Episode #3 : Comprehensive Lab Testing

Summary

In this conversation, Dr. K and Coach Kyle discuss comprehensive lab testing. They cover topics such as comprehensive lab testing for hormones, thyroid, and other areas. They emphasize the importance of tailoring testing based on symptoms and the benefits of comprehensive lab testing. They also discuss specialized testing, the cost and frequency of comprehensive lab testing, and the importance of educating yourself on lab results. In this episode, Kyle and Ben discuss the importance of hormone balance and how it affects overall health and performance. They explore common hormonal imbalances and the role of diet and lifestyle in maintaining hormonal health. They also touch on testing and treatment options for hormone imbalances. Finally, they tease future episodes that will dive deeper into specific hormone-related topics.

Takeaways

  • Comprehensive lab testing is important for understanding hormone levels, thyroid function, and other areas of health.
  • Tailoring testing based on symptoms can provide more targeted and effective results.
  • Comprehensive lab testing can be used for both investigative and preventative purposes.
  • Educating yourself on lab results and understanding the reference ranges is crucial for making informed decisions about your health. Hormone balance is crucial for overall health and performance.
  • Common hormonal imbalances include low testosterone, estrogen dominance, and thyroid disorders.
  • Diet and lifestyle choices play a significant role in maintaining hormonal health.
  • Testing and treatment options are available for identifying and addressing hormone imbalances.

Chapters

00:00 Introduction

03:20 Comprehensive Lab Testing for Hormones

08:06 Comprehensive Lab Testing for Thyroid

13:44 Other Tests in Comprehensive Lab Testing

15:27 Benefits of Comprehensive Lab Testing

17:10 Specialized Testing

20:58 Tailoring Testing Based on Symptoms

23:02 When to Pull Comprehensive Lab Testing

28:55 Lipids and Heart Markers

32:31 Cost and Frequency of Comprehensive Lab Testing

35:12 Educating Yourself on Lab Results

41:25 Conclusion

05:12 The Importance of Hormone Balance

15:20 Common Hormonal Imbalances

25:45 The Role of Diet and Lifestyle

35:10 Testing and Treatment Options

41:31 Future Topics

Sponsors

This episode is sponsored by Toxic Roots.  The optimal resource for online health coaching for optimizing performance and removing toxins. Click on the link below to get started on finding your toxic roots. 

Website: https://www.toxicrootswellness.com/

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Sources

https://www.journals.uchicago.edu/doi/abs/10.1086/596535

People

Peak Performance 

Dr. K 

Coach Kyle 

Full Transcript

Kyle Hulbert (00:02)

Hello, ladies and gentlemen, today we’re talking about comprehensive lab testing. What does that mean? What does that entail? Why should you do it? Why shouldn’t you do it? Uh, cost and many other things. I am coach Kyle and with me is Dr. K.

Ben Kosubevsky (00:16)

Hey everybody, thanks for joining our show today. We’re very excited to have you here. Let’s get into it.

Kyle Hulbert (00:22)

Well, before we get into it, Dr. K your wife posted a video online of you riding a horse. Um, and I gotta say, it kind of looked like you were like having some lumbar stress on the jerking motion of this horse. Um, I was kinda, I was like, is he okay? So how’s what’s the horse about? And, uh, is your back okay?

Ben Kosubevsky (00:44)

My back is okay, thank you for asking. That is actually good horse riding technique. Apparently to the untrained eye, it is not. What’s funny is she told me that right after you texted her and she goes, don’t worry, you’re doing good. It’s just Kyle. But no, we’re having a delayed honeymoon. We got married in July. So we are going to Africa on a seven day horseback riding safari.

Kyle Hulbert (00:49)

Hmm.

Ben Kosubevsky (01:09)

And hopefully this does not make it to the people putting on the Safari, but I only started learning in July. So I’ve had a very rapid, you know, learning experience where I’m taking lessons all the time, releasing some horses and all that, so that I don’t get eaten by a lion.

Kyle Hulbert (01:26)

Well, Dr. K is going to bless the rains done in Africa. Shout out to Toto there. Um, I know absolutely nothing about horses. In fact, I am the polar opposite of interested in horses. I am almost deathly allergic to them. So one of the few things I’m definitely allergic to, uh, my parents took me to Arabian nights as a kid and, uh, before, before the show even started, I was choking and I couldn’t breathe. Um, few other instances like that. I brushed up against a gate one time that.

Ben Kosubevsky (01:29)

That’s great.

Kyle Hulbert (01:54)

horse had touched, there was no horse nearby, it just touched it and my entire arm broke out in this crazy rash. So I don’t go to your horses, as close as I get is watching videos of Dr. K on horses. So that’s about my limit there. So let’s go ahead and get into comprehensive lab testing. So when it comes to comprehensive lab testing, all doctors comprehensive lab test, right?

Ben Kosubevsky (02:08)

Yes.

No, absolutely not. No.

Kyle Hulbert (02:22)

No? Wait, you’re telling me if I go to my primary care, he’s not going to give me comprehensive lab testing to figure out what’s going wrong with me?

Ben Kosubevsky (02:29)

So my favorite thing in the world is I’ll get patients that come in and go, oh, I just did a whole bunch of blood work last week, my doctor tested me for so many things, I’m like, okay, well mine’s about 26 vials of blood, how much did it take for him? And they go, oh, three vials, they took so much. I’m like, let’s get into it.

Kyle Hulbert (02:46)

Thank you.

So when it comes to comprehensive lab testing, I mean, there are different like sections and parts and things you can look for when you test and the number of tests and the type of tests and the style of tests vary crazily. I mean, it’s, it’s all kinds of stuff you could test for. But let’s start with hormones. A lot of times doctors will start by pulling what they call a hormone panel. And do you know that gin really entails a standard medical doctor pulling a hormone panel?

Ben Kosubevsky (03:20)

Testosterone, estrogen, FSH, LH, occasionally they’ll pull like sex hormone binding globulin DHA but I haven’t seen that pulled all the time.

Kyle Hulbert (03:31)

Yeah. And that’s, and that is, that’s if they’re a good one. So I have seen plenty of people who have, um, have shown me their lab results that have come and they have pulled, they said they went to their doctor and wanted testosterone and a hormone panel and they pulled literally testosterone. That was it. Total. So when it comes to hormones, yeah, I mean, just one number, when it comes to hormones, there are so, so many intricacies that you need to be looking for.

Ben Kosubevsky (03:48)

Nice.

Kyle Hulbert (03:56)

Um, but when you, when you test for them, there are certain things that you can, you can test for limiting your, your trips back to the lab because nobody’d like to get poked over and over again. And, um, and you can kind of nail what’s going on with your hormones in one or two good labs, um, if, if you’re comprehensive with the approach. So when it comes to testosterone, what do you look for generally in an overall, like if you want to assess someone’s sex hormones per se.

Ben Kosubevsky (04:25)

In what sense do you mean overall? You mean like if I have a guy come in who wants hormone panel testing done? So I will pull a testosterone

Kyle Hulbert (04:32)

Yeah, yeah, like what do you pull?

Ben Kosubevsky (04:37)

a total and a free, an estradiol, an FSH and LH, a DHEA, a sex hormone binding globulin, and a PSA. That’s my core hormones. Along with that I’ll pull a CBC which is the blood count, a CMP which looks like kidney and liver function, I’ll pull a lipid panel, and normally if they’re first coming in and they’re doing hormone testing I’ll probably pull a cortisol level and a thyroid level on them as well. I’ll just be a little bit more comprehensive.

Kyle Hulbert (05:06)

Yeah, I love that. I love that. So a lot of times when doctors pull testosterone, they’re looking

for possible testosterone, um, replacement therapy or as I like to refer to this testosterone optimization therapy, um, coined by Jay Campbell, um, and we can link to him in the show notes, um, they just pull total testosterone, but what happens is testosterone has a interplay, um, with. SBGH I believe is the breakdown sex hormone binding globulin.

Ben Kosubevsky (05:14)

Thanks for watching!

Kyle Hulbert (05:37)

And that limits or unlimits, depending on how much you have, uh, how much free testosterone you have and the free testosterone is what’s giving you the typical benefits or, um, produces kind of the feeling that you would associate from taking testosterone so, or having high testosterone. So SBGH, um, do you often see that high when it comes back?

Ben Kosubevsky (06:02)

Um, normally if I ever, I don’t really see a high almost ever. I see it low if anything.

Kyle Hulbert (06:08)

So if you’re, if you’re, if that’s high, it often means that it’s binding your, your total testosterone and giving you a very low free number, which can have a negative symptoms. So if you have just say 700 testosterone, but you’re having low testosterone symptoms and your doctor said, well, you don’t have to worry, it’s not testosterone because you’re 700 and they didn’t pull your free amount. Uh, it could be that you have a high.

sex hormone binding, gobbling, taking up all your free testosterone and giving you those low testosterone symptoms. So SBGH is a good thing to look for when you’re pulling for sex hormones as well as estradiol, E2. So you want to keep, there are a lot of camps out here on looking at estrogen, estradiol. And like Jay Campbell, I mentioned earlier, he likes a high estradiol because he finds it protective.

and neuroprotective and protective in a bunch of different ways. Some people can have symptoms of high estrogen, but I have found that’s probably mostly having to do with their toxic lifestyle and not so much the actual estrogen in their body. So moving on, you mentioned thyroid. Yeah, go ahead.

Ben Kosubevsky (07:20)

Let me just jump, you kept saying S-B-G-H, is that correct?

Kyle Hulbert (07:25)

sex hormone binding globulin. As a, yeah, for the audience, I did have mercury poisoning and I actually spent most of my high school and college years being dyslexic. So I still struggle with some of those issues now and again, so please bear with me. I didn’t take my methylene blue. And if you don’t know what I’m talking about, please see our previous episode on methylene blue. So you mentioned.

Ben Kosubevsky (07:28)

It’s S H G B. I’m sorry. The correct.

Okay, sir. Go ahead.

Kyle Hulbert (07:56)

You mentioned thyroid. So when it comes to the comprehensive testing for thyroid, a lot of doctors will pull one singular thyroid number and that is TSH.

So what…

Ben Kosubevsky (08:06)

That’s not true anymore. Thankfully, they’re at least now pulling TSH, T3, and T4. That’s standard practice now in medical school.

Kyle Hulbert (08:14)

Okay, so TSH, what is TSH, T3, T4? You mind giving us a quick rundown?

Ben Kosubevsky (08:19)

So yeah, it’s thyroid stimulating hormone. So basically there is, is it TRH, is the one in the brain? I can remember that. So the one in the brain, TRH, brain makes this out of your, I think it’s your pineal gland. Is it pineal? Pituitary, wrong P, pituitary. So your pituitary gland makes TRH. TRH tells your thyroid,

Kyle Hulbert (08:30)

I think so.

Is it your Pateriorary or Panenial? Yeah.

Ben Kosubevsky (08:48)

to work, it spits out TSH, which then tells your… is it adrenals? Adrenals? I believe it’s adrenals.

Kyle Hulbert (08:56)

I believe so, I do believe so. Well, I think it might be, I thought the brain made, I thought the brain made TSH and then that tells your thyroid to make T4.

Ben Kosubevsky (09:11)

No, so TRH, I had to Google this one actually, a little embarrassing. TRH is made in the hypothalamus, not the pineal, or the pituitary like I was thinking. The TRH kicks out to the pituitary which makes TSH, which then kicks into your thyroid, which then

Kyle Hulbert (09:27)

USA.

and your thyroid then makes T4.

Ben Kosubevsky (09:33)

The thyroid then makes T4, and then when it’s released, then your body turns into T3. T3 is the active form of all of it. But you need T4 to make T3, which is why we measure both.

Kyle Hulbert (09:45)

Okay, so when you’re measuring, isn’t it important to pull free T4 and free T3 to see how much of those actual effects you’re getting?

Ben Kosubevsky (09:53)

correct. You also want to pull reverse T3 because basically you’re looking for a balance between all of them and if you’re making T3 but not reverse T3 it shows that there’s a balance with your T4 to T3 production levels. So it actually gets a little complicated. So you can’t pull any one of those, this goes to say, you can’t pull any one of those without pulling the rest because a number in stand alone makes absolutely no sense.

Kyle Hulbert (10:22)

So when it comes to comprehensive lab testing, we’re really looking for PSH, T3, T4, free T3, free T4, and reverse T3. That’s about the base of comprehensive thyroid testing.

Ben Kosubevsky (10:37)

No, there’s two more. There’s thyroid peroxidase antibodies, which is Hashimoto’s, and thyroglobulin antibodies as well. Those are both autoimmune markers for thyroid, and if you miss those, you could be missing the precursor to Hashimoto’s or Graves’ disease. Basically, we’re trying to catch it even before it starts to affect the patient so we can get ahead of it.

Kyle Hulbert (10:39)

Good.

Okay, so to review comprehensive thyroid testing, T3, free T3, T4, free T4, TSH, reverse T3, and both sets of antibodies, thyroid antibodies. Is that correct? So that will give us a comprehensive picture of how the body is wanting or not wanting more thyroid, how much…

Ben Kosubevsky (11:14)

Yes.

Kyle Hulbert (11:23)

thyroid is being produced, how much thyroid is being converted, and if there’s any autoimmune or immune system that’s starting to attack the thyroid.

Ben Kosubevsky (11:33)

And if you want to be that A plus doctor, you will pull iodine and selenium levels as well.

Kyle Hulbert (11:39)

That’s really important, um, in my opinion, being, being not a doctor, uh, also while I’m mentioning, I’m not a doctor. I am not a doctor. Dr. K is a doctor and anything we’re on here, we’re not recommending to you or telling you to do without consulting your medical professional first. Um, so the, the iodine and selenium, I think those are very important because I’ve seen patients and actually experienced, I’ve seen people and actually experienced with myself. Um,

that just dosing up on iodine and selenium can help fix low thyroid if there’s not actually an autoimmune problem going.

Ben Kosubevsky (12:18)

In some cases, the reason that the low thyroid is happening is because there’s not enough iodine. Basically, the reason iodine is so important is you need the iodine to make the T3 and T4.

Kyle Hulbert (12:31)

Gotcha. So you’re telling me that you’re a medical doctor and you’re saying that the reason for a medical condition, low thyroid could be a nutrient deficiency.

Ben Kosubevsky (12:34)

Uh-huh.

Absolutely.

Kyle Hulbert (12:44)

That is shocking for many medical doctors to think. Um, from a lot of, a lot of doctors I’ve interacted with, they believe, uh, that nutrients and supplements don’t often have, um, root causes. Now that is changing. I think as, as education progresses and medical school is changing, I think awareness is becoming more part of it. Um, but I’ve, I’ve heard plenty of stories of people who have been prescribed thyroid medications, uh, when iodine selenium were not tried first or even tested for.

Ben Kosubevsky (13:14)

Yeah. That’s the thing is, you know, if you test for the iodine, you don’t necessarily have to put someone on iodine. You can either do the trial and error and test and put them on iodine for three months to see if things change, or you can just do a…as long as you’re going for blood work anyway, get an iodine level. Their insurance will pay for it.

Kyle Hulbert (13:30)

There you go, simple as that. So comprehensive lab testing for thyroid, we covered that comprehensive lab testing for sex hormones, we’ve dabbled in that. What other things do you pull with your crazy number of vials of blood?

Ben Kosubevsky (13:44)

Um, so the, let me cover the basics I pull first. The basics I pull are blood count, uh, metabolic panel, which are kidney and liver function. I pull pancreas function, which is amylase and lipase. I pull inflammatory markers, which are, uh, ESR and CRP. Those are the basic inflammatory markers. I pull a specific cardiovascular inflammatory marker called homocysteine and that we’re going to have a little discussion about that in a second.

Kyle Hulbert (14:03)

Peace.

Ben Kosubevsky (14:14)

Um, and then I pull lipid panels along with apolipoproteins. There’s four of those, right? Four.

Kyle Hulbert (14:22)

I do believe so. Usually, usually the heavy hitter in there is B, correct Apo B?

Ben Kosubevsky (14:27)

B and LpA2 are the two biggest ones. A1 and little a are less important. And then I pull some autoimmune markers such as an ANA. I do testing for Epstein-Barr, which is mono. Sedimeglovirus, which is a cousin to Epstein-Barr.

We pull for heavy metals in the bloodstream. We’re going to have a whole episode about heavy metals where we’ll talk about all that. Pull for a few different vitamin mineral markers, vitamin D, iodine, magnesium, a few others. I think that’s the bulk of it. Oh, I pulled candida is actually a good one to do as well. You can test for candida in IgA, M, and G, and we’ll explain those in a second as well.

I think that’s the bulk of it.

Kyle Hulbert (15:17)

That seems pretty comprehensive

overall, but what are you, why do you do this? Why would you do comprehensive testing? Why should anybody consider it? I mean, it seems expensive.

Ben Kosubevsky (15:27)

So luckily, yeah, it’s an $8,000 panel run through request if you don’t pay, if you pay cash for it. Luckily, if you’re using the right diagnosis codes, insurance pays for all, I’ve seen bills for maybe one or $200, nothing crazy. So it’s actually not expensive. So.

I run this for one of two reasons for my patients. One, which is most of my patients, they’re coming in because they’re sick and no one knows what’s wrong with them. So we have to start over, one, we start over from scratch and two, we really have to start digging. So my goal is whatever we can get insurance to pay for, let’s have them pay for it, save the patients as much money as we can. So we’ll do that whole big panel. And then the second thing.

is I have patients that are coming and they go, well, it’s the same idea as getting a full body MRI. Let’s find out everything that’s wrong with me and get ahead of it before it’s a problem.

Kyle Hulbert (16:20)

So you can use it as a investigative tool and a preventative tool.

Ben Kosubevsky (16:24)

That’s a good summation.

Kyle Hulbert (16:26)

Very nice. Yeah, I found there’s benefit in this. Some of the clients I’ve worked with, they’ve shown me their labs and I’ve had young people, I mean, I’m talking 21, 22 years old, come back with high APOB and cardiovascular risk numbers. And they probably wouldn’t have known that something they need to work on or focus on for another 30 years going through standard medical lab testing.

Ben Kosubevsky (16:52)

Yeah.

Kyle Hulbert (16:54)

So it is important for preventative, not just trying to get to the root of health issues. So when it comes to comprehensive lab testing, do you ever do any, like stool or urine or test like that?

Ben Kosubevsky (17:10)

So now we’re starting to venture away from what we can run through requests. You’re talking about getting to more specialized testing, right? So yeah, so specialized testing, I kind of do it in waves, mostly because at this point now patients are unfortunately spending cash because insurance stops covering all these specialized testing. So I try and do things in waves depending on which way I’m most suspicious.

Kyle Hulbert (17:18)

Mm-hmm.

Ben Kosubevsky (17:36)

Occasionally, actually most of the time, I start getting to heavy metal testing first. That’s just kind of what I’m known for in my area is to be the guy to go to for heavy metal testing. So we’ll get into that’s one avenue we go down. Another avenue we go into is Lyme testing. Unfortunately, the Western blot testing done through Quest is not that good for Lyme disease.

hyper-focused Lyme testing where they look at all strains of Lyme plus their co-infections. We can get into what’s called oats testing, organic acid testing. It has to do with nutritional balances and mold fungus balances. We can do a what’s called a Genova Nutrival test. I really like that test. It looks at your metabolic deficiencies and basically how to fix it with supplementation. We can

We can get into non-heavy metal, non-organic toxin testing, things like plastics, pesticides, fuel additives, etc. Those are all the ones off the top of my head. Kyle, you look like you have more.

Kyle Hulbert (18:51)

Yeah. Well, this is kind of, this is kind of the realm I operate in. I like the specialized testing. One of the best ones I do for working with clients for hormones is the Dutch test. So it’s a basically a 24 hour collection of urine, you dry it and it gives you a breakdown of your sex hormones as well as your cortisol and the metabolites and how it varies throughout the day. So that one can lend a lot of insight.

But kind of like Dr. K said, I want to highlight where I start with my clients is I recommend a comprehensive panel, a blood panel to cover our bases upfront. And then based on what I’ve heard from them in our first talks and kind of where the toxic roots might lie, where the suspicions of the toxins might be, that’s when I dial into the specific testing that I recommend.

Uh, because as Dr. K said, these things can get expensive. The blood work is often paid by insurance or, you know, if you cash pay, um, for some of the basic panels that I put my clients through, they’re not terribly expensive, but one of these specialized tests can run north of $500 very easily, five, seven, a grand. Some of those lime tests are absolutely insane on how expensive they are.

Ben Kosubevsky (20:11)

That’s why I use Vibrant. Their basic comprehensive is like $400 to $500, whereas Igenix is like $1600.

Kyle Hulbert (20:19)

Yeah, the igenex tests are very, very expensive. Um, so, so overall, um, comprehensive lab testing, this is, this is where you start. You start with blood drawl. So you can kind of paint the picture of where you’re at. Then, then you listen to the client, uh, or in Dr. Kay’s case, the patient, and, um, you kind of rely on the experience of the practitioner, uh, or the coach.

to kind of guide you on what specific testing you might need next. So on those specific testing, following up to like a basic comprehensive blood draw, what are some things that might tip you off when you’re talking to a patient that might push you towards one test or another?

Ben Kosubevsky (20:58)

So with the basic…

the big things that are tipping points. So Candida for example, Quest actually has a really good Candida test because they break it down into IgG, IgM and IgA. And what those three letters mean, IgA is specific to mucosal tissue which means it’s active in your GI tract, mouth to anus. IgM means an acute infection within the last couple days to weeks. And IgG means you’ve had it for three plus weeks. So if I see a high Candida, there’s a good

into bold testing. That’s one. Another one, if I see really high inflammation or if I see an ANA, I will usually, ANA is anti-neutrophilic antibody, it’s a precursor to autoimmune disease. It’s a very nonspecific question. If I see either of those or if I see heavy metals elevating the blood, I will obviously go into heavy metal testing.

Um, and then if I see, uh, malbalanced or misbalances in vitamin mineral levels, um, we’ll probably get into like oats testing and all that. Um, and so we kind of just tailor what comes up positive and then we kind of pick our direction.

Kyle Hulbert (22:13)

Yeah, with my clients, I go through a robust health history. So I go through a ton of information, spend hours reviewing their history, their symptoms, what they want to work on, what they want to improve. And then from there, I actually meet with them and ask them probably 20 to 30 follow-up questions, which kind of guides me to where I think they should go in testing. So I try to get it done in one swoop.

But if you’re working with a doctor, it probably is easier to get a comprehensive blood draw and then see what is off and then guide your testing from that. So should people, like a comprehensive lab test, we’ve mentioned it’s investigative as well as preventative. When should people in terms of age pull comprehensive lab testing?

Ben Kosubevsky (23:02)

Um, sooner the better, honestly. Uh, because one of those things, if we’re trying to get ahead of it, the sooner we get ahead of it, the sooner we could deal with it. You know, if we start to see your insulin levels are running high, then that tells us that, hey, you know, they’re not gonna have diabetes next week, but they might have it in 10 years. So why don’t we get them on metformin right away and have them drastically reduce their sugar intake. And that way they never have to deal with having diabetes or pre-diabetes.

Kyle Hulbert (23:32)

Yeah, that preventative aspect is huge. And even if not preventative, there’s something to be said about getting a comprehensive lab testing in your 20s, early 20s, because you have baseline levels. If you feel amazing, even if nothing is off, anywhere close to off on the lab testing, now you have baseline levels to go against when you get older. So if you know that your baseline level when you were a 24-year-old male was 1200 testosterone,

And then you go in complaining of testosterone symptoms when you’re 40 and the doctor says, you’re not low enough to treat because you’re 600. Well that might be because your body needs a higher level and you know that because you’re baseline. If you don’t have that baseline, you don’t have that information to go off.

Ben Kosubevsky (24:18)

Well, let’s actually take a pause right there and talk about baseline compared to normal. The way that…

Quest and LapCore and all the other major testing companies figure out what’s normal is they do a census every 10 years where let’s take testosterone for example. Every 10 years they’ll look at their data for that year and see what the average testosterone level is and what the outliers to it are and that’s where they establish their baselines. I think it’s a well known fact, it’s well known to me, the average testosterone levels in America have been decreasing over the last 50 to 100 years and Quest is just kind of rolling with it saying, okay well.

you know, it used to be 1,200 was normal, so if you’re below that you were low, and then shifted to 800 to 1,000, and now I think it’s 600 to 1,000 is considered normal. Whereas I would honestly argue that 600 is low for most guys, especially younger guys.

Kyle Hulbert (25:08)

I’ve seen reference ranges on, I won’t name the labs, but they’ve ended at 249 for total testosterone as acceptable. Meaning, if you go in and you pull your testosterone and it’s 300 and you have all the symptoms of testosterone, more than likely a standard medical doctor will say it’s not testosterone because you fall within the range, which is crazy because the range, like you said, is made up by Quest based on averages that have been dropping over the last few decades.

Ben Kosubevsky (25:39)

Well, while you mention it, what are the average symptoms of low testosterone?

Kyle Hulbert (25:45)

Um, well, it could be, it could be varying. Uh, it could be across the board, but, um, you know, the classic ones are, um, worst body composition, lower muscle, higher fat, lower libido. Um, what a lot of people don’t know is, um, anger, rage, annoyance. Those are not symptoms of high testosterone. Those are symptoms of low testosterone. And when someone fixes their testosterone levels, often they’re more at peace. Um, and there are studies to back this up. There’s, um, there’s a great study about, um, how testosterone levels affect.

your dominance slash tacticalness. And they found that the higher the testosterone, the more tactical you are, not the more dominant you are. So I find it pretty interesting that a lot of anger or emotional issues can be solved with supplementing with testosterone or some kind of testosterone replacement therapy, other symptoms include mental health symptoms. That’s a big one that I, that I dealt with. It was for me, it was depression, anxiety, low energy. I was just, just didn’t want to get out of bed.

in the morning, and then I went on testosterone replacement therapy, uh, not through actual testosterone, but through a different, uh, substance called in clomophene. Uh, and my depression and anxiety disappeared in two days, two days. So it wasn’t, it wasn’t actually a psychological issue I was dealing with. It was a biological issue that just needed to be fixed. It was a hormone imbalance. Uh, I have a theory that might be off base, but I think about 80% of.

of anxiety, depression, and mental health issues are not based in psychological roots, but they’re actually biological roots, either coming from toxins or homeowner dysfunction or gut issues. I don’t know if you could follow that, Dr. K.

Ben Kosubevsky (27:25)

I’ve had that same theory ever since I started getting into happy metals.

Kyle Hulbert (27:28)

Yeah, it’s, I mean, it is, it’s been remarkable. My mental health with, through testosterone replacement therapy and through the removal of my high mercury levels has dramatically improved. Um, which has then in turn led me to be able to do the harder work of diving into my past and working through places like 40 years of Zen and going deep and forgiving people, but I was not at a place with my low testosterone to be even able to consider doing that work before I fixed the base biological issues.

Ben Kosubevsky (27:58)

Yeah, that sounds about right. So what other test things should we talk about next?

Kyle Hulbert (28:06)

What other testing? Well, I don’t want to kind of spoil it, but we will have a episode airing probably a few weeks from now that will go over testing for heavy metals. It will be a pretty comprehensive episode on how to test for heavy metals, different ways to do it, best practices, and that will be associated with our, with our new guide. We’re going to have a guide to help people figure out how to test for heavy metals and other toxins.

It’s going to be the ultimate guide to toxin testing. So that’ll be coming out fairly soon. But I mean, I think we’ve basically covered it. We didn’t talk too much about lipids though, cholesterol and your heart markers. Can you mind reminding the audience kind of what you pull and looking at lipids and heart markers?

Ben Kosubevsky (28:55)

Yeah, so it breaks down to we’re going to do a lipid panel. A lipid panel is going to include total cholesterol.

LDL, which is the big cholesterol particles, HDL, which are considered the good ones or the small ones, triglycerides, which are the fatty ones, and non-HDL, so that’s a lipid panel. Then I also pull apolipoprotein A1, A2, little a, and b, those are four different cardiovascular markers. I pull an ADMA and SDMA, those are, they’re a little bit more genetic, but they’re also cardiovascular risk markers.

a homocysteine. That’s kind of the total cholesterol slash heart testing that we do. And so, you know, I came across a video a few years ago and I started doing a deep dive into it. I have a different approach to cholesterol than most doctors. Um,

I’m not a big fan of statins, talk to your doctor about being on statins, but personally I’m not a big fan of putting my patients on them. They’ve shown to have a lot of complications. They affect the brain, they affect muscle tissue. Basically because if you lower your cholesterol levels, cholesterol is a building block tissue. If you drop it too low, your body cannot repair and rebuild itself.

So I look at like this, some people are just going to be genetically predisposed to having higher LDL and that’s okay. So what I look at is triglycerides. Triglycerides are the sticky nasty ones that cause heart attacks and strokes. If your LDL is 20 points above normal but your triglycerides are low or normal, I’m not at all worried about you. Because that tells me your body, for whatever reason, you just sit higher there but you’re not going to have a heart attack. You don’t have the means to have one.

at this time.

Kyle Hulbert (30:42)

Gotcha. So I did a bunch of lab testing fairly recently, probably about six or eight months ago. And I was showing, actually going back a year or two, if I look at the data going back, cause I get regular comprehensive lab testing, and I was showing low overall cholesterol. What does that point to you?

Ben Kosubevsky (31:01)

Low total cholesterol?

Kyle Hulbert (31:04)

Low, yeah, low total, low HDL, low LDL, low everything.

Ben Kosubevsky (31:08)

That tells me that your body’s having trouble. It’s one of the two things. Either you are not intaking enough fat, which actually is a problem. You do have to have a certain amount of fat intake. Or two, your body is not utilizing the cholesterol that you’re intaking. So that points to either a GI issue, most likely, where you’re not absorbing it, or you’re not literally putting enough in your mouth.

Kyle Hulbert (31:31)

And the latter was my case. It was my liver was not properly digesting my food due to not enough stomach acid, due to some of the biohacking things I’m doing and supplements I’m taking. So it actually led to a decrease in my total cholesterol and all the different types of cholesterol, which then impacted my hormone levels.

Ben Kosubevsky (31:56)

And so that brings up a really good point is you could go to your doctor and you know if he’d gone to a regular Primary care doctor unfortunately, they would look at this cluster. I’ve been oh you’re doing great. Everything’s low You must be so healthy when reality he’s having really big problems

Kyle Hulbert (32:11)

Yeah. So I’m glad that I’m glad we got to the root of that one. So comprehensive lab testing. Let’s, let’s get back to that. When, so you pulled this crazy panel, right? Most, most doctors would consider it crazy. Um, but if insurance covers it, how often should someone pull that full panel or should they ever again?

Ben Kosubevsky (32:31)

Um, that’s a good question. I will typically, so that full panel, some of it’s genetic in there. Like I pull an MTHFR and the G6PD, Quest will pay for both of those. You never have to repeat those either again because they’re both genetic. So we’ve already dropped two vials off the count.

And then I won’t repeat that stuff in a year. If something came up high, I will repeat it at whatever threshold it needs to be repeated at. If I go through treatments, I’ll keep an eye on things. I wouldn’t pull that crazy panel more often than every five years.

Kyle Hulbert (33:04)

So basically you use it as a guide to kind of help your patients and then you’ll dial in the targeted testing to follow up on the things you’re actually working.

Ben Kosubevsky (33:14)

correct.

Kyle Hulbert (33:16)

Okay. Yeah, that makes a lot of sense. Um, I, I will, I would be remiss to, to not mention or to mention if you have low iron levels and you’re pulling excessive amounts of labs regularly, if you’re giving vials and vials and vials of labs and you already have low iron levels, this could lead to an even higher deficiency in iron. Um, and speaking from experience, iron is not a fun one to supplement with. It’s a, it can have all kinds of side effects from either IV or oral gut issues.

just random sweating and things like that. And it’s not easy to get up. It’s quite a long process. So be careful to watch your iron levels if you’re working with a practitioner who is asking you to do comprehensive lab testing very regularly. That’s probably one of the main reasons why you don’t follow up with a giant panel all the time.

Ben Kosubevsky (34:04)

Correct, yeah, I mean, it’s not an insane amount of blood. If you break it down, it’s roughly half of a blood donation. So if you ever donate blood and survive, you’re good. But yeah, if you were starting to creep into low iron, don’t keep doing it.

That’s one thing. The other thing I want to point out, because I run into this problem sometimes, it’s something called standard deviation on lab tests. And the easiest one to talk about with it is hemoglobin. Hemoglobin is kind of like your blood count almost. And they have standard deviation of.5. So 12 to like 17 is considered normal. But let’s say you are 13 the first time and you are…

12 the next time and then 11. With a standard deviation of 0.5 on each test, that means there’s a one point window of shift. So you may not necessarily be dropping as much as you think you are and so doing routine testing without knowing that in mind, that can scare people. So always talk to your doctor about big changes before you freak yourself out.

Kyle Hulbert (35:12)

That is important. So overall, I think we talked about cost a little bit. What if someone’s insurance doesn’t cover these tests? Because I’ve ran into that. It didn’t cover all of them. It covered some of them, or it was a shocking surprise to others. How do you navigate that? Or do you pull things off of your comprehensive list in order to target that better?

Ben Kosubevsky (35:35)

So, unfortunately, if you have insurance, we won’t know what they’re covering until like a month later when the insurance company actually gets the bill. They don’t tell you upfront if they’re going to cover it or not.

Kyle Hulbert (35:42)

Mmm.

Ben Kosubevsky (35:48)

So, often times if something doesn’t get covered, we will try and use the lab work that came back to add some diagnosis codes to give a proof of a reason why we wanted that done. It’s kind of like cheating almost because now we have answers to their questions. Whereas if someone just doesn’t have insurance, it does become more difficult. There is a lab near me that I use. They’re roughly… I don’t know.

somewhere between a fifth and a tenth the cash price of Quest. So I do use them for patients, but we’re still talking one to $2,000 for initial blood work. So at that point, it depends. Usually I’ll say, you know, what we’re going to target whatever you’re coming in for, instead of just throwing the kitchen sink at it and then we’ll, you know, if we have to add something down the road, we will. Whereas I, so I try not to pull that whole thing with there’s no insurance.

Kyle Hulbert (36:38)

That makes sense. Yeah, that makes a lot of sense. I do want to mention when it comes to comprehensive lab work or actually lab work in general, I’m not a doctor, but I am well-researched in these areas. You should know what you’re looking at. So if you get lab work, you often get the results to a similar time as your doctor would get them if you’re not going through the traditional medical outlets. But even if you do get them at your doctor’s appointment and they say everything’s fine.

or you’re preparing for your doctor’s appointment, I would encourage you to research. And you can literally type these lab tests into Google, and you can get a kind of synopsis that’s pretty easy to understand about what they are. And if you have anything that’s definitely outside the bounds of the standard reference ranges, or anything you even care about specifically, like say you care about a lot, testosterone, you can do some research on.

basic optimized testosterone levels. And you can be armed with that information when you go talk to your doctor to be able to ask them, depending on your stage of life for enclomaphen or testosterone, sepia, or something like that to supplement your testosterone levels. So educating yourself is highly important in my opinion. Is that something you encourage your patients to do, Dr. K?

Ben Kosubevsky (37:52)

Absolutely. I want my patients to leave smarter than me at the end of the day. And then one of the other things I do, unfortunately sometimes when you go to the doctor, and unfortunately timelines and rushing, they’ll say, oh your blood work looks fine, everything looks great, you’re good to go. My biggest encouragement is have your doctor go line by line through your blood work. Even if everything’s normal, what’s that one for? What’s that one for? What’s that one for? What’s that mean? That’s how you leave with the most possible knowledge out of that room.

Kyle Hulbert (38:21)

What do you do if your doctor says, I don’t know what that’s for?

Ben Kosubevsky (38:25)

So… I don’t want to answer that question.

Kyle Hulbert (38:30)

Okay, I’ll dump that on there. You might wanna consider finding a new medical practitioner if they ordered a test that they cannot explain to you. So.

Ben Kosubevsky (38:39)

My typical rule is if I order a test, I have to know how to interpret the results and what to do with it if there’s something wrong. That’s why I don’t order things like mammograms. I have no idea what to do with it if it comes back abnormal.

Kyle Hulbert (38:55)

You’re not a mammogramologist?

Ben Kosubevsky (38:57)

I am not, no.

Kyle Hulbert (38:59)

I don’t think that’s a word, but yeah. So I mean, education is huge. And even if nothing’s like I said, outside of the reference range, knowing what it is and educating yourself for the future is very important. And then things like testosterone, I know I keep coming back to it, but it’s just made such a big impact in my life. You can be well within the reference range, especially for women. This is actually very interesting and be suboptimal. So the reference range for women.

often by experts is considered lower than optimal. So the top of the reference range is actually lower than where they would want you to be for optimal. Meaning you could have high testosterone as a woman on a lab test, and some expert would consider you still not as high as they would like you to be. Which is pretty crazy because if you come in at the low end of that reference range, having some testosterone supplementation could…

could be life-changing for you.

Ben Kosubevsky (39:59)

Yeah. What is normal for a woman?

Kyle Hulbert (40:03)

I believe the reference ranges are 6 to 60 roughly, and I’ve heard experts cite anywhere between 60 and 80 being optimal. Some of them like them over 80.

Ben Kosubevsky (40:14)

You know, I try and put my women, I don’t do female hormones often. I really only do female hormones after menopause. It becomes a lot easier. Um, but my goal is somewhere between 50 and a hundred.

Kyle Hulbert (40:26)

Yeah, that makes a lot of sense. What’s actually crazy is I’ve seen this with clients of mine. They’ve came back in the reference range, but towards the bottom of it, six, seven, eight, nine, somewhere in there. They’ve asked their doctor for testosterone. They went on testosterone replacement therapy. And all of a sudden, their insulin markers, their glucose markers, their lipids, they all improve.

without changing anything on diet or anything else. It was just testosterone supplementation. Um, so it is a very powerful hormone for women, not just men.

Ben Kosubevsky (41:04)

Yeah, absolutely. Because it’s one of those building block things. No matter male, woman, whatever, you need testosterone and estrogen to build your tissue. Without it, tissue doesn’t build.

Kyle Hulbert (41:18)

Very true. So, did we miss anything? Comprehensive lab testing? Anything anybody else should know?

Ben Kosubevsky (41:25)

Um, without getting to nitty gritty of things, not really. I think we’ve covered pretty much all of it.

Kyle Hulbert (41:31)

Yeah, I think we should do in the future, we’ll probably do some episodes, um, really diving into testosterone, estrogen, and probably diving into thyroid, um, as well as some of the, um, auto-immune and like Lyme disease, uh, things that you see in your practice. So be looking for those in the future.

Ben Kosubevsky (41:51)

Okay, well thanks everybody for listening. This is Pete Performance Podcast, signing off.

Kyle Hulbert (41:56)

Signing off.