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Monday, April 29, 2013

Testosterone Injections Helped Obese Men Lose Weight

Introduction: Abdominal adipose tissue suppresses testosterone production by various mechanisms affecting the hypothalamic–pituitary–gonadal axis. Hypogonadism leads to further accumulation of fat mass thus creating a vicious circle. This study analysed the effects of restoring testosterone in obese hypogonadal men.

Methods: Cumulative, prospective, registry study of 181 men (mean age: 59.11±6.06 years) with testosterone levels below 12.1 nmol/l and a BMI of ≥30 kg/m2. All men received parenteral testosterone undecanoate 1000 mg/12 weeks following an initial 6-week interval. 89 men were treated 5 years, 114 4 years, 133 3 years, 159 2 years, 181 1 year. The changing numbers do not reflect drop-out rates but are a result of the design as new patients are added once they have received at least 1 year of treatment.

Results: At the end of the observation period, mean weight (kg) decreased from 114.71±11.59 (minimum 87.0, maximum 139.00) to 93.24±8.49 (min 80.0; max 115.0). This decrease was statistically significant vs baseline .
Waist circumference (cm) as a measure of abdominal fat decreased from 111.2±7.54 (min 89.00; max 129.00) to 100.47±7.11 (min 84.00; max 117.00), BMI from 36.72±3.72 (min 30.10; max 46.51) to 30.22±2.6 (min 25.66; max 36.71).

Fasting glucose decreased from 5.84±0.84 to 5.41±0.12 mmol/l, total cholesterol from 7.63±0.95 to 4.9±0.28, LDL from 4.47±1.03 to 2.94±0.93, triglycerides from 3.31±0.56 to 2.17±0.13 mmol/l. Systolic blood pressure decreased from 159.17±15.9 to 139.08±10.99 mmHg, diastolic blood pressure from 96.5±11.01 to 80.39±7.51 mmHg (P<00001 p="">

Conclusion: Normalising testosterone produced loss of weight/waist circumference and improved metabolic profile. These improvements were progressive over 5 years.

Friday, April 26, 2013

Clomid (clomiphene) Increases Testosterone and Sperm Count in Men- But No Mention About Sex Drive

Oral Enclomiphene Citrate Stimulates the Endogenous Production of Testosterone and Sperm Counts in Men with Low Testosterone: Comparison with Testosterone Gel. The Journal of Sexual Medicine. 

Introduction - Clomiphene citrate is employed off-label in men who have low testosterone and for the restoration of sperm counts in men who have used exogenous testosterone. Clomiphene is a mixture of two diastereoisomers: zuclomiphene and enclomiphene. We evaluated enclomiphene citrate in men with secondary hypogonadism.

Aim - Our aim was to compare oral enclomiphene citrate as an alternative to topical testosterone.

Main Outcome Measures - Blood levels of total testosterone (TT), estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex hormone binding globulin, thyroid stimulation hormone, prolactin, and insulin-like growth factor 1 IGF-1 were measured at certain times after treatment with each agent. Sperm parameters were determined at the same visits. Free testosterone (FT) was calculated.

Methods - This was a proof-of-principle, randomized, open-label, fixed dose, active-control, two-center phase IIB study in 12 men with secondary hypogonadism treated previously with topical testosterone.

Results - After discontinuation of topical testosterone, morning TT values averaged 165±66pg/dL. After 3 months, there was a significant rise in men receiving enclomiphene citrate and gel that was sustained for 3 months. At 6 months, TT levels were 545±268 and 525±256pg/dL for groups receiving the gel and enclomiphene citrate, respectively. Only men in the enclomiphene citrate group demonstrated increased LH and FSH. TT decreased one month posttreatment to pretreatment values. Enclomiphene citrate elevated sperm counts in seven out of seven men at 3 months and six out of six men at 6 months with sperm concentrations in the 75–334×106/mL range. The gel was ineffective in raising sperm counts above 20×106/mL for all five men at 3 months and raised counts in only two or five men at 6 months. At follow-up, only enclomiphene citrate treatment was associated with elevated sperm counts.

Conclusions - Enclomiphene citrate increased testosterone and sperm counts. Concomitant changes in LH and FSH suggest normalization of endogenous testosterone production and restoration of sperm counts through the hypothalamic–pituitary–testicular axis.

Wednesday, April 10, 2013

Another Company is Caught Adding an Analog of Viagra to Its "Natural" Testosterone Booster Supplement

Consumer Concepts, Inc. notified the public of a consumer/user level recall of all ROCK-It MAN Male Enhancement Capsules sold between October, 2012 and April, 2013. Analytical tests conducted by the FDA concluded that the product contained hydroxythiohomosildenafil. 

Hydroxythiohomosildenafil is an analogue of sildenafil (Viagra) and is expected to possess a similar pharmacological and adverse event profile. Sildenafil is the active pharmaceutical ingredient in a FDA approved drug that is used to treat erectile dysfunction, making these products unapproved new drugs.

Tuesday, April 9, 2013

Effect of Age, Body Weight and Smoking on Testosterone in Men

 This study showed that 

 1- Men with higher Body Mass Index (a measure of weight that takes into account height, calculate yours here: ) had lower testosterone as they aged compared to thinner men. In fact, "a change in BMI from nonobese to obese may be equivalent to a 15 yr fall in T" Note: BMI is a very rough measure that does not take into account muscle or fat mass.  A muscular man with little body fat may have high BMI (in my case, my BMI is 30). A better study would measure fat mass, but that tends to be cumbersome and expensive.

 2- Smoking did not affect testosterone, but it made the pituitary gland send a higher LH signal to testicles, which could be caused by progressive testicular dysfunction. 

 3- Not surprisingly, sex hormone binding globulin increased with age. SHBG binds to testosterone and renders it ineffective. Higher insulin levels and lower IGF-1 levels caused by aging may account for this increase in SHBG.

4- Aging causes primary testicular dysfunction with maintained total T and progressively blunted free T associated with higher LH. This interpretation is supported by the age-related attrition of the testicular Leydig cell population  and other factors involved with testicular function


Monday, April 8, 2013

Media Sensationalism: Meat and Carnitine are Bad for your Heart

This study was recently published, pushing the hypothesis that L-Carnitine in meats could be a connection between meats and cardiovascular disease risk, via TMAO (Trimethylamine oxide). It has received a lot of media coverage today. But there is a lot of speculation in this study.

For more click here

Carnitine and Heart Disease- Positive Results

8.1. Blood Pressure

ALCAR in conjunction with ALA can potentially reduce hypertension in via their combined anti-oxidant and pro-energetic effects[165] as well as insulin resistance and glucose tolerance in those with compromised cardiac health[166] with minimal to no side-effects at the dosage of 2g a day. At this dose of 2g daily, it has been implicating in reducing blood pressure in persons with poor glucose tolerance by almost 10 points systolic, with some decrease in diastolic as well.[49]
A dose of 4.5g GPLC has been shown to increase nitric oxide levels after 28 days of supplementation in some persons,[1] and does so at a dose of 3g as well.[33]
 May benefit blood pressure in unhealthy persons (metabolic syndrome, high blood pressure). Has the mechanisms to improve blood pressure independent of a disease state via nitric oxide, but it is unclear how it affects blood pressure in those with normal blood pressure.

8.2. Disorders of Blood Flow

Carnitine, in the form of Propionyl-L-Carnitine (PLC, or GPLC if bound to Glycine), has been shown to improve symptoms of intermittent claudication. PLC supplementation at a dose of 1-3g a day seems to reliably increase maximum walking time in persons suffering from intermittent claudication[14][167][15] and improve quality of life.[13] The benefit does not appear to be dose dependent, and seems to benefit persons with more severe symptoms to a greater degree than persons with lesser symptoms.
PLC aids peripheral arterial diseases in general as it increases peripheral microcirculation.[168][169] In persons with peripheral arterial diseases, PLC supplementation can increase strength and exercise performance[170] although exercise itself can also be seen as therapeutic.[171]
 Quite promising for periphery artery disease and intermittent claudication

8.3. Aging

During aging, defects in oxidative phosphorylation occur exclusively in Interfibrillar mitochondria, located between myofibrils.[172][173] Due to substrate poorly oxidized when introduced into complexes I, III, and IV and not alleviated by uncoupling it appears the aging 'defect' associated with cardiac mitochondria is located in the Electron Transport Chain.[113]Enzymatic activity of complexes III (through cytochrome C binding) and IV also appear to be decreased during cardiac aging.[172][174][175]
It appears these damages may be secondary to cardiac Ischemia.[113] Ischemia causes damage to the Electron Transport Chain after 10-20 minutes via reducing activity of complex I[176] and reducing phosphorylation at complex V and adenine dinucleotide translocase.[177][178] Complex III[176] and IV[179] are hindered at longer periods of Ischemia. It appears that the general process of Ischemia hits elderly persons harder than youth[180] despite some level of damage at both ages.[181]
Acetyl-L-Carnitine is proposed to target these defects its various mitochondrial benefits, discussed elsewhere. One such benefit is seen when aged rats were given a bolus of Acetyl-L-Carnitine 3 hours before cardiac Ischemia, and suffered less damage.[182] The same benefits were not seen with adult hearts subject to Ischemia, and the damage induced to aged hearts defaulted to similar levels as adult hearts.[182][113]
Another possible mechanism is increasing levels of CPT1 in the myocardium, without affecting overall carnitine levels.[183] A decline of this rate-limiting step is seen during aging, thus upregulating it may attenuate changes seen with aging. It has been noted in human hearts that less fatty acid oxidation occurs with aging, causing a shift towards cardiac glucose metabolism[184]which are thought to be due to less CPT1 activity.[185][186]

Wednesday, April 3, 2013

Blood Analysis Reference Table

PROBLEMS & SOLUTIONS (By Michael Scally)
Reference Range
Alanine aminotransferase (ALT, SGPT)
Levels are extremely increased in cases of liver cell necrosis of any cause, right heart failure, acute anoxia, extensive trauma, or left heart failure. A slightly high level may indicate cirrhosis, obstructive jaundice, liver tumors, extensive myocardial infarction, myositis, muscular dystrophy, fatty liver, chronic alcohol abuse, or severe pancreatitis. Levels will by low in cases of pyridoxal phosphate deficiency
7-30 U/liter
10-55 U/liter
There is no naturally occurring hyperalbuminemia. Any condition that results in the decrease of plasma water will increase the concentration of all plasma proteins, including albumin. Low concentrations of blood albumin may be due to acute and chronic inflammation, decreased synthesis by the liver, increased loss via body surfaces, increased catabolism, or increased blood volume. *albumin is the principal oncotically active component of plasma. As the major plasma protein, albumin acts as a nitrogen pool. Its role in transporting bilirubin, bile acids, metal ions, and drugs will be markedly affected by variations in concentrations.
3.1-4.3 g/dl
Alkaline phosphatase (adult)
Origins of the major phosphatases are liver, bone, intestine, endometrium, and lung. Ingestion of a meal increases the intestinal isoenzyme of alp in serum, especially in individuals who are blood type o or b and who are Lewis-positive secretors. Increased levels of alp may indicate increased bone metabolism (during healing of fracture, primary and secondary hyperparathyroidism, osteomalacia, or juvenile rickets). May also indicate bone disease, renal disease, or liver disease. Low levels may indicate hypothyroidism, scurvy, gross anemia, vitamin b12 deficiency or nutritional deficiency of zinc or magnesium.
30-100 U/liter
45-115 U/liter
Androstenedione (adult)
Androstenedione is a major precursor in the biosynthesis of androgens and estrogens.  It is produced in adrenals and gonads and serves as prohormone for testosterone and estrone. The test is useful in conjunction with other tests in the evaluation and management of androgen disorders
50-250 ng/dl
Aspartate aminotransferase  (AST, SGOT)
Increased levels may indicate liver cell necrosis or injury of any cause, including cholestatic and obstructive jaundice, chronic hepatitis, or drug-induced injury to liver. May also be associated with hepatic metastases and hepatoma, necrosis or trauma to heart or skeletal muscle, inflammatory disease of heart or skeletal muscle, heart failure, Forbes's disease, heat stroke, hypothyroidism, intestinal obstruction, lactate acidosis, or toxic shock syndrome. Also distinguishes neonatal hepatitis from biliary atresia.
9-25 U/liter
10-40 U/liter
Bilirubin, direct
High serum blood levels are associated with intrahepatic and extrahepatic biliary tree obstruction, hepatocellular damage, cholestasis, Dubin-Johnson syndrome, or rotor's syndrome.
0.0-0.4 mg/dl
Bilirubin, total
High serum levels may indicate hepatocellular damage (inflammatory, toxic, neoplastic), intrahepatic and extrahepatic biliary tree obstruction, hemolytic diseases, fructose intolerance, hypothyroidism or neonatal physiological jaundice
0.0-1.0 mg/dl
High blood calcium levels may indicate primary and tertiary hyperparathyroidism, malignant disease with bone involvement (in particular metastatic carcinoma of the breast, lung, kidney, multiple myeloma, lymphomas, and leukemia), vitamin d intoxication, milk-alkali syndrome, Paget's disease with immobilization, thyrotoxicosis, acromegaly, diuretic phase of acute tubular necrosis or dehydration. Low levels of calcium may indicate hypoparathyroidism; vitamin d deficiency, chronic renal failure, magnesium deficiency, prolonged anticonvulsant therapy, acute pancreatitis, anterior pituitary hypofunction, hypoalbuminemia, or inadequate nutrition.
8.5-10.5 mg/dl
Carbon dioxide content, total
High levels may indicate respiratory acidosis caused by poor gas exchange or depression of respiratory center; generalized respiratory disease; metabolic acidosis (after severe vomiting in pyloric stenosis, hypokalemic states, or excessive alkali intake). Low levels may indicate compensated respiratory alkalosis, metabolic acidosis in diabetes mellitus, renal glomerular or tubular failure, renal tubular acidosis and intestinal loss of alkali with coexisting increase in c1 and normal anion gap
24-30 mmol/liter
High chloride levels may be attributed to dehydration, renal tubular acidosis, acute renal failure, diabetes insipidus, metabolic acidosis associated with prolonged diarrhea with loss of nahco3, respiratory alkalosis, and some cases of primary hyperparathyroidism. Low serum chloride levels may be due to excessive sweating, prolonged vomiting from any cause or gastric suction, persistent gastric secretion, salt-losing nephritis, aldosteronism, potassium depletion associated with alkalosis, respiratory acidosis
100-108 mmol/liter
High total cholesterol levels may indicate familial or polygenic hyperlipoproteinemia types IIa and IIb, hyperlipidemia, hyperlipoproteinemias secondary to hepatocellular disease, intra- and extrahepatic cholestasis, chronic renal failure, malignant neoplasms of pancreas and prostate, hypothyroidism, gout, ischemic heart disease, pregnancy, diabetes, alcoholism, analbuminemia, dysglobulinemia, anorexia nervosa, idiopathic hypercalcemia, acute intermittent porphyria, or isolated hgh deficiency. Low levels may be associated with lipoprotein deficiency, hepatocellular necrosis, malignant neoplasm of liver, hyperthyroidism, malabsorption, malnutrition, megaloblastic anemias, chronic obstructive lung disease, mental retardation, rheumatoid arthritis, or intestinal lymphangiectasia. *secondary disorders that elevate cholesterol levels should be ruled out prior to initiating therapy with cholesterol-lowering drugs. *factors that have variable effects on cholesterol levels in different people include posture before and at time of blood sampling, a recent meal, emotional stress, and menstrual cycle.
 < 200 mg / dl
  Borderline high
200-239 mg/dl
  > 239 mg/dl
High serum or plasma levels may indicate renal function impairment, both acute and chronic; active acromegaly and gigantism, hyperthyroidism, and meat meals
0.6-1.5 mg/dl
Dehydroepiandrosterone (DHEA) sulfate (adult)
Decreased levels may be associated with increased age in men & women, hyperlipidemia, psychosis, or psoriasis.  Weakly androgenic
10-619 µg/dl
12-535 µg/dl
30-260 µg/dl
Estradiol is the most active of endogenous estrogens. The test is of value, together with gonadotropins, in evaluating menstrual and fertility problems in adult females. Measurement is also useful in the evaluation of gynecomastia or feminization states due to estrogen or producing tumors.
      Follicular phase
50-145 pg/ml
      Midcycle peak
112-443 pg/ml
      Luteal phase
50-241 pg/ml
 < 59  pg / ml
 < 50  pg / ml
Follicle-stimulating hormone (FSH)
In hypogonadism, FSH and LH levels lower than normal for the patient's age indicate hypothalamic or pituitary problems; higher levels indicate a primary gonadal defect
      Follicular phase
3.0-20.0 U/liter
      Ovulatory phase
9.0-26.0 U/liter
      Luteal phase
1.0-12.0 U/liter
18.0-153.0 U/liter
1.0-12.0 U/liter
High levels may be associated with chronic hepatitis, plasma cell dyscrasias/ lymphoproliferative disorders, cirrhosis, chronic liver diseases, chronic infections or certain autoimmune disorders. Low levels may indicate immune deficiency or suppression or lymphoproliferative disorder. Decreases in all fractions may be seen in bulk loss of proteins into the gut.
2.6-4.1 g/dl
Glucose, fasting
Serum glucose levels may be high due to diabetes mellitus, strenuous exercise, increased epinephrine, pancreatic disease or an endocrine disorder. A high serum level may also be related to acute myocardial infarction or severe angina, chronic liver disease, or chronic renal disease.
70-110 mg/dl
(gamma)-Glutamyltransferase (GGT)
 Very high levels can be associated with obstructive liver disease and posthepatic obstruction. Moderately high levels may indicate liver disease (inflammation, cirrhosis, space-occupying lesions), infectious mononucleosis, renal transplant, hyperthyroidism, myotonic dystrophy, diabetes mellitus, pancreatitis, or alcohol-induced liver disease. Low GGT levels will indicate hypothyroidism. *useful marker for pancreatic cancer, prostatic cancer, and hepatoma because levels reflect remission and recurrence.
1-94 U/liter
1-70 U/liter
Growth hormone (resting)
Secretion of GH is episodic and pulsatile; highest values occur during periods of deepest sleep. Ability to secrete GH in response to a conventional challenge declines with age. Random levels of GH provide little diagnostic information; GH secretion is best assessed during tests that stimulate or suppress release. Patients with GH-producing pituitary disorders often release GH in response to TRH or GnRH; and patients with suspected GH deficiencies have subnormal responses to stimulation tests (i.e. GH stimulation test after arginine, insulin,  l-dopa, glucagon, propanolol and insulin tolerance test.)
2-5 ng/ml
Hemoglobin A1C
Glycated hemoglobin concentration appears to reflect the mean blood glucose concentration over the previous 4-8 wks.  This test, while not useful for the diagnosis of diabetes mellitus, has been shown to be useful in monitoring its long-term control.  Glycated hemoglobins are increased as a reflection of hyperglycemia during the lifespan of erythrocytes
High-density lipoprotein cholesterol, as major risk factor
Epidemiological studies demonstrate the inverse association between HDL-c levels and the incidence and prevalence of coronary heart disease (CHD). It is suggested that for every 5 mg/dl decrease in HDL-c below the mean, the risk of CHD increases 25%. Another approach in assessing CHD risk is to calculate the ratio of HDL-c to either LDL-c or total cholesterol. The following primary disease states can lead to secondary decrease in HDL-c: uncontrolled diabetes, premature coronary heart disease, hepatocellular disorders, cholestasis, nephrotic syndrome, and chronic renal failure.
 above 40 mg/dl men
 above 50 mg/dl women
Decreased serum levels indicate inadequately treated type I diabetes mellitus.  High serum levels may indicate insulin overdose, insulin resistance syndromes, or endogenous hyperinsulinemia
2-20 U/ml
Lactate dehydrogenase (LDH)
Extremely high levels may indicate megaloblastic and pernicious anemia, extensive carcinomatosis, viral hepatitis, shock, hypoxia or extreme hyperthermia. Very high levels are associated with cirrhosis, obstructive jaundice, renal diseases, neoplastic diseases, skeletomuscular diseases, or congestive heart failure. Mildly high levels are associated with any cellular injury that results in loss of cytoplasm, myocardial or pulmonary infarction, leukemias, hemolytic anemias, hepatitis (nonviral), sickle cell disease, lymphoma, renal infarction, or acute pancreatitis.
110-210 U/liter
0-30 mg/dl
Low-density lipoprotein cholesterol
LDL encompasses all of the lipoproteins with density greater than 1.006 kg/l and less than or equal to 1.063 kg/l. High levels may indicate primary hyperlipoproteinemia types IIa and IIb; tendon and tuberous xanthomas, corneal arcus, and premature coronary heart disease. The following diseases can lead to secondary elevation of LDL-c: hyperlipoproteinemia secondary to hypothyroidism, nephrotic syndrome, hepatic obstruction, hepatic disease, pregnancy, anorexia nervosa, diabetes, chronic renal failure, and Cushing's syndrome.
mg/ dl
  Borderline high risk
130-159 mg/dl
High risk
greater than or equal to 160 mg/dl
High serum levels may indicate pernicious, aplastic, and hemolytic anemias; hemochromatosis, acute leukemia, lead poisoning, acute hepatitis, vitamin b6 deficiency, excessive iron supplementation/therapy, repeated transfusions, or nephritis. Low serum iron levels may indicate iron-deficiency anemia, remission of acute and chronic infection, carcinoma, nephrosis, hypothyroidism, or postoperative state. *symptoms of iron poisoning include abdominal pain, vomiting, bloody diarrhea, cyanosis, lethargy, and convulsions. Levels may vary widely for an individual within the same day or from day to day.
45-180 ug/dL (MALES FEMALES).
Luteinizing hormone (LH)
Test used to determine the preovulatory LH surge; also provides an integrated picture of LH secretion throughout the day. Shows pituitary or hypothalamic impairment or overproduction
      Follicular phase
      Ovulatory phase
      Luteal phase
Mg plays a vital role in glucose metabolism by facilitating the formation of muscle and liver glycogen from blood-borne glucose.  Also participates as a cofactor in the breakdown of glucose, fatty acids, and amino acids during energy metabolism.  High serum levels may indicate dehydration, renal insufficiency, uncontrolled diabetes mellitus, adrenocortical insufficiency, Addison's disease, hypothyroidism or  lupus erythematosus.  Phytate, fatty acids, and an excess of phosphate impair mg absorption. Symptoms of deficiency usually do not occur until serum levels are  above 1 meq / liter
1.4-2.0 meq/liter
Phosphorus, inorganic (adult)
Serum phosphorus concentrations have a circadian rhythm (highest level in late morning, lowest in evening) and are subject to rapid change secondary to environmental factors such as diet (carbohydrate), phosphate-binding antacids, and fluctuations in growth hormone, insulin, and renal function. High levels may indicate osteolytic metastatic bone tumors, myelogenous leukemia, milk-alkali syndrome, vitamin d intoxication, healing fractures, renal   failure, hypoparathyroidism, pseudohypoparathyroidism, diabetes mellitus with ketosis, acromegaly, portal cirrhosis, pulmonary embolism, lactic acidosis or respiratory acidosis.
2.6-4.5 mg/dl
High potassium levels are associated with reduced renal excretion of potassium or redistribution of potassium in the body (i.e. Massive hemolysis, severe tissue damage, severe acute starvation-anorexia nervosa, hyperkinetic activity, malignant hyperpyrexia following anesthesia, hyperkalemic periodic paralysis, and dehydration).
3.4-4.8 mmol/liter
The diagnostic value of this test lies in its detection of ovulation and in the evaluation of the function of the corpus luteum.  Serial sampling during the menstrual cycle is required.  During menopause, levels drop to 0
    Follicular phase
< 1 ng / ml
    Midluteal phase
3-20 ng/ml
< 1 ng / ml
May help assess Prolactin reserve and abnormal Prolactin secretion by the pituitary. May indicate pituitary tumors.
0-20 ng/ml
0-15 ng/ml
0-15 ng/ml
Prostate-specific antigen (PSA)
PSA is prostate-tissue specific, not prostate-cancer specific. Used for early detection of the recurrence of prostatic cancer. The test is of great value as a marker in the follow-up of patients at high risk for disease progression. PSA values increase with age.
   less than 40 years of age
0.0-2.0 ng/ml
    greater than or equal to 40 yr old
0.0-4.0 ng/ml
Prostate-specific antigen (PSA), free, in males 45-75 yr old, with PSA values between 4 and 20 ng/ml
  above 25% associated with benign prostatic hyperplasia
Protein, total
High blood levels may be associated with anabolic steroid use, androgens, corticosteroids, coritcotropin, epinephrine, insulin, progesterone, or thyroid preparations. Severe protein deficiency, chronic liver disease, malabsorption syndrome, and malnutrition may also lead to abnormal levels. Serum total protein decreases in the third trimester of pregnancy.
6.0-8.0 g/dl
High serum levels are associated with water loss in excess of salt through skin, lungs, GI tract, and kidneys. Also may indicate increased renal sodium conservation in hyperaldosteronism, Cushing's syndrome or disease, inadequate water intake because of inadequate thirst mechanism, dehydration, or excessive saline therapy. Low sodium levels may indicate low sodium intake, sodium losses due to vomiting, diarrhea, excessive sweating with adequate water intake and inadequate salt replacement, diuretics abuse, or salt-losing nephropathy
135-145 mmol/liter
Somatomedin C (Insulin-like growth factor I)
Blood concentrations of IGF-1 are constant during the day and after eating. In acromegaly, the test may serve as an indicator of the severity of the disease; serial determinations may be used to monitor efficacy of treatment. In dwarfism IGF-1 may be used to determine the response to GH therapy. Concentrations of IGF-1 rise during the first year of life, reaching the highest values in preadolescent or early adolescent years. Normal values tend to decline progressively until age 50
  16-24 yr
182-780 ng/ml
  25-39 yr
114-492 ng/ml
  40-54 yr
90-360 ng/ml
  > 54 yr
71-290 ng/ml
Testosterone, total (morning sample)
This test is a measure of total circulating testosterone, both protein bound and free. In adult men, serum levels peak in the early morning, decreasing 25% to the evening minimum. Levels increase after exercise and decrease after immobilization and after glucose load. Progressive decreases begin after age 50
6-86 ng/dl
270-1070 ng/dl
Testosterone, unbound (morning sample)
Free (nonprotein-bound) testosterone is independent of changes in concentrations of the principal testosterone transport protein, sex hormone-binding globulin.
    20-40 yr
0.6-3.1 pg/ml
    41-60 yr
0.4-2.5 pg/ml
    61-80 yr
0.2-2.0 pg/ml
    20-40 yr
15.0-40.0 pg/ml
    41-60 yr
13.0-35.0 pg/ml
    61-80 yr
12.0-28.0 pg/ml
Thyroid-stimulating hormone (TSH)
First-line test for hyper- and hypothyroidism. Test is considered by some to be the preferred screening test for evaluation of thyrometabolic states. Moderately high TSH is often found in euthyroid patients during treatment of hyperthyroidism.
0.5-5.0 U/ml
Thyroxine, total (T4)
Used in conjunction with other tests to measure thryoid function.  T4 testing is frequently used when TSH levels are abnormally high or low.  In hypothyroidism, total serum t4 falls before t3. High serum levels may represent hyperthyroidism.
4.5-10.9 g/dl
Transferrin is the major plasma transport protein for iron.  High serum levels may indicate iron deficiency (high levels often precede the appearance of anemia by days to months).  Serum ferritin levels fall with iron deficiency and with generalized malnutrition but remain normal in the presence of inflammation and iron deficiency
191-365 mg/dl
Triglycerides (fasting)
Increased triglyceride levels indicate hyperlipoproteinemia types I, IIb, III, IV, and V due to familial or sporadic endogenous hypertriglyceridemia. The following primary disease states or conditions can lead to secondary elevation of triglycerides: obesity, impaired glucose tolerance, viral hepatitis, alcoholism, alcoholic cirrhosis, biliary cirrhosis, acute and chronic pancreatitis, extrahepatic biliary obstruction, nephrotic syndrome, chronic renal failure, essential hypertension, acute myocardial infarction, chronic ischemic heart disease, cerebral thrombosis, hypothyroidism, diabetes mellitus, gout, pregnancy, glycogen storage diseases types I, II, III, and IV, down syndrome, respiratory distress syndrome, Werner's syndrome, anorexia nervosa, or idiopathic hypercalcemia. Low levels of triglycerides may indicate chronic obstructive lung disease, brain infarction, hyperthyroidism, hyperparathyroidism, lactosuria, malnutrition, malabsorption syndrome, intestinal lymphangiectasia or end-stage parenchymal liver disease.
40-150 mg/dl
Triiodothyronine, total (T3)
Used in conjunction with other tests to measure thyroid function.  High serum levels may indicate hyperthyroidism while low levels may indicate hypothyroidism.  At least 80% of circulating T3 is derived from monodeiodination of T4 in peripheral tissues.  T3 is 4 to 5 times more potent in biological systems than T4
60-181 ng/dl
Urea nitrogen (BUN) (adult)
High serum blood levels may indicate impaired kidney function associated with an increase with age or protein content of diet.
8-25 mg/dl
Uric acid
High serum levels may indicate gout, renal failure, leukemia, lymphoma, psoriasis, polycythemia, multiple myeloma, kidney disease, and or chronic lead nephropathy. Associated with hyperlipidemia, obesity, hypertension, arteriosclerosis, diabetes mellitus, hypoparathyroidism, acromegaly, and liver disease.
3.6-8.5 mg/dl
2.3-6.6 mg/dl

Differential blood count
Reference Range
Erythrocyte count
Red Blood Cell count; filled with hemoglobin and specialized for carrying O2 and CO2 (adult)
4.50-5.30 X 106/mm3
4.10-5.10 X 106/mm3
Surplus iron is stored as Ferritin, primarily in the liver
30-300 ng/ml
10-200 ng/ml
Folate (folic acid)
Water soluble vitamin involved with amino acid metabolism & transfer of single-carbon units in nucleic acid
3.1-17.5 ng/ml
  Borderline deficient
2.2-3.0 ng/ml
 < 2 ng / ml
 above 17.5 ng/ml
Hematocrit (adult)
% of Red Blood Cells present in total blood
Hemoglobin (adult)
Oxygen-carrying compound of blood.  Numerical value of hemoglobin present in Red Blood Cells
13.0-18.0 g/dl
12.0-16.0 g/dl
Constituent of hemoglobin (transport of oxygen in blood) and enzymes involved in energy metabolism
30-160 g/dl
Leukocyte count (WBC)
White Blood Cell (WBC); Central to the immune system that defends against infection
Mean corpuscular hemoglobin (MCH)
Value is calculated from hemoglobin and erythrocyte count.  MCH= Erc÷Hb
25.0-35.0 pg/cell
Mean corpuscular hemoglobin concentration (MCHC)
Mean cell hemoglobin concentration is calculated from Hb and hematocrit (Hct)
MCHC=  Hct÷Hb
31.0-37.0 g/dl
Mean corpuscular volume (MCV) (adult)
Mean cell volume may not be reliable when a large number of abnormal erythroctes or a dimorphic population of erythrocytes is present. It may also be calculated from the hematocrit and erythrocyte count
MCV= Erc÷Hct
78-100 m3
78-102 m3
Platelet count
Helps mediate the blood clotting that prevents loss of blood after injury
Platelet, mean volume
6.4-11.0 m3

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