Some considerations about interpreting your blood test results in Australia

Some considerations about interpreting your blood test results in Australia.

Back in the Arny days, getting your blood work done before a cycle, on a cycle or after a cycle was only a practice for the select few science nerds mostly. The internet was not around back then and so the sharing of information and communication was far less efficient compared to today. Fast forward to 2018 and social media pages, groups and forums such as the one you’re reading from now are popping up all over the globe on every topic and the corresponding geographical location. Everyone who likes the same thing you do can connect with you among these semi-private online communities. What then happens when you bring together many of the most intelligent, creative and passionate minds on a specific topic? Well, advance within that topic is achieved at a much faster rate than before. Often now, medical papers are funded on the basis of the sheer amount of common experiences shared among these forums. There is now a good chance that if you experience outcome XY with a novel approach and so do another 10,000 others on a forum experience the same outcome XY; if there is ethics for the study to be conducted, it just may happen! We saw that with the Metformin study currently underway for anti-ageing in healthy older individuals. The first ever anti-ageing study conducted on humans; where the sharing of information and anecdote over the internet played a massive role in the decision to fund that study. Wow! It seems that we really can make an impact on the world if there is enough voices shouting about it (in an intelligent and methodical way of course).

So why then, despite all of the information and change around the world, is Australia behind when it comes to medical advance in the field of hormones? Because this discussion (or rant) requires some depth to even briefly outline some of the issues and solutions we face as hormone hobbyists, I have decided to create this text in several parts. The first part will discuss a rather boring but critical topic: blood work and the diagnostic errors in Australia. I’ll get to that in a moment. But first, an explanation of how I endeavour to explain things to you all.

I have mentioned before, but I do my best to write for the layman. A layman can be defined as:

“A person without professional or specialized knowledge in a particular subject.”

That is most of us reading. What good is it me possessing all of this knowledge and then not being able to easily explain that to you all so that you can use it in your everyday life? There is this rigid dichotomy between a patient and a doctor that kind of leaves a patient often thinking:

“Well, the doctor uses big words and so I guess that means he knows what he is talking about. I’ll take his word for it.”

We do not want this happening to the masses. We must always practice professional scepticism where possible. There is another definition. Professional scepticism is when you question information presented to you regardless of the social status or achievements from who distributed that information to you. That most definitely includes questioning your doctor in Australia. Don’t get me wrong, academic achievements matter, but these Dr. and MD titles do not give academics the right to override the data. That includes myself. I keep an open mind and most definitely I do not try and “win” a debate by spraying my academic achievements all over the page like an egomaniacal a-hole. The goal of an intelligent discussion should be to end at the right answer, not to win at all costs. Unfortunately, we are all humans and that includes our Doctors in Australia. Sometimes, the lack of an open mind is present in our physicians. That is not to say we do not have some fine physicians either though.

“So what are we questioning about blood tests in Australia then? I thought it was an easy and affordable process to do with a private service. No doctor required?”

Well, the ease at which we can get blood work done in Australia is fantastic when compared to most parts of the world. Many of these tests are “free” with bulk billed requests from your local doctor too if he/she is willing to provide you with the request form. And even if your doctor is not willing, there are private services that are this simple:

1.) Select which serum markers you would like tested (for example, Total Testosterone is a serum marker).
2.) Pay for the request form via credit card online.
3.) The service will email you a request form.
4.) Go to the corresponding pathology closest to you. Draw the blood.
5.) Within days the private service will email you the results. You can interpret some of those results from one of my previous blogs here.

If you’ve read this far then I know you’re one of the select few who will care about what it is I’ve been meaning to raise this entire text. The issue with blood tests in Australia that is. Blood tests in Australia do not use the LC-MS/MS method (Liquid-chromatography tandem mass-spectrometry) for key hormone panels such as testosterone, DHT and oestrogen. We use the IA (Immunoassay) in Australia as the “gold standard” for testing these hormones but the data is clear in favour of using the LC-MS/MS method only. The IA method has been demonstrated in several study papers to have the potential to show inaccurate results and this is bad for obvious reasons. let’s name a few important reasons:

1.) What if your oestrogen is tested with the IA method and results come back “high oestrogen” when in fact your oestrogen is not high. Then, in an attempt to treat your high E2 (oestrogen) you use arimidex in excess and tank your E2? Not a good time that will be. Several study papers and anecdote make it clear that very low oestrogen is very bad for health and the symptoms can be very severe. PS, for the sake of auto-correct I have begun to spell oestrogen the Australian way, not the way some other nations do [estrogen].

2.) What if you are trying to quantify the legitimacy of your product of testosterone using TT (Total Testosterone) or Free T (Free Testosterone) as your comparative? I urge you all if the hassle is not a concern, to take several blood tests using the same product, same dose, same time of dose and you will see that it is most often that your lab results differ from one to the next. In fact, I have drawn blood on the same day and saw 3 different results from 3 different pathologies too. This matters less when you are using the highest doses of testosterone, because if your product is slightly under or overdosed you will not know, but if you are on TRT (Testosterone Replacement Therapy) then every mg matters. The analogy I like to use here is such that:

“If you were hit by a 50-foot wave of water, then hit by a 60-foot wave, would you feel the 10 foot difference as much as if you were hit by a 1 foot wave, then an 11 foot wave?” The answer is obviously no. From 25 mg to 300 mg weekly, the effects of testosterone act in an exponential fashion both physiologically and clinically [how you feel], but from 300-600 mg of testosterone the effects are not as dramatic. Then after 600 mg, the effects wane even further. So, as we can tell, it is important to have accurate diagnostic methods if we want to know what is going on under the hood. You would not want a false heart health assessment. So why would you feel any different about your testosterone levels?

3.) There is another important hormone panel known as a Thyroid Function Test which usually includes at least TSH, T4 and T3. Almost the same issues as above arise in these tests also. As seen in the literature reviews, using the CMIA instead of LC-MS/MS after UF or ED can have serious clinical implications. An example of which so the layman reading can understand what I mean by “serious clinical implications:”

You walk into a Doctor’s office with unique symptoms indicative of thyroid hormone deficiency or thyroid related disease. Then, if your doctor is willing to test beyond TSH, you may receive T3, T4 and thyroid antibody tests too. You get your blood test, then go back to your doctor when the results are in. If your results come back “within reference ranges” or “within normal ranges” then your Doctor sends you on your merry way and tells you the usual. “Get more rest, sleep better and eat better” (which is actually pretty good advice ironically enough, but that is not the point). Now, if your blood was tested with the LC-MS/MS method and not the CMIA (IA) there is every chance based on the data that you may be in fact sub-clinical hypothyroid or hypothyroid, which means low thyroid. (hypo = low). Anyone who has used oral T3 at high enough doses then stopped it abruptly, will tell you how ****ty it can feel to be hypothyroid. When you take T3 and then stop taking T3, for 2-6 weeks you can be hypothyroid before your thyroid function returns to normal. This is similar to what happens when you take exogenous testosterone (synthetic = exogenous), but with thyroid there is no PCT required and thyroid function returns much easier and faster than testosterone does.

There you have part one of my rant about Australia’s delay in medical advance when it comes to the topic of hormone management. Next time I will discuss the issues with getting a prescription for HRT (Hormone Replacement Therapy) in Australia. It is a doozy and one that I feel must be discussed here because of the sheer number of customers in the underground market that are seeking illegal options for their HRT. They simply cannot get prescribed, or prescribed without massive inconvenience. Fear not, for I have come to offer assistance on how best to manage your own hormones so you can live life to the fullest.