Any Endocrinologists about?

[944fan]

Sorry long post but will put the question first:

Does the normal range for testosterone in a blood test take into account the size of the person? Mine is bordline low, its either very slightly in the range or very slightly out. However I have had a number of symptoms related to low testosterone. NHS seem to only want to look at the numbers. I am 6'5'' and broad. Should I therefore be expected to have a higher than normal level if everything was normal? i.e. do I need more T because I am bigger?

I am seeing an endrocynologist at the min but I have been sent way for 6 weeks and told to stop the testogel so they can do a baseline blood test and get a true picture of what is going on. Since stopping the gel I have started to feel st again and the symptoms that had been improved (not completely got rid of) by taking the gel have returned.

I want to be armed with all the info when I go back as I am worried the next test will show me slightly in the range again and they will tell me to bugger off.

Taking the T has improved my symptoms by a lot and so far I have had zero side effects. I appreciate that taking T for life is not something they will take lightly but I cannot spend the rest of my life feeling like this.

[popeyewhite]

944fan said:

Does the normal range for testosterone in a blood test take into account the size of the person?

A serum testosterone test is measured in nanograms per decilitre.

[944fan]

popeyewhite said:

944fan said:

Does the normal range for testosterone in a blood test take into account the size of the person?

A serum testosterone test is measured in nanograms per decilitre.

But the person testing wont know my size? What I mean is should a dr look at the result and say ok its on the low end of the range but because you are large you should be higher?

Like for example a while ago I was giving a prescription for something else and the Dr said I will prescribe you the maximum dose because of your size.

[Prof Prolapse]

944fan said:

But the person testing wont know my size? What I mean is should a dr look at the result and say ok its on the low end of the range but because you are large you should be higher?

Like for example a while ago I was giving a prescription for something else and the Dr said I will prescribe you the maximum dose because of your size.

I had held off replying through risk I misunderstood but I think I know what you mean. I'm not a medic however.

The results we get from the hospital laboratories have reference ranges. Broadly speaking these ranges are designed to approximate healthy people of all shapes, sizes and ethnicities. A primary function is to flag results which fall out with this range for review. It is this review that is critical, as it takes into account all other factors such as your health, size, concomitant medications etc. which may account for you falling out of the norm without it being "clinically significant". It's rare an out of range result is use to diagnose in itself. Just to caveat however, I don't do much endocrinology so perhaps that is how it's done for that specialism.

Medication dose is an entirely different matter. Your size may be a factor, or it may be one dose fits all. We have drugs that body surface area is more relevant, or ethnicity, sex, and age etc. We here in the drug companies provide the guidance for this based on our data. Your doctor can deviate based on their expertise, but it varies.

Where medicines require a serum level in a range, the dose is often prescribed based on this being mindful of side effects and toxicities, rather than your body weight. Again though, I only base this on my work in unrelated areas. Your doctor will be much more insightful.

Edited by Prof Prolapse on Friday 29th July 12:36

[popeyewhite]

Prof Prolapse said:

The results we get from the hospital laboratories have reference ranges.

This. Body size generally make little difference to the results of the test unless you are a very big bloke/woman...and at 6'5" that possibly qualifies. I'd raise the point with your Doc, but in reality an appointment with a specialist might be in order. Perhaps you could ask for a referral?

ETA just reread your post and noticed you're already with an endo chap, I really should wear my glasses!

Edited by popeyewhite on Friday 29th July 17:04

[FlyingMeeces]

Amount of T per decilitre is a measurement per, effectively, unit of blood in your body. As - natch - your blood volume relates really very directly to your weight, height, body volume, it should be reasonably accurate and effectively take into account your size, but as someone else said, it's all ranges and averages and people who are significantly above or below the average person size are much more likely to find that the average ranges used don't reflect how their body works terribly well.

It's definitely sensible for them to do a careful check for other causes of issues before embarking on what sounds likely to be very long-term treatment; I'm hoping to start on it soon - different set of issues entirely at play - and similarly that'll be it for good, more accurately, until late middle age at least.

[drmark]

Size does not alter accuracy of reading, but time of day does. Ideally do test at 9am for consistent comparison with normal range.

Weight matters though if level low, as excess fat exacerbates problem (alters osteogen/testosterone balance in favour of former)

[mph1977]

944fan said:

popeyewhite said:

944fan said:

Does the normal range for testosterone in a blood test take into account the size of the person?

A serum testosterone test is measured in nanograms per decilitre.

But the person testing wont know my size? What I mean is should a dr look at the result and say ok its on the low end of the range but because you are large you should be higher?

Like for example a while ago I was giving a prescription for something else and the Dr said I will prescribe you the maximum dose because of your size.

A serum testosterone test is measured in nanograms per decilitre.

if you do not understand this i don't think you should be asking for dose adjustments, blood results are given is volume or mass / volume or a fraction/ percentage

[dave_s13]

He's not asking for a dose adjustment. He's asking if his size has a bearing on how they view his results and how this may influence treatment.

It's a perfectly valid question for someone that doesn't understand the intricacies of serum test results.

[mph1977]

dave_s13 said:

He's not asking for a dose adjustment. He's asking if his size has a bearing on how they view his results and how this may influence treatment.

It's a perfectly valid question for someone that doesn't understand the intricacies of serum test results.

we are talking about GCSE level science / maths topics here .

[944fan]

mph1977 said:

dave_s13 said:

He's not asking for a dose adjustment. He's asking if his size has a bearing on how they view his results and how this may influence treatment.

It's a perfectly valid question for someone that doesn't understand the intricacies of serum test results.

we are talking about GCSE level science / maths topics here .

No we are not. My question is not about the test but as dave says about how the result is viewed in light of my size. For example, lets say my result is 10.4 (I can't remember the exact result) and I am 6'5'' should that be viewed in the same way as a man who is 5'8'' with the same result? Does my body need more T to function normally.

I have had two tests outside the range and one 0.2 in it. The first Dr I saw seemed to jump on the result that was in a everything is normal go away, despite there being a history of chronic symptoms possibly related to having low T.

I don't know the intricacies of the tests but I do know how I feel. I have had two periods on the T replacement and two off this year and I have certainly felt a lot better when taking it. I just want to try and understand how the Dr will view the results as I don't want to be fobbed off again with one slightly in the range result.

[dave_s13]

You just need to relay this clearly to the consultant, make sure they know you have symptoms despite a seemingly in range result and see what they say.

Doctors can tend to treat the data rather than the patient sometimes, which is understandable given they have a lot going on.

[drmark]

mph1977 said:

A serum testosterone test is measured in nanograms per decilitre.

if you do not understand this i don't think you should be asking for dose adjustments, blood results are given is volume or mass / volume or a fraction/ percentage

Actually, irrespective of units used, size does have a bearing on interpretation of some physiological readings, eg kidney function (eGFR) albeit not reflected in reference ranges. Age too - eg blood sugars and diabetes. So doctors will adjust what is normal and what is not depending on who is sitting in front of them.

But size not a factor in this particular respect.

Edited by drmark on Saturday 30th July 10:00

[944fan]

Thanks dave and drmark. The consultant is aware but I am going to make it clear that since stopping again I have felt worse.

Annoyingly I have to wait till October for another appointment. Not sure why they need 6 weeks between having the blood taken and the next appointment but never mind. I am going to try and phone the consultant and see if I can star the medication again before the next appointment.

[drmark]

944fan said:

Thanks dave and drmark. The consultant is aware but I am going to make it clear that since stopping again I have felt worse.

Annoyingly I have to wait till October for another appointment. Not sure why they need 6 weeks between having the blood taken and the next appointment but never mind. I am going to try and phone the consultant and see if I can star the medication again before the next appointment.

Most men feel better on a bit of testosterone (and other steroids too) but that is not the same as proving they need it, or that benefits are likely to outweigh risks (small but there).

[mph1977]

drmark said:

Most men feel better on a bit of testosterone (and other steroids too) but that is not the same as proving they need it, or that benefits are likely to outweigh risks (small but there).

i also suspect most men who have issues with a functional overlay over their percieved 'lack of manliness' would feel better on a placebo if blinded from the exact numbers ...

[dave_s13]

The elephant in room needs to be addressed too. Are you unfit, overweight etc etc. If yes then you'll likely feel shoite after a certain age,

We aren't really designed to live much past 30.....any good days after that should be treated as a bonus really.

[944fan]

dave_s13 said:

The elephant in room needs to be addressed too. Are you unfit, overweight etc etc. If yes then you'll likely feel shoite after a certain age,

We aren't really designed to live much past 30.....any good days after that should be treated as a bonus really.

I am fit as fiddle, exercise 6 days a week. Did a half ironman 4 weeks ago. A little overweight but have brought it down recently. My BMI is 26 now so yes need to lose a bit more but as I said I am broad as well so its not like I have a massive gut. I have also had symptoms as per below my entire adult life including when I was mid twenties and weighed 13.5 stone.

I am 36.

Its a lot more than just feeling a bit crap.

The main symptoms are to do with stress handling and specifically anxiety which I have suffered with for years. I also have problems, ahem, getting the little General to stand to attention. Both of these problems have been far less serve whilst I have been taking the T. Especially the anxiety. The other thing can be taken care of with a little blue pill, the anxiety feelings I was never able to shake. I have seen specialist for the cock thing, and tried SSRIs and counselling for the anxiety.

So far only the T has given me a significant improvement and whilst I understand there are potential risks with long term use, thus far I have 0 side effects. Not like the SSRIS which did nothing and were utter horrific to get on and off.