DHT is high out of range, and Quest dropped ball on other tests

[blackebob]

Quest was supposed to test a whole panel of things, but they did not. The tech did not see that there were two test scripts. So I wasted a DR. appointment today and have to go back.

What was tested:

TSH 2.95mIU/L In Dec. it was 2.11 range 0.111-4.9

Aldosterone (lc/ms/ms) 6 range <28

Prolactin 12.1 range no reference given for males, I am probably closest to menapausal


Dihydrotestosterone 55 range 5-46 ng/dl

I have been pounding the search key, but man there is a lot to go over. I have been retaining water and have had elevated BP, could this be tied into the DHT? I know it is good for libido, but if it is to high what does it change?

My father is the youngest of a family of 4 boys and a girl. He is the only one that went bald, and I am the youngest of our family of four brothers and one sister. I too am the only one to lose my hair. Now how the hell does that work?

 

[Vince Carter]

I think you know hairloss is a lot more genetic than demonizing DHT which is the norm, apparently you got the trait and your siblings didnt or haven't started to loos their hair yet. IIRC DHT opposes or counters Estrogen to a limited extent. Having high DHT isn't of concern as long as your monitoring your PSA and since you are high and on the upper limit good advice would be to include PSA in your semiannual labs.

When I have DHT thru Quest it's a 16-79 lab range so you clearly got something different this time around. Here's a tip for you that I have to use with Quest and my lab scripts, is when they enter everything they print a sheet and have you verify your personal info at the top. Do that but look at the bottom where your labs tests are listed, based on their entries. If anything is wrong there hand it back to them unsigned. But know to they will only enter exactly what is written on the script without interpreting it. For instance the tech couldn't find Estrogen, Free, as it was written. So I say to her it's probably "Estradiol, Free" thats what you need to select. She refused...

Are those lab scripts from Defy by chance?

 

[blackebob]

All labs are Quest Diagnostics. I just figured out why the range was different for me than you, they had a big old F for my gender.

I learned that about checking the sheet this morning. On Saturday when they didn't do that, and I never thought twice about it. PSA and ferritin was supposed to get checked Saturday, bad deal is after I had my blood drawn I donated two bags of platelets and a pint of red. I I don't know if having my blood test today then if that's going to jack up those readings.

 

[Vince Carter]

Oh wow I guess I'll have to start checking that, too; Gender.

 

[IronKnight]

The natural range of DHT for males seems to be 250-990pg/ml (25-99ng/dL), so 55 is well within range, funny mistake to put the wrong Gender
btw, I had a reading of 119ng/dL recently (1195,9pg/ml), which is truly slightly above range, but my son also had his DHT around this number and he is a teenager not on TRT, so I am not worrying about this for now.

 

[Re-Ride]

Quest was supposed to test a whole panel of things, but they did not. The tech did not see that there were two test scripts. So I wasted a DR. appointment today and have to go back. ...

... TSH 2.95mIU/L In Dec. it was 2.11 range 0.111-4.9 ...

STLEMIYC ( Stop the Lab Error Madness If You Can )

I caught such a mistake last week by checking the tubes and labels before the draw. Prior to my arrival I communicated with the lab manager about a pattern of errors. When I checked in I verified the orders. All that and they still erred. Checking your tubes and labels insures that at least the sample was drawn. I'd also recommend asking that extra tubes be drawn in case the test needs to be re-run or something else tested.

General tips for testing:

Before the draw:

Discuss with your MD the methodology. If appropriate, as in E2, ask that he specify methodology on the order.

Choosing between electronic orders or written ones:

A manually written order may by-pass insurance pre-authorization . CMS requires a ICD-10 diagnostic code which falls within their guidelines for coverage. Asking for both manual and electronic orders may trigger another problem: Some lab system computers will automatically void the electronic order if the MD prints it. The order is "released" (voided) the moment he prints them out. Even though you have a valid written order in hand the "released" flag may pop up when you check in for the draw.

More than one MD or multiple orders:
Can be a problem owing to a combination of antiquated computers, lousy software and misinformed personnel.

The DHS issued a final rule effective April 7 2014:
https://www.federalregister.gov/doc...-privacy-rule-patients-access-to-test-reports

Here DHS explains how this rule was a collaboration of the CDC the CMS and the OCR Office of Civil Rights:
https://www.hhs.gov/hipaa/for-professionals/special-topics/clia/index.html

Four year later we are still hearing:

"Those are the doctor's lab orders." "They belong to him." "Your other MD's needs to request the results from the ordering MD"

NO, no, no! Every one of your treating physicians are privy to all your lab results. Per HIPAA 1996 they always have been and without the need to first obtain a HIPAA release from you. The 2014 Final Rule simply extends right of access to you. Common sense and health care cost reduction dictate that a particular assay be run just once and the results shared. Neither the lab software nor the lab personnel and in most cases not even the MDs have adjusted to this reality.

Other:

In advance of the draw try contacting the lab manager or supervisor regarding on-going issues. Verify that all docs and yourself are to be resulted. The ordering MD can help by indicating who is to be resulted and their fax number as well as "result pt immediately".

A tech will enter the orders again at time of draw and print the tube labels. This is an opportunity to catch a mistake but you're not done. Show your list to the phlebotomist and ask her to verify that her tube labels, tube types and orders concur with your list even if you have done all of the above. As insane as it may seem I had verified yesterdays labs at check in after going back and forth with the lab manager for weeks to consolidate the orders. The lab data entry tech required well over an hour to re-enter the labs. She had compared her list against mine and assured me all was correct. - -Fortunately I asked the phlebotomist to go over it again. - - Tubes and labels were missing!!

 

[blackebob]

"In advance of the draw contact the lab manager or supervisor to request a consolidated list of assays to be run and the methodology to be used. Verify that all docs and yourself are to be resulted. The ordering MD can help by indicating who is to be resulted and their fax number as well as "result pt immediately". "

This is Quest. I cannot ever get a hold of a local lab. All calls go to customer service. I was on hold for 20 mins got to talk to a lady, was rerouted straight to exit survey, and disconnected. I was told the manger of the lab where it happened would call me. It has been three days, I am pretty sure they dont care.

You make could points. I saw the orders though, they were right there on the screen. He just either did not want to do them, or I do not know. I could see them from the chair behind the tech yesterday.

 

[Re-Ride]

The safest bet is to verify tubes and labels with the phlebotomist. Submitting a print out the second link above at check in which explains that increased pt involvement is now official DHS policy will alert the lab of your intention to pursue Q.C. measures. This should diffuse any resentment lab personnel may have to Q.C. measures taken by the pt. Let them know in adv

Did the monitor you viewed indicate it was HAL 9000 terminal? Failures may be human error, an obstinate computer or both. Consumers are purchasing the lab product at a premium price. They deserve better than Nixon era computers sourced from military salvage running modified Pac Man software. Laboratories are regulated by the CMS and CDC. Perhaps it is they that need to receive the complaints. Also both Medicare and private insurers are obliged to investigate complaints from consumers. Lab Admin will get off their duff only when their record is sufficiently blackened by complaint history. Meanwhile the pt can perform the Q.C. that staff are unwilling to do. Being forced to fix errors on the spot cuts in to their bottom line with delays.