Show notes
See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog/ Dr Sullivan and I spend much of our visits with our patients explaining the meaning of each lab test that we order for our patients. We explain what a lab test is meant to evaluate, which lab tests measure their general health or their hormone status or tell us whether they may have side effects from hormone therapy. After our patients go through their lab test results, they realize that self-interpretation is literally impossible. We must also explain why we write in different reference ranges from those of the lab. This blog is meant to help you and our patients understand the problem with the current reference ranges printed on lab tests. Choice Of Laboratory Companies Is Vital to Getting an Accurate Result! Lab tests are vital to our treatment of hormone deficiencies and our practice of preventive medicine; however, we always balance our results with our patients’ symptoms when we decide on a treatment plan. We preferentially order tests from Quest labs, but we also receive results from Labcorp, private hospitals and doctor’s offices. We prefer Quest labs because they are the most accurate in terms of reporting reproducible results, which indicates accuracy. Another competing lab continually change the test we order to another test that is always inaccurate. I have talked to LabCorp’s medical director about this, and he said that the fact that they change the test I order is a problem, but the fact that the results that I get from one Free Testosterone level is drastically different from the other test they offer by a power of 10 did not bother him. His only defense was that the Endocrinologists think this is ok, so I should think its ok. Well Truth is truth and that is an excuse like the dog ate my homework. In addition, LabCorp is currently giving us “wrong” results on the test for Estrone that we must repeat by Quest just to get an accurate, reproducible blood level that matches the symptoms of our patients! We want our patients to have their lab paid for by their insurance company to save them additional out of pocket expense, so we choose Quest because they have drawing offices all over the country and because they have contracts with all US insurance companies. Quest has also given us a patient discount for patients to self-pay that is many times lower than what they would pay to the lab itself. This is usually for patients who don’t have insurance or who have high deductibles, but anyone can take advantage of it if they don’t want to use their insurance. Importance Of Lab Results and Reference Ranges Determines Whether a Patient Is Treated! Once we get lab results and medical history, we decide whether we can help a patient with hormone replacement. If we have inaccurate results OR inaccurate reference ranges, we can’t determine the true health of a patient. So, what is wrong with the reference ranges on current labs. Tests that don’t account for the gender of the patient, even though there are gender differences found in recent research (e.g. Lipid panel, Thyroid panel), the labs don’t differentiate. Tests that don’t adjust for whether a patient is taking a medication or not. Eg Thyroid panel normal are different ranges for patients who are on thyroid replacement. Gender specific tests that assume that a female patient is cycling monthly even if they are menopausal. Cycling women have a lower Hemoglobin and Hematocrit because they lose blood with periods every month and the “normal” for women is based on cycling, bleeding women. The lab uses this “normal” for menopausal women, women on the pill, and women who have had a hysterectomy too! In these three cases, H/H levels are the same as the level of Hemoglobin, Hematocrit, and ferritin as men! The CBC should be adjusted for the menstrual status of a woman. Some blood tests should be drawn when a patient is fasting, but reference ranges are not changed for non-fasting patients. The lab company has the fasting status written at the top of the page and should adjust for that factor. Not using scientific methods of developing a “healthy” blood level: Reference Ranges for thyroid are changed yearly based on the thyroid tests the lab did in the last 12 months of tests. This is not scientific. I have watched the lab tests change yearly for over a decade. I have only recently discovered that the “new” blood levels are obtained from testing the “sick and old population” that comes into the lab for other reasons and get their thyroid tested too. The proper way to develop a scientific healthy range (reference range) for a blood test in general and specifically for thyroid is to test young, healthy people of the same sex who have no symptoms of low or high thyroid disease. The ranges they are using are leading to the misdiagnosis of thousands of women. Doctors have not changed their testing protocols with new technology. Lab methods have improved, and the results are more accurate, so the reason endocrinologists and PCPs only test TSH levels instead of free T3 and free T4 plus the TSH, has disappeared. Most doctors test only TSH levels like they did in medical school decades ago. Test result that are average for an older menopausal woman is the basis of the reference range instead of comparing all women to young healthy ranges. This is an example of gender bias. When men’s FSH and LH are outside the normal youthful range, they are considered abnormal! Female FSH and LH levels go up when a woman is deficient in estrogen (menopausal), and symptomatic with hot flashes, anxiety, and sweats. LH and FSH are considered normal when they are very high, even though women are miserable and symptomatic. Reference ranges should indicate young healthy levels when a woman is not symptomatic. There are so many inaccuracies and adjustments that must be accounted for when a doctor interprets blood tests by just looking down the column of “out of range” results, we must use artificial intelligence to take into account age and compared to young healthy, sex, fasting status, medication status and develop young healthy blood levels for women as the healthy range we are looking for. indicates lack of symptoms and disease. If total cholesterol, is representative of a dangerous score when it is over 200, then it should not be obtained by adding the good cholesterol plus the bad cholesterol. Total cholesterol is not equal to risk for heart disease. 50% of men and women with elevated total cholesterol have zero cardiac calcium scores, and 50% of both sexes who have normal cholesterol numbers have high plaque numbers. I disregard the total cholesterol in women, and only look at the LDL level. CBC and Ferritin: The gender differences that are adjusted for in the CBC, Hemoglobin and HCT, is misleading for postmenopausal women, and is not corrected for the fact that non menstruating women have the same H/H ref and Ferritin range as men.