# Ben: bloodwork reference

Source: N Health (BDMS), Bangkok. Most recent full panel **25 April 2026**. Lab IDs DNS904165, DNS904166, DNS904170. Source PDF verified 27 August 2026 against the original lab report.

**Staleness, resolved 27 August 2026:** the follow up panel was **never run**. On 27 August Ben supplied what he believed were his most recent tests. Every page carries collected date 25 April 2026; the PDF itself was simply exported from the portal on 4 July 2026 (macOS Quartz creation date), which is what made it look newer. **These numbers are the April panel and are now four months old.** Do not let a re-exported PDF be mistaken for a new draw again: check the collected date on the report, not the file date.

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## Draw context, required for interpretation

Do not read the hormone values without this.

- Draw time 9:00am Bangkok, wake approx 6:00 to 6:30am, so cortisol drawn 2.5 to 3 hours post waking, past CAR peak, on the descending limb
- Fasted approx 8 hours (last meal 1am)
- Last TRT injection Wed 22 April 2026, 3 days pre draw, mid cycle on weekly protocol
- Last Aromasin (exemestane 6.25 mg) approx Tue 21 April 2026, 4 days pre draw
- Aromasin restarted approx 11 April 2026 after a 3 to 4 year gap, so only 14 days in at draw
- **Estradiol run on standard immunoassay, not LC-MS.** LC-MS sensitive assay unavailable in Bangkok. Treat the absolute number with appropriate looseness, trend across the same assay is the useful signal
- Ben was mid cut on retatrutide at the time, which suppresses thyroid and shifts lipids

## Hormones

| Marker | Result | Reference | Flag |
|---|---|---|---|
| Total testosterone | 1095 ng/dL | n/a | Supraphysiological, expected on TRT |
| Free testosterone (calc) | 28.5 ng/dL | 5.71 to 17.84 | High |
| Free testosterone % | 2.6% | 1.53 to 2.88% | Mid range |
| Bioavailable testosterone (calc) | 623 ng/dL | 125.65 to 412.10 | High |
| Bioavailable T % | 56.9% | 35.0 to 66.3% | Mid range |
| SHBG | 33.4 nmol/L | 13.5 to 71.4 | Mid range |
| Estradiol | 29 pg/mL | under 44 | In target |
| LH | under 0.04 mIU/mL | 0.57 to 12.07 | Suppressed, expected |
| FSH | 0.12 mIU/mL | 0.95 to 11.95 | Suppressed, expected |
| Progesterone | under 0.20 ng/mL | under 0.2 | Normal |
| **DHEA-S** | **103.4 ug/dL** | 139.7 to 484.4 | **LOW** |
| Prolactin | 8.60 ng/mL | 3.46 to 19.40 | Normal |
| Cortisol (AM approx 9am) | 10.3 ug/dL | 3.7 to 19.4 | Mid range, past CAR peak |
| Insulin (fasting) | 8.20 uU/mL | 2.00 to 25.00 | Normal, HOMA-IR approx 1.74 |
| **IGF-1** | **249 ng/mL** | 58 to 219 | **HIGH**, unexplained in the record |
| **DHT** | **574.1 pg/mL** | 143 to 842 | Mid range absolute, **low relative to T** (see below) |

Note on progesterone: measured under 0.20 in April, before pregnenolone was introduced. Pregnenolone converts to progesterone, so this baseline is the useful comparator on the next panel.

### DHT, added 27 August 2026, previously listed as never measured

Measured 25 April 2026, serum, ELISA method, lab DNS904165. **The master file wrongly listed DHT as never tested.** It was on the April panel.

**574.1 pg/mL sits mid range in absolute terms and low relative to his testosterone.**

- DHT 574.1 pg/mL against total T of 1095 ng/dL (10,950 pg/mL) gives a **DHT:T ratio of roughly 5.2%**
- Eugonadal men typically run around 10%, and on a supraphysiological total T of 1095 you would expect DHT pushed toward or past the 842 ceiling if 5-alpha-reductase were converting at a typical rate. It is not
- Read: **modest 5-alpha-reductase activity**

Two consequences worth carrying:

1. **Lower DHT-driven pressure on hair, prostate and sebum.** Consistent with PSA 0.864 staying low while total T is supraphysiological
2. **Weaker allopregnanolone production, which changes how pregnenolone lands on him.** Allopregnanolone is made from progesterone via 5-alpha-reductase as the obligatory first step. Modest 5AR means the calming allopregnanolone arm of pregnenolone is weak relative to the alerting pregnenolone-sulfate arm (a negative allosteric modulator at GABA-A, positive at NMDA). This predicts exactly the profile Ben reports on 100 to 200 mg: focused, decisive, driven, "a little bit on the angry side", rather than calm and sedated

Uncertainty, stated honestly: DHT by ELISA is a weaker assay than LC-MS, the reference range is built on men not on TRT, and serum DHT is an imperfect proxy for 5-alpha-reductase activity in the central nervous system. The direction of the inference is sound, the precision is not.

Practical: never give him a 5-alpha-reductase inhibitor (finasteride, dutasteride) casually. On this profile it would suppress an already modest conversion and cut the allopregnanolone arm further.

## Metabolic

| Marker | Result | Reference | Flag |
|---|---|---|---|
| Glucose (fasting) | 86 mg/dL | 70 to 99 | Normal |
| HbA1c | 5.3% | under 5.7 | Normal |
| Estimated average glucose | 105 mg/dL | n/a | Normal |

## Lipids

| Marker | Result | Reference | Flag |
|---|---|---|---|
| Total cholesterol | 110 mg/dL | under 200 | Excellent |
| **Triglycerides** | **177 mg/dL** | under 150 | **HIGH** |
| HDL-C | 41 mg/dL | over 40 | Low end |
| LDL direct | 42 mg/dL | under 130 | Excellent |
| **VLDL** | **35 mg/dL** | under 30 | **HIGH** |
| Cholesterol/HDL ratio | 2.7 | n/a | Good |
| LDL/HDL ratio | 1.02 | n/a | Good |
| **TG/HDL ratio** | **4.32** | under 2 ideal | **Atherogenic pattern** |

Interpretation: LDL is excellent and the old "atherogenic high LDL e4 case" framing is wrong. The residual problem is triglycerides and VLDL, giving a small dense LDL signal. **EPA is the correct lever.** Berberine was floated then dropped because there is no metabolic problem to fix (HbA1c 5.3, glucose 86, HOMA-IR 1.7).

ApoB has never been measured and is the instrument that actually settles risk here given 9p21 triple homozygous plus e4.

## Liver

| Marker | Result | Reference | Flag |
|---|---|---|---|
| AST | 20 U/L | 5 to 34 | Normal |
| ALT | 14 U/L | 0 to 45 | Normal |
| ALP | 63 U/L | 40 to 150 | Normal |
| Bilirubin total | 0.5 mg/dL | 0.2 to 1.2 | Normal |
| Bilirubin direct | 0.3 mg/dL | 0.0 to 0.5 | Normal |
| Total protein | 6.82 g/dL | 6.40 to 8.30 | Normal |
| Albumin | 4.03 g/dL | 3.50 to 5.20 | Normal |
| Globulin | 2.79 g/dL | 2.10 to 3.70 | Normal |
| A/G ratio | 1.44 | 1.00 to 2.00 | Normal |

## Kidney

| Marker | Result | Reference | Flag |
|---|---|---|---|
| BUN | 10.80 mg/dL | 8.90 to 20.60 | Normal |
| Creatinine | 1.04 mg/dL | 0.73 to 1.18 | Normal |
| eGFR (non AA) | 87.52 | n/a | Normal |
| eGFR (Thai) | 92.38 | n/a | Normal |
| Uric acid | 4.4 mg/dL | 3.5 to 7.2 | Normal |

## Electrolytes

| Marker | Result | Reference | Flag |
|---|---|---|---|
| Sodium | 141 mmol/L | 136 to 145 | Normal |
| Potassium | 4.59 mmol/L | 3.50 to 5.10 | Normal |
| Chloride | 105 mmol/L | 98 to 107 | Normal |
| TCO2 | 27 mmol/L | 22 to 29 | Normal |
| Anion gap | 9.0 mmol/L | 10.0 to 12.0 | Mildly LOW, likely benign |
| Calcium | 9.0 mg/dL | 8.4 to 10.2 | Normal |
| Magnesium (serum) | 2.4 mg/dL | 1.6 to 2.6 | Normal, high end. Serum Mg is a weak proxy, RBC Mg never run |

## Thyroid

| Marker | Result | Reference | Flag |
|---|---|---|---|
| TSH | 1.744 uIU/mL | 0.350 to 4.940 | Normal |
| Free T3 | 2.69 pg/mL | 1.58 to 3.91 | Mid low, cut suppressed |
| Free T4 | 0.97 ng/dL | 0.70 to 1.48 | Mid low |
| Thyroglobulin Ab | 2.38 IU/mL | 0.00 to 4.11 | Negative |
| Anti-TPO | 0.92 IU/mL | 0.00 to 5.61 | Negative |

Free T3 and T4 mid low are consistent with an active retatrutide cut, not thyroid disease. Antibodies negative. Reverse T3 never run.

## Vitamins and nutritional

| Marker | Result | Reference | Flag |
|---|---|---|---|
| Vitamin D 25-OH total | 92.00 ng/mL | 30 to 100 | **High end of sufficiency, saturated. Do not increase** |
| **Vitamin B12** | **1482.0 pg/mL** | 187 to 883 | **HIGH, supplement driven** |
| Folate (serum) | 8.70 ng/mL | 3.10 to 20.50 | Normal |
| Ferritin | 138.6 ng/mL | 15.0 to 200.0 | Normal |
| **Zinc (blood, ICP-MS)** | **549.24 ug/L / 54.92 ug/dL** | 551 to 925 ug/L | **LOW, and low while supplementing** |

### Zinc, added 27 August 2026, previously listed as never measured

Measured 25 April 2026, EDTA plasma, ICP-MS, Bio Molecular Laboratories, lab DNS904165. **The master file wrongly listed zinc as never tested.**

**549.24 against a floor of 551. Marginally below range, and he was taking 25 to 30 mg daily at the time.**

This inverts the standing assumption. The old note warned about zinc overshoot and copper depletion. The measurement says he was **not** overshooting, he was at the floor despite supplementing.

Read it with two caveats, both of which matter:

- **Plasma zinc is an insensitive marker.** It is tightly homeostatically controlled and a poor reflection of total body zinc. RBC zinc would be better and has still never been run
- **Inflammation depresses plasma zinc.** During an acute phase response, IL-6 drives zinc redistribution out of plasma and into tissue. His hsCRP was 2.44 and his IL-6 genotype is GG, high production. So part of this reading is the inflammation, not the intake
- He was also mid cut on retatrutide, so intake was likely down

Conclusion: this is the one item from the dropped stack with a **measured abnormality** justifying reinstatement, rather than being reinstated on faith. Copper still deserves pairing at roughly 1 mg if zinc runs long term, but the depletion concern is not the live one here.

## Inflammation and cardiovascular

| Marker | Result | Reference | Flag |
|---|---|---|---|
| **hsCRP** | **2.44 mg/L** | under 1.0 ideal for e4 | **Average risk band, above optimal** |
| NT-proBNP | 19 pg/mL | under 125 | Normal |
| PSA | 0.864 ng/mL | 0.000 to 4.000 | Normal |

## Complete blood count

| Marker | Result | Reference | Flag |
|---|---|---|---|
| WBC | 6.63 x10³/mm³ | 4.00 to 10.00 | Normal |
| RBC | 5.58 x10⁶/mm³ | 4.50 to 5.90 | Normal |
| Haemoglobin | 16.4 g/dL | 13.0 to 18.0 | Normal |
| Haematocrit | 47.7% | 40.0 to 54.0 | Normal, monitor on TRT, donate at 50 to 52 |
| MCV | 85.5 fL | 80.0 to 100.0 | Normal |
| MCH | 29.4 pg | 26.0 to 34.0 | Normal |
| MCHC | 34.4 g/dL | 31.0 to 37.0 | Normal |
| RDW | 13.1% | 9.0 to 15.0 | Normal |
| Platelets | 241 x10³/mm³ | 150 to 450 | Normal |
| MPV | 10.0 fL | 6.0 to 12.0 | Normal |
| Neutrophils | 65.6%, 4349/mm³ | 46.5 to 75.0% | Normal |
| Lymphocytes | 25.2%, 1671/mm³ | 12.0 to 44.0% | Normal |
| Monocytes | 6.8%, 451/mm³ | 0.0 to 11.2% | Normal |
| Eosinophils | 1.8%, 119/mm³ | 0.0 to 9.5% | Normal |
| Basophils | 0.6%, 40/mm³ | 0.0 to 2.5% | Normal |
| NLR (calculated) | approx 2.6 | under 2.0 ideal | Mildly elevated |

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## Historical trends

### Estradiol (standard immunoassay throughout)

| Date | E2 | Context |
|---|---|---|
| March 2024 | 21 pg/mL | On AI |
| May 2024 | 62 pg/mL | Off AI |
| October 2024 | 86 pg/mL | Off AI |
| December 2025 | 89 pg/mL | Off AI |
| April 2026 | 29 pg/mL | Back on AI, 14 days |

Chronic elevated E2 across 2024 to 2025 was the single largest unmanaged variable. Aromasin restart corrected it inside 14 days.

### Multi point trends

| Marker | May 2024 | Oct 2024 | Dec 2025 | Apr 2026 |
|---|---|---|---|---|
| Total testosterone | 1539 | 2391 | 2391 | 1095 |
| SHBG | 11.5 (below range) | n/a | 20.4 | 33.4 |
| Haematocrit | 52.2% | 53.0% | 48.0% | 47.7% |
| HDL | 50 | n/a | 39 | 41 |
| PSA | 0.505 | n/a | 1.146 | 0.864 |
| ALT | 40 | n/a | 10 | 14 |
| GGT | 38 | n/a | 17 | not run |

PSA doubled between May 2024 and December 2025 during the high T and high E2 window, then fell to 0.864 once dose and E2 were controlled. **Keep PSA on every panel and track velocity, not just absolute value.**

SHBG climbing from 11.5 (below range) to 33.4 tracks the E2 correction and the dose reduction. Haematocrit falling from 53.0 to 47.7 is the other confirmation that the protocol change worked.

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## Never measured, all should be on the next draw

Corrected 27 August 2026. DHT and zinc came off this list because the April panel actually included them. Everything below is still genuinely untested.

Priority order:

1. **ApoB** — top priority given 9p21 triple homozygous plus e4. LDL-C is not the right instrument for him. Still never measured
2. **Homocysteine** — settles whether the methylated B stack is doing anything, especially now that C677T is known wild type. Still never measured
3. **DHEA-S recheck** — 8 to 10 weeks after starting DHEA 25 mg, confirm it moved from 103.4 toward 250 to 400. Never done, and now confounded by pregnenolone sitting upstream
4. **Omega 3 index** — settles EPA/DHA dosing against the triglyceride problem. Still never measured
5. **Progesterone repeat** — new relevance since pregnenolone was added. April baseline under 0.20 is the clean comparator
6. **RBC zinc** — plasma zinc came back 549.24, marginally low, but plasma is the weak marker. RBC settles whether that is real depletion or inflammation redistribution
7. Serum Lp(a), once only, to confirm what the genetics predict
8. 4 point salivary cortisol with CAR
9. RBC magnesium, cystatin C, reverse T3
10. p-tau217 and Abeta42/40 baseline, plus NfL and GFAP, flagged as worth establishing given e4. Never done

**Repeat DHT on the next draw too.** Not because it is untested, but because 574.1 was measured before pregnenolone was introduced, and pregnenolone feeds the androgen pathway upstream.