Healthcast 650 – Why blood test of testosterone and free testosterone alone don’t reveal how you will respond to hormones.

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At Bio Balance Health I order blood tests to evaluate my future patients before I even have my first appointment with them.  I use them to find a baseline for an individual patient, and to see if hormones will help them with their symptoms.  Blood tests work well for establishing a diagnosis but are not the only factor in determining an ideal dose of hormone that works for that patient.  Symptoms and medical history supply most of the information for determining dosage as well as help me find other medical problems to treat at the same visit. Many diseases in the early stages are not treated by primary care doctors because they are overwhelmed with their number of patients and the short-time they are allowed to see them.  Our goal is to prevent disease that have been missed or treat conditions at an early stage before they become severe.

 

Blood tests establish and confirm both hormone deficiencies and provide a baseline level before treatment and the optimal level for each individual patient.   That blood level may or may not be within the range that is expected for a treatment success (written on the lab report). You are an individual and it is my job to find the ideal blood level of hormones for you.

 

Why would the blood level not tell the whole story?

 

Your body is genetically programed to both PRODUCE hormones from your endocrine glands and ACCEPT those same hormones in each cell.  Every person is an individual and each person makes hormones based on their genetic map and environment. Everyone is programed genetically to accept hormones into their cells in an individual manner. This is the key to understanding the differences between patients’ responses to an equivalent dose of hormones, either excreted from their own glands or absorbed through their chosen delivery system (oral, vaginal, transdermal or subdermal pellets) after their glands have aged and don’t produce enough hormone, like estradiol and testosterone.

 

I was in Cambridge in 2014 for the release of my first book, The Secret Female Hormone, when I visited a medical bookstore.  I discovered a large red book that weighed no less than 10 lbs was titled Testosterone.  I looked through this book and found that there was information that I had not discovered in my research of the American medical journals and books, so I bought it and read some of it on the long flight home to St. Louis, MO. I found that this book had answers to questions I had uncovered in my then,13 years of hormone medical practice. My biggest question at that time was why 2 people of the same sex having the equivalent blood level of free testosterone often feel completely different. For example, I was trained that if a man had a blood level of free testosterone that was above 129 pg/ml and under 350 pg/ml (using Quest Diagnostics lab), then he should feel normal, like he did when he was in his thirties (barring any other illnesses interfering). However, I observed that some men felt great at 110 pg/ml while others at 130 continued to have the symptoms of low T. This puzzled me, but at that time I had no answer. Then I read the first chapter of Testosterone.

 

The answer is found in the individual differences in the receptors on each cell for that hormone, the receiving end of the hormone physiology.  It informed me that receptor sites are genetically created differently in each individual and that one-size-does-not-fit-all!

 

You can bathe a person’s cells with what is considered an adequate blood concentration of testosterone for most people, let’s say men since that was the subject of the first chapter, of the book Testsosterone, but some men would receive and use only a small portion of the circulating hormone. Their cells were “resistant”, therefore they required a higher concentration of hormone, to activate their cells. This very important fact in endocrinology has been ignored until recently when we began to use genetics to find the differences between individuals’ receptor sites for all hormones and all peptide communicators. In the last 10 years we have found that receptor sites are the missing link in determining a person’s required dose of a hormone, and they are genetically determined.

 

Here is an example from the book in a very simplified translation. Think of a key and lock. Each cell has “locks” or receptor sites all over it, and the keys are the testosterone molecules.  Some people’s cells have locks that are easy to open and turn on a cell. They are “sensitive” to that hormone.  Some cells have difficult “locks” and they must be bombarded with a hormone “keys” to turn the cells on. This led the researchers to look for the snips of DNA that were responsible for the difference. They found them and then tested men from all over the world to see if there were regional groups, genetic groups, that contained more sensitive receptor sites or more resistant.

 

The results are quite telling and explain the differences between races and peoples in terms of how their bodies use the testosterone hormones available.  The men with the most sensitive receptor sites live closer to the equator: Mediterranean, African, Brazilian, and those men with more resistant receptors had DNA from ancestors who came from closer to both North and South poles: Scandinavia, Canada, Europe, South Africa, Southern Argentina etc.  The results mean that if you have a clear genetic line from one of these groups, we can predict whether you need a higher dose or lower dose to get the same resolution of symptoms. Most people in America are mixtures of genes so most patients don’t give me any information from their ancestry.

 

However, there are two catches to this system of determining an individual’s receptor site sensitivity; 1) In this century we are able to travel and find a mate on the other side of the globe and have been able to do so for generations, therefore we are “mutts”, or people who have multiple genetic sources in our DNA and therefore how we look or where we are from is not a good predictable factor for how we will accept our testosterone. 2) There is no commercially available test to evaluate the sensitivity of our receptors. Currently, the best science has found is to test DNA for the snips that predict sensitivity or resistance to testosterone!

 

This too will come to the practice of medicine, but “medicine” moves slowly and the government and people in control are always looking for a one-size-fits-all approach to illness and or aging, which makes me think this type of test will not be embraced by general American medicine.

 

At this point all I can tell you about dosing and blood levels is that you have an individual level that is good for you, so I try to figure out what that is, and “mark it” with your “perfect blood level”.  I proceed with is the knowledge that there are many other factors that affect the blood level of free-testosterone (active form) and the effect it has on individual patients.  This leads me to practice individualized medicine like a tailor makes a dress or suit that fits one person only. I have a lot of experience to recognize resistant or sensitive T receptor patients and I now know how to approach their care.  It is NOT by trying to adjust their hormones into the very inaccurate free T levels printed on the blood lab sheet, however I do look at those numbers to establish a baseline for that person, and I do listen to my patients when they tell me whether their symptoms are resolved or not. Resolving all SYMPTOMS is the real sign of a successful replacement of testosterone in both men and women.