A Comprehensive Look at Lab Blood Tests

You just had some blood work done, and the friggin' doctor or his nurses are
guarding the results as if they're state secrets. However, after much cajoling
and explaining that you'd like to at least be an informed partner in your own
goshdarn health care, they begrudgingly give you a copy of your lab tests.

Trouble is, as much as you've been posturing about how you've had more than a
smattering of medical education, you still can't figure out what half the tests
are for and whether or not those abnormal values are anything to worry about.

One note, though, before I get started. The values I'll be listing are merely
averages and the ranges may vary slightly from laboratory to laboratory. Also,
if there's only one range given, it applies to both men and women.

HDL/LDL and Total Cholesterol

These lipoproteins should look rather familiar to most of you. HDL is simply the
"good" lipoprotein that acts as a scavenger molecule and prevents a buildup of
material. LDL is the "bad" lipoprotein which collects in arterial walls and
causes blockage or a reduction in blood flow. The total cholesterol to HDL ratio
is also important. I went in to detail about this particular subject ? as well
as how to improve your lipid profile ? in my article "Bad Blood".

Nevertheless, a quick remonder: your HDL should be 35 or higher; LDL below 130;
and total to HDL ratio should be below 3.5. Oh and don't forget VLDL (very low
density lipoprotein) which can be extremely worrisome. You should have less than
30 mg/dl in order to not be considered at risk for heart disease.

On a side note, I'm sure some of you are wishing that you had abnormally low
plasma cholesterol levels (as if it's something to brag about), but the fact is
that having extremely low cholesterol levels is actually indicative of severe
liver disease.

Triglycerides

Triglycerides are simply a form of fat that exists in the bloodstream. They're
transported by two other culprits, VLDL and LDL. A high level of triglycerides
is also a risk factor for heart disease as well. Triglycerides levels can be
increased if food or alcohol is consumed 12 to 24 hours prior to the blood draw
and this is the reason why you're asked to fast for 12-14 hours from food and
abstain from alcohol for 24 hours. Here are the normal ranges for healthy
humans.

16-19 yr. old male
40-163 mg/dl

Adult Male
40-160 mg/dl

16-19 yr. old female
40-128 mg/dl

Adult Female
35-135 mg/dl

Homocysteine

Unfortunately, this test isn't always ordered by the doctor. It should be.
Homocysteine is formed in the metabolism of the dietary amino acid methionine.
The problem is that it's a strong risk factor for atherosclerosis. In other
words, high levels may cause you to have a heart attack. A good number of
lifters should be concerned with this value as homocysteine levels rise with
anabolic steroid usage.

Luckily, taking folic acid (about 400-800 mcg.) as well as taking a good amount
of all B vitamins in general will go a long way in terms of preventing a rise in
levels of homocysteine.

Normal ranges:

Males and Females age 0-30
4.6-8.1 umol/L

Males age 30-59
6.3-11.2 umol/L

Females age 30-59
4.5-7.9 umol/L

>59 years of age
5.8-11.9 umol/L

The Hemo Profile

These are various tests that examine a number of components of your blood and
look for any abnormalities that could be indicative of serious diseases that may
result in you being an extra in the HBO show, "Six Feet Under."

WBC Total (White Blood Cell)

Also referred to as leukocytes, a fluctuation in the number of these types of
cells can be an indicator of things like infections and disease states dealing
with immunity, cancer, stress, etc.

Normal ranges:

4,500-11,000/mm3

Neutrophils

This is one type of white blood cell that's in circulation for only a very short
time. Essentially their job is phagocytosis, which is the process of killing and
digesting bacteria that cause infection. Both severe trauma and bacterial
infections, as well as inflammatory or metabolic disorders and even stress, can
cause an increase in the number of these cells. Having a low number of
neutrophils can be indicative of a viral infection, a bacterial infection, or a
rotten diet.

Normal ranges:

2,500-8,000 cells per mm3

RBC (Red Blood Cell)

These blood cells also called erythrocytes and their primary function is to
carry oxygen (via the hemoglobin contained in each RBC) to varioustissues as
well as giving our blood that cool "red" color. Unlike WBC, RBC survive in
peripheral blood circulation for approximately 120 days. A decrease in the
number of these cells can result in anemia which could stem from dietary
insufficiencies. An increase in number can occur when androgens are used. This
is because androgens increase EPO (erythropoietin) production which in turn
increases RBC count and thus elevates blood volume. This is essentially why some
androgens are better than others at increasing "vascularity." Anyhow, the danger
in this could be an increase in blood pressure or a stroke.

Androgen-using lifters who have high values should consider making modifications
to their stack and/or immediately donating some blood.

Normal ranges:

Adult Male
4,700,000-6,100,000 cells/uL

Adult Female
4,200,000-5,400,000 cells/uL

Hemoglobin

Hemoglobin is what serves as a carrier for both oxygen and carbon dioxide
transportation. Molecules of this are found within each red blood cell. An
increase in hemoglobin can be an indicator of congenital heart disease,
congestive heart failure, sever burns, or dehydration. Being at high altitudes,
or the use of androgens, can cause an increase as well. A decrease in number can
be a sign of anemia, lymphoma, kidney disease, sever hemorrhage, cancer, sickle
cell anemia, etc.

Normal ranges:

Males and females 6-18 years
10-15.5 g/dl

Adult Males
14-18 g/dl

Adult Females
12-16 g/dl

Hematocrit

The hematocrit is used to measure the percentage of the total blood volume
that's made up of red blood cells. An increase in percentage may be indicative
of congenital heart disease, dehydration, diarrhea, burns, etc. A decrease in
levels may be indicative of anemia, hyperthyroidism, cirrhosis, hemorrhage,
leukemia, rheumatoid arthritis, pregnancy, malnutrition, a sucking knife wound
to the chest, etc.

Normal ranges:

Male and Females age 6-18 years
32-44%

Adult Men
42-52%

Adult Women
37-47%

MCV (Mean Corpuscular Volume)

This is one of three red blood cell indices used to check for abnormalities. The
MCV is the size or volume of the average red blood cell. A decrease in MCV would
then indicate that the RBC's are abnormally large(or macrocytic), and this may
be an indicator of iron deficiency anemia or thalassemia. When an increase is
noted, that would indicate abnormally small RBC (microcytic), and this may be
indicative of a vitamin B12 or folic acid deficiency as well as liver disease.

Normal ranges:

Adult Male
80-100 fL

Adult Female
79-98 fL

12-18 year olds
78-100 fL

MCH (Mean Corpuscular Hemoglobin)

The MCH is the weight of hemoglobin present in the average red blood cell. This
is yet another way to assess whether some sort of anemia or deficiency is
present.

Normal ranges:

12-18 year old
35-45 pg

Adult Male
26-34 pg

Adult Female
26-34 pg

MCHC (Mean Corpuscular Hemoglobin Concentration)

The MCHC is the measurement of the amount of hemoglobin present in the average
red blood cell as compared to its size. A decrease in number is an indicator of
iron deficiency, thalassemia, lead poisoning, etc. An increase is sometimes seen
after androgen use.

Normal ranges:

12-18 year old
31-37 g/dl

Adult Male
31-37 g/dl

Adult Female
30-36 g/dl

RDW (Red Cell Distribution Width)

The RDW is an indicator of the variation in red blood cell size. It's used in
order to help classify certain types of anemia, and to see if some of the red
blood cells need their suits tailored. An increase in RDW can be indicative of
iron deficiency anemia, vitamin B12 or folate deficiency anemia, and diseases
like sickle cell anemia.

Normal ranges:

Adult Mal
11.7-14.2%

Adult Female
11.7-14.2%

Platelets

Platelets or thrombocytes are essential for your body's ability to form blood
clots and thus stop bleeding. They're measured in order to assess the likelihood
of certain disorders or diseases. An increase can be indicative of a malignant
disorder, rheumatoid arthritis, iron deficiency anemia, etc. A decrease can be
indicative of much more, including things like infection, various types of
anemia, leukemia, etc.

On a side note for these ranges, anything above 1 million/mm3 would be
considered a critical value and should warrant concern and/or giving second
thoughts as to whether you should purchase a lifetime subscription to Muscle
Media.

Normal ranges:

Child
150,000-400,000/mm3
(Most commonly displayed in SI units of 150-400 x 10(9th)/L

Adult
150,000-400,000/mm3
(Most commonly displayed in SI units of 150-400 x 10(9th)/L

ABS (Differential Count)

The differential count measures the percentage of each type of leukocyte or
white blood cell present in the same specimen. Using this, they can determine
whether there's a bacterial or parasitic infection, as well as immune reactions,
etc.

Pt. 2

Neutrophils

As explained previously, severe trauma and bacterial infections, as well as
inflammatory disorders, metabolic disorders, and even stress can cause an
increase in the number of these cells. Also, on the other side of the spectrum,
a low number of these cells can indicate a viral infection, a bacterial
infection, or a deficient diet.

Percentile Range:

55-70%

Basophils

These cells, and in particular, eosinophils, are present in the event of an
allergic reaction as well as when a parasite is present. These types of cells
don't increase in response to viral or bacterial infections so if an increased
count is noted, it can be deduced that either an allergic response has occurred
or a parasite has taken up residence in your shorts.

Percentile Range:

Basophils
0.5-1%

Eosinophils
1-4%

Lymphocytes and Monocytes

Lymphocytes can be divided in to two different types of cells: T cells and B
cells. T cells are involved in immune reactions and B cells are involved in
antibody production. The main job of lymphocytes in general is to fight off ?
Bruce Lee style ? bacterial and viral infections.

Monocytes are similar to neutrophils but are produced more rapidly and stay in
the system for a longer period of time.

Percentile Range:

Lymphocytes
20-40%

Monocytes
2-8%

Selected Clinical Values

Sodium

This cation (an ion with a postive charge) is mainly found in extracellular
spaces and is responsible for maintaining a balance of water in the body. When
sodium in the blood rises, the kidneys will conserve water and when the sodium
concentration is low, the kidneys conserve sodium and excrete water. Increased
levels can result from excessive dietary intake, Cushing's syndrome, excessive
sweating, burns, forgetting to drink for a week, etc. Decreased levels can
result from a deficient diet, Addison's disease, diarrhea, vomiting, chronic
renal insufficiency, excessive water intake, congestive heart failure, etc.
Anabolic steroids will lead to an increased level of sodium as well.

Normal range:

Adults
136-145 mEq/L

Potassium

On the other side of the spectrum, you have the most important intracellular
cation. Increased levels can be an indicator of excessive dietary intake, acute
renal failure, aldosterone-inhibiting diuretics, a crushing injury to tissues,
infection, acidosis, dehydration, etc. Decreased levels can be indicative of a
deficient dietary intake, burns, diarrhea or vomiting, diuretics, Cushing's
syndrome, licorice consumption, insulin use, cystic fibrosis, trauma, surgery,
etc.

Normal range:

Adults
3.5-5 mEq/L

Chloride

This is the major extracellular anion (an ion carrying a negative charge). Its
purpose it is to maintain electrical neutrality with sodium. It also serves as a
buffer in order to maintain the pH balance of the blood. Chloride typically
accompanies sodium and thus the causes for change are essentially the same.

Normal range:

Adult
98-106 mEq/L

Carbon Dioxide

The CO2 content is used to evaluate the pH of the blood as well as aid in
evaluation of electrolyte levels. Increased levels can be indicative of severe
diarrhea, starvation, vomiting, emphysema, metabolic alkalosis, etc. Increased
levels could also mean that you're a plant. Decreased levels can be indicative
of kidney failure, metabolic acidosis, shock, and starvation.

Normal range:

Adults
23-30 mEq/L

Glucose

The amount of glucose in the blood after a prolonged period of fasting (12-14
hours) is used to determine whether a person is in a hypoglycemic (low blood
glucose) or hyperglycemic (high blood glucose) state. Both can be indicators of
serious conditions. Increased levels can be indicative of diabetes mellitus,
acute stress, Cushing's syndrome, chronic renal failure, corticosteroid therapy,
acromegaly, etc. Decreased levels could be indicative of hypothyroidism,
insulinoma, liver disease, insulin overdose, and starvation.

Normal range:

Adult Male
65-120 mg/dl

Adult Female
65-120 mg/dl

BUN (Blood Urea Nitrogen)

This test measures the amount of urea nitrogen that's present in the blood. When
protein is metabolized, the end product is urea which is formed in the liver and
excreted from the bloodstream via the kidneys. This is why BUN is a good
indicator of both liver and kidney function. Increased levels can stem from
shock, burns, dehydration, congestive hear failure, myocardial infarction,
excessive protein ingestion, excessive protein catabolism, starvation, sepsis,
renal disease, renal failure, etc. Causes of a decrease in levels can be liver
failure, overhydration, negative nitrogen balance via malnutrition, pregnancy,
etc.

Normal range:

Adults
10-20 mg/dl

Creatinine

Creatinine is a byproduct of creatine phosphate, the chemical used in
contraction of skeletal muscle. So, the more muscle mass you have, the higher
the creatine levels and therefore the higher the levels of creatinine. Also,
when you ingest large amounts of beef or other meats that have high levels of
creatine in them, you can increase creatinine levels as well. Since creatinine
levels are used to measure the functioning of the kidneys, this easily explains
why creatine has been accused of causing kidney damage, since it naturally
results in an increase in creatinine levels.

However, we need to remember that these tests are only indicators of functioning
and thus outside drugs and supplements can influence them and give false
results, as creatine may do. This is why creatine, while increasing creatinine
levels, does not cause renal damage or impair function. Generally speaking,
though, increased levels are indicative of urinary tract obstruction, acute
tubular necrosis, reduced renal blood flow (stemming from shock, dehydration,
congestive heart failure, atherosclerosis), as well as acromegaly. Decreased
levels can be indicative of debilitation, and decreased muscle mass via disease
or some other cause.

Normal range:

Adult Male
0.6-1.2 mg/dl

Adult Female
0.5-1.1 mg/dl

BUN/Creatinine Ratio

A high ratio may be found in states of shock, volume depletion, hypotension,
dehydration, gastrointestinal bleeding, and in some cases, a catabolic state. A
low ratio can be indicative of a low protein diet, malnutrition, pregnancy,
severe liver disease, ketosis, etc. Keep in mind, though, that the term BUN,
when used in the same sentence as hamburger or hotdog, usually means something
else entirely. An important thing to note again is that with a high protein
diet, you'll likely have a higher ratio and this is nothing to worry about.

Normal range:

Adult
6-25

Calcium

Calcium is measured in order to assess the function of the parathyroid and
calcium metabolism. Increased levels can stem from hyperparathyroidism,
metastatic tumor to the bone, prolonged immobilization, lymphoma,
hyperthyroidism, acromegaly, etc. It's also important to note that anabolic
steroids can also increase calcium levels. Decreased levels can stem from renal
failure, rickets, vitamin D deficiency, malabsorption, pancreatitis, and
alkalosis.

Normal range:

Adult
9-10.5 mg/dl

Liver Function

Total Protein

This measures the total level of albumin and globulin in the body. Albumin is
synthesized by the liver and as such is used as an indicator of liver function.
It functions to transport hormones, enzymes, drugs and other constituents of the
blood.

Globulins are the building blocks of your body's antibodies. Measuring the
levels of these two proteins is also an indicator of nutritional status.
Increased albumin levels can result from dehydration, while decreased albumin
levels can result from malnutrition, pregnancy, liver disease, overhydration,
inflammatory diseases, etc. Increased globulin levels can result from
inflammatory diseases, hypercholesterolemia (high cholesterol), iron deficiency
anemia, as well as infections. Decreased globulin levels can result from
hyperthyroidism, liver dysfunction, malnutrition, and immune deficiencies or
disorders.

As another important side note, anabolic steroids, growth hormone, and insulin
can all increase protein levels.

Normal range:

Adult
Total Protein: 6.4-8.3 g/dl
Albumin: 3.5-5 g/dl
Globulin: 2.3-3.4 g/dl

Albumin/Globulin Ratio:

Adult
0.8-2.0

Bilirubin

Bilirubin is one of the many constituents of bile, which is formed in the liver.
An increase in levels of bilirubin can be indicative of liver stress or
damage/inflammation. Drugs that may increase bilirubin include oral anabolic
steroids (17-AA), antibiotics, diuretics, morphine, codeine, contraceptives,
etc. Drugs that may decrease levels are barbiturates and caffeine. Non-drug
induced increased levels can be indicative of gallstones, extensive liver
metastasis, and cholestasis from certain drugs, hepatitis, sepsis, sickle cell
anemia, cirrhosis, etc.

Normal range:

Total Bilirubin for Adult
0.3-1.0 mg/dl

Alkaline Phosphatase

This enzyme is found in very high concentrations in the liver and for this
reason is used as an indicator of liver stress or damage. Increased levels can
stem from cirrhosis, liver tumor, pregnancy, healing fracture, normal bones of
growing children, and rheumatoid arthritis. Decreased levels can stem from
hypothyroidism, malnutrition, pernicious anemia, scurvy (vitamin C deficiency)
and excess vitamin B ingestion. As a side note, antibiotics can cause an
increase in the enzyme levels.

Normal range:

16-21 years
30-200 U/L

Adult
30-120 U/L

Pt. 3

AST (Aspartate Aminotransferase, previously known as SGOT)

This is yet another enzyme that's used to determine if there's damage or stress
to the liver. It may also be used to see if heart disease is a possibility as
well, but this isn't as accurate. When the liver is damaged or inflamed, AST
levels can rise to a very high level (20 times the normal value). This happens
because AST is released when the cells of that particular organ (liver) are
lysed. The AST then enters blood circulation and an elevation can be seen.
Increased levels can be indicative of heart disease, liver disease, skeletal
muscle disease or injuries, as well as heat stroke. Decreased levels can be
indicative of acute kidney disease, beriberi, diabetic ketoacidosis, pregnancy,
and renal dialysis.

Normal range:

Adult
0-35 U/L (Females may have slightly lower levels)

ALT (Alanine Aminotransferase, previously known as SGPT)

This is yet another enzyme that is found in high levels within the liver. Injury
or disease of the liver will result in an increase in levels of ALT. I should
note however, that because lesser quantities are found in skeletal muscle, there
could be a weight-training induced increase . Weight training causes damage to
muscle tissue and thus could slightly elevate these levels, giving a false
indicator for liver disease. Still, for the most part, it's a rather accurate
diagnostic tool. Increased levels can be indicative of hepatitis, hepatic
necrosis, cirrhosis, cholestasis, hepatic tumor, hepatotoxic drugs, and
jaundice, as well as severe burns, trauma to striated muscle (via weight
training), myocardial infarction, mononucleosis, and shock.

Normal range:

Adult
4-36 U/L

Endocrine Function

Testosterone (Free and Total)

This is of course the hormone that you should all be extremely familiar with as
it's the name of this here magazine! Anyhow, just as some background info, about
95% of the circulating Testosterone in a man's body is formed by the Leydig
cells, which are found in the testicles. Women also have a small amount of
Testosterone in their body as well. (Some more than others, which accounts for
the bearded ladies you see at the circus, or hanging around with Chris Shugart.)
This is from a very small amount of Testosterone secreted by the ovaries and the
adrenal gland (in which the majority is made from the adrenal conversion of
androstenedione to Testosterone via 17-beta HSD).

Nomal range, total Testosterone:

Male

Age 14
<1200 ng/dl

Age 15-16
100-1200 ng/dl

Age 17-18
300-1200 ng/dl

Age 19-40
300-950 ng/dl

Over 40
240-950 ng/dl

Female

Age 17-18
20-120 ng/dl

Over 18
20-80 ng/dl

Normal range, free Testosterone:

Male
50-210 pg/ml

LH (Luteinizing Hormone)

LH is a glycoprotein that's secreted by the anterior pituitary gland and is
responsible for signaling the leydig cells to produce Testosterone. Measuring LH
can be very useful in terms of determining whether a hypogonadic state (low
Testosterone) is caused by the testicles not being responsive despite high or
normal LH levels (primary), or whether it's the pituitary gland not secreting
enough LH (secondary). Of course, the hypothalamus ? which secretes LH-RH
(luteinizing hormone releasing hormone) ? could also be the culprit, as well as
perhaps both the hypothalamus and the pituitary.

If it's a case of the testicles not being responsive to LH, then things like
clomiphene and hCG really won't help. If the problem is secondary, then there's
a better chance for improvement with drug therapy. Increased levels can be
indicative of hypogonadism, precocious puberty, and pituitary adenoma. Decreased
levels can be indicative of pituitary failure, hypothalamic failure, stress, and
malnutrition.

Normal ranges:

Adult Male
1.24-7.8 IU/L

Adult Female
Follicular phase: 1.68-15 IU/L
Ovulatory phase: 21.9-56.6 IU/L
Luteal phase: 0.61-16.3 IU/L
Postmenopausal: 14.2-52.3 IU/L

Estradiol

With this being the most potent of the estrogens, I'm sure you're all aware that
it can be responsible for things like water retention, hypertrophy of adipose
tissue, gynecomastia, and perhaps even prostate hypertrophy and tumors. As a
male it's very important to get your levels of this hormone checked for the
above reasons. Also, it's the primary estrogen that's responsible for the
negative feedback loop which suppresses endogenous Testosterone production. So,
if your levels of estradiol are rather high, you can bet your ass that you'll be
hypogonadal as well.

Increased estradiol levels can be indicative of a testicular tumor, adrenal
tumor, hepatic cirrhosis, necrosis of the liver, hyperthyroidism, etc.

Normal ranges:

Adult Male
10-50 pg/ml

Adult Female
Follicular phase: 20-350 pg/ml
Midcycle peak: 150-750 pg/ml
Luteal phase: 30-450 pg/ml
Postmenopausal: 20 pg/ml or less

Thyroid (T3, T4 Total and Free, TSH) t3 (Triiodothyronine) t3 is the more
metabolically active hormone out of T4 and t3. When levels are below normal it's
generally safe to assume that the individual is suffering from hypothyroidism.
Drugs that may increase t3 levels include estrogen and oral contraceptives.
Drugs that may decrease t3 levels include anabolic steroids/androgens as well as
propanolol (a beta adrenergic blocker) and high dosages of salicylates.
Increased levels can be indicative of Graves disease, acute thyroiditis,
pregnancy, hepatitis, etc. Decreased levels can be indicative of hypothyroidism,
protein malnutrition, kidney failure, Cushing's syndrome, cirrhosis, and liver
diseases.

Normal ranges:

16-20 years old
80-210 ng/dl

20-50 years
75-220 ng/dl or 1.2-3.4 nmol/L

Over 50
40-180 ng/dl or 0.6-2.8 nmol/L

T4 (Thyroxine)

T4 is just another indicator of whether or not someone is in a hypo or
hyperthyroid state. It too is rather reliable but free thyroxine levels should
be assessed as well. Drugs that increase of decrease t3 will, in most cases, do
the same with T4. Increased levels are indicative of the same things as t3 and a
decrease can be indicative of protein depleted states, iodine insufficiency,
kidney failure, Cushing's syndrome, and cirrhosis.

Normal ranges:

Adult Male
4-12 ug/dl or 51-154 nmol/L

Adult Female
5-12 ug/dl or 64-154 nmol/L

Free T4 or Thyroxine

Since only 1-5% of the total amount of T4 is actually free and useable, this
test is a far better indicator of the thyroid status of the patient. An increase
indicates a hyperthyroid state and a decrease indicates a hypothyroid state.
Drugs that increase free T4 are heparin, aspirin, danazol, and propanolol. Drugs
that decrease it are furosemide, methadone, and rifampicin. Increased and
decreased levels are indicative of the same possible diseases and states that
are seen with T4 and t3.

Normal ranges:

0.8-2.8 ng/dl or 10-36 pmol/L

TSH (Thyroid Stimulating Hormone)

Measuring the level of TSH can be very helpful in terms of determining if the
problem resides with the thyroid itself or the pituitary gland. If TSH levels
are high, then it's merely the thyroid gland not responding for some reason but
if TSH levels are low, it's the hypothalamus or pituitary gland that has
something wrong with it. The problem could be a tumor, some type of trauma, or
an infarction.

Drugs that can increase levels of TSH include lithium, potassium iodide and TSH
itself. Drugs that may decrease TSH are aspirin, heparin, dopamine, t3, etc.
Increased TSH is indicative of thyroiditis, hypothyroidism, and congenital
cretinism. Decreased levels are indicative of hypothyroidism (pituitary
dysfunction), hyperthyroidism, and pituitary hypofunction.

Normal ranges:

Adult
2-10 uU/ml or 2-10 mU/L

Knowing how to interpret these tests can be a very valuable tool in terms of
health and your body building and athletic progress. Use your new knowledge
wisely!