New Labs - Progesterone high???

[shan1784]

Latest labs done.. I know cholesterol is an issue.. It's been high like this for years... Never had Progesterone high before...

Current protocol is -
60mg TestCyp 2 x week
100iu HCG daily
.5MG Anastrozole 2 x week
1gr Dessicated Thyroid 2 x daily


Was under the care of Dr. Crisler but since he has left Defy I have follow up with Dr. Saya on the 22nd of November.. About a month away.. Not to happy with having to wait this long for a follow up with a Defy doctor...

 

[Vince Carter]

Cholesterol does start the hormonal cascade to downstream Progesterone but I'm not sure it's of any concern here.

 

[johndoesmith]

When was this drawn relative to injection?

How do you feel?

Other than progesterone being high, what are your concerns?

 

[HarryCat]

Labcorp recently changed their reference range for progesterone for males from 0.2-1.4 to 0.0-0.1. I have not seen a published explanation for why they did this. I wouldn't worry about it until you speak to Dr. Saya.

 

[shan1784]

Last injection previous to these labs was done on 10/15, labs were done on 10/20. My injection was actually due on 10/19 but since labs scheduled for the next day I decided to wait a day and do injection after labs were drawn...

I feel ok for the most part.. Usually this time of the year I get a lil seasonal depression and start putting some weight on after the summer months of dieting and slimming down.. No exception now... I'm currently working to drop a few pounds put on since late August... So adjusting to that...

So my energy level is a little on the low side and mood and motivation is very lack luster. Not sure if this is due to this time of year or something else...

 

[shan1784]

Ok, I will discuss with him.. Just didn't know if this is something to be concerned with or not...

 

[Dr Justin Saya MD]

LabCorp inexplicably changed their progesterone reference range for males about 3 weeks ago to an absurd range of 0.0 - 0.1ng/mL (basically nothing). Previously the range was 0.0 - 1.2 (or 1.5ng/mL depending on lab).

I can tell you that EVERY SINGLE patient has tested "high" for progesterone since that time...however it is NOT normal to have a progesterone level of 0.0 for a male. Rest assured your progesterone level of 0.3ng/mL is FULLY normal and in fact on the lower end of normal for the average male. We can discuss further during consult.

 

[shan1784]

LabCorp inexplicably changed their progesterone reference range for males about 3 weeks ago to an absurd range of 0.0 - 0.1ng/mL (basically nothing). Previously the range was 0.0 - 1.2 (or 1.5ng/mL depending on lab).

I can tell you that EVERY SINGLE patient has tested "high" for progesterone since that time...however it is NOT normal to have a progesterone level of 0.0 for a male. Rest assured your progesterone level of 0.3ng/mL is FULLY normal and in fact on the lower end of normal for the average male. We can discuss further during consult.

Ok, feel much better, thank you so much Dr. Saya!

 

[johndoesmith]

Last injection previous to these labs was done on 10/15, labs were done on 10/20. My injection was actually due on 10/19 but since labs scheduled for the next day I decided to wait a day and do injection after labs were drawn...

I feel ok for the most part.. Usually this time of the year I get a lil seasonal depression and start putting some weight on after the summer months of dieting and slimming down.. No exception now... I'm currently working to drop a few pounds put on since late August... So adjusting to that...

So my energy level is a little on the low side and mood and motivation is very lack luster. Not sure if this is due to this time of year or something else...

So instead of 84 hours after injection(3.5D) you did 96 hours or so?

Then you have a great trough! I'm surprised you didn't get SHBG, defy is usually great about that, could be labcorp forgot it though. No big deal.

Where do you live? I'm in the northeast and yesterday was miserable, cold, raining all day, and really dark. It really affected my mood, but that's normal. TRT will not make you superhuman and impervious to external factors. Traffic still bothers me, family issues still bother me, and so does work. The difference is I bounce back quicker, and I'm able to control my emotions better and think about what I am feeling and realize it's not worth getting upset. I still feel sad or upset or angry though, it's just that the volume is turned down a little.

 

[johndoesmith]

LabCorp inexplicably changed their progesterone reference range for males about 3 weeks ago to an absurd range of 0.0 - 0.1ng/mL (basically nothing). Previously the range was 0.0 - 1.2 (or 1.5ng/mL depending on lab).

I can tell you that EVERY SINGLE patient has tested "high" for progesterone since that time...however it is NOT normal to have a progesterone level of 0.0 for a male. Rest assured your progesterone level of 0.3ng/mL is FULLY normal and in fact on the lower end of normal for the average male. We can discuss further during consult.

How exactly are these reference ranges determined? Unless they changed their assay methodology, IMO such a large change seems rather drastic.

Do they test use an average of test results they get from their regular patients? Or do they use a sample group of volunteers not there for medical testing purposes?

I always thought if they use random data from anyone who walks into labcorp, then how do they know who is "healthy"? I certainly wasn't getting my testosterone tested because I felt healthy, but how would labcorp know that and disregard my data?

 

[shan1784]

So instead of 84 hours after injection(3.5D) you did 96 hours or so?

Then you have a great trough! I'm surprised you didn't get SHBG, defy is usually great about that, could be labcorp forgot it though. No big deal.

Where do you live? I'm in the northeast and yesterday was miserable, cold, raining all day, and really dark. It really affected my mood, but that's normal. TRT will not make you superhuman and impervious to external factors. Traffic still bothers me, family issues still bother me, and so does work. The difference is I bounce back quicker, and I'm able to control my emotions better and think about what I am feeling and realize it's not worth getting upset. I still feel sad or upset or angry though, it's just that the volume is turned down a little.

I live in Michigan or as I call it Mordor (Lord of the Rings reference) and yes, past few days have been very dreary out. I think it's more of the drastic transistion of the seasons to warm and nice to cold windy rainy and all the green trees dying off and what not... I don't expect TRT to solve this.. This year is worst then past few years since being on TRT though.. The plan in the next 10 years or so will be to move to Flordia with the wife and whatever kids that want to come with (They should be on their own by then).

 

[Dr Justin Saya MD]

How exactly are these reference ranges determined? Unless they changed their assay methodology, IMO such a large change seems rather drastic.

Do they test use an average of test results they get from their regular patients? Or do they use a sample group of volunteers not there for medical testing purposes?

I always thought if they use random data from anyone who walks into labcorp, then how do they know who is "healthy"? I certainly wasn't getting my testosterone tested because I felt healthy, but how would labcorp know that and disregard my data?

Labs determine the "criteria" or algorithm for their reference ranges internally (meaning different labs may have different criteria), also obviously different labs have different patient populations, which also impacts any said reference range criteria. This is a reason why "reference ranges" can vary so much from one lab to another (I've seen probably two dozen DIFFERENT testosterone reference ranges used by various labs over the years, for example).

Reference ranges, for this reason, have to be taken with a grain of salt. The skilled provider doesn't just know what a reference range tells them, more importantly they know what the reference range does NOT tell them...which is it doesn't tell them, necessarily, what "normal" is (although many providers fall victim to exactly that flawed thinking).

 

[Dr Justin Saya MD]

Lastly regarding johndoesmith mention of SHBG testing. We don't draw this lab for every patient routinely as we try to balance cost vs necessity (seeing that patients are cash-pay for the labs - and SHBG is a comparatively more expensive test). When there is suspicion of a clinically significant SHBG level (low/high) based on Total T/Free T ratio or otherwise clinical suspicion, then we feel the benefit of drawing the SHBG outweighs the cost for the patient and we add it on follow-up. It's purely customized to each patient with the art of trying to treat patients effectively while at the same time keep their costs as affordable as possible.

 

[johndoesmith]

Labs determine the "criteria" or algorithm for their reference ranges internally (meaning different labs may have different criteria), also obviously different labs have different patient populations, which also impacts any said reference range criteria. This is a reason why "reference ranges" can vary so much from one lab to another (I've seen probably two dozen DIFFERENT testosterone reference ranges used by various labs over the years, for example).

Reference ranges, for this reason, have to be taken with a grain of salt. The skilled provider doesn't just know what a reference range tells them, more importantly they know what the reference range does NOT tell them...which is it doesn't tell them, necessarily, what "normal" is (although many providers fall victim to exactly that flawed thinking).

So essentially, there is no standardization in how they determine their ranges. Whether it's based on statistical models of patients results, or if they use a "healthy" sample group?

I've noticed things like testosterone and E2 ranges vary significantly, while HGB or HCT never change. I always thought it was due to different methodology such as ECLIA vs LC/MS/MS. For example the standard vs sensitive E2 test.

Does that mean 400ng/dl on a 250-850 range is the same as 400 on a 348-1197 range assuming the same methodology?

I think part of the confusion is that "normal" refers to the statistical normal, as opposed to the colloquial "normal" meaning of the word. Correct me if I am wrong on anything here.

 

[johndoesmith]

Lastly regarding johndoesmith mention of SHBG testing. We don't draw this lab for every patient routinely as we try to balance cost vs necessity (seeing that patients are cash-pay for the labs - and SHBG is a comparatively more expensive test). When there is suspicion of a clinically significant SHBG level (low/high) based on Total T/Free T ratio or otherwise clinical suspicion, then we feel the benefit of drawing the SHBG outweighs the cost for the patient and we add it on follow-up. It's purely customized to each patient with the art of trying to treat patients effectively while at the same time keep their costs as affordable as possible.

Oops, I didn't even see this post until now.

You make a great point and I think it makes perfect sense when you explain it like that. SHBG certainly is costly, luckily for me my insurance covers labs, and hasn't been a problem, hopefully that doesn't change!

 

[Nelson Vergel]

Our buddy Lee Meyers wrote a good review:

Progesterone in Men