Blood work/Labs

Rdg1970

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A space focused on labs and blood work. Which blood panels are needed for which peptides. Ways to read and make sense of what your results show. Encourage folks to share fresh findings that go against what doctors typically believe. For example, testosterone levels and similar topics.
 
I believe this concept is absolutely brilliant. Despite hanging around all the peptide enthusiasts for close to 8 months now, I still find myself mixed up when it comes to blood panels and various tests and so on.
 
I've been doing some early-stage reading. Are there any additional tests beyond what I listed — things that are nice to have?

The information below comes from an article on the National Library of Medicine site.

Labs That Are Necessary for GLP‑1 Safety

According to the article, these are the labs it explicitly says have to be tracked so that prescribing and continued use of GLP‑1 receptor agonists remain safe.

---

1. Hemoglobin A1c — REQUIRED

What it's for: keeping an eye on long‑term glycemic control and confirming that treatment is working.

“Patients taking GLP‑1 analogs should periodically have their hemoglobin A1c measured…”

For every GLP‑1 user, this is the main lab that is required.

(Isn’t warfarin rat poison🐀)

2. INR — REQUIRED only if on warfarin

What it's for: GLP‑1 drugs slow gastric emptying, and that can change how warfarin gets absorbed.

“The clinician should follow the international normalized ratio (INR) in patients prescribed warfarin…”

This lab isn't needed if the patient isn't taking warfarin.

3. Kidney Function Labs — REQUIRED

These consist of:

• Serum creatinine

• eGFR

What they're for: GLP‑1 drugs leave the body through the kidneys, so kidney problems can affect safety.

When a medication is renally eliminated, it means:

• Your kidneys filter the drug out of your blood

• The drug (or its metabolites) is then excreted in urine

• Kidney function directly affects how long the drug stays in your system

• Impaired kidneys = slower clearance, higher drug levels, and higher risk of side effect


“…monitor blood glucose levels, weight, and kidney function.”

Blood tests are always part of kidney function monitoring.

4. Blood Glucose — REQUIRED

What it's for: spotting hypoglycemia (deficiency of glucose in the bloodstream) when GLP‑1 is taken together with insulin or sulfonylureas(organic compounds).

“…monitor blood glucose levels…”

Whether it's a fingerstick or drawn in a lab, it's still a required part of monitoring .
 
Here's the panel I use as my baseline whenever I feel like I'm spinning my wheels:

Complete Blood Count (CBC, includes Differential and Platelets)

Comprehensive Metabolic Panel

Hemoglobin A1c

Insulin-Like Growth Factor-1 (IGF-1) with Z-Score

Lipid Panel With Apolipoprotein B (ApoB)

Insulin and C-Peptide

C-Reactive Protein, High Sensitivity (HS-CRP)

Gamma Glutamyl Transferase (GGT)

GLP stuff doesn't call for IGF-1 — I'm just working on solidifying my baseline z score after an odd result in March.

When I'm evaluating TRT, these get tacked onto my baseline:

Sex Hormone Binding Globulin (SHBG)

Total Testosterone (LC/MS-MS)

Free Testosterone

Dihydrotestosterone (DHT)

Prostate-Specific Antigen (PSA)

Estradiol (E2), Ultrasensitive, LC/MS, Serum
 
Rdg1970 said:

I've been doing some early-stage reading. Are there any additional tests beyond what I listed — things that are nice to have?

The information below comes from an article on the National Library of Medicine site.

Labs That Are Necessary for GLP‑1 Safety

According to the article, these are the labs it explicitly says have to be tracked so that prescribing and continued use of GLP‑1 receptor agonists remain safe.

---

1. Hemoglobin A1c — REQUIRED

What it's for: keeping an eye on long‑term glycemic control and confirming that treatment is working.

“Patients taking GLP‑1 analogs should periodically have their hemoglobin A1c measured…”

For every GLP‑1 user, this is the main lab that is required.

(Isn’t warfarin rat poison🐀)

2. INR — REQUIRED only if on warfarin

What it's for: GLP‑1 drugs slow gastric emptying, and that can change how warfarin gets absorbed.

“The clinician should follow the international normalized ratio (INR) in patients prescribed warfarin…”

This lab isn't needed if the patient isn't taking warfarin.

3. Kidney Function Labs — REQUIRED

These consist of:

• Serum creatinine

• eGFR

What they're for: GLP‑1 drugs leave the body through the kidneys, so kidney problems can affect safety.

When a medication is renally eliminated, it means:

• Your kidneys filter the drug out of your blood

• The drug (or its metabolites) is then excreted in urine

• Kidney function directly affects how long the drug stays in your system

• Impaired kidneys = slower clearance, higher drug levels, and higher risk of side effect


“…monitor blood glucose levels, weight, and kidney function.”

Blood tests are always part of kidney function monitoring.

4. Blood Glucose — REQUIRED

What it's for: spotting hypoglycemia (deficiency of glucose in the bloodstream) when GLP‑1 is taken together with insulin or sulfonylureas(organic compounds).

“…monitor blood glucose levels…”

Whether it's a fingerstick or drawn in a lab, it's still a required part of monitoring .
It isn't a poison. That said, Paracelsus's maxim still holds true: “Everything is poison; nothing is without poison; it is the dose that makes the poison.”

Rats sustain injuries constantly; administering an anticoagulant (warfarin) to them leads to fatal bleeding.
 
Electrolytes are something you shouldn't overlook. Make sure to get a full lipid panel, with triglycerides being particularly important. Also check creatinine clearance. Testing iron, B12, and D is a good idea too. Include liver enzymes. And uric acid.
 
Rdg1970 said:

I've been doing some early-stage reading. Are there any additional tests beyond what I listed — things that are nice to have?

The information below comes from an article on the National Library of Medicine site.

Labs That Are Necessary for GLP‑1 Safety

According to the article, these are the labs it explicitly says have to be tracked so that prescribing and continued use of GLP‑1 receptor agonists remain safe.

---

1. Hemoglobin A1c — REQUIRED

What it's for: keeping an eye on long‑term glycemic control and confirming that treatment is working.

“Patients taking GLP‑1 analogs should periodically have their hemoglobin A1c measured…”

For every GLP‑1 user, this is the main lab that is required.

(Isn’t warfarin rat poison🐀)

2. INR — REQUIRED only if on warfarin

What it's for: GLP‑1 drugs slow gastric emptying, and that can change how warfarin gets absorbed.

“The clinician should follow the international normalized ratio (INR) in patients prescribed warfarin…”

This lab isn't needed if the patient isn't taking warfarin.

3. Kidney Function Labs — REQUIRED

These consist of:

• Serum creatinine

• eGFR

What they're for: GLP‑1 drugs leave the body through the kidneys, so kidney problems can affect safety.

When a medication is renally eliminated, it means:

• Your kidneys filter the drug out of your blood

• The drug (or its metabolites) is then excreted in urine

• Kidney function directly affects how long the drug stays in your system

• Impaired kidneys = slower clearance, higher drug levels, and higher risk of side effect


“…monitor blood glucose levels, weight, and kidney function.”

Blood tests are always part of kidney function monitoring.

4. Blood Glucose — REQUIRED

What it's for: spotting hypoglycemia (deficiency of glucose in the bloodstream) when GLP‑1 is taken together with insulin or sulfonylureas(organic compounds).

“…monitor blood glucose levels…”

Whether it's a fingerstick or drawn in a lab, it's still a required part of monitoring .
A one-time fasting blood glucose test won't catch a lone instance of low blood sugar.

Without a CGM, I'd have no way of knowing about my nighttime hypoglycemia.
 
Rdg1970 said:

I've been doing some early-stage reading. Are there any additional tests beyond what I listed — things that are nice to have?

The information below comes from an article on the National Library of Medicine site.

Labs That Are Necessary for GLP‑1 Safety

According to the article, these are the labs it explicitly says have to be tracked so that prescribing and continued use of GLP‑1 receptor agonists remain safe.

---

1. Hemoglobin A1c — REQUIRED

What it's for: keeping an eye on long‑term glycemic control and confirming that treatment is working.

“Patients taking GLP‑1 analogs should periodically have their hemoglobin A1c measured…”

For every GLP‑1 user, this is the main lab that is required.

(Isn’t warfarin rat poison🐀)

2. INR — REQUIRED only if on warfarin

What it's for: GLP‑1 drugs slow gastric emptying, and that can change how warfarin gets absorbed.

“The clinician should follow the international normalized ratio (INR) in patients prescribed warfarin…”

This lab isn't needed if the patient isn't taking warfarin.

3. Kidney Function Labs — REQUIRED

These consist of:

• Serum creatinine

• eGFR

What they're for: GLP‑1 drugs leave the body through the kidneys, so kidney problems can affect safety.

When a medication is renally eliminated, it means:

• Your kidneys filter the drug out of your blood

• The drug (or its metabolites) is then excreted in urine

• Kidney function directly affects how long the drug stays in your system

• Impaired kidneys = slower clearance, higher drug levels, and higher risk of side effect


“…monitor blood glucose levels, weight, and kidney function.”

Blood tests are always part of kidney function monitoring.

4. Blood Glucose — REQUIRED

What it's for: spotting hypoglycemia (deficiency of glucose in the bloodstream) when GLP‑1 is taken together with insulin or sulfonylureas(organic compounds).

“…monitor blood glucose levels…”

Whether it's a fingerstick or drawn in a lab, it's still a required part of monitoring .
At first I meant to call this out as something a chatbot wrote, and quite off the mark, but then I noticed its origin, and now I am simply puzzled. The entire section on kidney function looks questionable. According to the manufacturer's official labeling, no dose changes are required for renal or hepatic impairment, and the drug is not eliminated through the kidneys. I ran this past a prompted version of chatgpt in research scholar mode. Even though my source is itself AI generated, at least it contains no glaring factual mistakes, matches how these agents are actually used in clinical practice, and in my view is far more trustworthy.

semaglutide tirzepatide retatrutide (based on available data)

are not mainly removed via renal excretion of the intact molecule. (the fatty side chain makes the drug bind to albumin, which stops it from being filtered out by the kidneys)

As with many peptides, they undergo proteolytic breakdown throughout the body into amino acids and smaller fragments.

For a person with obesity but no significant comorbidity:

Baseline - meaning before starting

HbA1c

fasting glucose

renal function

liver function

lipid profile

Follow-up - there truly are no specific tests that are mandatory, it mostly hinges on other medical conditions that weight loss or side effects might influence, or on pre existing abnormal blood tests, such as elevated lipids, to see whether they have improved,, clearly when severe GI side effects occur, testing renal function to catch dehydration matters, along with probably liver function and amylase

Usually driven by:

weight loss

symptoms

comorbidities

rather than the drug itself.

For someone with metabolic syndrome, which is quite likely alongside obesity, checking FBE. LFT, U&E, fasting glucose, hb1ac, and lipids is probably sensible every so often ?6mo, though likely unnecessary if younger and all those baseline tests came back normal
 
For elderly individuals dealing with additional health conditions, the more detailed lists shared in the posts above are fairly reasonable.
 
Dirtcheaplabs.com is a recent option and costs less than quality labs.

If you're taking a GLP and dropping weight fast, get your bilirubin tested. I ruined my gallbladder from losing 3lbs per week over a long stretch.

To stay ahead of it, have breakfast once you wake up that includes healthy fats such as olive oil or coconut oil, ensure adequate fiber (psilium husk), and support bile flow using TUDCA and taurine.

Wegovy lists this among its box warnings.
 
birdwhacker said:

Dirtcheaplabs.com is a recent option and costs less than quality labs.

If you're taking a GLP and dropping weight fast, get your bilirubin tested. I ruined my gallbladder from losing 3lbs per week over a long stretch.

To stay ahead of it, have breakfast once you wake up that includes healthy fats such as olive oil or coconut oil, ensure adequate fiber (psilium husk), and support bile flow using TUDCA and taurine.

Wegovy lists this among its box warnings.
Did the GLP-1s give you jaundice?
 
CNCCurrency said:

birdwhacker said:

Dirtcheaplabs.com is a recent option and costs less than quality labs.

If you're taking a GLP and dropping weight fast, get your bilirubin tested. I ruined my gallbladder from losing 3lbs per week over a long stretch.

To stay ahead of it, have breakfast once you wake up that includes healthy fats such as olive oil or coconut oil, ensure adequate fiber (psilium husk), and support bile flow using TUDCA and taurine.

Wegovy lists this among its box warnings.
Did the GLP-1s give you jaundice?
Nope, that wasn't me.

When the problems first showed up, I posted a single thread about it. Before long I'll put up a fresh thread over in the Weight Loss section covering all of what I've picked up. Clogging this thread with that isn't something I want to do, though my advice to anyone aiming to drop more than 2lbs per week is to take supplements as a preventive measure and to treat a properly balanced breakfast as non-negotiable, with no less than 25g of fat in it (avoid getting that fat from beef — beef only makes things worse, unfortunately).

Short version: upper right quadrant pain set in, managing it has been an enormous struggle, and my stools haven't been normal at any point since those episodes started. From how things look, surgery is nearly a certainty for me.
 
birdwhacker said:

CNCCurrency said:

birdwhacker said:

Dirtcheaplabs.com is a recent option and costs less than quality labs.

If you're taking a GLP and dropping weight fast, get your bilirubin tested. I ruined my gallbladder from losing 3lbs per week over a long stretch.

To stay ahead of it, have breakfast once you wake up that includes healthy fats such as olive oil or coconut oil, ensure adequate fiber (psilium husk), and support bile flow using TUDCA and taurine.

Wegovy lists this among its box warnings.
Did the GLP-1s give you jaundice?
Nope, that wasn't me.

When the problems first showed up, I posted a single thread about it. Before long I'll put up a fresh thread over in the Weight Loss section covering all of what I've picked up. Clogging this thread with that isn't something I want to do, though my advice to anyone aiming to drop more than 2lbs per week is to take supplements as a preventive measure and to treat a properly balanced breakfast as non-negotiable, with no less than 25g of fat in it (avoid getting that fat from beef — beef only makes things worse, unfortunately).

Short version: upper right quadrant pain set in, managing it has been an enormous struggle, and my stools haven't been normal at any point since those episodes started. From how things look, surgery is nearly a certainty for me.
Dropping 30+ pounds over only a couple of months wrecked my gallbladder. The hida scan showed it functioning at a 4% EF, so they scheduled surgery right away. I genuinely needed that operation, yet roughly 4 months after it, the gallbladder area still aches whenever I swim, lift weights, or simply twist my torso.

From what I gather, that's expected during recovery, and full healing might take a year (so say the folks at r/gallbladder).

Being free of constant pain is a relief, but it can still hurt, and sometimes does.

ask for a hida scan.
 
This thread seems like a really great concept to me. Because of some unusual issues with my blood, I end up getting tested every couple of months no matter what, and I've been keeping an eye on a fair number of metrics from those tests. It would be really interesting to see how what I'm seeing lines up with what others here are experiencing.
 
Rdg1970 said:

I've been doing some early-stage reading. Are there any additional tests beyond what I listed — things that are nice to have?

The information below comes from an article on the National Library of Medicine site.

Labs That Are Necessary for GLP‑1 Safety

According to the article, these are the labs it explicitly says have to be tracked so that prescribing and continued use of GLP‑1 receptor agonists remain safe.

---

1. Hemoglobin A1c — REQUIRED

What it's for: keeping an eye on long‑term glycemic control and confirming that treatment is working.

“Patients taking GLP‑1 analogs should periodically have their hemoglobin A1c measured…”

For every GLP‑1 user, this is the main lab that is required.

(Isn’t warfarin rat poison🐀)

2. INR — REQUIRED only if on warfarin

What it's for: GLP‑1 drugs slow gastric emptying, and that can change how warfarin gets absorbed.

“The clinician should follow the international normalized ratio (INR) in patients prescribed warfarin…”

This lab isn't needed if the patient isn't taking warfarin.

3. Kidney Function Labs — REQUIRED

These consist of:

• Serum creatinine

• eGFR

What they're for: GLP‑1 drugs leave the body through the kidneys, so kidney problems can affect safety.

When a medication is renally eliminated, it means:

• Your kidneys filter the drug out of your blood

• The drug (or its metabolites) is then excreted in urine

• Kidney function directly affects how long the drug stays in your system

• Impaired kidneys = slower clearance, higher drug levels, and higher risk of side effect


“…monitor blood glucose levels, weight, and kidney function.”

Blood tests are always part of kidney function monitoring.

4. Blood Glucose — REQUIRED

What it's for: spotting hypoglycemia (deficiency of glucose in the bloodstream) when GLP‑1 is taken together with insulin or sulfonylureas(organic compounds).

“…monitor blood glucose levels…”

Whether it's a fingerstick or drawn in a lab, it's still a required part of monitoring .
For a lot of things, the National Library of Medicine is a dependable resource. 👍
 
Zuul said:

This thread seems like a really great concept to me. Because of some unusual issues with my blood, I end up getting tested every couple of months no matter what, and I've been keeping an eye on a fair number of metrics from those tests. It would be really interesting to see how what I'm seeing lines up with what others here are experiencing.
I'm not sure whether the peculiarities in your case mean our results can be lined up side by side. A few days ago I got a full panel drawn — it covered a lot and cost a lot. To have everything run, I ended up paying 600 dollars out of my own pocket. Even so, I'd be glad to pass my numbers along so we can put them next to each other.
 
Rdg1970 said:

Zuul said:

This thread seems like a really great concept to me. Because of some unusual issues with my blood, I end up getting tested every couple of months no matter what, and I've been keeping an eye on a fair number of metrics from those tests. It would be really interesting to see how what I'm seeing lines up with what others here are experiencing.
I'm not sure whether the peculiarities in your case mean our results can be lined up side by side. A few days ago I got a full panel drawn — it covered a lot and cost a lot. To have everything run, I ended up paying 600 dollars out of my own pocket. Even so, I'd be glad to pass my numbers along so we can put them next to each other.
For years my hemoglobin, white blood cell, and similar blood readings have shown polycythemia vera markers, yet a Jak2 mutation test came back negative — so my hematologist dismisses it as 'just how you normally are,' never mind that I also deal with every physical symptom of polycythemia vera.

Wednesday morning I'm scheduled for a complete blood panel that includes cortisol; results ought to arrive by Friday. Would you want to compare notes once I have them?
 
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