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Optimal Blood Test Reference Range Charts

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Blood testing is a cornerstone component of any anti-aging program. However, there are several problems with the standard lab references listed on the blood test results you and/or your doctor will receive from any lab.

The labs base their reference ranges on the results of all the blood samples each particular lab has tested. The "normal" range reflects the test results of "healthy" subjects meaning anyone who did not have a clinical diagnosis of a disease at the time of the test. Unfortunately, there are many "healthy" individuals who are not in optimal health or are headed toward disease but have not reached the extremes that allow diagnosis yet. The U.S. medical culture is focused on diagnosing and treating disease, not on promoting and preserving optimal health.

For anti-aging purposes, there is an additional problem with these "standard" reference ranges because they are based on the "normal" lab results for the age of the subject. Many "normal" changes in hormone and other levels are common as we age and cause many of the symptoms of aging if not some facets of aging itself. I'm 64 years old and without intervention, my testosterone levels are normal for a 64-year-old but I function and feel better with the testosterone level of a 25 to 30 year-old. In addition, the higher level of testosterone helps protect me from heart disease, cancer, and other problems.

Not only are the standard reference ranges different from the optimal ranges, they do not take into account the relationships between different hormones and other factors. So when your doctor scans your blood tests for the typical "H" or "L" flags indicating measurements outside the "normal" range and ignores other less obvious implications, you are being done a disservice that can have dire health consequences for you.

Of course, research is ongoing so these references are subject to continuing update but these are the numbers I currently use with my clients, friends, family and myself.

Note: There is a link on page 1 for a calculator for rT3 ratios that may be difficult to read and is not active. For those reasons, I include it here: http://www.stopthethyroidmadness.com/rt3-ratio/

Charts Last Updated 6/21/13

bamacat22's picture

Dr. Ken Knott's book- Dangerous medicine, " what your doctor don't know can hurt you " is an excellent and informative read. He is an anti-aging doc out of Atlanta, GA. He talks about this and its importance for both men and women. Please let me know what you think.

pathtaker's picture

Update: Making headway on Hertoghe's Hormone Manual and working on a modified version of the above reference ranges based on his recommendations. Just this last week I FINALY found a local doc who knows what she is doing and will be working with her and my local clients. I found her by sending a shotgun email to all of the docs listed on the A4M (American Academy of Anti-Aging Medicine) website for my area. I didn't mince any words - I said I was looking for a doc who understood that TSH (Thyroid Stimulating Hormone) is NOT a good indicator of thyroid status and who understood that synthetic T4 only (Synthroid) is NOT the treatment of choice for a hypothyroid state. I realistically didn't expect any response BUT I got a call the next morning! She said "We need to talk!" After spending nearly an hour with her in her clinic, it was clear that we were on the same page. She is interested in Hertoghe's approach and is purchasing his Hormone Manual so we can discuss his ideas. Stay tuned...! Smile

klon's picture

One more quick point.

When creating the updated reference ranges, keep in mind that what he indicates are typically for a sedentary individual at a specific weight. Activity, weight, diet, medical conditions, environmental factors, medicines, other hormone deficiencies will modify the reference range.

The optimal dose is reached when there are physical and mental complaints associated with the deficiency.

klon's picture

Pathtaker, I haven't checked in for a while.

This is outstanding. Purchasing Hertoghe's book will place on a new plateau in terms of your understanding. This is why I like this site so much. We can exchange information, learn from one another and hopefully be the driving force to provide the proper educational materials in the hands of our physicians.
If she hasn't purchased the book yet, licensed docs can get a copy at wholesale pricing from University Compounding.

Carefully examine estradiol and progesterone replacement. Understanding how these hormones work in women will provide new light on male replacement therapy. It's far more complicated dealing with their issues because of the constantly changing levels throughout their cycle. It makes out stuff seem elementary.

Also look carefully at Cortisol. This is a critically important hormone that has major impacts on our health. We DON'T want to minimize cortisol. There is an optimal range that must be maintained for many reasons.

Finally look at Increlex. I plan on adding this therapy as soon as its available. The manufacturer has had a production problem and there is a world wide shortage until at least 2014. In terms of age management - this medicine has huge potential. If you choose to discuss this here, please be judicious in your comments. It has many of the same risks as Insulin - specifically hypoglycemia. An overdose by an uninformed user could easily be fatal.

pathtaker's picture

I must really love you guys... Just plunked down $410 for Hertoghe's Hormone Manual. It should be here on Thursday. At more than 850 pages, it may take me a while to soak this one up! Will keep you posted.

snuka2012's picture

Thx...trying to keep up with your updates. +1

pathtaker's picture

Thanks, snuka - Me too! ;-)

Gorillafit's picture

Thanks for all the information you share! +2

pathtaker's picture

Thanks, my pleasure to help any way I can.

pathtaker's picture

@ klon

Hey klon - I'm still researching the ideas you put forth below but am far enough along that I have updated the reference ranges in the charts. I've found several references to back up my edits but would really like to find a copy of Hertoghe's manual. So far I've located a library copy in Germany (in German of course) but it looks like purchasing is going to be my only option.

I agree that clinical observation should be the foundation for Testosterone dosage adjustment but want to be able to provide reference ranges as a back-up tool for my clients.

Thanks again for all your valuable input to this group... That is what makes eroids an exceptional asset for us all.

klon's picture

Pathtaker: You have done a great job in compiling this information. The only thing that jumped out when I quickly reviewed the data is free test. The optimal range is for a 155 pound, sedentary male is 250-350 pg/ml. More importantly though is that free testosterone has low value in assessing endocrine function.
1. it's unstable in serum;
2. it fluctuates dramatically throughout the day; and
3. the reference range for young, healthy men is exceedingly low compared to actual levels.

It's far better to use Total T, SHBG and Androstanediol Glucoronide (AG). AG is the first major metabolite of DHT and is produced only after testosterone has acted.

What is the etiology of the ratios?

pathtaker's picture

Hey klon, Thanks for the comments and question.

Interesting points and approach.

There seems to be continuing debate on whether to use free T or Total T but most of the anti-aging references I'm familiar with are using the Free T. To get around the daily fluctuations, I recommend testing at 8:00 a.m. or close to it. Most of the docs who have a long history in BHRT that I've read, trust serum tests of free T taken in the morning. There are others who swear by other methods including saliva and 24-hour urine collection but they all seem to be having good and consistent results.

Please forgive me, I might be missing something, but I'm not sure what you mean by the reference range for young, healthy men compared to "actual levels".

I also see a lot of anti-agers using 5-alpha-reductase inhibitors which might likely affect AG levels along with DHT.

In my experience, I've had good results using these methods.

I believe the ratios for testosterone/E2 etc. are from "The Life Extension Revolution" by Dr. Phillip Lee Miller and the Life Extension Foundation. I have a copy in .mobi format... If you are interested, let me know. It's cracked so you can read it on a Kindle or Kindle app for iPhone, iPad, or other device.

klon's picture

It appears that we have had a similar approach in dealing with age management. I am a bit older as well and have been invoked in training (not as a coach) for more than 2 decades.

Since I have been looking into age management for some time I am familiar with the information in your posts. I suspect that we can both pick up some information through this group.

I also am very familiar with LEF. They are very thorough and sell high quality supplements. There are 2 things I have disagreed with them on recently.

  1. Their analysis of free test levels;
  2. Their use is 5 alpha reductase inhibitors for reducing PSA.

Let me explain.
As you indicated the reference range indicated on a lab test form is based on the lab's reference group. This group of patients are not a representative sample of young, healthy adults with optimal hormone levels (regardless of a diagnosis on their lab form). Most patients have their hormone levels checked because of a suspected illness. So the lab's reference group is skewed toward those not in optimal health. The lab then analyzes the data utilizing a 95% confidence internal on the samples and creates the reference range. To be higher or lower than the reference range, your levels must be at least 2 standard deviations from the mean.

To exacerbate the problem with free T, it's unstable in serum. So it further degrades before analysis. The resulting lab range is substantially lower than the optimal level.

Young health men can have free T over 300 pg/mL. This is almost 10 times higher than what the lab believes is normal and leads the clinician to believe that low free testosterone levels are "normal".

The other area where I disagree with them is on their use of 5 alpha reductase inhibitors for reducing PSA and/or bph.

The prostate consists of a muscular capsule that surrounds a few glands imbedded in fibrous tissue called stroma. If men start to experience an increase in PSA or have difficulty urinating, the recommendation is to start a 5 alpha reductase inhibitor. Over the long term, this shrinks and damages the glands. Initially there is some relief from urinary symptoms however the metabolism of T is shifted from DHT to estradiol. High estradiol results in a dramatic proliferation of the stroma and the size/hardness of the prostate gland further exacerbating the problem.

The use of 5 alpha reductive inhibitors would certainly have an impact on AG, however that makes the use of this test that much more critical. We need to know the level of testosterone action and AG provides just that.

LEF had a recent article on reducing PSA with a variety if supplements. 10 mg of Lycopene appears very promising along with a few other options.

pathtaker's picture

Hey klon, I appreciate your willingness to be involved on this group. I know what it takes to be "up" on the current information and research.

You raise some interesting points. I haven't seen any 300 pg/mL Free T readings but that doesn't mean they don't exist or even that they are outside the norm. Do you have any research or articles on the subject you could refer me to? You may have noticed that my reference ranges for Free T are higher than LEF's and in practice I shoot for 25 to 30 pg/mL. That is still far lower than 300 but much higher than what I have seen in my clients before TRT. For example, my level before TRT was between 5 and 6. 125 mg. of Test-E/wk has kept it steady at 30. I also use LEF's Mira Forte for aromatase inhibition.

I've also seen some controversy on use of 5 alpha reductase inhibitors and the indication for the use of Lycopene. LEF includes both strategies in their Prostate formula. They also include another 10 mg of Lycopene in their Booster and 3 mg in their Life Extension Mix. I also agree that inhibition of the conversion of T to E2 is paramount for prostate protection as well as for cardiac health.

Any input you can provide is appreciated. So what reference ranges would you recommend and what would be your suggested criteria for adjusting TRT dosing? And, can you guide us to some research or articles in support? Always looking for new information! Smile

klon's picture

Sure. I will provide some studies for you to review.

The most important point I am trying to get across regarding free T is that it has low value HRT.

pathtaker's picture

Awesome, looking forward to studying them.

I understand your point about Free T. That is why I asked for your recommended protocol for determining need/dosage for TRT. What exactly do you have in mind?

klon's picture

My source for the free testosterone levels of 300 pg/mL is Thierry Hertoghe, MD. He trains thousands of physicians in HRT. Please refer to his Hormone Handbook. Unfortunately there isn't any data that I can find that provides evidence for the appropriate range in young healthy men. Why? For all the reasons that we both discussed. The lab determines the reference range based on their patients that are not in optimum health.

Do you have any data or studies that establish the reference range for testosterone or any other hormone that is representative of healthy young men?

Need for therapy is based primarily on the clinical picture. The optimum dose of any hormone is set such that the patient is free of physical symptoms and complaints.

For most men 40+, an outstanding starting dose of testosterone cypionate is 200 mg/wk with about 2 mg of arimidex per week. My experience is that the majority of men have no symptoms, feel better psychologically and improve most risk factors for CV disease with a dose of about 250-300 mg/wk and 2-3 mg of arimidex per week.

This will surprise some of you as you have been conditioned to believe that higher levels of testosterone are unhealthy. As long as estradiol is aggressively managed at around 25 pg/mL, this level of testosterone is perfectly acceptable long term.

300 mg/wk will put most men's trough level just above the reference range for most labs. Please keep in mind that the reference range most labs use is skewed toward unhealthy men. So, being slightly above the high end of a reference range skewed toward an unhealthy population is not a problem.

pathtaker's picture

I've got a copy of his book "The Hormone Solution" but $450 for the handbook is nuts. Any suggestions?

klon's picture

I agree it is nuts if all you want is the reference for free T.

The bottom line is that there isn't really a scientifically verified reference group used to establish levels I young healthy men.

The protocol I provided for T administration is what I have seen utilized for years and works very well. Thierry's protocol is slightly different.

pathtaker's picture

OK, I think I am starting to see what you are advocating... Please correct me if I'm still not getting it.

Are you suggesting to start most men (over 40) at 200 mg Test E or C per week balanced with 1 mg Adex per 100 mg Test and then increase their dosage toward 250 to 300 mg (w additional Adex) and instead of using a lab reference, see how they feel at that dosage and adjust if needed? In your experience, have you seen dislipidemia and high hematocrit at these dosages on a long term basis? Or, would you consider these possible side effects a reason to reduce dosage?

Also, if the above is correct, how does Hertoghe's protocol differ? And, using a protocol like this, could we not develop reference ranges that would be more appropriate - Whether Free T or Total T and SHBG?

klon's picture

200 mg/week plus 2mg per week of arimidex is a good base. Arimidex dosing is based, in part, on aromatase activity. If a patient walks in with higher levels than average of female fat deposits, bph, gynocomastia, high levels of estradiol etc, then arimidex may need to be as high as 2 mg/100 mg of test cyp.

A good physician will see these things before the patient speaks by evaluating their silhouette. They will also see what's going on with thyroid, insulin and cortisol. An exam and detailed history will provide solid clues on aldosterone, vasopressin, pregnenolone, hGh, oxytocin, msh and progesterone. The lab data is used to confirm a diagnosis and find gross deficiencies and excesses. Correcting all deficiencies increases efficacy of treatment and lowers dosing requirements of all hormones.

Elevated hematocrit/hemoglobin requires giving blood or lowering testosterone dose. This is non-negotiable.

Typically cholesterol improves with the above dosing protocol. Minor point: as we have discussed in another post, elevated cholesterol is not necessarily a risk factor for heart disease. An increase in the smaller particle size of LDL cholesterol can result in oxidation of this species of LDL that more easily enters the endothelium and starts or contributes to cardio vascular disease.

I will get back to you on Hertoghe's protocol and developing the proper reference ranges.

pathtaker's picture

Now I know you're dreaming! lol A "good physician", "government worker", "spare time", "extra money"... There are just some pairs of words that were never meant to be used together! It's been a LONG time since I've seen a doc who was a good clinician. I just figured they were actively filtered out in med school - Some sort of go/no go test. lol

I suspect I will do what I have always done and be my own guinea pig and try this approach out. After I finish Hertoghe's Hormone Solution book of course! Will keep you posted...

pathtaker's picture

I am interested in his protocol not just a number for free T. So far I'm not in disagreement with what I've been able to dig up on his ideas but I'm on a fixed income and can't afford that kind of expense for his book.

Edited: Question answered elsewhere.

gsleepy's picture

high hematocrit

your thoughts?

pathtaker's picture

I'm also a retired cycling coach (bicycling!!) and I ride about 200 miles/week so with TRT, HGH, and a LOT of cardio I have a consistent hematocrit of 48 - 49. I don't like to see it over 50. It can be a problem but I believe the risk is offset to some degree by some of the other anti-aging strategies that I use that have a tendency to thin the blood and prevent abnormal clotting.

I take fish oil, full-spectrum Vit E (including the gamma fraction), 3 baby aspirin/wk, Vit D3 (balanced with Vit K2-MK7) etc. I also keep my iron/ferritin and fibrinogen levels in the optimal range by donating blood when needed. The fibrinogen is also reduced by the small amount of nattokinase included in my Vit K2.

Also, I think it is important to keep the dietary potassium/sodium ratio high 5:1 to 15:1 by getting plenty of vegetables - Cruciferous, squash, zucchini, and also avocados, etc. Helps keep the BP in check. Optimal target BP is 115/75.

My next post will be a list of at least 17 independent heart disease risk factors... Working on it now and will post soon.

Does that answer your question? Have you tested your level especially during longer cycles?

gsleepy's picture

57.8 in December that was after giving blood.

pathtaker's picture

!!! Here is the good news... You know about the high level. That's a lot better than operating in the blind!

Cycle history - anabolic agents - cycle length - frequency? Age? Blood pressure? Iron, Fibrinogen, Ferrotin levels? Supplements and/or prescription drugs you take on a regular basis? Other history/diagnoses? If you prefer, FR and PM me but please keep in mind that this discussion might be highly beneficial to someone else lurking in the dark. ;-)

Make sure you stay hydrated... Dehydration will raise the number and the risk. If your Iron or Ferrotin levels are high, then donating blood again would likely be a good idea. I would also recommend a baby aspirin per day and fish oil supplements unless you have a bleeding disorder.

One of the next posts I'm working on is a basic foundational life extension supplement regimen. Some of the components of that regimen will likely help protect you while you get the number down.

gsleepy's picture

Also thank you for your response Smile

gsleepy's picture

Thank you for the offer but like you said this is a forum intended to help everyone.
47 yrs
195 lbs
5'9"
BP 120/90 pulse 101 but I have bronchitis so I suspect that is the reason for the elevated numbers.

Cycle history: 5 full cycles since 2011 each approx 12 weeks long. other than that I am on trt. Cycles have consisted of test base with deca and tren.

Iron, Fibrinogen, Ferrotin levels: I am told when I give blood that my iron is high, the other levels I do not know. I drink about a gallon of water each day. I give blood approx. every 2 months.

hemoglobin 19.4
RBC 6.14

Supplements: triglyceride meds one aspirin turmeric and a multi.
Diet pretty good mostly protein and salad, eggs in the morning lunch protein I recently started up with fiber therapy.

Exercise: 5 days a week with 10 minutes of cardio and then about 1 hour of weight training.

pathtaker's picture

Good Man... Thanks for your help!

It's no surprise that your hemoglobin and RBC are both high with your hematocrit where it is.

5 12-week cycles since 2011 how long do you think your average time was between cycles?

What are you using for TRT and dosage? Have you had a Testosterone test either free or total? Are you doing any HGH? Any aromatase inhibitors? Does your multi contain any iron?

gsleepy's picture

And here I thought I was being thorough... LOL Blum 3

Time off is 3 months although I ran a couple back to back in late 2011 and 2012 with maybe a month off
trt = test cyp approx 125mgs per week BUT I feel better at 200 mgs ;)
aromasin = 12.5 eod
hgh = 2.5 ui ed Riptropin brand
Iron = 12 mgs ed
lest test 868 again these are decmeber numbers

I am due to take some blood tests the doc suggested but have been holding off because of the bronchitis.

pathtaker's picture

There's always another question! ;-)

Of course you feel better on 200 and probably even better on 300!!

Drop the multi immediately and replace with one that doesn't have iron. I can't prove it yet without a test but I'll bet your iron, and ferritin levels are high as well. Iron is pro-oxidant and increases risk of a cardiac event. You're probably getting more than enough from meat sources of protein.

Have you tested IGF-1 to confirm your Rips dose and what protocol are you using for the Rips... Every day, twice per day, 6 on/1 off per week, etc.? (Always more questions!!)

How long before you can give blood again?

I see you found my post for discounted LabCorp blood tests. Take a look at my recommended annual tests at http://www.eroids.com/pics/recommended-annual-labcorp-blood-tests-for-ca...

gsleepy's picture

That moment when your best buddy Path says something that makes you say DUH! Of course taking a pill with iron when you have high iron is probably not the smartest.. LOL

Rips are just replacement 2.5iu ed no cycling I was just gonna run for 6 months and take 6 months off. My good buddy here megaT did labs same time as I bought and from the same supplier so I went with the grapevine on that one. I can give blood now just trying to fit it in and while being sick they probably won't take it anyway til I am better I imagine.

pathtaker's picture

Cut yourself some slack! ;-) Nobody thinks about the negative side of iron unless they are around this anti-aging shit all the time.

Like I said in my PM... I'd like to see an IGF-1 so we could set your HGH dosage to optimum levels and run them all the time instead of taking 6 months off. IMO they should be run year-round on a 6 on/1 off protocol. I consider HGH to be the top priority when it comes to BHRT (bio-identical hormone replacement therapy). However, cost sometimes kicks it to a lower level! ;-)

HGH and Test both increase red blood cell production so I'm thinking, along with donating blood AS SOON AS POSSIBLE, comprehensive testing and developing an overall plan should be a high priority. For TRT, I like either Test-C or Test-E given twice per week. I use Monday mornings and Thursday evenings for mine. At the typically low TRT dosages (usually around 50 to 60 mg/injection), you can inject subcutaneously and save punching so many holes in your muscles! I use the thighs but a lot of my clients like the abdomen (off center).

klon's picture

One more point on gh. When Test is optimized along with cortisol and thyroid, IGF-1 continues to rise over time. This makes the use of gh with the proper protocol relatively inexpensive.

If you have been on test therapy and have optimized other hormones, your IGF-1 will increase about 100 pts.

At this point start gh at 1 unit per day and reduce dose by 50% each month for 4 months and retest. This may put you in the 300 range. This can be maintained in some patients at 1/8th unit per day. At this dose a 15 unit vial will 120 days. Some may need a bit more and some much less. At approximately $170/vial with Rx that reduces monthly gh cost to about $43.

klon's picture

What are your levels at 50 to 60 mg semi-weekly. I use much, much more than that and am typically in the upper quintile with my trough levels.

klon's picture

If your hemoglobin is also elevated I'd highly recommend giving blood asap.

gsleepy's picture

Thank you it is on the to do list. Smile