Blood Work - end of 2024 edition

[jcross485]

I posted my blood work last year sometime and there was a bit of discussion but the thread is locked so figured I would post here again for anyone interested in this stuff.

Blood work taken on 12/13; all results finally back today.

Since the last time I had comprehensive blood work just over a year ago, I've been able to improve lipids, maintain or slightly improve glucose / A1C / fasting insulin. Thyroid markers have dropped just a tad. Hemoglobin and hemocrit down a bit as well but I went from being at sea level for about 2 1/2 months to back home at 850m just a few days before the test, I am guessing being home will help bring those numbers back up with time.

The big concern I have is the hormonal numbers.

Last time I only had testosterone, estradiol, and DHEA tested.

Total testosterone dropped from 281 to 208, estradiol dropped from 15.5 to 8, and DHEA increased slightly from 147 to 170.

I was able to get much more thorough blood work this time around though; free testosterone is low, IGF-1 levels on the lower end based on standard deviations. I know numbers are just that and its important to look at how someone is feeling as well; let's just say I'm not terribly surprised with some of the results.

I have an appt next week with my PCP to review in more depth.

Marker Range Test

Testosterone (Total) 250 - 1000 208
Estradiol <= 29 8
DHEA-Sulfate 95 - 415 170

Free Testosterone 46.0 - 224.0 32.4
SHBG 10 - 50 24
Cortisol 2.0 - 22.0 12.3
FSH 1.4 - 12.8 5.7
IGF-1 53 - 331 93
IGF-1 -2.0 - +2.0 SD -0.9
LH 1.5 - 9.3 4.3
Progesterone < 1.4 < .5
Prolactin 2.0 - 18.0 5
PSA <= 4.0 0.27

TSH .4 - 4.5 2.11
T4 Free, Direct .8 - 1.8 1.1

Fasting Insulin < = 18.4 3.2
Glucose 65-99 90
Hemo A1C < 5.7 5.3

Cholesterol (Total) < 200 210
HDL > = 40 61
LDL < = 150 149
Triglycerides < = 150 42

BUN 7-25 26
A/G Ratio 1.0-2.5 2.6
Albumin 3.6-5.1 4.9
Alkaline Phosphatase 36-130 24
ALT 9-46 36
AST 10-40 38
Bilirubin .2-1.2 0.3
BUN / Creatinine 6-22 25
Calcium 8.6-10.3 10.1
Carbon Dioxide 20-32 28
Chloride 98-110 103
Creatinine .6-1.26 1.03
eGFR >60 95
Ferritin 38 - 380 186
Folates > 5.4 >24.0
Globulin 1.9-3.7 1.9
Iron, Serum 50 - 180 112
Potassium 3.5 - 5.3 4.5
Protein 6.1-8.1 6.8
Sodium 135-146 139
Vitamin B12 200 - 1100 1023
Vitamin D, 25-Hydroxy 30.0 - 100 41

BASO (Absolute) 0-200 40
BASOS NA 0.9
EOS NA 1.6
EOS (Absolute) 15-500 70
Hemocrit 38.5-50 40.8
Hemoglobin 13.2-17.1 13.6
Lymphs NA 42.3
Lymphs (Absolute) 850-3900 1861
MCH 27-33 28.9
MCHC 32-36 33.3
MCV 80-100 86.8
Monocytes NA 11.1
Monocytes (Absolute) 200-950 488
Neutrophils NA 44.1
Neutrophils (Absolute) 1500-7800 1940
Platelets 140-400 224
RDW 11.0-15.0 12.7
RBC 4.2-5.8 4.7
WBC 3.8-10.8 4.4
MPV 7.5-12.5 10.2

***Apologies for the format; I tried to format it so it was readable but it came out quite messy. The way it reads is the marker, the range, then what I tested at.***

[Dangerscouse]

I never realised that there was so much info in a blood sample.

Can you dumb it all down, and confirm if there's anything of concern and things that can't change over time?

[gvcormac]

That's a lot of tests. Am I correct in reading that you have LDL 149 mg/dl? That's high. Do you take statins?

Also, don't see ApoB. Recommend that.

[jcross485]

I never realised that there was so much info in a blood sample.

Can you dumb it all down, and confirm if there's anything of concern and things that can't change over time?

It really depends on what you want checked. I got the standard panels that are normally ordered, some pretty in depth hormone panels, extra tests for A1C and fasting insulin as I have a familial history of diabetes, and a couple of thyroid markers.

Right now, I wouldn't say I have concerns with things that can't be changed.

I am surprised that my fasting glucose and A1C aren't a bit lower as I tend to eat a low carb diet; I might try an over the counter supplement to see if that does anything but the numbers are still well within normal.

I do have some other concerns but it's all stuff that can be addressed in one form or another. I don't know that I would want to go the route of addressing some of them, depending on the course of action needed, as it could be a lifelong commitment, but given the way some things have changed over the last year and how I'm feeling, it's certainly a thought. My LDL is a bit elevated but with a pretty low carb, higher fat diet, good HDL numbers, low triglycerides, a healthy weight, healthy blood pressure, I don't know that an LDL being a bit up is overly concerning at this time.

That's a lot of tests. Am I correct in reading that you have LDL 149 mg/dl? That's high. Do you take statins?

Also, don't see ApoB. Recommend that.

Yes, LDL is up there a bit. I do not take statins; I am not staunchly anti-statin as they have a decent safety profile but they are not without risk either. With some of the other numbers though (HDL, trigs) and the way I eat, I was not terribly concerned with it being up. I'm interested to see what my PCP says next week.

I did not get ApoB tested. Outside of my father being terribly unhealthy with a whole host of issues before he passed last year, I don't have a familial history of heart related conditions. It's probably something worth looking into though for sure!

[Tsnor]

"...probably one of the biggest mistake that I see amateur cyclists make is just training all year long as if the next race is constantly right around the corner. Stop doing that and take a break. There is actually a physiological purpose for taking a break. There is research to show that an offseason break can allow certain hormones to reset that may have gotten out of whack during the season like testosterone for example which can be suppressed after a stressful season. The same can be said for certain blood markers" https://youtu.be/rrcvXdrZtuA?si=xEnJsha19XdDRiHq&t=235 - link starts about 3:50 in.

Your blood work can also be messed up by short term exercise and fasting. If you are trying to make your LDL look as good as possible then fast for exactly 12 hours, longer or shorter gives a higher number. Don't exercise in the 24 hours leading up to the blood test.

For many diet composition (rather than total calories) is key to lowing LDL.

[jcross485]

"...probably one of the biggest mistake that I see amateur cyclists make is just training all year long as if the next race is constantly right around the corner. Stop doing that and take a break. There is actually a physiological purpose for taking a break. There is research to show that an offseason break can allow certain hormones to reset that may have gotten out of whack during the season like testosterone for example which can be suppressed after a stressful season. The same can be said for certain blood markers" https://youtu.be/rrcvXdrZtuA?si=xEnJsha19XdDRiHq&t=235 - link starts about 3:50 in.

Your blood work can also be messed up by short term exercise and fasting. If you are trying to make your LDL look as good as possible then fast for exactly 12 hours, longer or shorter gives a higher number. Don't exercise in the 24 hours leading up to the blood test.

For many diet composition (rather than total calories) is key to lowing LDL.

Even though I'm not a cyclist, he's got a great channel.

He's definitely got some points re. blood work. I am going to have to dig more into some of the studies he was referencing as it would be interesting to see what type of amateur cyclists he is referring to with respect to actual performance, training volume, etc. He mentions he got back into training after a break with 9-15 hours a week of low intensity; I was training about 8-10 hours a week with a mix of intensity for about 2 months or so prior to blood work, about 3-4 hours in the week leading up to the blood taken on a Friday. His intensity is likely substantially lower than mine but the volume was higher.

I was fasted during the blood work, about 16 hours or so from the last caloric consumption. I did train once in the ~48 hours before blood was taken (~24 hours prior) but it was pretty much an aerobic only session that was just under an hour in length so nothing too serious.

My hormone levels for the most part were what I was most concerned about with this test. Levels have been consistently dropping, which I presume is going to be the case as I am not getting younger, but I was a bit surprised with just how low they've gotten. I would think if it was correlated with training though, I would see elevation in other markers like kidney / liver markers or even cortisol.

[Tsnor]

I am going to have to dig more into some of the studies he was referencing as it would be interesting to see what type of amateur cyclists he is referring to with respect to actual performance, training volume, etc.

Not as clear cut as I thought. Read this study (runners this time), which seemed to support the endurance athlete --> suppressed testosterone thesis then focus on "However, in a recent review suggesting that running mileage alone is not enough to predict the low T concentrations [52], it was proposed that the alterations in the endocrine–reproductive hormonal system observed in endurance runners are related to the development of low energy availability " Says they weren't getting enough food which triggered the low testosterone. " it is difficult to consume the energy required by athletes who perform chronic strenuous exercise, resulting in an energy deficit that causes alterations in the hypothalamic- pituitary- gonadal axis." https://pmc.ncbi.nlm.nih.gov/articles/P ... ailability. Or the correlation could be training season vs seasonal daylight hour changes, read near "sun exposure and solar irradiance in the vitamin D and T concentrations in professional soccer players during two sports seasons, also, significant correlations between vitamin D and T were reported."

FWIW looking for endurance related studies I had to skip around a million studies that said strength training raises testosterone at least short term.

[gvcormac]

Yes, LDL is up there a bit. I do not take statins; I am not staunchly anti-statin as they have a decent safety profile but they are not without risk either. With some of the other numbers though (HDL, trigs) and the way I eat, I was not terribly concerned with it being up. I'm interested to see what my PCP says next week.

I did not get ApoB tested. Outside of my father being terribly unhealthy with a whole host of issues before he passed last year, I don't have a familial history of heart related conditions. It's probably something worth looking into though for sure!

149 is more than "a bit" and there's no evidence that high HDL or low trig is prophylactic. I suggest you should eschew all these other tests and consult a lipidologist.

[jcross485]

Not as clear cut as I thought. Read this study (runners this time), which seemed to support the endurance athlete --> suppressed testosterone thesis then focus on "However, in a recent review suggesting that running mileage alone is not enough to predict the low T concentrations [52], it was proposed that the alterations in the endocrine–reproductive hormonal system observed in endurance runners are related to the development of low energy availability " Says they weren't getting enough food which triggered the low testosterone. " it is difficult to consume the energy required by athletes who perform chronic strenuous exercise, resulting in an energy deficit that causes alterations in the hypothalamic- pituitary- gonadal axis." https://pmc.ncbi.nlm.nih.gov/articles/P ... ailability. Or the correlation could be training season vs seasonal daylight hour changes, read near "sun exposure and solar irradiance in the vitamin D and T concentrations in professional soccer players during two sports seasons, also, significant correlations between vitamin D and T were reported."

FWIW looking for endurance related studies I had to skip around a million studies that said strength training raises testosterone at least short term.

Interesting findings for sure! I will likely dig into more of the literature when I get a bit of a breath from work.

149 is more than "a bit" and there's no evidence that high HDL or low trig is prophylactic. I suggest you should eschew all these other tests and consult a lipidologist.

Would you say then that LDL then is more indicative of issues than any of the other markers taken?

What are your thoughts on the lean mass hyper-responder phenomen?

[gvcormac]

Would you say then that LDL then is more indicative of issues than any of the other markers taken?

What are your thoughts on the lean mass hyper-responder phenomen?

Yes. At least most of them. A1C and fasting glucose are informative, as are some of the kidney/liver tests. And ApoB is better than LDL-C. And if you don't have ApoB, then use non-HDL cholesterol; i.e. Total Cholesterol minus HDL-C. Also, everybody (particularly with family history) should get an LP(a) "lp little-a" test once in their lives.

Nick Norwitz is a smart but smarmy YouTuber who provides special pleading fodder for those who want to go against the scientific consensus. He always couches his comments with the equivalent of "just askin'" but what he is really doing is promoting false beliefs.

He is very careful to state that your chance of being what he defined as a LMHR is smaller than the chance of being hit by lightening, and even if you are, that there's no proof they are exempt from atherogenic factors. But he knows full well that his followers will glom onto the faint hope that they don't have to worry about their astronomical LDL-C levels.

[jcross485]

Yes. At least most of them. A1C and fasting glucose are informative, as are some of the kidney/liver tests. And ApoB is better than LDL-C. And if you don't have ApoB, then use non-HDL cholesterol; i.e. Total Cholesterol minus HDL-C. Also, everybody (particularly with family history) should get an LP(a) "lp little-a" test once in their lives.

Nick Norwitz is a smart but smarmy YouTuber who provides special pleading fodder for those who want to go against the scientific consensus. He always couches his comments with the equivalent of "just askin'" but what he is really doing is promoting false beliefs.

He is very careful to state that your chance of being what he defined as a LMHR is smaller than the chance of being hit by lightening, and even if you are, that there's no proof they are exempt from atherogenic factors. But he knows full well that his followers will glom onto the faint hope that they don't have to worry about their astronomical LDL-C levels.

I'm definitely going to be getting ApoB and LP(a) tested with my next round of blood work in mid 2025. That said, I generally am not one to look at one marker as the be all / end all, rather I tend to look at the whole picture. My personal background in biostatistics and epidemiology ends up being both a blessing and a curse when it comes to digging into the literature around common markers.

I don't know that I would call my LDL-C numbers astronomical at this point but elevated beyond where I would like to see it ideally. That said, everything else seems to be in a good place with respect to lipids and some other important markers, hence why I didn't have alarm bells going off in my head.

[Dave Neve]

<<Total testosterone dropped from 281 to 208, estradiol dropped from 15.5 to 8, and DHEA increased slightly from 147 to 170.>>

At my age, I prefer not to know how much my testosterone levels have dropped. It would just depress me

On the other hand, as you mentioned it specifically, did you give your age somewhere? The biggest drop in general due to age seems to be around your early to mid-fifties, but other factors can affect testosterone too besides age of course

[jcross485]

<<Total testosterone dropped from 281 to 208, estradiol dropped from 15.5 to 8, and DHEA increased slightly from 147 to 170.>>

At my age, I prefer not to know how much my testosterone levels have dropped. It would just depress me

On the other hand, as you mentioned it specifically, did you give your age somewhere? The biggest drop in general due to age seems to be around your early to mid-fifties, but other factors can affect testosterone too besides age of course

I am 39, will turn 40 in April. My concern with the numbers wasn't the number per se but just overall how I've been feeling even though I'm still able to train and make some progress. That said, the numbers came back quite low (IMO) and arguably not ideal / optimal given my age.