Men’s Lab Panels 101 (Part 1)

By Dan Covert

Introduction and Basic Tests

The Failure of the Medical Establishment

After originally starting out as a strength coach specializing in rehab and performance training over a decade ago, I eventually came to realize that I have a knack for thinking about and solving complex health problems beyond those only pertaining to joint pain and stagnant gym progress.

In more recent years, part of my job has become effectively acting as a “detective” for clients with persistent health issues who have been failed by the medical establishment and are looking for answers. They say we tend to attract what we are, so given my own experiences with being failed by healthcare, it comes as no surprise that this is the case. And with my population being predominantly health and fitness-obsessed men who are constantly looking for ways to improve themselves, it also comes as no surprise that these clients tend to be suffering from hormonal issues, specifically.

After years of calling for and analyzing comprehensive lab panels, it still amazes me to say that I’ve yet to see a provider order and interpret labs properly, especially when it comes to hormones. While this failure may or may not always be consequential to the client, it usually comes down to at least one of three reasons:

1. Failure to include relevant tests that help create a full and accurate clinical picture

2. Ordering the wrong versions of tests (extremely common with testosterone and estradiol panels, for example)

3. Incorrect or incomplete interpretation of the results (often as a result of #1)

I’ve interviewed several healthcare professionals over the years in attempts to find out why this is the case, and I’ve learned that it basically comes down to a combination of lack of training, lack of time, and big hurdles to jump when dealing with insurance companies. While perhaps shocking, understandably angering, and definitely concerning, these conversations have also helped remind me that most doctors and practitioners are just regular people with good intentions for their patients, doing their best to make a living like the rest of us while drowning in a sea of top-down corruption from the highest level.

Putting blame aside, I might not have even believed these types of errors are made so frequently if I had not also experienced the repercussions personally. Several years ago when I was dealing with some seemingly-mysterious health issues of my own, I ended up seeing six different providers across various medical specialties, and not one of them was able to get to the root of my problem.

At the time, I was in the process of cultivating a deeper knowledge about the intricacies of hormones and interpreting full lab panels, so I ended up calling for 10 (literally, 10) different sets of labs for myself over a two-year span to finally get to the root of my issue. I guess it’s true that if you want something done right, you have to do it yourself (and if you can’t, just hire me and I’ll do it).

In addition to ultimately fixing what I was dealing with at the time, I walked away having gained a ton of knowledge from a pivotal learning experience, and I was able to develop a strategic and finely-tuned process that I now use to get to the root of my clients’ problems quickly and efficiently.

This isn’t trivial, because I’ve seen guys who have literally been put on TRT and might not have even needed it if other things had been discovered and addressed first. While hormone replacement therapy is completely safe and can be life-changing when necessary and implemented properly (stay tuned for a later article, “Why Your TRT Protocol Sucks”, since I rarely see that prescribed properly either), it can complicate fertility, accelerate hair loss, and is typically a lifelong commitment. Those seem like pretty good reasons to make sure the diagnosis is absolutely certain and leaves out any guess-work.

Since your average healthcare practitioner is almost certain to fall short when it comes to thoroughly calling for and analyzing labs, I’m here to arm you with the information to advocate for yourself. While in-depth lab analysis obviously requires a lot of knowledge and experience combined with a very refined thought process, let’s make sure you’re at least getting all of the necessary panels and the proper versions of them to make sure nothing glaring stands out. If you know what to ask for, some providers are happy to comply, and if yours isn’t, you can self-order labs in most states via sites such as walkinlab.com.

The Basics

All providers are typically going to call for a CBC (Complete Blood Count, with differential and platelets) and CMP (Comprehensive Metabolic Panel) anytime a lab draw is performed. These are the basic tests looking at things like red and white blood cell activity, organ function, overall metabolic health, and hydration and electrolyte levels to make sure all of your essentials are functioning properly and there’s nothing potentially serious to be aware of.

In addition to a CMP, sometimes clinicians will also call for an HbA1c test, which serves as an additional metabolic marker that measures average blood sugar levels over the last 2-3 months to screen for type 2 diabetes or prediabetes. I call for this test if a client has obvious body fat to lose, especially if diet and exercise aren't budging things, at which time I'll also often call for a fasted insulin panel as well. If you're younger, active, and have some muscle definition with some amount of abs visible, it’s highly likely that you don’t have to worry about type 2 diabetes, and you can most likely skip this one.

What About a Lipid Panel?

A lipid panel looks at cholesterol levels and related values. While most providers are going to call for a lipid panel when assessing for overall health (which makes sense in their line of work, especially if you’re older and/or being assessed for cardiovascular risk), I don’t always take this approach initially with my clients.

Put simply, if your lifestyle is less-than-optimal and you don’t sleep enough, eat well, exercise, or your hormones are compromised for whatever reason, cholesterol and related markers probably aren’t going to reflect well unless you have very fortunate genetics. I like to call these variables the “low-hanging fruit” that should be addressed before even bothering to call for a lipid panel in an otherwise-healthy client.

Something also important to note is that serum levels of cholesterol in the blood are less affected by dietary cholesterol levels than the medical establishment suggested for decades, and determining true cardiovascular risk is more nuanced than simply looking at total cholesterol, HDL, and LDL. Although this has been empirically proven in scientific literature in more recent years, many people (including some healthcare professionals, still, somehow) will see elevated blood levels and think, “I’d better cut out all the cholesterol from my diet”. They then proceed to cut out animal-based foods such as meat and eggs and end up with more health problems than they started with, while often failing to even bring down the cholesterol markers they initially set out to change.

Another important caveat to understand about cholesterol is that it is the fundamental building block for all hormones in the body. Google images of the “hormonal cascade” and you’ll see that all hormones are interconnected via a step-conversion process in the body, with cholesterol at the top of that cascade. This demonstrates the fundamental purpose of cholesterol in the body, so it’s not as simple as “cholesterol = bad”.

Once a client understands these nuances and has optimized their lifestyle along with other necessary lab markers (especially hormones), a lipid panel becomes a better proxy for assessing their “true” cardiovascular health.

https://www.youtube.com/watch?v=tlLr_yKSvp8

Stay tuned for Part 2, which will cover essential vitamins and minerals…