Lab Cheat Sheet That Every Women Needs

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5 BLOOD TESTS ALL FEMALE PATIENTS NEED

(EXPERT DETAILED TOPIC OVERVIEW)

5 WHAT FIVE TESTS SHOULD I BE REQUESTING FOR A FEMALE PATIENT?

With the rising cost of health care, many health professionals are urged by insurance companies to cut-costs. As such, often the data ordered is often incomplete.

Here’s the panel of tests I suggest running ideally every 6 months, or at minimum, annually.

For women in their menstruating years, there are ideal times of the month to assess sex hormones which will be indicated where appropriate.

In general, morning blood draws are best with no food or drink from dinnertime the night before.

The morning of consuming water, coffee or plain tea is fine Aim for a blood draw time between 7am-9am. No later. This is especially true if you are evaluating thyroid, and metabolic parameters like glucose and insulin.

If you are on thyroid hormone replacement medication, do not take your medications before the test as this will artificially skew the results. Bring your medications with you to the lab and take them immediately afterwards

MARKERS OF INFLAMMATION

(HIGH-SENSITIVITY C-REACTIVE PROTEIN)

If you’re interested in checking for low-grade chronic inflammation or for an indication of your heart disease risk,perform a hs-CRP test.

hs-CRP test measures CRP in the range from 0.5 to 10 mg/L. The sensitivity of the hs-CRP test allows you to detect slightly elevated CRP levels that would otherwise go unnoticed with a regular CRP test.

CRP levels are associated with heart disease risk, as follows

Low risk: hs-CRP level under 1.0 mg/L

Average risk: between 1 0 and 3 0 mg/L

High risk: above 3.0 mg/L

Very high risk: 5-10 mg/L

Above 10 mg/L – clinically significant inflammatory states

CRP levels complement cholesterol levels to give a more accurate prediction of a person’s cardiovascular risk For example, based on a study in almost 28k apparently healthy American women, when both CRP and cholesterol levels were high, a person’s overall risk of a cardiovascular event (such as a heart attack) increased up to 9-fold compared with that of a person with low CRP and cholesterol levels

HS-CRP

FERRITIN

70-150 ng/mL (females), 70-300 ng/mL (males)

If you are losing hair, you need your ferritin levels to be >40 ng/mL

HEMOGLOBIN (HB) A1C

The hemoglobin A1c test tells you your average level of blood sugar over the past 2 to 3 months It's also called HbA1c, glycated hemoglobin

Red blood cells live for about 3 months, so the test shows the average level of glucose in your blood for the past 3 months.

Labs 4.6% -5.2% would be the highest I would be willing to accept

Keep in mind that anything that affects red blood cells and hemoglobin – such as anemia, dehydration and genetic disorders – will skew A1c results.

An A1c of 5 1% maps to an average blood sugar of about 100 mg/dL

INSULIN

High insulin is higher than 7mIU/mL. Ideally between 2-5 mIU/mL

Ladies - if you’re trying to rule in a PCOS diagnosis, you will need to evaluate insulin If you have a family history of diabetes or your clinician suspects insulin dysregulation, this is a test they should order.

Typically, insulin is tested while fasting along with blood glucose. Because of this, the test is commonly done first thing in the morning.

DR. STEPHANIE

(MARKERS

INSULIN-LIKE GROWTH FACTOR 1

There is no standard for IGF-1, and you will find a plethora of ranges based on your age. For instance, according to the Mayo Clinic Laboratories, here is roughly the normal reference range for IGF-1 depending on your age, although this lab, like others need to be evaluated in context of other labs and parameters:

0–3 years: 18–229 ng/mL

4–8 years: 30–356 ng/mL

8–13 years: 61–589 ng/mL

14–22 years: 91–442 ng/mL

23–35 years: 99–310 ng/mL

36–50 years: 48–259 ng/mL

51–65 years: 37–220 ng/mL

66–80 years: 33–192 ng/mL

81–>91 years: 32–173 ng/mL

HOWEVER, I think IGF-1 should be high for your whole life For that reason, - I’d like IGF-1 (irrespective of menstrual status) to be 275 ng/mL - 400 ng/mL.

GLUCOSE

Fasted Glucose: 65-85 mg/dL

GLUCOSE TOLERANCE TEST

After meals, your blood sugar is going to go up, it is how much, and how long it stays elevated that we are interested in.

If you are 70-75 mg/dL before your meal, and you’re under 120mg/dL 2 hours post-meal, this can indicate that your blood glucose regulation is great, and the risk of glycation and AGEs (Advanced Glycated Endproducts) are not as high as someone with the same preprandial bg but then bg spikes up over 140mg/dL and stays there.

If after 2 hours, blood glucose is hanging around in the 140-199 range, this is where we are at an increased risk for damage to beta cells of the pancreas, nerve damage, and retinopathy

If following a low-carb diet, fasting blood sugars in the 90s and even low 100s may not be a problem, provided A1c and post-meal blood sugars are within the normal range.

LIPID PANEL

Total cholesterol: 180–250 (but OK up to 300 in context to other lab values and ratio are good). This is not the only lab value that counts!

HDL: 50–80 mg/dL

LDL(c): less than 100 mg/dL

LDL(p): under 1000

Triglycerides: less than 100 mg/dL

Lp(a): less than 10 mg/dL

Lp(a) is Lipoprotein a, low-density lipoprotein that has been identified as a risk factor for atherosclerosis, coronary artery disease, and stroke

Testing ApoB is not part of routine practice, but doctors should use ApoB to help determine risk of heart disease. It is also used to diagnose genetic diseases that cause extremely low or high ApoB levels.

The normal range for apolipoprotein B is generally below 120 mg/dL and optimally below 90 mg/dL

Some labs may report a slightly different range for men and women. Men tend to have slightly higher levels on average. (MARKERS

ApoB

DR. STEPHANIE

Some labs also report a lower limit of the normal range, which is generally around 40 – 50 mg/dL (0.4 – 0.5 g/L).

Then there are lipid ratios you can run for context:

LDL to HDL ratio: 3:1 ratio at the minimum, and 2:1 is ideal

Non-HDL: Total Cholesterol – HDL. What is cool about this simple calculation is it is highly correlated with your LDL particle number. Meaning if this number is good, it suggests your LDL(p) will likely be good also

Triglyceride to HDL ratio: 2:1 at a minimum, 1:1 or higher HDL than triglycerides are (MARKERS OF INFLAMMATION - CONTINUED)

SEX HORMONES

ESTROGEN

When evaluating female estrogen levels, testing on day 3 to evaluate proper levels of estradiol should be tested. Remember day 1 of the cycle is the first day of the period

During your reproductive years, estradiol or E2 is the predominant form of estrogen.

As we transition into menopause, estrone or E1 becomes the most common circulating estrogen. This is important to understand because depending on age, your estrogen levels and the type of estrogen will vary.

You might also consider testing estrogen levels (in addition to day three) between days 19-22 or roughly 5-7 days after ovulation.

Evaluating your estrogen levels, especially in relation to progesterone during the luteal phase can help you identify if your symptoms like weight gain, tender breasts, water retention, irritability, and heavy periods are related to estrogen dominance.

I like estrogen between 60-200 pg/mL

DR. STEPHANIE ESTIMA

(SEX HORMONES - CONTINUED)

FSH & LH

Testing FSH can help us understand brain-ovarian communication. Measuring FSH and LH is important to assess how the brain is talking to the ovaries Ideally we want a 1:1 ratio of these two hormones.

For fertility or evaluating ovarian reserve, FSH is tested on day 3 of your cycle A normal hormone level is typically determined by comparing your test result to a standard reference range. In the case of FSH, the standard reference range varies by lab.

The normal FSH range is between 3.85 and 8.78 mIU/mL.

If you have high FSH, that could mean you have fewer eggs your body needs to produce more FSH to mature your follicles.

For context, postmenopausal women have consistently high FSH (typically over 25 mIU/mL) and women with FSH levels over 15 might see less success with in-vitro fertilization (IVF).

TESTOSTERONE

Testosterone is highest in the morning and best tested between 7 a m and 9 a m

You can test testosterone levels any time of the month.

Testosterone levels vary by age so results have to be interpreted accordingly. You have to test BOTH total and free testosterone and sex hormone-binding globulin (SHBG) to get a clear picture of what exactly is going on

Free T: 2.5-6 pg/mL

Total T: 20-45 ng/dL

SHBG: 35-80 nmol/L

DR. STEPHANIE ESTIMA

(SEX

PROGESTERONE

Progesterone levels are highest 5-7 days following ovulation, which is within our luteal phase (the second half of your cycle). This is why testing is recommended on days 19-22 of a 28 day cycle

Because we don’t know the exact moment we ovulate, tracking basal body temperature and cervical mucus will help you pinpoint when you are about to ovulate and when you have

With ovulation, body temperature rises ( because progesterone is being secreted) and vaginal discharge becomes the consistency of stretchy egg whites

For most women, this will mean that testing for progesterone should happen on roughly day 19-22 of their cycle

Optimal ranges of progesterone will be between 3-10 ng/dL

DHEA

Dehydroepiandrosterone (DHEA) is a crucial anti-aging hormone that the body can convert into estrogen or testosterone It is an important marker of adrenal function and is a hormone that declines with age.

DHEA can be tested at any time of the month and is typically done alongside a cortisol test.

DHEA-sulfate or DHEAs (age dependent): 150-380 mcg/dL

VITAMIN D

25-Hydroxy / 25(OH)D Test

<20ng/mL: Deficient

21-29 ng/mL: Insufficient

>30 ng/mL: Adequate

52-90 mg/mL: Optimal range

THYROID LABS

As a woman, you can test thyroid at any point in your cycle, but it is best to test them before 9am.

In general, morning blood draws are best with no food or drink from dinnertime the night before.

The morning of consuming water, coffee, or plain tea is fine. Aim for a blood draw time between 7 am-9 am. No later. This is especially true if you are evaluating thyroid and metabolic parameters like glucose and insulin.

If your patient is on thyroid hormone replacement medication, advise them to not take medications before the test as this will artificially skew the results. They can bring medications with you to the lab and take them immediately afterward

THYROID IMAGING

Before we dive into labs for your thyroid, it might also be worth considering a physical exam of your thyroid. A physical exam, which includes feeling in and around the thyroid for nodules, as well as evaluating the overall size of the thyroid will also provide valuable clinical insight.

I cannot tell you how many times I have picked up nodules or an enlarged thyroid on imaging for a patient with ultrasound or an X-ray. Ultrasound is the best choice for imaging the thyroid for overall size and potential palpable nodules

DR. STEPHANIE ESTIMA

(SEX HORMONES - CONTINUED)

FREE T4

This will tell you the levels of free or active form of T4 This will be low in cases of hypothyroidism but can be normal in subclinical, early stages of thyroid dysfunction.

Optimal range: 1 0-1 5 ng/dL

FREE T3

This is the more active, usable form of your thyroid hormone The problem is, if you’re taking a synthetic T4 medication, your body isn’t converting the hormone properly into T3, though there are many reasons your thyroid medication may not be working.

Optimal range: 3.0-4.0 pg/mL

REVERSE T3

Chronic stress and high cortisol can raise levels of reverse T3, which is an unusable form of the thyroid hormone.

This is the more active, usable form of your thyroid hormone The problem is, if you re taking a synthetic T4 medication, your body isn’t converting the hormone properly into T3, though there are many reasons your thyroid medication may not be working.

Optimal range: 3.0-4.0 pg/mL

REVERSE T3

Chronic stress and high cortisol can raise levels of reverse T3, which is an unusable form of the thyroid hormone.

Optimal range: 9 2-24 1 ng/dL

THYROID ANTIBODIES

High levels of thyroid antibodies show an autoimmune attack against the thyroid. The overwhelming majority of low thyroid cases are on the autoimmune spectrum, the most common being Hashimoto’s disease.

Thyroid Peroxidase (TPO) Ab optimal range: 0-15 IU/mL

Thyroglobulin Ab optimal range: 0-0.9 IU/mL