It’s an everyday occurrence when someone calls the doc line at the lab and wants to know how they can change the labs to improve their patients’ symptoms. However, it’s important to take a step back and look at what labs can tell us. While it’s true that abnormal lab findings can contribute to symptoms – high thyroid-stimulating hormone reflects hypothyroidism, high testosterone reflects polycystic ovary syndrome, and hyperandrogenism or low cortisol may contribute to fatigue. Yet, in many other conditions, labs reflect the medical condition happening in that patient’s body and not a cause of the problems. Let’s look at a couple of examples of this chicken-and-egg discussion.
We have a 35-year-old male with low testosterone and fatigue who recently was in a car accident. It would be so easy to just give this patient testosterone, but that would be missing the point. The patient has pain, he’s on medications, and it’s acute. The testosterone is reflecting this acute situation and not a long-term problem with low testosterone. History reflects that his libido has dropped recently but has been fine until the accident; no issues with erectile function, his energy is now poor, but not historically. In other words, the low testosterone reflects his acute trauma, pain, and medications. The best approach is to support the patient’s pain situation and then reassess for testosterone in the future.
In many other conditions, labs reflect the medical condition happening in that patient’s body and not a cause of the problems.
A 65-year-old woman with a new onset of vasomotor symptoms (hot flashes and night sweats) who tests her hormones has low estrogen and progesterone. It’s very instinctual for a bioidentical hormone replacement therapy provider to quickly put the patient on hormones and often we are seeing vasomotor symptoms due to menopause. Nevertheless, we need to take the second to do a full history. In a 65-year-old, if we discover that menopause happened years before with minimal symptoms, then we need to be very cautious about contributing those symptoms to hormones. Instead, it’s important for us to remember that vasomotor symptoms can be the result of medications, viral illness, and cancer, among other things – so look deeper.
And a last case. We have a 45-year-old woman with fatigue and high cortisol. To many, this is such a confusion, but in fact, cortisol isn’t energy and fatigue has many causes. Medications, low epinephrine and norepinephrine, low dopamine, low glutamate, and low serotonin can all contribute to fatigue. That said, additional issues like inflammatory cytokines can commonly contribute to fatigue and cause an increase in cortisol. Reducing cortisol in a situation like this tends to increase pain and inflammation and doesn’t improve energy.
By taking a thorough history and remembering that hormones are sometimes changed because of other factors in a patient’s life, we not only get to the root cause of illness, we also can look at the results of lab testing as a contributor to symptoms, but not the end game.