Episode 225 - Beyond Basic Hormone Testing

In this clinical episode, Justin takes a closer look at the Hormonal Homeostasis Panel and how providers can use a broader set of laboratory markers to better understand hormonal balance, metabolism, body composition, healthy aging, and potential treatment response.

He walks through the different components of the panel, including sex hormones, reproductive hormones, thyroid markers, metabolic health, and growth related factors, while explaining what different patterns can tell you about a patient's overall health and treatment needs.

This episode is designed as a practical clinical pearl for nurse practitioners looking to take a more comprehensive approach to hormone and longevity care.

Transcript

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00:00:02:12 - 00:00:24:07
Unknown
Greetings. This is just an hour for nurse practitioner. Welcome to the Elite Nurse Practitioner Show podcast dedicated to nurse practitioner entrepreneurism and achieving financial freedom, where I talk directly with nurse practitioners who need help. Listen up. Our market is saturated. Jobs can be scarce. We are underpaid. We are undervalued. We are taken advantage of by the sharks within the healthcare system.

00:00:24:07 - 00:00:47:14
Unknown
And frankly, screw that. Sick of it. It's time for a change. And listen, I'm here to help make that happen. We are powerful. We can forge a path. We are in control of our career and ultimately our financial and personal well-being. You do not need to submit to healthcare ministry and your doctor who you don't have to take the easily salary.

00:00:47:16 - 00:01:08:22
Unknown
You do not have to work 50 to 60 hours a week. There is a different way. I'm here to show you that path. This podcast is written for. I have not talked to the nurse practitioners of this podcast prior to the call. Outside of an email exchange to schedule the episode. What you're about to listen to is a consultation session between the nurse practitioner and myself.

00:01:09:03 - 00:01:31:00
Unknown
It is real. Is it scripted? It is unplanned. I have no idea what we're going to talk about. Anything and everything can happen. During our conversation, the nurse practitioner. These episodes are struggling with an issue in their professional or financial life. They have reached out to me for help. My goal is to help the nurse practitioner with actionable advice that will enhance their professional, business and financial life.

00:01:31:01 - 00:01:51:10
Unknown
My other goal is to hopefully help my nurse practitioner, sisters and brothers build a more productive, powerful and free life. So I hope the content information within these podcast episodes does just that. All right unto the upset everyone just now and with the late nurse practitioner. Thank you for listening to the Leadership Podcast. Today's episode going to be a little bit different.

00:01:51:14 - 00:02:07:05
Unknown
It's not going to be an interview with another or another practitioner looking for business help. Instead, I'm going to be doing a little clinical podcast series. So you guys like it. Give me a little bit shorter, but it's going to be straight to the point and I'm going to try to serums, you know, a lot of information.

00:02:07:07 - 00:02:26:18
Unknown
You kind of get down to it. So, so access medical Labs, has been kind enough to, provide all let me, listeners and members, discount pricing through Access Medical Labs. So if you haven't took advantage of that, definitely take advantage of that. You go to access medical labs and inside of bird accounts, mention your major with your with the MP, like you said, discount pricing.

00:02:26:20 - 00:02:48:14
Unknown
And it's help a lot of people scale their practice just because it's, it's it's pretty cheap. And so they're going to have these like little monthly lab panels that'll go kind of go out, that you can take advantage of. I think it's like 50% off. So if you are a client with Access Medical Labs or wanting to start your own practice, or if your have already started your practice, then by all means ask them about this panel.

00:02:48:14 - 00:03:07:05
Unknown
So they gave me the information about the panel and I kind of want to go over the lab works. These going to be little these would be little I call them little short and short little mini class, I guess about about these lab panels. Think that more like a an extended clinical pearl, so to speak. Okay.

00:03:07:06 - 00:03:28:16
Unknown
So today we're going to talk about the hormone panels called the hormonal homeostasis panel. All right. You can order this through Access Medical Labs. I believe the, you know, I don't wanna give you guys wrong information. It's, the order code. If you, you if you're an access customers for, for one p for males and four for £0.00 for for females.

00:03:28:16 - 00:03:54:07
Unknown
But but anyways though so this panel is called the hormonal homeostasis panel. I want to go over this panel and kind of go over what you're looking for in terms of the patterns go and how this can ultimately help you treat patients okay. So this is a comprehensive view, of hormonal balance and metabolism, body composition, healthy aging, and potential treatment response.

00:03:54:07 - 00:04:12:17
Unknown
84 people on a GLP one or, you know, or hormone replacement therapy. Okay. So this basically interconnects a variety of different hormonal metabolic pathways. Okay. Instead of just getting, you know, individual biomarkers alone, if you were doing a initial lab panel on a patient, this would be a good initial lab panel on a patient or maybe a lab panel.

00:04:12:18 - 00:04:47:13
Unknown
You can do, once a year on your patients. It would be a really, really good one. You get a good high level view of the patient's metabolic, hormonal health, essentially. Okay. So functional patterns and calculated ratios in this assist in identifying suboptimal functioning, various bodily compensations, or maybe potential dysfunctions, metabolically. And so you want to take a look at the hormone production, the availability, the conversion of these hormones, the thyroid function, how the patient is reacting to stress in everyday life.

00:04:47:15 - 00:05:12:04
Unknown
I think that is something that most providers and best MDS possess. However, I think they overlook the stress in patients lives. I know in my men's health clinic, oftentimes, I will see patients who have very normal optimal lab panels and on a random follow up or something, their labs just look awful. Their lipids are out of whack.

00:05:12:04 - 00:05:37:19
Unknown
Their hormones are not balanced, thyroid function has tanked. Maybe they're A1 sees high. And I usually ask, you know, what's what's going on? And often times I can usually pinpoint the, the, the dysregulation to some kind of stressful event in their life, be it a divorce, a death of a family member, a loss of a job, whatever it may be.

00:05:37:19 - 00:06:00:00
Unknown
Okay, so that's something that, you definitely want to be asking patients about during initial evaluations and even follow ups. Okay. But you're also going to examine metabolic health. You want to evaluate all of these different lab, markers together, and you can identify relationships, imbalances and trends. And this provides you just a more complete view of the patient's health overall.

00:06:00:04 - 00:06:22:16
Unknown
Okay. So very, very, very important if you want to be providing comprehensive care to your patients, I think providing comprehensive care to your patients, not just quick labs to get them in and out. I think by doing that, it sets you apart from the big dogs in the space, the franchises, the corporate telemedicine practices, those sorts of things.

00:06:22:18 - 00:06:54:20
Unknown
You want to separate yourself out as much as you possibly can and provide as much value to the patients. If you do that, then you will your basically your churn rate, your turnover rate for your patients will be significantly reduced. Okay. So very, very, very important. So this hormonal homeostasis, this hormonal homeostasis panel through Access Medical Labs is a, this would be a really, really good panel to do for an initial evaluation on honestly, most patients that you have okay.

00:06:54:22 - 00:07:18:02
Unknown
So what's included in this panel? I want to go over what's included. And then I want to go over, various pattern that you can see in this lab work to determine if something is potentially wrong with your patient and what they and what it actually could mean. Okay. So this is going to help you with hormonal optimization okay.

00:07:18:04 - 00:07:55:14
Unknown
I'm going to help you with the weight and metabolism, of the patient, the health of the patient. Okay. You evaluate the thyroid there, their metabolic health lipid profile or glucose, hormonal factors, body composition and performance. Your look at hormonal growth related factors associated with muscle fat distribution, energy recovery, essentially. And of course, it is, abnormal to men or women, I mean, depending on how in-depth you want to go on the lab panel, with your medical patients or your female patients, hair and skin, very, very important for hair and skin.

00:07:55:20 - 00:08:19:00
Unknown
You know, if there's an ingredient deficiencies, thyroid deficiencies, iron deficiencies, any kind of nutritional pattern that you might, that, you know, that you might pick up on that can contribute to hair or skin problems. And very, very important to for people who might be on growth hormone secreting peptides, or if you have like a longevity program or something like that.

00:08:19:02 - 00:08:47:15
Unknown
Okay. Establishing hormonal baselines for your patient, establishing IGF baselines for your patient. Remember IGF, when we're measuring IGF one and IGF three, that is basically giving you a high level view of their growth hormone health. Right. And so by looking at all this, you can get a good, baseline for personalized health aging strategies. Okay. So what's in this panel okay.

00:08:47:15 - 00:09:15:14
Unknown
So sex and reproductive. So you're gonna do a DHEA. Remember DHEA is the pro hormone okay. You know low DHEA levels can typically point to some kind of adrenal insufficiency potentially okay. DHT, the conversion of, testosterone and dihydrogen to testosterone, the active form estradiol, all estrogen. Okay. You want to check those? Especially your female patients, at this H and LH.

00:09:15:14 - 00:09:36:20
Unknown
So follicular stimulating hormone, luteinizing hormone, I get emails from NPS who want to want me to give them advice. Basically. What would you do in this case if you saw a patient with these labs basically. And, and they might give me like the lab work of a patient or something like that. I mean, they'll block out the names and that sort of thing, and they'll just basically give me the results.

00:09:36:22 - 00:09:59:12
Unknown
And there's no FSA. Your LH taken. And guys, you need to be checking in FSH and LH on all of your almost well patients. Okay. During the initial basically panel, there's really no point in checking those once you start them on treatment. Because remember the negative feedback loop when you start a patient or a sex hormone, especially testosterone, typically the FSH and LH will completely shut down.

00:09:59:13 - 00:10:23:21
Unknown
It'll be zero. So there's no value in checking that lab panel. Okay. But checking in FSH and LH at the get go will point you to primary or secondary causes of hormonal of hormonal deficiencies, right? The FSH and LH are really high. A male patient as an example, could have maybe their testicles aren't working very well. The pituitary gland senses this and are sending at the agent LH to the testicles and nothing is happening.

00:10:23:21 - 00:10:43:23
Unknown
Okay, kind of the same thing with females too. There's something, you know, maybe the ovaries are functioning, progesterone, FBG, sex hormone binding globulin, a very overlooked, lab. And, you know, often cases at the FBG is high, guys, it is going to bind all the sex hormones up, and there will be no free or bioavailable hormone for the patient.

00:10:44:00 - 00:11:06:03
Unknown
And that can make people very, very symptomatic. I have had guys come in. I've even seen females who have pretty much normal hormone levels, but their FBG is through the roof there, and they're completely symptomatic because they have a higher FBG. How you treat that? This little bit beyond this podcast, though, there's a variety of ways you can do it.

00:11:06:03 - 00:11:30:17
Unknown
You just did Google it basically. And then you're also going to check testosterone free and total very, very important. Okay. You're also gonna check thyroid free T3, free T4, TSH and TBO. Make sure you have autoimmune issues going on. You want to check adrenal health cortisol basically. Human growth hormone. That's the IGF one idea B3. See if they have, any kind of growth hormone deficiency or suboptimal growth hormone levels.

00:11:30:19 - 00:12:02:07
Unknown
I often see in patients, especially over the age of typically 35 or 40 IGF one levels begin to decrease significantly. And it's one of the reasons why people have poor recovery, poor healing as they get older. Additionally, it can point to stress issues, poor sleep energy. In my practice, poor sleep is usually the number one cause of low IGF one, IGF, BPD three, low growth hormone.

00:12:02:08 - 00:12:23:02
Unknown
Okay, poor sleep. Your body produces growth hormone when you sleep. And if you're getting crappy sleep, your growth hormone levels are just going to plummet. Okay. So usually if you see a patient with a low IGF one, IGF three, it is a, indication of poor sleep, basically. Okay. Now you don't want to go over some metabolic and cardio.

00:12:23:04 - 00:12:47:06
Unknown
Panels. Okay. It's included this hormonal homeostasis panel. It will ANC no brainer. Lipid panel. No brainer. Right. Total cholesterol, triglycerides HDL, LDL and those ratios. And you shouldn't want to check a, high a sensitive CRP as well okay. That usually can point in in the direction of some kind of systemic inflammatory issue going on. Okay.

00:12:47:06 - 00:13:08:18
Unknown
And that sometimes can just be diet related. You know, if you're eating junk food all the time, you're you're information not going to be fairly high. Right. And then, some nutritional stuff, the foundational things, you know, a CBC, CMP, ferritin levels. I feel like every single patient you see during the initial panel should have a ferret and level checked.

00:13:09:00 - 00:13:32:07
Unknown
Right. It can be the cause of fatigue in so many patients. And it blows my mind that it's just not checked. Right. People who donate blood regularly. So if you have mental health patients and you're making them donate blood all the time because their their hematocrit is 54% or something, you're making them donate every 1 or 2 months.

00:13:32:12 - 00:13:58:10
Unknown
You're going to bottom out their ferritin levels and they are going to feel like garbage. All right. So you need to be careful with phlebotomy right? Female patients especially, I think I have maybe seen a couple female patients who have normal ferritin levels. I mean, most females I've ever checked labs on their fair two levels are low, like you.

00:13:58:13 - 00:14:24:12
Unknown
And if they're not low, they're like bottom of the range kind of low. I mean, I feel like probably most females can benefit from iron supplementation really? Vitamin D obviously check vitamin D. Vitamin D is a hormone in itself. Very important for bone health, preventing cancer, energy, good sleep. I mean, vitamin D basically is a, a, important vitamin for a variety, different functions and every cell in your body.

00:14:24:12 - 00:14:47:21
Unknown
Right. And then obviously a PSA. Right. If you're a B treating then you want to see what their PSA is. Right. So so that's the panel in a nutshell. Right? It's it's very, very comprehensive. And it's a good way to, to get a good high level view of your patient. So there's some key ratios here on what you want to be looking at.

00:14:47:21 - 00:15:11:18
Unknown
So free testosterone, the total testosterone, the bioavailability right. Total testosterone levels do not matter that much. It's the free testosterone that you should be using as a guiding tool for your men and female patients. Okay, your male or female patients looking at the free testosterone level, I normally don't really care what a total testosterone is. I just I don't care what it is, it it can be 700.

00:15:11:18 - 00:15:35:12
Unknown
It can be 800 and it is high 7580. Their free testosterone is going to be through the floor. It's going to be so bottom out. They will be completely symptomatic. Same thing with female patients okay. DHEA two quarters. All right. Ratio. This will teach this will show you about, adrenal resilience. Anabolic to catabolic state, free T3 to free T4 ratio.

00:15:35:12 - 00:16:02:12
Unknown
Okay. Is there peripheral thyroid conversion going on because the, the T3, a T44 two, T3 that ratio, you know, the conversion of active thyroid hormone can happen in the peripheral tissues, triglyceride to HDL ratio okay. This is important for insulin resistance. And also just overall metabolic health in patients. You want your patient at a high HDL level okay.

00:16:02:15 - 00:16:21:22
Unknown
You do not want them to have a high triglyceride level. Any high LDL, you know, you can go into a little bit more depth and, you know, check APO B's and, you know, a variety different other, you know, an omega three index. You can also do some stuff like that. I've been doing that with more of my executive patients going a little bit more in depth on the lipid profile.

00:16:22:00 - 00:16:43:17
Unknown
But you really want patients at a high HDL. It really helps buffer their cardiovascular system for the for the bad lipids, essentially. So you want to know what that ratio is. Estrogen and progesterone balance Zulu your phase focus more for for women okay. So different patterns in the lab work. So if you do this hormonal homeostasis panel and you check all the blowers I just went over.

00:16:43:17 - 00:17:11:00
Unknown
Okay. These are patterns to be looking for in the blood work. And this will help point you to, a variety different issues in your patient. Okay. So if you're looking at a patient who is tired all the time, who has basically this weight gain that just does not want to go away, more resistant to diet and exercise.

00:17:11:00 - 00:17:40:11
Unknown
Okay. Doing this lab panel on that patient can point you in certain directions, right now, I will say this. All right? The law of thermodynamics. Calories in, calories out. I know there's a lot of debate about this in various Facebook groups and amongst different providers and stuff. It is a law of physics, okay? Energy just is not magically happen, right?

00:17:40:13 - 00:18:07:22
Unknown
For your body to function, for you to walk around, for you to talk, for your brain to work, for digestion to occur. You need energy. And that energy has to come from somewhere. It just doesn't magically appear. All right. The reason why GLP ones work so great because people stop eating. All right. The evidence for the you know, the law of thermodynamics is right there in GLP.

00:18:07:22 - 00:18:33:14
Unknown
Once patients stop eating, they lose weight. It doesn't matter what their thyroid panel is, what their cortisol levels are. It with their A1, C is none of that matters. Your body will lose weight if you just stop eating food. You will. All right. So oftentimes in patients who have this you know I'm not doing quotations. This word weight loss this this resistant weight loss.

00:18:33:16 - 00:18:54:16
Unknown
Normally they are lying to you and they're snacking and eating garbage. Okay. They are not taking it serious. Okay. You know, I believe everyone. I mean, I hate to say that, and I be controversial for some people, but it is the law of thermal. It's physics. It's the law of thermodynamics. Okay? Cannot break the law of thermodynamics, right?

00:18:54:18 - 00:19:21:07
Unknown
Okay. So anyways, so the exhausted in weight gain resistant kind of pattern in your patient here. Okay. So what labs are you looking at to help you determine this. So you're looking at cortisol free T3 free T4, ferritin CRP hemoglobin A1. See okay. So if the patient has high cortisol in high crappy. All right. You often see this together.

00:19:21:08 - 00:19:43:17
Unknown
Oftentimes they're having an abnormal stress response. And the stress is causing inflammation in their body to the CRP will be elevated. The cause all the elevated because they are in a sympathetic tone. Most of the time they're in an adrenaline kind of tone. Right. We've all been there. You wake up anxious, just adrenaline kind of feeling right. Your core is always high.

00:19:43:19 - 00:20:10:20
Unknown
The reason why most people feel more anxious in the morning is because you have a natural surge of cortisol when you first wake up, that's how you wake up. It's the surge in cortisol is other factors, but that is one of them. Okay. This is why drinking coffee first thing in the morning can make you anxious. If you wait an hour and a half after you wake up and then drink coffee, normally, you don't get that right.

00:20:10:22 - 00:20:24:04
Unknown
It works, trust me, does I? Usually I try to wait about an hour to an hour and a half for dream coffee. In the morning, I will work out. I'll just do whatever, and then I'll have a cup of coffee. I drink it first thing in the morning. I usually makes me a little adrenaline. Usually makes me a little anxious.

00:20:24:09 - 00:20:49:23
Unknown
So anyways, so high cortisol and a high crp. Okay together these. This suppresses the conversion of free T4 to free T3 in the peripheral tissues. All right. So if they're stressed and they're inflammatory they are not going to be converting the T4 to T3. And they need the T3 to increase their energy levels to increase their metabolism. Right okay.

00:20:50:00 - 00:21:03:11
Unknown
Low ferritin all right. Also will further impair thyroid peroxidase function okay. So low ferritin just adds fuel to that fire right.

00:21:03:13 - 00:21:21:17
Unknown
All right I hope everyone's enjoying the episode so far. I just wanted to take a quick break to thank everyone listening, and also give a big thank you to all of my social media followers and email subscribers. If you haven't done so yet, please subscribe to our email list at WW, WW lead np.com and make sure to follow us on Facebook, Instagram and LinkedIn.

00:21:21:23 - 00:21:46:16
Unknown
Email subscribers will receive updates on new weekly podcast episodes, multiple weekly articles, we publish, new courses and everything else related to helping you succeed. Remember, all elite nurse practitioner courses are designed to help you build in each practice, increase your financial strength, and to break free from the rat race. If I can break free and the other countless nurse practitioners can break free and so can you.

00:21:46:16 - 00:22:13:13
Unknown
Additionally, please share this podcast with your other nurse practitioner sessions with others out there. The more NPS that venture out on their own, a stronger our profession will become. Now let's get back to the episode. After that, tissue level hypothyroidism occurs, slowing metabolism and causing downstream rises in hemoglobin A1. C right. You decrease and you basically decrease insulin sensitivity.

00:22:13:14 - 00:22:46:14
Unknown
Your body, your muscles cannot absorb that blood sugar appropriately because your thyroid is your hypothyroid. You're cold all the time, etc.. Right? So this can cause fatigue and it can and it can cause, you know, difficult weight loss. If they stop eating, they will lose weight. Right? But if they are someone who wants to try to maintain their muscle mass, let's just say you put someone on a, you know, on a diet and they have about 40 pounds to lose or something, you know, kind of like this early metabolic syndrome said they're about 40 pounds overweight, kind of like a dad bod or something.

00:22:46:14 - 00:23:11:11
Unknown
Right. And they're having trouble, trouble dropping the weight and they're working out, lifting weights and they kind of thing. But they're not losing weight. They're not losing fat. When it comes down to it, they're not at a calorie deficit. Now, if they if their thyroid was optimal, their cortisol levels were optimal, their inflammation was optimal, then they probably would lose weight, at least just for simple math, 32,000 calories a day and the thyroid function was normal.

00:23:11:11 - 00:23:35:20
Unknown
Ferritin levels were normal cause all levels were normal. Then they probably would lose weight. If all that stuff is abnormal and they're eating 2000 calories a day and it's supposedly a deficit, they might have a slower metabolism. They might actually not lose weight. So that's why, looking at that pattern there is important okay. So cortisol levels, free T3, free T4, ferritin CRP and even low latency okay.

00:23:35:22 - 00:23:58:04
Unknown
That's the pattern you're gonna be looking at for the exhausted weight gain resistant patient. We've all seen these people right. All right. So this is going to be for female patients right. I am not an expert in female HRT here. So I'm going to give you kind of brief here okay. The androgen excess PCOS, PMO s and metabolic syndrome kind of pattern in women.

00:23:58:04 - 00:24:34:17
Unknown
Okay. We've all seen these women. All right. Live with one, but but metformin was a miracle drug. Okay, so markers involved, right? Total and free testosterone, DHEA, DHT, S, FBG, hemoglobin A1, C and lipid profile, triglycerides, HDL. Okay. So insulin resistance. So if you see a high A1 C an abnormal triglyceride to HDL ratio this is stimulates ovarian androgen synthesis.

00:24:34:21 - 00:25:02:03
Unknown
Right. They're going to be producing testosterone okay. While suppressing liver FBG. So if a they have a low FBG they're gonna have unbound. All right. Testosterone with testosterone levels will spike. And that's where you start getting those patterns. What you see in PCOS females and a DHT spike a dihydrotestosterone spike. Right. This can drive, hirsutism, alopecia. Mood swings, etc..

00:25:02:03 - 00:25:27:13
Unknown
Right. And then, if they have a high DHEA as well, this could point to an adrenal stress driven component. On top of that okay. So oftentimes what you'll see in a woman and I've diagnosed PCOS and you know, I'd say about a dozen women I don't see a lot of female patients. Right. But I have diagnosis and mostly friends of family, personal people that I know.

00:25:27:15 - 00:25:45:15
Unknown
And it's mood swings, almost, almost bipolar in a way. They're not bipolar. They have these these mood swings. Happy one day, sad. The next kind of stuff. Difficulty losing weight.

00:25:45:17 - 00:26:15:13
Unknown
Maybe they start losing their hair in the shower often. Growing hair, you know, on their upper lip, that sort of thing. Okay. Those people will usually have a very high testosterone level. And when you check the blood work on them, you'll be like, why does this woman have a total testosterone of 200? And she's not on, you know, and she's not on on test replacement therapy, like their free test will be like eight, right?

00:26:15:15 - 00:26:38:07
Unknown
Could be PCOS, right? You'll need to do some imaging to verify that. All right. But the pattern here you're looking for, right, is insulin resistance. Many of these women will have high A1 C's. Maybe not diabetic, but this pre-diabetic stuff 5.7 to 6.4 kind of right there. You'll see that very often you will see high triglycerides, low HDL.

00:26:38:07 - 00:26:56:16
Unknown
And they're all they're also their other lipids will be kind of out of whack. You will see low BG sometimes if they're if they're at their on birth control though, their speed will be high. He'll throw off all of this and then they'll have high testosterone levels. Okay. So that's a pattern to look for in that patient okay.

00:26:56:18 - 00:27:22:15
Unknown
All right. So high stress and muscle wasting poor recovery. We see this in all of our patients pretty much. Right. I know I do in my men's health clinic. So you're gonna be looking at this pattern. The high stress, losing lean muscle mass, poor recovery kind of patient. This is a very, very common pattern in people over the age of 40, especially.

00:27:22:15 - 00:27:49:07
Unknown
Right. So the markers involved here, what's going to be looking at in this panel okay. On this lab work you can look at the causal level IGF one IGF three free testosterone and ferritin okay okay. So how does all this work. Elevated cortisol exerts a catabolic effect on muscles okay. It is catabolic. It is hard to build muscle if you have high cortisol level right.

00:27:49:09 - 00:28:09:22
Unknown
It's why you see I believe it's, you know, people with high cortisol levels, Cushing's disease, I believe. Right. That's why they have like that, that moon phase and like that big body, but skinny arms and skinny legs. I mean, you've all seen these people walk around and, you know, people like this, right? Trunk all obesity.

00:28:10:01 - 00:28:36:14
Unknown
Right? They just they look like, they look like a grape. Those sticks coming out of a basically like, like like toothpicks. Right. And then they have these skinny arms and these skinny legs. We've all seen these patients. Okay. Might not necessarily mean they have Cushing's disease, okay. But they could have high cortisol levels. Right. So elevated cortisol causes a catabolic effect on the muscle that blunts pituitary growth hormone output.

00:28:36:14 - 00:29:01:12
Unknown
So you'll see the low IGF numbers okay. So typically IGF will be low paired with suppressed free testosterone. So you'll typically see low free testosterone levels in these people. And they sometimes will have low ferritin as well. And then you also see maybe like an anemia or a pre anemia, a sort of pattern. And so now they have low oxygen delivery to their body as well.

00:29:01:12 - 00:29:23:09
Unknown
So knowing if you're tired fatigued all the time. So basically what happens is the body then enters a non recovery state marked by fatigue and loss of lean mass. They just chalk it up to getting older basically. Right. So this is a very very common pattern. This is why I like to check cortisol levels on a lot of my new patients.

00:29:23:11 - 00:29:45:09
Unknown
This is why I check IGF on all of my patients. That's why I check testosterone. So I check ferritin as well. Okay. You will usually see these patterns in these patients okay. Again this podcast is, treatment is beyond this podcast I'm going to talk about how to treat these things right. Normally it's one of these lifestyle guys.

00:29:45:09 - 00:30:11:08
Unknown
Normally a lot of times you just stop stressing out so much and eat real food, exercise. Let's, you know, let's let's get your testosterone levels up, get good sleep. Like all these common sense things that we've been told all of our lives that no one actually that no one actually does. Right? Right. That's kind of where longevity medicine is really going.

00:30:11:08 - 00:30:28:09
Unknown
It's just there's no magic pill. Sorry. You're going to have to just put the work into it. You know, I'm 42 years old. I feel like I look 35. You know, I'm a I'm full of energy. I don't I don't get tired. Like, I usually go to bed at like 839. I'm up at four. I'm just wide awake.

00:30:28:11 - 00:30:48:01
Unknown
Wake up. You know, I'm on a very low carb diet. I'm on keto diet right now, which is helped a lot. Look into that. Like it's, it's a game changer. And the reason why a lot of CEOs and entrepreneurs and stuff are on keto. Okay. Anyways, so so the metabolism and androgen conversion pattern in men very common.

00:30:48:03 - 00:31:15:06
Unknown
Okay. This is this is up for debate. This is kind of controversial on how you treat it with anastrozole etc. blah, blah, blah. I'm not going to go into that. I personally am fine treating some of my patients with the Nestor's all, because it treats their symptoms. It works. I'm sorry, but, having a someone's estradiol level of 90 is not normal.

00:31:15:07 - 00:31:41:09
Unknown
It's not physiological. That can cause issues. Okay, okay. Anyway, so markers involved here. So the metabolism, androgen conversion pattern in, in your male patients markers involved, you're going to be, look at that total testosterone free testosterone extra diol estrogen SBG and the CRP. All right. So systemic inflammation, high CRP levels okay. And this are all fat.

00:31:41:09 - 00:32:05:04
Unknown
So they have a lot of belly fat. And they probably have a lot of internal organ fat around the liver all that kind of stuff. That upregulate the aromatase enzyme. Okay. I typically see this in my overweight patients that we don't see this in patients who are lean. Okay. I normally have no problem with my hand like in my patients who are lean, normal, weight, normal, BMI, workout, all that kind of stuff.

00:32:05:06 - 00:32:41:12
Unknown
My male patients, I very rarely ever see them having an issue with estrogenic side effects of testosterone replacement therapy. I very rarely ever see that it's mostly, mostly, mostly obese people. Okay, okay, so the CRP and the visceral fat upregulate the aromatase enzyme, okay. They do. Testosterone converts rapidly into the extra dial in the estrogen, the estrogens presenting as low bioavailable androgens symptoms alongside high estrogenic side effects gynecomastia, fluid retention, moodiness, rectal dysfunction, low libido.

00:32:41:13 - 00:33:13:20
Unknown
Men feel off. They feel heavy. It is a very subjective side effect, and you need to be listening to your patients when they complain about this stuff. Okay, you would be amazed at what 0.5mg of a nesters all once every two weeks will do for your patient. I am sorry people are not going to have crazy long term side effects from 0.5mg of an astronaut once every two weeks.

00:33:13:22 - 00:33:41:18
Unknown
Okay, let's just be real here, all right? They're not going to. Yes, one milligram twice a week is stupid. One milligram daily is asinine, right? One milligram once a month is not going to cause them to become osteoporotic. It's going to increase their risk of heart disease. Come on. All right. But it's just enough to lower Ashton level down to block the aromatase enzyme and dropping their Ashton levels down just a little bit.

00:33:41:18 - 00:34:02:15
Unknown
So they're not symptomatic okay I see I've seen I've been doing this for 7 or 8 years now. I see it time and time again. I even take one milligram estrogen probably every 6 to 8 weeks. I know when it's going up and I take it and then I'm good to go. It magically fixes my brain fog, my heavy feeling, all that kind of stuff.

00:34:02:15 - 00:34:26:04
Unknown
Right? I know it's not in my head. It works. Right. So this is something to look at. Okay, so normally at the lab at high CRP, that visceral fat, they need to lose weight. They need de-stress, they need to get better sleep. And oftentimes just doing that will reduce the aromatase enzyme activity and boom free testosterone goes up Ashton goes down.

00:34:26:10 - 00:35:04:23
Unknown
And now they feel better. Right okay. And then the last pattern here that you will see with this hormonal homeostasis panel here okay. PSA. So it's gonna be female patients PSA free testosterone DHT diol CRP okay. So high DHT okay. So prostate androgens right. Essentially combined with elevated estradiol promote stromal tissue growth. All right. And a high CRP indicates active prostate tissue remodeling or BPH or prostatitis, rather than doing an elevated PSA as an isolated tumor marker.

00:35:05:00 - 00:35:28:10
Unknown
Okay. So you need to be looking at all of these. So if you see an elevated PSA, check these other things too because it could point into more of an acute kind of growth versus someone having prostate cancer. Right. You see someone have a PSA of four and you freak out, don't freak out. Their PSA goes up 1 or 2 points.

00:35:28:10 - 00:35:51:09
Unknown
Yes, that is a large increase over three months. But I have seen it all times. Right. You recheck blood work in 2 to 4 weeks. If you send them to a urologist, that's all they're going to do. I was going to recheck the PSA, so why don't you do that? All right. Now if the PSA is ten or something crazy like that then obviously urgent referral.

00:35:51:09 - 00:36:13:20
Unknown
Right. Talking about just like if it goes up 1 or 2 points or if it's like four, 4.5 or even five, okay. Check for make sure you're checking the free testosterone with DHT, the estradiol or CRP. Okay. If the DHT is high, if the estradiol is high, the and the CRP is elevated, this usually will indicate active prostate tissue remodeling.

00:36:13:20 - 00:36:38:20
Unknown
It is benign in nature, and usually when you check the PSA after a little bit of time, it begins trending downward and they're fine. Okay, last thing you want to do is send patients out for unnecessary prostate biopsies for something that's just a that's just a transitory sort of a thing. And then what you can resolve on its own okay.

00:36:38:20 - 00:37:12:13
Unknown
So very, very important. So this is what I mean by when you do comprehensive lab work on people. You can look at these different patterns if you understand what this blood work means, how all of it combines together. Right. You know, when you're doing lab work on people and you're looking at, well, these these these comprehensive panels, you're looking at their metabolic profile, you know, really look at it, you know, is it someone who has metabolic dysfunction or are they eating garbage all the time?

00:37:12:15 - 00:37:38:12
Unknown
Can I fix this by just diet and exercise. You know, look at all the hormones. How are all these things working together? Okay. Vitamin D levels. Almost every single person is deficient in vitamin D, even if they're not deficient. But their levels 30, 35, 40, it's still low normal. I still put them on vitamin D. Every single one of my patients is on 5000 units, eight day minimum.

00:37:38:14 - 00:38:01:20
Unknown
I take 10,000 units every other day. My vitamin D levels 80. Right. Perfect. Okay, so this is the, this is one of the key benefits of doing a comprehensive panel like this on your patients. I would say, you know, if you use access medical labs, it's called the hormonal homeostasis panel. Use this panel on initial patients. It works great for initial patients.

00:38:01:23 - 00:38:19:19
Unknown
Any kind of wellness visit a hormone patient you have. This works fantastic. This is also a great panel to do I would say at least once a year. Okay. If FSH and LH are really the only labs in this that would be redundant to do every single year if they're on hormone replacement therapy. Okay. So you should be able to take those out of there.

00:38:19:19 - 00:38:48:09
Unknown
If you don't, you know, if you don't want them. But for an initial patient you need to be checking those. So so anyways that is the panel that was kind of a brief rundown of how this lab panel, specifically how those labs work when identifying certain patterns in your patients. So yeah. Yeah, guys, it's, you need to understand this stuff if you want to be a a good provider, your provide good comprehensive care to your patients.

00:38:48:11 - 00:39:10:05
Unknown
So. So anyways, though, if you are interested in, re interested in signing up with, with Access Medical Labs, by all means, just holler at them. Okay, guys, you can go to, here. We got this link for you. It's real quick. I gave me this link in case you want to, where do you use it?

00:39:10:06 - 00:39:33:13
Unknown
So here is. Yeah. Access med lab.com/elite go access, med lab complete. You can go there, to sign up if you want to. And, take advantage of the, the discounted labs. I mean, they're pretty. They're significantly discounted. Can be hard to find a better deal, in my opinion. So, so, anyways, though, I hope everyone enjoyed this.

00:39:33:15 - 00:39:48:07
Unknown
If you want to do some more, these, like, little clinical rundown, lab overview podcasts, I think I'm gonna try to. I think I'll think about doing one about once a month, probably. So if you liked this, follow me. You give me feedback. Email me Justin at Elite np.com. I would love to know, you know, what your thoughts are.

00:39:48:07 - 00:40:13:12
Unknown
So we'll figure some value out of this. I'm sure you that probably listen to this a couple times to really to really get that information out of there. Okay. Okay. I thought you there. Thanks. Bye. Thank you for listening to the show. The legal disclaimer the content of this podcast is meant for informational and entertainment purposes only and should not be used as legal, financial, medical, regulatory, or practice specific advice for information pertaining to your specific legal, financial, medical, or practice specific needs.

00:40:13:12 - 00:40:31:01
Unknown
Please be sure to consult with your lawyer, CPA, medical director, and or your state's practice laws and the most up to date clinical guidelines. As always, do your due diligence when it comes to any information found online in podcast. The content in this podcast is copyrighted by Galaxie Medical Southwest 2023, and it cannot be duplicated, rebroadcast it, or reproduced without our written permission.