood clots, heart attack, and stroke. Good to include this one too.
• Kidney Health Category:
Kidney Function Tests: a lot is covered here, but the most important will be *urea*, *creatinine* and *eGFR*. Making sure your kidney is filtering your blood at healthy levels gives a good indication that they are working well. This is more a concern for guys pushing heavy amounts of nephrotoxic drugs (particularly boldenone/tren) than it is for guys on TRT, but still good to know that your kidneys are healthy. What’s important here too is keeping your blood pressure low - that will reduce stress on your kidneys over time. 120/80 is the gold standard, do everything you can to keep it there on TRT, and if you cannot naturally, don’t feel ashamed to use an ARB or blood pressure medication.
Keeping a healthy BP level will directly add years to your life, and this has been proven in almost all longitudinal studies ever performed.
If eGFR + Creatinine are out of range; Cystatin C: Cystatin C is a protein which is filtered through the kidneys. Increased Cystatin C levels typically indicate that the kidney's glomerular filtration rate is impaired, and is a good indicator of how bad the damage is to your kidneys. Note: this isn’t needed in 99% of men on TRT, and I will usually only recommend this if other kidney values are significantly awry.
• Liver Health:
Liver Function Test (LFTs): Gives a good indication of liver health (AST, ALT, Bilirubin, GGT, Total Protein). Important to see how ‘hard’ your liver is working, and shows any damage (enzymatic or otherwise). Testosterone esters are also cleaved off by the liver, so it is important to check this pathway is properly functioning, especially for all of us on injectable esters.
• Thyroid Health:
TSH/FT3/FT4/Reverse T3: gives us an idea about your thyroid function, and whether you are normal/underactive/overactive. T3 + Reverse T3 are important to check, as T3 is the active form of thyroid hormone in that it influences many body processes, in particular the regulation of metabolism (bodybuilders who have just finished a prep cycle with very low calories…you hear me?)
• Prostate Health:
PSA: measures a protein that is produced by the prostate gland, and can be (although, definitely not always) indicative of prostate cancer.
• General Testing Category:
Full Blood Count: a lot is covered here, but the most important will be looking at your red blood cell morphology/physiology. TRT can increase production of red blood cells, and Haematocrit (Hct) will be vital to check here. Hct is the % of your blood that is made up by red blood cells. Guys pushing 55%+ Hct will be at greater risk of clotting. Keeping your blood thin will be vital for longevity and keeping your heart healthy. Donating blood is always an option if you cannot manage your blood thickness.
Vit B12: General health, DNA health, blood + nerve cell health
Creatine Kinase: for the guys who train hard and are turning over large amounts of muscle, CK is a good value to check (will likely be high) - but good to know how far above range you are.
Iron Studies: Iron is an essential component of haemoglobin, and in some men, TRT can raise iron levels in the blood. Checking this is a way to ensure completeness.
Fasting Glucose + HbA1c: gives a good idea about your insulin sensitivity and risk of diabetes + how well your body is managing its glycemic load (glycemic control).
Zinc: Zinc is an important mineral required for a number of bodily functions involving energy and metabolism. Zinc is necessary for a strong immune system, normal growth, cell reproduction and the healing of wounds.
There you have it guys! If you have any blood tests that you think I missed, feel free to share them below.
Thanks so much!
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