Growth Hormone vs. Testosterone: A Retrospective Based on the Latest Research
by Karlis Ullis, MD with Josh Shackman, MA
I was one of the first private practitioners in the country to dispense growth hormone as part of an overall anti-program hormone replacement program for adults that fit the criteria of the "Adult Onset Growth Hormone Deficiency Syndrome". Like many other anti-aging physicians, I was extremely impressed by the initial research on growth hormone showing dramatic improvements in body composition, kidney function, skin, mood, well being, etc. I have been a member of the Growth Hormone Research Society for many years and have closely followed all the latest research on growth hormone and other adult hormone replacement therapies. As the number of studies on growth hormone as well as testosterone has piled up since I first began prescribing testosterone, I believe now is the time to look back at the research and see if growth hormone and testosterone have lived up to their promises.
It is well established in bodybuilding circles that testosterone is superior to growth hormone for gaining muscle. However, growth hormone still is enormously popular and generally has a better reputation than testosterone both in bodybuilding and in anti-aging circles. The general impression is that testosterone will make you big, but at the price of acne, puffiness, temper tantrums, prostate enlargement, and possibly "gyno". Well it is acknowledged that growth hormone is not as anabolic as testosterone, people still think of growth hormone as a hormone that will make you lean and toned with almost no side effects. Growth hormone also has a reputation as being the "fountain of youth" among anti-aging enthusiasts, whereas testosterone is still considered somewhat dangerous. The purpose of this article is to see how the research on testosterone and growth hormone from the last few years has supported or disputed the public’s view of these two hormones.
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Which is Better for Body Composition?
New research has shed some light on the anabolic effects of growth hormone. Several studies in the past have shown an increase in lean body mass in subjects taking growth hormone. However, lean body mass does not necessarily mean muscle, but anything that is not fat and this includes water, organ tissue growth, bone mass, and connective tissue growth. My friend Michael Mooney (author of Built to Survive and editor of the Medibolics Newsletter) has helped publicize the fact that not much, if any, of the lean mass gained while on growth hormone is actually muscle. One recent study on HIV positive test subjects showed no significant change in skeletal muscle mass after taking six milligrams (about 18 units) per day of growth hormone for 12 weeks.(1) Another study, also on HIV positive test subjects, also showed a lack of muscle growth when doses of nine milligrams (roughly 27 units) per day were given.(2) Keep in mind that HIV positive individuals are often suffering from muscle wasting conditions, which should make them more responsive to any possible anabolic effects of growth hormone. Growth hormone is probably equally ineffective in healthy individuals.
One study on young (aged 22-33), highly trained athletes did show a significant increase in lean mass after six weeks of taking 2.67 milligrams (about 8 units) per day.(3) However this increase was only 4%, and may have not included any muscle mass at all. It seems overwhelming clear that growth hormone is either non-anabolic or very weakly anabolic for skeletal muscle when taken by itself, and it definitely not worth the large price if you are taking it solely for gaining muscle. The only real use in gaining muscle may be as a synergistic agent with testosterone. A synergistic effect of taking growth hormone with testosterone has been reported for increases in lean mass, but further research needs to be done to see if this synergistic effects holds for skeletal muscle. Keep in mind that some increases in lean mass are not desirable. Growing some organs too big such as kidneys can produce some embarrassing effects seen in some professional bodybuilders. You do not want your "guts" sticking blatantly out of your body.
But enough on growth hormone for muscle gain. For information, see Bryan Haycock’s article in this issue or go to Michael Mooney’s web site. If you are going to spend the money on growth hormone to try to improve your body, your best bet is to use it as a fat loss or "sculpting" agent. The previously mentioned study with growth hormone on trained athletes did show an impressive 12% decrease in bodyfat. So well it is well established that testosterone is far, far better for building muscle than growth hormone, is growth hormone the better choice for fat loss? The research on this issue is mixed, and there is no easy answer to this question.
One recent study put growth hormone head to head with testosterone and measured its effects on fat loss. In this study, men on growth hormone lost an average of 13% of their bodyfat compared to 5.8% in the group taking testosterone.(4) But before you jump to conclusions, there are a couple of reasons why this study doesn’t settle the question. For one thing, this study was on very old individuals (aged 65 to 88) who had low IGF-1 and testosterone levels. Another problem is that the doses of the hormones haven’t been reported yet (the study is only in abstract form right now) which also makes the comparison difficult to make. Most interesting about this study was that a synergistic effect was found in a group taking both testosterone and growth hormone, as they lost an average of 21% of their bodyfat. This is more than the averages of the testosterone alone and growth hormone alone groups combined.
Not all studies have shown this dramatic of an effect on body fat. One study using fairly large doses (adjusted by weight, but roughly 5 mg per day) on obese women failed to show any significant effects on body fat.(5) The growth hormone group lost less than two pounds more than the placebo group over a one month period. The main significant result was that the growth hormone group lost much less lean mass (an average loss of 1.52 kg compared to 3.79 in the placebo). While this may seem impressive, the same results could be achieved with a caffeine/ephedrine formula at a fraction of the price. While there are a good number of studies showing growth hormone to be effective for fat loss, testosterone may be almost as good for this purpose.
Testosterone was recently found to be effective for fat loss in young men even in small doses. One recent study showed that men given only 100 milligrams per week of testosterone enanthate lost an average of six percent of their bodyfat after eight weeks.(6) 100 mg per week is generally considered a very low dose by bodybuilding standards. Most impressive about this study was that the result was obtained in young, normal healthy men (aged 18 to 45), not obese or testosterone deficient. Most of the studies showing positive effects with hormone replacement therapy are on subjects who are obese or hormone deficient – i.e. the very subjects most likely to respond. While the amount of muscle gain reported in this study was not reported (it is still just in abstract form), another study showed 100 mg per week of testosterone enanthate was not anabolic.(7) It appears that testosterone has a strong mechanism for fat loss other than increased metabolic rate from increased muscle. Considering how much cheaper testosterone is than growth hormone, it may well be the cost-effective choice for burning fat even if it is slightly less effective overall.
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Safety of Growth Hormone and Testosterone
Testosterone is widely believed to be far more dangerous than growth hormone. However, recent research is rapidly showing that much of these dangers have been exaggerated. For instance, the hypothesis that testosterone causes prostate cancer has never been established. In fact, one study even showed a slight negative correlation between testosterone levels and prostate cancer! A study on young men given supraphysiologic doses of testosterone showed no change is prostate specific antigen (PSA), which is one measure of prostate cancer risk.(8)
Growth hormone may also be less dangerous to the prostate than previously believed. One study showed strong positive correlation with prostate cancer and IGF-1 levels.(9) Since growth hormone stimulates IGF-1 synthesis in the liver, this study and others bring up the possibility of a link of growth hormone and prostate and breast cancer. Keep in mind that statistical correlations do not necessarily prove causality, i.e. IGF-1 has not yet been proven to be a cancer-causing villain. Actually IGF-11 may be one of the culprits in the cancer story, and not IGF-1. At the Serano sponsored Symposia on the Endocrinology of Aging in October, 1999 and at the Endocrine Society Meeting in June, 1999 there was an informal consensus that patients on growth hormone did not increase their risk of breast or prostate cancer. Several other recent studies have also cast doubt on the role of growth hormone as a cancer-causing villain.
Testosterone may have also gotten a bad rap for its effects on blood lipids. Since testosterone and other anabolic steroids have been shown in some studies to lower HDL cholesterol levels, it was believed that testosterone may increase the risk for heart disease. This was refuted in one recent study on testosterone that showed some positive results. A study on 21 hypogonadal men (aged 36 to 57) showed a replacement dose of testosterone using the Androderm transdermal patch to reduce blood clotting.(9) While HDL levels did drop slightly, blood coagulability is believed to be the more important marker of heart disease risk. Another study showed a very strong negative correlation with testosterone levels and heart disease.
Growth hormone has shown mixed results on its effects on heart disease risk. One study on elderly men and women (aged 65-88) showed that growth hormone administration to lower LDL levels, but raised triglyceride levels.(10) Since high LDL and triglyceride levels are considered measures of heart disease risk, growth hormone’s effects on heart disease risk are ambiguous. However, long-term use of growth hormone as been shown to decrease the thickness of the carotid artery lining – i.e. increased room for blood flow.
While much more research needs to be done, I am convinced right now that testosterone replacement therapy in hypogonadal men may be safer than excessively large doses of growth hormone. The long-term studies have not yet been done to test the true long-term effects of these hormones, but the research seems quite clear at the moment. Michael Mooney has reported similar results on safety and side effects of these hormones:
While none of the studies on testosterone or anabolic steroids used for HIV have documented any significant health problems associated with their proper therapeutic use, Dr. Gabe Torres' data on his patients who experienced a reduction in symptoms of HIV-related lipodystrophy with Serostim growth hormone showed that at the standard 5 and 6 mg doses, 80 percent of his HIV patients experienced significant side effects, that included elevated glucose, elevated pancreatic enzymes, or carpal tunnel syndrome. (1)
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Conclusion
Don’t get me wrong – I still use both growth hormone and testosterone as part of overall anti-aging programs in my patients. This article is not meant to say one hormone is "good" and another is "bad". It is just my opinion at the moment that the overall benefit/cost ratio for improving body composition is higher with testosterone than growth hormone. By cost, I mean both the monetary price – testosterone is far cheaper than growth hormone, and the side effect/safety profile – testosterone is safer than high-dose growth hormone use.
Since growth hormone is extremely expensive and perhaps riskier than testosterone, I screen patients very carefully and only recommend it to those who either have very low IGF-1 levels and fail growth hormone stimulation tests, or those who have failed to respond to testosterone or other therapies. The new research has also made me confident in encouraging more and more patients to go on testosterone. However, we must keep constant track of the new research to better refine both anti-aging and bodybuilding programs. The science of hormone supplementation is still in its infancy, and there is still a lot more questions that need to be answered.
19 Aralık 2007 Çarşamba
Blood testing ; a necessity in AAS usage
A Comprehensive Look at Lab Tests
by Cy Willson
You just had some blood work done, and the friggin' doctor or his nurses are guarding the results as if they're state secrets. However, after much cajoling and explaining that you'd like to at least be an informed partner in your own goshdarn health care, they begrudgingly give you a copy of your lab tests.
Trouble is, as much as you've been posturing about how you've had more than a smattering of medical education, you still can't figure out what half the tests are for and whether or not those abnormal values are anything to worry about.
Well, in the following article, I'm going to go over each of the most common tests. I'll include why it's performed, what it tells you, and what the typical ranges are for normal humans. That way, you'll have something more to go on in assessing your health other than your family doctor saying, "Well, these few values are a little worrisome, but you'll probably be okay."
One note, though, before I get started. The values I'll be listing are merely averages and the ranges may vary slightly from laboratory to laboratory. Also, if there's only one range given, it applies to both men and women.
Lipid Panel — Used to determine possible risk for coronary and vascular disease. In other words, heart disease.
HDL/LDL and Total Cholesterol
These lipoproteins should look rather familiar to most of you. HDL is simply the "good" lipoprotein that acts as a scavenger molecule and prevents a buildup of material. LDL is the "bad" lipoprotein which collects in arterial walls and causes blockage or a reduction in blood flow. The total cholesterol to HDL ratio is also important. I went in to detail about this particular subject — as well as how to improve your lipid profile — in my article "Bad Blood".
Nevertheless, a quick remonder: your HDL should be 35 or higher; LDL below 130; and total to HDL ratio should be below 3.5. Oh and don't forget VLDL (very low density lipoprotein) which can be extremely worrisome. You should have less than 30 mg/dl in order to not be considered at risk for heart disease.
On a side note, I'm sure some of you are wishing that you had abnormally low plasma cholesterol levels (as if it's something to brag about), but the fact is that having extremely low cholesterol levels is actually indicative of severe liver disease.
Triglycerides
Triglycerides are simply a form of fat that exists in the bloodstream. They're transported by two other culprits, VLDL and LDL. A high level of triglycerides is also a risk factor for heart disease as well. Triglycerides levels can be increased if food or alcohol is consumed 12 to 24 hours prior to the blood draw and this is the reason why you're asked to fast for 12-14 hours from food and abstain from alcohol for 24 hours. Here are the normal ranges for healthy humans.
16-19 yr. old male
40-163 mg/dl
Adult Male
40-160 mg/dl
16-19 yr. old female
40-128 mg/dl
Adult Female
35-135 mg/dl
Homocysteine
Unfortunately, this test isn't always ordered by the doctor. It should be. Homocysteine is formed in the metabolism of the dietary amino acid methionine. The problem is that it's a strong risk factor for atherosclerosis. In other words, high levels may cause you to have a heart attack. A good number of lifters should be concerned with this value as homocysteine levels rise with anabolic steroid usage.
Luckily, taking folic acid (about 400-800 mcg.) as well as taking a good amount of all B vitamins in general will go a long way in terms of preventing a rise in levels of homocysteine.
Normal ranges:
Males and Females age 0-30
4.6-8.1 umol/L
Males age 30-59
6.3-11.2 umol/L
Females age 30-59
4.5-7.9 umol/L
>59 years of age
5.8-11.9 umol/L
The Hemo Profile
These are various tests that examine a number of components of your blood and look for any abnormalities that could be indicative of serious diseases that may result in you being an extra in the HBO show, "Six Feet Under."
WBC Total (White Blood Cell)
Also referred to as leukocytes, a fluctuation in the number of these types of cells can be an indicator of things like infections and disease states dealing with immunity, cancer, stress, etc.
Normal ranges:
4,500-11,000/mm3
Neutrophils
This is one type of white blood cell that's in circulation for only a very short time. Essentially their job is phagocytosis, which is the process of killing and digesting bacteria that cause infection. Both severe trauma and bacterial infections, as well as inflammatory or metabolic disorders and even stress, can cause an increase in the number of these cells. Having a low number of neutrophils can be indicative of a viral infection, a bacterial infection, or a rotten diet.
Normal ranges:
2,500-8,000 cells per mm3
RBC (Red Blood Cell)
These blood cells also called erythrocytes and their primary function is to carry oxygen (via the hemoglobin contained in each RBC) to varioustissues as well as giving our blood that cool "red" color. Unlike WBC, RBC survive in peripheral blood circulation for approximately 120 days. A decrease in the number of these cells can result in anemia which could stem from dietary insufficiencies. An increase in number can occur when androgens are used. This is because androgens increase EPO (erythropoietin) production which in turn increases RBC count and thus elevates blood volume. This is essentially why some androgens are better than others at increasing "vascularity." Anyhow, the danger in this could be an increase in blood pressure or a stroke.
Androgen-using lifters who have high values should consider making modifications to their stack and/or immediately donating some blood.
Normal ranges:
Adult Male
4,700,000-6,100,000 cells/uL
Adult Female
4,200,000-5,400,000 cells/uL
Hemoglobin
Hemoglobin is what serves as a carrier for both oxygen and carbon dioxide transportation. Molecules of this are found within each red blood cell. An increase in hemoglobin can be an indicator of congenital heart disease, congestive heart failure, sever burns, or dehydration. Being at high altitudes, or the use of androgens, can cause an increase as well. A decrease in number can be a sign of anemia, lymphoma, kidney disease, sever hemorrhage, cancer, sickle cell anemia, etc.
Normal ranges:
Males and females 6-18 years
10-15.5 g/dl
Adult Males
14-18 g/dl
Adult Females
12-16 g/dl
Hematocrit
The hematocrit is used to measure the percentage of the total blood volume that's made up of red blood cells. An increase in percentage may be indicative of congenital heart disease, dehydration, diarrhea, burns, etc. A decrease in levels may be indicative of anemia, hyperthyroidism, cirrhosis, hemorrhage, leukemia, rheumatoid arthritis, pregnancy, malnutrition, a sucking knife wound to the chest, etc.
Normal ranges:
Male and Females age 6-18 years
32-44%
Adult Men
42-52%
Adult Women
37-47%
MCV (Mean Corpuscular Volume)
This is one of three red blood cell indices used to check for abnormalities. The MCV is the size or volume of the average red blood cell. A decrease in MCV would then indicate that the RBC's are abnormally large(or macrocytic), and this may be an indicator of iron deficiency anemia or thalassemia. When an increase is noted, that would indicate abnormally small RBC (microcytic), and this may be indicative of a vitamin B12 or folic acid deficiency as well as liver disease.
Normal ranges:
Adult Male
80-100 fL
Adult Female
79-98 fL
12-18 year olds
78-100 fL
MCH (Mean Corpuscular Hemoglobin)
The MCH is the weight of hemoglobin present in the average red blood cell. This is yet another way to assess whether some sort of anemia or deficiency is present.
Normal ranges:
12-18 year old
35-45 pg
Adult Male
26-34 pg
Adult Female
26-34 pg
MCHC (Mean Corpuscular Hemoglobin Concentration)
The MCHC is the measurement of the amount of hemoglobin present in the average red blood cell as compared to its size. A decrease in number is an indicator of iron deficiency, thalassemia, lead poisoning, etc. An increase is sometimes seen after androgen use.
Normal ranges:
12-18 year old
31-37 g/dl
Adult Male
31-37 g/dl
Adult Female
30-36 g/dl
RDW (Red Cell Distribution Width)
The RDW is an indicator of the variation in red blood cell size. It's used in order to help classify certain types of anemia, and to see if some of the red blood cells need their suits tailored. An increase in RDW can be indicative of iron deficiency anemia, vitamin B12 or folate deficiency anemia, and diseases like sickle cell anemia.
Normal ranges:
Adult Mal
11.7-14.2%
Adult Female
11.7-14.2%
Platelets
Platelets or thrombocytes are essential for your body's ability to form blood clots and thus stop bleeding. They're measured in order to assess the likelihood of certain disorders or diseases. An increase can be indicative of a malignant disorder, rheumatoid arthritis, iron deficiency anemia, etc. A decrease can be indicative of much more, including things like infection, various types of anemia, leukemia, etc.
On a side note for these ranges, anything above 1 million/mm3 would be considered a critical value and should warrant concern and/or giving second thoughts as to whether you should purchase a lifetime subscription to Muscle Media.
Normal ranges:
Child
150,000-400,000/mm3
(Most commonly displayed in SI units of 150-400 x 10(9th)/L
Adult
150,000-400,000/mm3
(Most commonly displayed in SI units of 150-400 x 10(9th)/L
ABS (Differential Count)
The differential count measures the percentage of each type of leukocyte or white blood cell present in the same specimen. Using this, they can determine whether there's a bacterial or parasitic infection, as well as immune reactions, etc.
Pt. 2
Neutrophils
As explained previously, severe trauma and bacterial infections, as well as inflammatory disorders, metabolic disorders, and even stress can cause an increase in the number of these cells. Also, on the other side of the spectrum, a low number of these cells can indicate a viral infection, a bacterial infection, or a deficient diet.
Percentile Range:
55-70%
Basophils
These cells, and in particular, eosinophils, are present in the event of an allergic reaction as well as when a parasite is present. These types of cells don't increase in response to viral or bacterial infections so if an increased count is noted, it can be deduced that either an allergic response has occurred or a parasite has taken up residence in your shorts.
Percentile Range:
Basophils
0.5-1%
Eosinophils
1-4%
Lymphocytes and Monocytes
Lymphocytes can be divided in to two different types of cells: T cells and B cells. T cells are involved in immune reactions and B cells are involved in antibody production. The main job of lymphocytes in general is to fight off — Bruce Lee style — bacterial and viral infections.
Monocytes are similar to neutrophils but are produced more rapidly and stay in the system for a longer period of time.
Percentile Range:
Lymphocytes
20-40%
Monocytes
2-8%
Selected Clinical Values
Sodium
This cation (an ion with a postive charge) is mainly found in extracellular spaces and is responsible for maintaining a balance of water in the body. When sodium in the blood rises, the kidneys will conserve water and when the sodium concentration is low, the kidneys conserve sodium and excrete water. Increased levels can result from excessive dietary intake, Cushing's syndrome, excessive sweating, burns, forgetting to drink for a week, etc. Decreased levels can result from a deficient diet, Addison's disease, diarrhea, vomiting, chronic renal insufficiency, excessive water intake, congestive heart failure, etc. Anabolic steroids will lead to an increased level of sodium as well.
Normal range:
Adults
136-145 mEq/L
Potassium
On the other side of the spectrum, you have the most important intracellular cation. Increased levels can be an indicator of excessive dietary intake, acute renal failure, aldosterone-inhibiting diuretics, a crushing injury to tissues, infection, acidosis, dehydration, etc. Decreased levels can be indicative of a deficient dietary intake, burns, diarrhea or vomiting, diuretics, Cushing's syndrome, licorice consumption, insulin use, cystic fibrosis, trauma, surgery, etc.
Normal range:
Adults
3.5-5 mEq/L
Chloride
This is the major extracellular anion (an ion carrying a negative charge). Its purpose it is to maintain electrical neutrality with sodium. It also serves as a buffer in order to maintain the pH balance of the blood. Chloride typically accompanies sodium and thus the causes for change are essentially the same.
Normal range:
Adult
98-106 mEq/L
Carbon Dioxide
The CO2 content is used to evaluate the pH of the blood as well as aid in evaluation of electrolyte levels. Increased levels can be indicative of severe diarrhea, starvation, vomiting, emphysema, metabolic alkalosis, etc. Increased levels could also mean that you're a plant. Decreased levels can be indicative of kidney failure, metabolic acidosis, shock, and starvation.
Normal range:
Adults
23-30 mEq/L
Glucose
The amount of glucose in the blood after a prolonged period of fasting (12-14 hours) is used to determine whether a person is in a hypoglycemic (low blood glucose) or hyperglycemic (high blood glucose) state. Both can be indicators of serious conditions. Increased levels can be indicative of diabetes mellitus, acute stress, Cushing's syndrome, chronic renal failure, corticosteroid therapy, acromegaly, etc. Decreased levels could be indicative of hypothyroidism, insulinoma, liver disease, insulin overdose, and starvation.
Normal range:
Adult Male
65-120 mg/dl
Adult Female
65-120 mg/dl
BUN (Blood Urea Nitrogen)
This test measures the amount of urea nitrogen that's present in the blood. When protein is metabolized, the end product is urea which is formed in the liver and excreted from the bloodstream via the kidneys. This is why BUN is a good indicator of both liver and kidney function. Increased levels can stem from shock, burns, dehydration, congestive hear failure, myocardial infarction, excessive protein ingestion, excessive protein catabolism, starvation, sepsis, renal disease, renal failure, etc. Causes of a decrease in levels can be liver failure, overhydration, negative nitrogen balance via malnutrition, pregnancy, etc.
Normal range:
Adults
10-20 mg/dl
Creatinine
Creatinine is a byproduct of creatine phosphate, the chemical used in contraction of skeletal muscle. So, the more muscle mass you have, the higher the creatine levels and therefore the higher the levels of creatinine. Also, when you ingest large amounts of beef or other meats that have high levels of creatine in them, you can increase creatinine levels as well. Since creatinine levels are used to measure the functioning of the kidneys, this easily explains why creatine has been accused of causing kidney damage, since it naturally results in an increase in creatinine levels.
However, we need to remember that these tests are only indicators of functioning and thus outside drugs and supplements can influence them and give false results, as creatine may do. This is why creatine, while increasing creatinine levels, does not cause renal damage or impair function. Generally speaking, though, increased levels are indicative of urinary tract obstruction, acute tubular necrosis, reduced renal blood flow (stemming from shock, dehydration, congestive heart failure, atherosclerosis), as well as acromegaly. Decreased levels can be indicative of debilitation, and decreased muscle mass via disease or some other cause.
Normal range:
Adult Male
0.6-1.2 mg/dl
Adult Female
0.5-1.1 mg/dl
BUN/Creatinine Ratio
A high ratio may be found in states of shock, volume depletion, hypotension, dehydration, gastrointestinal bleeding, and in some cases, a catabolic state. A low ratio can be indicative of a low protein diet, malnutrition, pregnancy, severe liver disease, ketosis, etc. Keep in mind, though, that the term BUN, when used in the same sentence as hamburger or hotdog, usually means something else entirely. An important thing to note again is that with a high protein diet, you'll likely have a higher ratio and this is nothing to worry about.
Normal range:
Adult
6-25
Calcium
Calcium is measured in order to assess the function of the parathyroid and calcium metabolism. Increased levels can stem from hyperparathyroidism, metastatic tumor to the bone, prolonged immobilization, lymphoma, hyperthyroidism, acromegaly, etc. It's also important to note that anabolic steroids can also increase calcium levels. Decreased levels can stem from renal failure, rickets, vitamin D deficiency, malabsorption, pancreatitis, and alkalosis.
Normal range:
Adult
9-10.5 mg/dl
Liver Function
Total Protein
This measures the total level of albumin and globulin in the body. Albumin is synthesized by the liver and as such is used as an indicator of liver function. It functions to transport hormones, enzymes, drugs and other constituents of the blood.
Globulins are the building blocks of your body's antibodies. Measuring the levels of these two proteins is also an indicator of nutritional status. Increased albumin levels can result from dehydration, while decreased albumin levels can result from malnutrition, pregnancy, liver disease, overhydration, inflammatory diseases, etc. Increased globulin levels can result from inflammatory diseases, hypercholesterolemia (high cholesterol), iron deficiency anemia, as well as infections. Decreased globulin levels can result from hyperthyroidism, liver dysfunction, malnutrition, and immune deficiencies or disorders.
As another important side note, anabolic steroids, growth hormone, and insulin can all increase protein levels.
Normal range:
Adult
Total Protein: 6.4-8.3 g/dl
Albumin: 3.5-5 g/dl
Globulin: 2.3-3.4 g/dl
Albumin/Globulin Ratio:
Adult
0.8-2.0
Bilirubin
Bilirubin is one of the many constituents of bile, which is formed in the liver. An increase in levels of bilirubin can be indicative of liver stress or damage/inflammation. Drugs that may increase bilirubin include oral anabolic steroids (17-AA), antibiotics, diuretics, morphine, codeine, contraceptives, etc. Drugs that may decrease levels are barbiturates and caffeine. Non-drug induced increased levels can be indicative of gallstones, extensive liver metastasis, and cholestasis from certain drugs, hepatitis, sepsis, sickle cell anemia, cirrhosis, etc.
Normal range:
Total Bilirubin for Adult
0.3-1.0 mg/dl
Alkaline Phosphatase
This enzyme is found in very high concentrations in the liver and for this reason is used as an indicator of liver stress or damage. Increased levels can stem from cirrhosis, liver tumor, pregnancy, healing fracture, normal bones of growing children, and rheumatoid arthritis. Decreased levels can stem from hypothyroidism, malnutrition, pernicious anemia, scurvy (vitamin C deficiency) and excess vitamin B ingestion. As a side note, antibiotics can cause an increase in the enzyme levels.
Normal range:
16-21 years
30-200 U/L
Adult
30-120 U/L
Pt. 3
AST (Aspartate Aminotransferase, previously known as SGOT)
This is yet another enzyme that's used to determine if there's damage or stress to the liver. It may also be used to see if heart disease is a possibility as well, but this isn't as accurate. When the liver is damaged or inflamed, AST levels can rise to a very high level (20 times the normal value). This happens because AST is released when the cells of that particular organ (liver) are lysed. The AST then enters blood circulation and an elevation can be seen. Increased levels can be indicative of heart disease, liver disease, skeletal muscle disease or injuries, as well as heat stroke. Decreased levels can be indicative of acute kidney disease, beriberi, diabetic ketoacidosis, pregnancy, and renal dialysis.
Normal range:
Adult
0-35 U/L (Females may have slightly lower levels)
ALT (Alanine Aminotransferase, previously known as SGPT)
This is yet another enzyme that is found in high levels within the liver. Injury or disease of the liver will result in an increase in levels of ALT. I should note however, that because lesser quantities are found in skeletal muscle, there could be a weight-training induced increase . Weight training causes damage to muscle tissue and thus could slightly elevate these levels, giving a false indicator for liver disease. Still, for the most part, it's a rather accurate diagnostic tool. Increased levels can be indicative of hepatitis, hepatic necrosis, cirrhosis, cholestasis, hepatic tumor, hepatotoxic drugs, and jaundice, as well as severe burns, trauma to striated muscle (via weight training), myocardial infarction, mononucleosis, and shock.
Normal range:
Adult
4-36 U/L
Endocrine Function
Testosterone (Free and Total)
This is of course the hormone that you should all be extremely familiar with as it's the name of this here magazine! Anyhow, just as some background info, about 95% of the circulating Testosterone in a man's body is formed by the Leydig cells, which are found in the testicles. Women also have a small amount of Testosterone in their body as well. (Some more than others, which accounts for the bearded ladies you see at the circus, or hanging around with Chris Shugart.) This is from a very small amount of Testosterone secreted by the ovaries and the adrenal gland (in which the majority is made from the adrenal conversion of androstenedione to Testosterone via 17-beta HSD).
Nomal range, total Testosterone:
Male
Age 14
<1200 ng/dl
Age 15-16
100-1200 ng/dl
Age 17-18
300-1200 ng/dl
Age 19-40
300-950 ng/dl
Over 40
240-950 ng/dl
Female
Age 17-18
20-120 ng/dl
Over 18
20-80 ng/dl
Normal range, free Testosterone:
Male
50-210 pg/ml
LH (Luteinizing Hormone)
LH is a glycoprotein that's secreted by the anterior pituitary gland and is responsible for signaling the leydig cells to produce Testosterone. Measuring LH can be very useful in terms of determining whether a hypogonadic state (low Testosterone) is caused by the testicles not being responsive despite high or normal LH levels (primary), or whether it's the pituitary gland not secreting enough LH (secondary). Of course, the hypothalamus — which secretes LH-RH (luteinizing hormone releasing hormone) — could also be the culprit, as well as perhaps both the hypothalamus and the pituitary.
If it's a case of the testicles not being responsive to LH, then things like clomiphene and hCG really won't help. If the problem is secondary, then there's a better chance for improvement with drug therapy. Increased levels can be indicative of hypogonadism, precocious puberty, and pituitary adenoma. Decreased levels can be indicative of pituitary failure, hypothalamic failure, stress, and malnutrition.
Normal ranges:
Adult Male
1.24-7.8 IU/L
Adult Female
Follicular phase: 1.68-15 IU/L
Ovulatory phase: 21.9-56.6 IU/L
Luteal phase: 0.61-16.3 IU/L
Postmenopausal: 14.2-52.3 IU/L
Estradiol
With this being the most potent of the estrogens, I'm sure you're all aware that it can be responsible for things like water retention, hypertrophy of adipose tissue, gynecomastia, and perhaps even prostate hypertrophy and tumors. As a male it's very important to get your levels of this hormone checked for the above reasons. Also, it's the primary estrogen that's responsible for the negative feedback loop which suppresses endogenous Testosterone production. So, if your levels of estradiol are rather high, you can bet your ass that you'll be hypogonadal as well.
Increased estradiol levels can be indicative of a testicular tumor, adrenal tumor, hepatic cirrhosis, necrosis of the liver, hyperthyroidism, etc.
Normal ranges:
Adult Male
10-50 pg/ml
Adult Female
Follicular phase: 20-350 pg/ml
Midcycle peak: 150-750 pg/ml
Luteal phase: 30-450 pg/ml
Postmenopausal: 20 pg/ml or less
Thyroid (T3, T4 Total and Free, TSH) t3 (Triiodothyronine) t3 is the more metabolically active hormone out of T4 and t3. When levels are below normal it's generally safe to assume that the individual is suffering from hypothyroidism. Drugs that may increase t3 levels include estrogen and oral contraceptives. Drugs that may decrease t3 levels include anabolic steroids/androgens as well as propanolol (a beta adrenergic blocker) and high dosages of salicylates. Increased levels can be indicative of Graves disease, acute thyroiditis, pregnancy, hepatitis, etc. Decreased levels can be indicative of hypothyroidism, protein malnutrition, kidney failure, Cushing's syndrome, cirrhosis, and liver diseases.
Normal ranges:
16-20 years old
80-210 ng/dl
20-50 years
75-220 ng/dl or 1.2-3.4 nmol/L
Over 50
40-180 ng/dl or 0.6-2.8 nmol/L
T4 (Thyroxine)
T4 is just another indicator of whether or not someone is in a hypo or hyperthyroid state. It too is rather reliable but free thyroxine levels should be assessed as well. Drugs that increase of decrease t3 will, in most cases, do the same with T4. Increased levels are indicative of the same things as t3 and a decrease can be indicative of protein depleted states, iodine insufficiency, kidney failure, Cushing's syndrome, and cirrhosis.
Normal ranges:
Adult Male
4-12 ug/dl or 51-154 nmol/L
Adult Female
5-12 ug/dl or 64-154 nmol/L
Free T4 or Thyroxine
Since only 1-5% of the total amount of T4 is actually free and useable, this test is a far better indicator of the thyroid status of the patient. An increase indicates a hyperthyroid state and a decrease indicates a hypothyroid state. Drugs that increase free T4 are heparin, aspirin, danazol, and propanolol. Drugs that decrease it are furosemide, methadone, and rifampicin. Increased and decreased levels are indicative of the same possible diseases and states that are seen with T4 and t3.
Normal ranges:
0.8-2.8 ng/dl or 10-36 pmol/L
TSH (Thyroid Stimulating Hormone)
Measuring the level of TSH can be very helpful in terms of determining if the problem resides with the thyroid itself or the pituitary gland. If TSH levels are high, then it's merely the thyroid gland not responding for some reason but if TSH levels are low, it's the hypothalamus or pituitary gland that has something wrong with it. The problem could be a tumor, some type of trauma, or an infarction.
Drugs that can increase levels of TSH include lithium, potassium iodide and TSH itself. Drugs that may decrease TSH are aspirin, heparin, dopamine, t3, etc. Increased TSH is indicative of thyroiditis, hypothyroidism, and congenital cretinism. Decreased levels are indicative of hypothyroidism (pituitary dysfunction), hyperthyroidism, and pituitary hypofunction.
Normal ranges:
Adult
2-10 uU/ml or 2-10 mU/L
Knowing how to interpret these tests can be a very valuable tool in terms of health and your body building and athletic progress. Use your new knowledge wisely!
by Cy Willson
You just had some blood work done, and the friggin' doctor or his nurses are guarding the results as if they're state secrets. However, after much cajoling and explaining that you'd like to at least be an informed partner in your own goshdarn health care, they begrudgingly give you a copy of your lab tests.
Trouble is, as much as you've been posturing about how you've had more than a smattering of medical education, you still can't figure out what half the tests are for and whether or not those abnormal values are anything to worry about.
Well, in the following article, I'm going to go over each of the most common tests. I'll include why it's performed, what it tells you, and what the typical ranges are for normal humans. That way, you'll have something more to go on in assessing your health other than your family doctor saying, "Well, these few values are a little worrisome, but you'll probably be okay."
One note, though, before I get started. The values I'll be listing are merely averages and the ranges may vary slightly from laboratory to laboratory. Also, if there's only one range given, it applies to both men and women.
Lipid Panel — Used to determine possible risk for coronary and vascular disease. In other words, heart disease.
HDL/LDL and Total Cholesterol
These lipoproteins should look rather familiar to most of you. HDL is simply the "good" lipoprotein that acts as a scavenger molecule and prevents a buildup of material. LDL is the "bad" lipoprotein which collects in arterial walls and causes blockage or a reduction in blood flow. The total cholesterol to HDL ratio is also important. I went in to detail about this particular subject — as well as how to improve your lipid profile — in my article "Bad Blood".
Nevertheless, a quick remonder: your HDL should be 35 or higher; LDL below 130; and total to HDL ratio should be below 3.5. Oh and don't forget VLDL (very low density lipoprotein) which can be extremely worrisome. You should have less than 30 mg/dl in order to not be considered at risk for heart disease.
On a side note, I'm sure some of you are wishing that you had abnormally low plasma cholesterol levels (as if it's something to brag about), but the fact is that having extremely low cholesterol levels is actually indicative of severe liver disease.
Triglycerides
Triglycerides are simply a form of fat that exists in the bloodstream. They're transported by two other culprits, VLDL and LDL. A high level of triglycerides is also a risk factor for heart disease as well. Triglycerides levels can be increased if food or alcohol is consumed 12 to 24 hours prior to the blood draw and this is the reason why you're asked to fast for 12-14 hours from food and abstain from alcohol for 24 hours. Here are the normal ranges for healthy humans.
16-19 yr. old male
40-163 mg/dl
Adult Male
40-160 mg/dl
16-19 yr. old female
40-128 mg/dl
Adult Female
35-135 mg/dl
Homocysteine
Unfortunately, this test isn't always ordered by the doctor. It should be. Homocysteine is formed in the metabolism of the dietary amino acid methionine. The problem is that it's a strong risk factor for atherosclerosis. In other words, high levels may cause you to have a heart attack. A good number of lifters should be concerned with this value as homocysteine levels rise with anabolic steroid usage.
Luckily, taking folic acid (about 400-800 mcg.) as well as taking a good amount of all B vitamins in general will go a long way in terms of preventing a rise in levels of homocysteine.
Normal ranges:
Males and Females age 0-30
4.6-8.1 umol/L
Males age 30-59
6.3-11.2 umol/L
Females age 30-59
4.5-7.9 umol/L
>59 years of age
5.8-11.9 umol/L
The Hemo Profile
These are various tests that examine a number of components of your blood and look for any abnormalities that could be indicative of serious diseases that may result in you being an extra in the HBO show, "Six Feet Under."
WBC Total (White Blood Cell)
Also referred to as leukocytes, a fluctuation in the number of these types of cells can be an indicator of things like infections and disease states dealing with immunity, cancer, stress, etc.
Normal ranges:
4,500-11,000/mm3
Neutrophils
This is one type of white blood cell that's in circulation for only a very short time. Essentially their job is phagocytosis, which is the process of killing and digesting bacteria that cause infection. Both severe trauma and bacterial infections, as well as inflammatory or metabolic disorders and even stress, can cause an increase in the number of these cells. Having a low number of neutrophils can be indicative of a viral infection, a bacterial infection, or a rotten diet.
Normal ranges:
2,500-8,000 cells per mm3
RBC (Red Blood Cell)
These blood cells also called erythrocytes and their primary function is to carry oxygen (via the hemoglobin contained in each RBC) to varioustissues as well as giving our blood that cool "red" color. Unlike WBC, RBC survive in peripheral blood circulation for approximately 120 days. A decrease in the number of these cells can result in anemia which could stem from dietary insufficiencies. An increase in number can occur when androgens are used. This is because androgens increase EPO (erythropoietin) production which in turn increases RBC count and thus elevates blood volume. This is essentially why some androgens are better than others at increasing "vascularity." Anyhow, the danger in this could be an increase in blood pressure or a stroke.
Androgen-using lifters who have high values should consider making modifications to their stack and/or immediately donating some blood.
Normal ranges:
Adult Male
4,700,000-6,100,000 cells/uL
Adult Female
4,200,000-5,400,000 cells/uL
Hemoglobin
Hemoglobin is what serves as a carrier for both oxygen and carbon dioxide transportation. Molecules of this are found within each red blood cell. An increase in hemoglobin can be an indicator of congenital heart disease, congestive heart failure, sever burns, or dehydration. Being at high altitudes, or the use of androgens, can cause an increase as well. A decrease in number can be a sign of anemia, lymphoma, kidney disease, sever hemorrhage, cancer, sickle cell anemia, etc.
Normal ranges:
Males and females 6-18 years
10-15.5 g/dl
Adult Males
14-18 g/dl
Adult Females
12-16 g/dl
Hematocrit
The hematocrit is used to measure the percentage of the total blood volume that's made up of red blood cells. An increase in percentage may be indicative of congenital heart disease, dehydration, diarrhea, burns, etc. A decrease in levels may be indicative of anemia, hyperthyroidism, cirrhosis, hemorrhage, leukemia, rheumatoid arthritis, pregnancy, malnutrition, a sucking knife wound to the chest, etc.
Normal ranges:
Male and Females age 6-18 years
32-44%
Adult Men
42-52%
Adult Women
37-47%
MCV (Mean Corpuscular Volume)
This is one of three red blood cell indices used to check for abnormalities. The MCV is the size or volume of the average red blood cell. A decrease in MCV would then indicate that the RBC's are abnormally large(or macrocytic), and this may be an indicator of iron deficiency anemia or thalassemia. When an increase is noted, that would indicate abnormally small RBC (microcytic), and this may be indicative of a vitamin B12 or folic acid deficiency as well as liver disease.
Normal ranges:
Adult Male
80-100 fL
Adult Female
79-98 fL
12-18 year olds
78-100 fL
MCH (Mean Corpuscular Hemoglobin)
The MCH is the weight of hemoglobin present in the average red blood cell. This is yet another way to assess whether some sort of anemia or deficiency is present.
Normal ranges:
12-18 year old
35-45 pg
Adult Male
26-34 pg
Adult Female
26-34 pg
MCHC (Mean Corpuscular Hemoglobin Concentration)
The MCHC is the measurement of the amount of hemoglobin present in the average red blood cell as compared to its size. A decrease in number is an indicator of iron deficiency, thalassemia, lead poisoning, etc. An increase is sometimes seen after androgen use.
Normal ranges:
12-18 year old
31-37 g/dl
Adult Male
31-37 g/dl
Adult Female
30-36 g/dl
RDW (Red Cell Distribution Width)
The RDW is an indicator of the variation in red blood cell size. It's used in order to help classify certain types of anemia, and to see if some of the red blood cells need their suits tailored. An increase in RDW can be indicative of iron deficiency anemia, vitamin B12 or folate deficiency anemia, and diseases like sickle cell anemia.
Normal ranges:
Adult Mal
11.7-14.2%
Adult Female
11.7-14.2%
Platelets
Platelets or thrombocytes are essential for your body's ability to form blood clots and thus stop bleeding. They're measured in order to assess the likelihood of certain disorders or diseases. An increase can be indicative of a malignant disorder, rheumatoid arthritis, iron deficiency anemia, etc. A decrease can be indicative of much more, including things like infection, various types of anemia, leukemia, etc.
On a side note for these ranges, anything above 1 million/mm3 would be considered a critical value and should warrant concern and/or giving second thoughts as to whether you should purchase a lifetime subscription to Muscle Media.
Normal ranges:
Child
150,000-400,000/mm3
(Most commonly displayed in SI units of 150-400 x 10(9th)/L
Adult
150,000-400,000/mm3
(Most commonly displayed in SI units of 150-400 x 10(9th)/L
ABS (Differential Count)
The differential count measures the percentage of each type of leukocyte or white blood cell present in the same specimen. Using this, they can determine whether there's a bacterial or parasitic infection, as well as immune reactions, etc.
Pt. 2
Neutrophils
As explained previously, severe trauma and bacterial infections, as well as inflammatory disorders, metabolic disorders, and even stress can cause an increase in the number of these cells. Also, on the other side of the spectrum, a low number of these cells can indicate a viral infection, a bacterial infection, or a deficient diet.
Percentile Range:
55-70%
Basophils
These cells, and in particular, eosinophils, are present in the event of an allergic reaction as well as when a parasite is present. These types of cells don't increase in response to viral or bacterial infections so if an increased count is noted, it can be deduced that either an allergic response has occurred or a parasite has taken up residence in your shorts.
Percentile Range:
Basophils
0.5-1%
Eosinophils
1-4%
Lymphocytes and Monocytes
Lymphocytes can be divided in to two different types of cells: T cells and B cells. T cells are involved in immune reactions and B cells are involved in antibody production. The main job of lymphocytes in general is to fight off — Bruce Lee style — bacterial and viral infections.
Monocytes are similar to neutrophils but are produced more rapidly and stay in the system for a longer period of time.
Percentile Range:
Lymphocytes
20-40%
Monocytes
2-8%
Selected Clinical Values
Sodium
This cation (an ion with a postive charge) is mainly found in extracellular spaces and is responsible for maintaining a balance of water in the body. When sodium in the blood rises, the kidneys will conserve water and when the sodium concentration is low, the kidneys conserve sodium and excrete water. Increased levels can result from excessive dietary intake, Cushing's syndrome, excessive sweating, burns, forgetting to drink for a week, etc. Decreased levels can result from a deficient diet, Addison's disease, diarrhea, vomiting, chronic renal insufficiency, excessive water intake, congestive heart failure, etc. Anabolic steroids will lead to an increased level of sodium as well.
Normal range:
Adults
136-145 mEq/L
Potassium
On the other side of the spectrum, you have the most important intracellular cation. Increased levels can be an indicator of excessive dietary intake, acute renal failure, aldosterone-inhibiting diuretics, a crushing injury to tissues, infection, acidosis, dehydration, etc. Decreased levels can be indicative of a deficient dietary intake, burns, diarrhea or vomiting, diuretics, Cushing's syndrome, licorice consumption, insulin use, cystic fibrosis, trauma, surgery, etc.
Normal range:
Adults
3.5-5 mEq/L
Chloride
This is the major extracellular anion (an ion carrying a negative charge). Its purpose it is to maintain electrical neutrality with sodium. It also serves as a buffer in order to maintain the pH balance of the blood. Chloride typically accompanies sodium and thus the causes for change are essentially the same.
Normal range:
Adult
98-106 mEq/L
Carbon Dioxide
The CO2 content is used to evaluate the pH of the blood as well as aid in evaluation of electrolyte levels. Increased levels can be indicative of severe diarrhea, starvation, vomiting, emphysema, metabolic alkalosis, etc. Increased levels could also mean that you're a plant. Decreased levels can be indicative of kidney failure, metabolic acidosis, shock, and starvation.
Normal range:
Adults
23-30 mEq/L
Glucose
The amount of glucose in the blood after a prolonged period of fasting (12-14 hours) is used to determine whether a person is in a hypoglycemic (low blood glucose) or hyperglycemic (high blood glucose) state. Both can be indicators of serious conditions. Increased levels can be indicative of diabetes mellitus, acute stress, Cushing's syndrome, chronic renal failure, corticosteroid therapy, acromegaly, etc. Decreased levels could be indicative of hypothyroidism, insulinoma, liver disease, insulin overdose, and starvation.
Normal range:
Adult Male
65-120 mg/dl
Adult Female
65-120 mg/dl
BUN (Blood Urea Nitrogen)
This test measures the amount of urea nitrogen that's present in the blood. When protein is metabolized, the end product is urea which is formed in the liver and excreted from the bloodstream via the kidneys. This is why BUN is a good indicator of both liver and kidney function. Increased levels can stem from shock, burns, dehydration, congestive hear failure, myocardial infarction, excessive protein ingestion, excessive protein catabolism, starvation, sepsis, renal disease, renal failure, etc. Causes of a decrease in levels can be liver failure, overhydration, negative nitrogen balance via malnutrition, pregnancy, etc.
Normal range:
Adults
10-20 mg/dl
Creatinine
Creatinine is a byproduct of creatine phosphate, the chemical used in contraction of skeletal muscle. So, the more muscle mass you have, the higher the creatine levels and therefore the higher the levels of creatinine. Also, when you ingest large amounts of beef or other meats that have high levels of creatine in them, you can increase creatinine levels as well. Since creatinine levels are used to measure the functioning of the kidneys, this easily explains why creatine has been accused of causing kidney damage, since it naturally results in an increase in creatinine levels.
However, we need to remember that these tests are only indicators of functioning and thus outside drugs and supplements can influence them and give false results, as creatine may do. This is why creatine, while increasing creatinine levels, does not cause renal damage or impair function. Generally speaking, though, increased levels are indicative of urinary tract obstruction, acute tubular necrosis, reduced renal blood flow (stemming from shock, dehydration, congestive heart failure, atherosclerosis), as well as acromegaly. Decreased levels can be indicative of debilitation, and decreased muscle mass via disease or some other cause.
Normal range:
Adult Male
0.6-1.2 mg/dl
Adult Female
0.5-1.1 mg/dl
BUN/Creatinine Ratio
A high ratio may be found in states of shock, volume depletion, hypotension, dehydration, gastrointestinal bleeding, and in some cases, a catabolic state. A low ratio can be indicative of a low protein diet, malnutrition, pregnancy, severe liver disease, ketosis, etc. Keep in mind, though, that the term BUN, when used in the same sentence as hamburger or hotdog, usually means something else entirely. An important thing to note again is that with a high protein diet, you'll likely have a higher ratio and this is nothing to worry about.
Normal range:
Adult
6-25
Calcium
Calcium is measured in order to assess the function of the parathyroid and calcium metabolism. Increased levels can stem from hyperparathyroidism, metastatic tumor to the bone, prolonged immobilization, lymphoma, hyperthyroidism, acromegaly, etc. It's also important to note that anabolic steroids can also increase calcium levels. Decreased levels can stem from renal failure, rickets, vitamin D deficiency, malabsorption, pancreatitis, and alkalosis.
Normal range:
Adult
9-10.5 mg/dl
Liver Function
Total Protein
This measures the total level of albumin and globulin in the body. Albumin is synthesized by the liver and as such is used as an indicator of liver function. It functions to transport hormones, enzymes, drugs and other constituents of the blood.
Globulins are the building blocks of your body's antibodies. Measuring the levels of these two proteins is also an indicator of nutritional status. Increased albumin levels can result from dehydration, while decreased albumin levels can result from malnutrition, pregnancy, liver disease, overhydration, inflammatory diseases, etc. Increased globulin levels can result from inflammatory diseases, hypercholesterolemia (high cholesterol), iron deficiency anemia, as well as infections. Decreased globulin levels can result from hyperthyroidism, liver dysfunction, malnutrition, and immune deficiencies or disorders.
As another important side note, anabolic steroids, growth hormone, and insulin can all increase protein levels.
Normal range:
Adult
Total Protein: 6.4-8.3 g/dl
Albumin: 3.5-5 g/dl
Globulin: 2.3-3.4 g/dl
Albumin/Globulin Ratio:
Adult
0.8-2.0
Bilirubin
Bilirubin is one of the many constituents of bile, which is formed in the liver. An increase in levels of bilirubin can be indicative of liver stress or damage/inflammation. Drugs that may increase bilirubin include oral anabolic steroids (17-AA), antibiotics, diuretics, morphine, codeine, contraceptives, etc. Drugs that may decrease levels are barbiturates and caffeine. Non-drug induced increased levels can be indicative of gallstones, extensive liver metastasis, and cholestasis from certain drugs, hepatitis, sepsis, sickle cell anemia, cirrhosis, etc.
Normal range:
Total Bilirubin for Adult
0.3-1.0 mg/dl
Alkaline Phosphatase
This enzyme is found in very high concentrations in the liver and for this reason is used as an indicator of liver stress or damage. Increased levels can stem from cirrhosis, liver tumor, pregnancy, healing fracture, normal bones of growing children, and rheumatoid arthritis. Decreased levels can stem from hypothyroidism, malnutrition, pernicious anemia, scurvy (vitamin C deficiency) and excess vitamin B ingestion. As a side note, antibiotics can cause an increase in the enzyme levels.
Normal range:
16-21 years
30-200 U/L
Adult
30-120 U/L
Pt. 3
AST (Aspartate Aminotransferase, previously known as SGOT)
This is yet another enzyme that's used to determine if there's damage or stress to the liver. It may also be used to see if heart disease is a possibility as well, but this isn't as accurate. When the liver is damaged or inflamed, AST levels can rise to a very high level (20 times the normal value). This happens because AST is released when the cells of that particular organ (liver) are lysed. The AST then enters blood circulation and an elevation can be seen. Increased levels can be indicative of heart disease, liver disease, skeletal muscle disease or injuries, as well as heat stroke. Decreased levels can be indicative of acute kidney disease, beriberi, diabetic ketoacidosis, pregnancy, and renal dialysis.
Normal range:
Adult
0-35 U/L (Females may have slightly lower levels)
ALT (Alanine Aminotransferase, previously known as SGPT)
This is yet another enzyme that is found in high levels within the liver. Injury or disease of the liver will result in an increase in levels of ALT. I should note however, that because lesser quantities are found in skeletal muscle, there could be a weight-training induced increase . Weight training causes damage to muscle tissue and thus could slightly elevate these levels, giving a false indicator for liver disease. Still, for the most part, it's a rather accurate diagnostic tool. Increased levels can be indicative of hepatitis, hepatic necrosis, cirrhosis, cholestasis, hepatic tumor, hepatotoxic drugs, and jaundice, as well as severe burns, trauma to striated muscle (via weight training), myocardial infarction, mononucleosis, and shock.
Normal range:
Adult
4-36 U/L
Endocrine Function
Testosterone (Free and Total)
This is of course the hormone that you should all be extremely familiar with as it's the name of this here magazine! Anyhow, just as some background info, about 95% of the circulating Testosterone in a man's body is formed by the Leydig cells, which are found in the testicles. Women also have a small amount of Testosterone in their body as well. (Some more than others, which accounts for the bearded ladies you see at the circus, or hanging around with Chris Shugart.) This is from a very small amount of Testosterone secreted by the ovaries and the adrenal gland (in which the majority is made from the adrenal conversion of androstenedione to Testosterone via 17-beta HSD).
Nomal range, total Testosterone:
Male
Age 14
<1200 ng/dl
Age 15-16
100-1200 ng/dl
Age 17-18
300-1200 ng/dl
Age 19-40
300-950 ng/dl
Over 40
240-950 ng/dl
Female
Age 17-18
20-120 ng/dl
Over 18
20-80 ng/dl
Normal range, free Testosterone:
Male
50-210 pg/ml
LH (Luteinizing Hormone)
LH is a glycoprotein that's secreted by the anterior pituitary gland and is responsible for signaling the leydig cells to produce Testosterone. Measuring LH can be very useful in terms of determining whether a hypogonadic state (low Testosterone) is caused by the testicles not being responsive despite high or normal LH levels (primary), or whether it's the pituitary gland not secreting enough LH (secondary). Of course, the hypothalamus — which secretes LH-RH (luteinizing hormone releasing hormone) — could also be the culprit, as well as perhaps both the hypothalamus and the pituitary.
If it's a case of the testicles not being responsive to LH, then things like clomiphene and hCG really won't help. If the problem is secondary, then there's a better chance for improvement with drug therapy. Increased levels can be indicative of hypogonadism, precocious puberty, and pituitary adenoma. Decreased levels can be indicative of pituitary failure, hypothalamic failure, stress, and malnutrition.
Normal ranges:
Adult Male
1.24-7.8 IU/L
Adult Female
Follicular phase: 1.68-15 IU/L
Ovulatory phase: 21.9-56.6 IU/L
Luteal phase: 0.61-16.3 IU/L
Postmenopausal: 14.2-52.3 IU/L
Estradiol
With this being the most potent of the estrogens, I'm sure you're all aware that it can be responsible for things like water retention, hypertrophy of adipose tissue, gynecomastia, and perhaps even prostate hypertrophy and tumors. As a male it's very important to get your levels of this hormone checked for the above reasons. Also, it's the primary estrogen that's responsible for the negative feedback loop which suppresses endogenous Testosterone production. So, if your levels of estradiol are rather high, you can bet your ass that you'll be hypogonadal as well.
Increased estradiol levels can be indicative of a testicular tumor, adrenal tumor, hepatic cirrhosis, necrosis of the liver, hyperthyroidism, etc.
Normal ranges:
Adult Male
10-50 pg/ml
Adult Female
Follicular phase: 20-350 pg/ml
Midcycle peak: 150-750 pg/ml
Luteal phase: 30-450 pg/ml
Postmenopausal: 20 pg/ml or less
Thyroid (T3, T4 Total and Free, TSH) t3 (Triiodothyronine) t3 is the more metabolically active hormone out of T4 and t3. When levels are below normal it's generally safe to assume that the individual is suffering from hypothyroidism. Drugs that may increase t3 levels include estrogen and oral contraceptives. Drugs that may decrease t3 levels include anabolic steroids/androgens as well as propanolol (a beta adrenergic blocker) and high dosages of salicylates. Increased levels can be indicative of Graves disease, acute thyroiditis, pregnancy, hepatitis, etc. Decreased levels can be indicative of hypothyroidism, protein malnutrition, kidney failure, Cushing's syndrome, cirrhosis, and liver diseases.
Normal ranges:
16-20 years old
80-210 ng/dl
20-50 years
75-220 ng/dl or 1.2-3.4 nmol/L
Over 50
40-180 ng/dl or 0.6-2.8 nmol/L
T4 (Thyroxine)
T4 is just another indicator of whether or not someone is in a hypo or hyperthyroid state. It too is rather reliable but free thyroxine levels should be assessed as well. Drugs that increase of decrease t3 will, in most cases, do the same with T4. Increased levels are indicative of the same things as t3 and a decrease can be indicative of protein depleted states, iodine insufficiency, kidney failure, Cushing's syndrome, and cirrhosis.
Normal ranges:
Adult Male
4-12 ug/dl or 51-154 nmol/L
Adult Female
5-12 ug/dl or 64-154 nmol/L
Free T4 or Thyroxine
Since only 1-5% of the total amount of T4 is actually free and useable, this test is a far better indicator of the thyroid status of the patient. An increase indicates a hyperthyroid state and a decrease indicates a hypothyroid state. Drugs that increase free T4 are heparin, aspirin, danazol, and propanolol. Drugs that decrease it are furosemide, methadone, and rifampicin. Increased and decreased levels are indicative of the same possible diseases and states that are seen with T4 and t3.
Normal ranges:
0.8-2.8 ng/dl or 10-36 pmol/L
TSH (Thyroid Stimulating Hormone)
Measuring the level of TSH can be very helpful in terms of determining if the problem resides with the thyroid itself or the pituitary gland. If TSH levels are high, then it's merely the thyroid gland not responding for some reason but if TSH levels are low, it's the hypothalamus or pituitary gland that has something wrong with it. The problem could be a tumor, some type of trauma, or an infarction.
Drugs that can increase levels of TSH include lithium, potassium iodide and TSH itself. Drugs that may decrease TSH are aspirin, heparin, dopamine, t3, etc. Increased TSH is indicative of thyroiditis, hypothyroidism, and congenital cretinism. Decreased levels are indicative of hypothyroidism (pituitary dysfunction), hyperthyroidism, and pituitary hypofunction.
Normal ranges:
Adult
2-10 uU/ml or 2-10 mU/L
Knowing how to interpret these tests can be a very valuable tool in terms of health and your body building and athletic progress. Use your new knowledge wisely!
Nolva vs. Clomid for PCT
While practically similar compounds in structure, few people ever really consider Clomid and nolva to be similar. Its not just a common myth in steroid circles, but even in the medical community. This misconception originates from their completely different uses. Nolvadex is most commonly used for the treatment of breast cancer in women, while Clomid is generally considered a fertility aid. In bodybuilding circles, from day one, Clomid has generally been used as post-cycle therapy and Nolvadex as an anti-estrogen.
But as I intend to demonstrate this is in essence the same. I believe the myth to have originated because nolva is clearly a more powerful anti-estrogen, and the people selling Clomid needed another angle to sell the stuff, so it was mostly used as a post-cycle aid. But few users really understand how Clomid (and also Nolvadex, logically) works to bring back natural testosterone in the body after the conclusion of a cycle of androgenic anabolic steroids. After a cycle is over, the level of androgens in the body drop drastically. The body compensates with an overproduction of estrogen to keep steroid levels up. Estrogen as well inhibits the production of natural testosterone, and in the period between the return of natural testosterone and the end of a cycle, a lot of mass is lost. So its in everybody's best interest to bring back natural test as soon as humanly possible. Clomid and Nolvadex will reduce the post-cycle estrogen, so that a steroid deficiency is constated and the hypothalamus is stimulated to regenerate natural testosterone production in the body. That's basically how the mechanism works, nothing more, nothing less.
Both compounds are structurally alike, classified as triphenylethylenes. Nolvadex is clearly the stronger component of the two as it can achieve better results in decreasing overall estrogen with 20-40 mg a day, than Clomid can in doses of 100-150 mg a day. A noteworthy difference. Triphenylethylenes are very mild estrogens that do not exert a lot, if any activity at the estrogen receptor, but are still highly attracted to it. As such they will occupy the receptor and keep it from binding estrogens. This means they do not actively work to reduce estrogen in the body like Proviron, Viratase or arimidex would (by competing for the aromatase enzyme), but that it blocks the receptor so that any estrogen in the body is basically inert, because it has no receptor to bind to.
This has advantages and disadvantages. The disadvantage is that when use is discontinued, the estrogen level is still the same and new problems will develop much sooner. The advantage is that it works much faster and has results sooner than with an aromatase blocker like Proviron or arimidex. Therefor, when problems such as gynocomastia occur during a cycle of steroids one will usually start 20 mg/day of nolva or 100 mg/day of Clomid straight away, in conjunction with some Proviron or arimidex. The proviron or arimidex will actively reduce estrogen while the Clomid or Nolvadex will solve your ongoing problem straight away. This way, when use is discontinued there is no immediate rebound.
So which one should you use? Well personally, I'd have to say Nolvadex. Both as an on-cycle anti-estrogen and a post-cycle therapy. As an anti-estrogen its simply much stronger, demonstrated by the fact that better results are obtained with 20-40 mg than with 100-150 mg of Clomid. For post-cycle, this plays a key role as well. It deactivates rebound estrogen much faster and more effective. But most importantly, Nolvadex has a direct influence on bringing back natural testosterone, where as Clomid may actually have a slight negative influence. The reason being that tamoxifen (as in Nolvadex) seems to increase the responsiveness of LH (luteinizing hormone) to GnRH (gonadtropin releasing hormone), whereas Clomid seems to decrease the responsiveness a bit1.
Another noteworthy fact about Nolvadex is that it acts more potently as an estrogen in the liver. As you remember, I mentioned that clomiphene and tamoxifen are basically weak estrogens. Well, tamoxifen is apparently still quite potent in the liver. This offers us the positive benefits of this hormone in the liver, while avoiding its negative effects elsewhere in the body. As such Nolvadex can have a very positive impact on negative cholesterol levels2 in the body, and therefore too should be considered a better choice than Clomid. It will not solve the problem of bad cholesterol levels during Steroid use, but will help to contain the problem to a larger degree.
Another reason why I promote the use of Nolvadex over Clomid post-cycle (as if being 3-4 times stronger and having more of a direct effect on restoring natural test wasn't enough) is because it's a lot safer. Not just because it improves lipid profiles, but also because it simply doesn't have the intrinsic side-effects that Clomid has. Clomid causes more acne for sure, but that's mainly because you need to use a 3-4 times higher dose. But Clomid seems to also affect the eyesight. Long-term Clomid therapy causes irreversible changes in eyesight3 in users. Irreversible. For me that alone is reason enough to prefer Nolvadex.
Lastly, one should be aware that use of these compounds can reduce the gains made on steroids. Nolvadex more so than Clomid, simply because it is stronger. Estrogen is responsible for a number of anabolic factors such as increasing growth hormone output, upgrading the androgen receptor and improving glucose utilization. This is why aromatizing steroids like testosterone are still best suited for maximum muscle gain. When reducing the estrogen levels, we therefore reduce the potential gains being made. For this reason one may opt to try Clomid during a cycle instead of Nolvadex. Although I would imagine that the problem that needed solved would be of more concern, in which case nolva remains the weapon of choice. It's a plain fact that there is a high correlation between gains and side-effects. Either you go for maximum gains and tolerate the side-effects, or you reduce the side-effects, and with it the gains. That's life, nothing is free.
Stacking and Use:
If problems of Gynocomastia or other estrogen related symptoms tend to pop up during a cycle the use of 20-30 mg of Nolvadex or 100 mg of Clomid daily should easily contain the problem, and be used until a few days after the problem subsides. For best results and the least amount of problems upon cessation it is best stacked with Proviron (50 mg) or arimidex (0.5 mg) for this duration as well. Its not advised that these products be ran concomitantly with the steroid for the entire duration of the stack, as this will reduce your gains. Instead cease the usage of anti-estrogens once the problem is contained, and should the problem resurface, simply recommence the use of the products in the same manner as described above.
Once a cycle of steroids is concluded one should always initiate a post-cycle therapy to help bring back natural testosterone as soon as possible. This will help you to retain the mass you gained. How this is done depends highly on the type of steroid used. If only orals were used, therapy should start immediately, even the last day of the stack. If short-acting esters or water-based injectables were used, therapy should commence within 4-7 days after last injection, and if long-acting esters were used then it should commence 1.5 to 2 weeks after the last injection was given. The length of the therapy will vary as well, from 3-5 weeks. The longer acting the product was, the longer therapy should be continued to make sure all suppressive factors are cleared before use of Clomid/Nolvadex is discontinued.
For best results, it is best stacked with HCG (Human Chorionic gonadotrophin), which functions as an LH analog and can help bring testicle size back up. HCG use starts the last week of a cycle, and on from there every 5-6 days (usually 1500-3000 IU) and discontinued 1.5 to weeks prior to the cessation of Nolvadex/clomid. The reason being that HCG itself is also suppressive of natural testosterone and should be out of the body before therapy is over, or it will inhibit natural testicle function. But I can not stress enough that HCG possibly plays a more important role in post-cycle therapy than clomid/Nolvadex. For Clomid and Nolvadex, doses are usually tapered down. Its best to start with 40-50 mg of Nolvadex or 150 mg of Clomid for the first week or the first two weeks, and then finish the program with 20-25 mg of Nolvadex or 100 mg of Clomid for an additional two weeks.
References
1 Vermeulen A., Comhaire F., Hormonal effects of an anti-estrogen, tamoxifen, in normal and oligospermic men, Fertil. Ster. 29 (1978) 320-27
2 Bruning PF, Bronfer JMG, Hart AAM, Jong-Bakker M, tamoxifen, serum lipoproteins and cardiovascular risk, Br. J. Cancer 1988 Oct, 58 (4) 497-9
But as I intend to demonstrate this is in essence the same. I believe the myth to have originated because nolva is clearly a more powerful anti-estrogen, and the people selling Clomid needed another angle to sell the stuff, so it was mostly used as a post-cycle aid. But few users really understand how Clomid (and also Nolvadex, logically) works to bring back natural testosterone in the body after the conclusion of a cycle of androgenic anabolic steroids. After a cycle is over, the level of androgens in the body drop drastically. The body compensates with an overproduction of estrogen to keep steroid levels up. Estrogen as well inhibits the production of natural testosterone, and in the period between the return of natural testosterone and the end of a cycle, a lot of mass is lost. So its in everybody's best interest to bring back natural test as soon as humanly possible. Clomid and Nolvadex will reduce the post-cycle estrogen, so that a steroid deficiency is constated and the hypothalamus is stimulated to regenerate natural testosterone production in the body. That's basically how the mechanism works, nothing more, nothing less.
Both compounds are structurally alike, classified as triphenylethylenes. Nolvadex is clearly the stronger component of the two as it can achieve better results in decreasing overall estrogen with 20-40 mg a day, than Clomid can in doses of 100-150 mg a day. A noteworthy difference. Triphenylethylenes are very mild estrogens that do not exert a lot, if any activity at the estrogen receptor, but are still highly attracted to it. As such they will occupy the receptor and keep it from binding estrogens. This means they do not actively work to reduce estrogen in the body like Proviron, Viratase or arimidex would (by competing for the aromatase enzyme), but that it blocks the receptor so that any estrogen in the body is basically inert, because it has no receptor to bind to.
This has advantages and disadvantages. The disadvantage is that when use is discontinued, the estrogen level is still the same and new problems will develop much sooner. The advantage is that it works much faster and has results sooner than with an aromatase blocker like Proviron or arimidex. Therefor, when problems such as gynocomastia occur during a cycle of steroids one will usually start 20 mg/day of nolva or 100 mg/day of Clomid straight away, in conjunction with some Proviron or arimidex. The proviron or arimidex will actively reduce estrogen while the Clomid or Nolvadex will solve your ongoing problem straight away. This way, when use is discontinued there is no immediate rebound.
So which one should you use? Well personally, I'd have to say Nolvadex. Both as an on-cycle anti-estrogen and a post-cycle therapy. As an anti-estrogen its simply much stronger, demonstrated by the fact that better results are obtained with 20-40 mg than with 100-150 mg of Clomid. For post-cycle, this plays a key role as well. It deactivates rebound estrogen much faster and more effective. But most importantly, Nolvadex has a direct influence on bringing back natural testosterone, where as Clomid may actually have a slight negative influence. The reason being that tamoxifen (as in Nolvadex) seems to increase the responsiveness of LH (luteinizing hormone) to GnRH (gonadtropin releasing hormone), whereas Clomid seems to decrease the responsiveness a bit1.
Another noteworthy fact about Nolvadex is that it acts more potently as an estrogen in the liver. As you remember, I mentioned that clomiphene and tamoxifen are basically weak estrogens. Well, tamoxifen is apparently still quite potent in the liver. This offers us the positive benefits of this hormone in the liver, while avoiding its negative effects elsewhere in the body. As such Nolvadex can have a very positive impact on negative cholesterol levels2 in the body, and therefore too should be considered a better choice than Clomid. It will not solve the problem of bad cholesterol levels during Steroid use, but will help to contain the problem to a larger degree.
Another reason why I promote the use of Nolvadex over Clomid post-cycle (as if being 3-4 times stronger and having more of a direct effect on restoring natural test wasn't enough) is because it's a lot safer. Not just because it improves lipid profiles, but also because it simply doesn't have the intrinsic side-effects that Clomid has. Clomid causes more acne for sure, but that's mainly because you need to use a 3-4 times higher dose. But Clomid seems to also affect the eyesight. Long-term Clomid therapy causes irreversible changes in eyesight3 in users. Irreversible. For me that alone is reason enough to prefer Nolvadex.
Lastly, one should be aware that use of these compounds can reduce the gains made on steroids. Nolvadex more so than Clomid, simply because it is stronger. Estrogen is responsible for a number of anabolic factors such as increasing growth hormone output, upgrading the androgen receptor and improving glucose utilization. This is why aromatizing steroids like testosterone are still best suited for maximum muscle gain. When reducing the estrogen levels, we therefore reduce the potential gains being made. For this reason one may opt to try Clomid during a cycle instead of Nolvadex. Although I would imagine that the problem that needed solved would be of more concern, in which case nolva remains the weapon of choice. It's a plain fact that there is a high correlation between gains and side-effects. Either you go for maximum gains and tolerate the side-effects, or you reduce the side-effects, and with it the gains. That's life, nothing is free.
Stacking and Use:
If problems of Gynocomastia or other estrogen related symptoms tend to pop up during a cycle the use of 20-30 mg of Nolvadex or 100 mg of Clomid daily should easily contain the problem, and be used until a few days after the problem subsides. For best results and the least amount of problems upon cessation it is best stacked with Proviron (50 mg) or arimidex (0.5 mg) for this duration as well. Its not advised that these products be ran concomitantly with the steroid for the entire duration of the stack, as this will reduce your gains. Instead cease the usage of anti-estrogens once the problem is contained, and should the problem resurface, simply recommence the use of the products in the same manner as described above.
Once a cycle of steroids is concluded one should always initiate a post-cycle therapy to help bring back natural testosterone as soon as possible. This will help you to retain the mass you gained. How this is done depends highly on the type of steroid used. If only orals were used, therapy should start immediately, even the last day of the stack. If short-acting esters or water-based injectables were used, therapy should commence within 4-7 days after last injection, and if long-acting esters were used then it should commence 1.5 to 2 weeks after the last injection was given. The length of the therapy will vary as well, from 3-5 weeks. The longer acting the product was, the longer therapy should be continued to make sure all suppressive factors are cleared before use of Clomid/Nolvadex is discontinued.
For best results, it is best stacked with HCG (Human Chorionic gonadotrophin), which functions as an LH analog and can help bring testicle size back up. HCG use starts the last week of a cycle, and on from there every 5-6 days (usually 1500-3000 IU) and discontinued 1.5 to weeks prior to the cessation of Nolvadex/clomid. The reason being that HCG itself is also suppressive of natural testosterone and should be out of the body before therapy is over, or it will inhibit natural testicle function. But I can not stress enough that HCG possibly plays a more important role in post-cycle therapy than clomid/Nolvadex. For Clomid and Nolvadex, doses are usually tapered down. Its best to start with 40-50 mg of Nolvadex or 150 mg of Clomid for the first week or the first two weeks, and then finish the program with 20-25 mg of Nolvadex or 100 mg of Clomid for an additional two weeks.
References
1 Vermeulen A., Comhaire F., Hormonal effects of an anti-estrogen, tamoxifen, in normal and oligospermic men, Fertil. Ster. 29 (1978) 320-27
2 Bruning PF, Bronfer JMG, Hart AAM, Jong-Bakker M, tamoxifen, serum lipoproteins and cardiovascular risk, Br. J. Cancer 1988 Oct, 58 (4) 497-9
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