Upcoming Standardization for Testosterone Lab Tests

[Guest guest]

Hello everyone,

I saw a medical article/interview dated Dec. 15th, 2010 which I think has

significant implications for us.

(http://www.renalandurologynews.com/standardization-the-future-of-testosterone-t\

esting/article/192840/)

The article addresses standardization for testosterone testing by 2012. Dr.

Rossner asserts that immunoassay tests for testosterone, though cheap

and quick, are often inaccurate. Mass spectroscopy, by contrast, is " the gold

standard " for testing, providing better accuracy but may also be more expensive.

What will this mean for us? No certainty, just possibilities.

1) Possible increase in testing expenses. For those of us who purchase our own

tests, this may make it more expensive in 2 or more years, when this

standardization is scheduled for completion.

2) Possible increase in diagnosis of low testosterone. Provided that the

inaccuracies of immunoassay tests are giving artificially elevated results, mass

spectroscopy may identify low T among men who are otherwise being told their

" low normal " reading is acceptable and that they should just take some Prozac.

3) Possible decrease in diagnosis of low testosterone. If those who a) tested

below the normal threshold of the reference range or near the " borderline

area " test higher on the upcoming tests, it's possible that men who would have

otherwise qualified for testosterone replacement therapy will be discouraged

from taking it- manifesting Dr. Rossner's concern of " under-treat[ing] " .

The last possiblity is my greatest concern because of the current trend of

physicians overvaluing lab results against other signs & symptoms. Dr. Rossner

betrays this contradiction in the medical approach toward T treatment: " It's

easy if men have really low testosterone, but in the borderline area—say between

200-300 ng/dl—you need an accurate assay to know who needs replacement. Of

course, we don't replace testosterone on the numbers alone; we replace it based

on the combination of symptoms and blood tests. "

Is Dr. Rossner cautioning against a) TRT when a man has low T but no symptoms or

TRT when a man has " normal " T but all the signs and symptoms? Or both?

Perhaps a clinical lab. technician can weigh in. Barring that, it seems to me

that the variation in lab test results is somewhat self-corrected by noting the

normal area of the reference range depending on which lab is conducting the

test. Provided that the lab results were repeatable, it shouldn't make a

significant difference that a man tests at 290 ng/dL total T at Quest and 240

ng/dL total T at LabCorp on the same day at the same time. Both indicate levels

near or below the bottom threshold of each respect lab's reference range, and

along with signs and symptoms, would provide additional evidence that a man may

need TRT.

Again, it would be worthwhile discussion if anyone else could weigh in.

~Xian

[Guest guest]

Great find I just copied this and put it on Dr. 's forum lets see what

happens with all the Dr.'s that post there.

Co-Moderator

Phil

> From: d00fu524 <calvin1564@...>

> Subject: Upcoming " Standardization " for Testosterone Lab Tests

>

> Date: Friday, December 31, 2010, 4:39 PM

> Hello everyone,

>

> I saw a medical article/interview dated Dec. 15th, 2010

> which I think has significant implications for us.

>

>

(http://www.renalandurologynews.com/standardization-the-future-of-testosterone-t\

esting/article/192840/)

>

> The article addresses standardization for testosterone

> testing by 2012.  Dr. Rossner asserts that

> immunoassay tests for testosterone, though cheap and quick,

> are often inaccurate.  Mass spectroscopy, by contrast,

> is " the gold standard " for testing, providing better

> accuracy but may also be more expensive.

>

> What will this mean for us?  No certainty, just

> possibilities.

>

> 1) Possible increase in testing expenses.  For those

> of us who purchase our own tests, this may make it more

> expensive in 2 or more years, when this standardization is

> scheduled for completion.

>

> 2) Possible increase in diagnosis of low

> testosterone.  Provided that the inaccuracies of

> immunoassay tests are giving artificially elevated results,

> mass spectroscopy may identify low T among men who are

> otherwise being told their " low normal " reading is

> acceptable and that they should just take some Prozac.

>

> 3) Possible decrease in diagnosis of low

> testosterone.  If those who a) tested below the normal

> threshold of the reference range or near the " borderline

> area " test higher on the upcoming tests, it's possible that

> men who would have otherwise qualified for testosterone

> replacement therapy will be discouraged from taking it-

> manifesting Dr. Rossner's concern of " under-treat[ing] " .

>

> The last possiblity is my greatest concern because of the

> current trend of physicians overvaluing lab results against

> other signs & symptoms.  Dr. Rossner betrays this

> contradiction in the medical approach toward T

> treatment:  " It's easy if men have really low

> testosterone, but in the borderline area—say between

> 200-300 ng/dl—you need an accurate assay to know who needs

> replacement. Of course, we don't replace testosterone on the

> numbers alone; we replace it based on the combination of

> symptoms and blood tests. "  

>

> Is Dr. Rossner cautioning against a) TRT when a man has low

> T but no symptoms or TRT when a man has " normal " T but

> all the signs and symptoms?  Or both? 

>

> Perhaps a clinical lab. technician can weigh in. 

> Barring that, it seems to me that the variation in lab test

> results is somewhat self-corrected by noting the normal area

> of the reference range depending on which lab is conducting

> the test.  Provided that the lab results were

> repeatable, it shouldn't make a significant difference that

> a man tests at 290 ng/dL total T at Quest and 240 ng/dL

> total T at LabCorp on the same day at the same time. 

> Both indicate levels near or below the bottom threshold of

> each respect lab's reference range, and along with signs and

> symptoms, would provide additional evidence that a man may

> need TRT. 

>

> Again, it would be worthwhile discussion if anyone else

> could weigh in.

>

> ~Xian 

>

>

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Here is what I got in replys so far about his from Dr. 's.

===================================================

#2 15 Hours Ago

00slotiv

Senior Member Join Date: Jan 22, 2008

Location: Nebraska

Posts: 1,995

Re: Upcoming " Standardization " for Testosterone Lab Tests

--------------------------------------------------------------------------------

Thank you very much Phil. Thanks for giving this its own thread. I am looking

into this at the moment.

Bob

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#3 2 Hours Ago

mouk

Contributor Join Date: Jan 09, 2010

Location: Western Europe

Posts: 182

Re: Upcoming " Standardization " for Testosterone Lab Tests

--------------------------------------------------------------------------------

That's one of the reasons why on this ATM forum, we try to find the most

accurate tests and the best labs either in US or in the rest of the world.

__________________

-------------

One size does not fit all.

When lab and clinical do not agree - Clinical wins

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#4 2 Hours Ago

JanSz

Senior Member Join Date: Dec 08, 2007

Posts: 11,215

Re: Upcoming " Standardization " for Testosterone Lab Tests

--------------------------------------------------------------------------------

Quote:

Originally Posted by mouk

That's one of the reasons why on this ATM forum, we try to find the most

accurate tests and the best labs either in US or in the rest of the world.

But what we are finding out is that not all tests that are by definition are

supposed to be accurate, indeed are.

The E2, ultrasensitive is one bad example.

I am sure there are many more.

Per my experience, standardization for testosterone is probably a last test that

I would go for, but I think the whole industry should get closer look.

Testosterone got into spot light probably because of political reason as it it

mixed up and not distinguished from steroid use.

//

__________________

I am not a Dr, any opinion that I have is based on my own experience.

Any changes in my regime are always discussed with and are approved by my

doctor.

....all legitimate rights have one thing in common: they are rights to action,

not to rewards from other people. "

" The people who cast the votes decide nothing. The people who count the votes

decide everything. "

>

> > From: d00fu524 <calvin1564@...>

> > Subject: Upcoming " Standardization " for Testosterone Lab

Tests

> >

> > Date: Friday, December 31, 2010, 4:39 PM

> > Hello everyone,

> >

> > I saw a medical article/interview dated Dec. 15th, 2010

> > which I think has significant implications for us.

> >

> >

(http://www.renalandurologynews.com/standardization-the-future-of-testosterone-t\

esting/article/192840/)

> >

> > The article addresses standardization for testosterone

> > testing by 2012.  Dr. Rossner asserts that

> > immunoassay tests for testosterone, though cheap and quick,

> > are often inaccurate.  Mass spectroscopy, by contrast,

> > is " the gold standard " for testing, providing better

> > accuracy but may also be more expensive.

> >

> > What will this mean for us?  No certainty, just

> > possibilities.

> >

> > 1) Possible increase in testing expenses.  For those

> > of us who purchase our own tests, this may make it more

> > expensive in 2 or more years, when this standardization is

> > scheduled for completion.

> >

> > 2) Possible increase in diagnosis of low

> > testosterone.  Provided that the inaccuracies of

> > immunoassay tests are giving artificially elevated results,

> > mass spectroscopy may identify low T among men who are

> > otherwise being told their " low normal " reading is

> > acceptable and that they should just take some Prozac.

> >

> > 3) Possible decrease in diagnosis of low

> > testosterone.  If those who a) tested below the normal

> > threshold of the reference range or near the " borderline

> > area " test higher on the upcoming tests, it's possible that

> > men who would have otherwise qualified for testosterone

> > replacement therapy will be discouraged from taking it-

> > manifesting Dr. Rossner's concern of " under-treat[ing] " .

> >

> > The last possiblity is my greatest concern because of the

> > current trend of physicians overvaluing lab results against

> > other signs & symptoms.  Dr. Rossner betrays this

> > contradiction in the medical approach toward T

> > treatment:  " It's easy if men have really low

> > testosterone, but in the borderline area†" say between

> > 200-300 ng/dl†" you need an accurate assay to know who needs

> > replacement. Of course, we don't replace testosterone on the

> > numbers alone; we replace it based on the combination of

> > symptoms and blood tests. "  

> >

> > Is Dr. Rossner cautioning against a) TRT when a man has low

> > T but no symptoms or TRT when a man has " normal " T but

> > all the signs and symptoms?  Or both? 

> >

> > Perhaps a clinical lab. technician can weigh in. 

> > Barring that, it seems to me that the variation in lab test

> > results is somewhat self-corrected by noting the normal area

> > of the reference range depending on which lab is conducting

> > the test.  Provided that the lab results were

> > repeatable, it shouldn't make a significant difference that

> > a man tests at 290 ng/dL total T at Quest and 240 ng/dL

> > total T at LabCorp on the same day at the same time. 

> > Both indicate levels near or below the bottom threshold of

> > each respect lab's reference range, and along with signs and

> > symptoms, would provide additional evidence that a man may

> > need TRT. 

> >

> > Again, it would be worthwhile discussion if anyone else

> > could weigh in.

> >

> > ~Xian 

> >

> >

> >

> >

> >

> >

> > ------------------------------------

> >

> >