• Total testosterone is usually adequate in the evaluation of adult males

• Evaluate symptoms of male hypogonadism (eg, erectile dysfunction, lowered sperm count, gynecomastia, change in mood, osteopenia or osteoporosis, decreased muscle mass, shrunken or softened testes)

• Evaluate male infertility to distinguish primary hypogonadism (low total testosterone, increased blood LH, FSH; infertile) from secondary hypogonadism (low total testosterone, low to low-normal blood LH, FSH; potentially fertile)

• Evaluate for suspected androgen-secreting tumor

• Monitor total testosterone therapy in males to ensure normal testosterone concentrations are achieved

• Monitor antiandrogen testosterone deprivation therapy in males (eg, treatment of prostate cancer)

• Not the preferred test to evaluate testosterone levels in children and females as the small amount of testosterone present may not be accurately quantified

Testosterone Total $60

Testosterone Free/Total/ SHBG $70

Useful in screening for abnormalities of urine in the diagnosis and management of renal diseases, urinary tract infection (UTI), urinary tract neoplasms, inflammatory or neoplastic entities adjacent to the urinary tract, and systemic disorders.

$30

• Evaluation of women with abdominal/pelvic pain, abnormal menstrual bleeding

• Screen women at risk for pregnancy prior to radiologic imaging, surgery, or use of some medications

• Provides pregnant women with a hCG level to see how far along their pregnancy is

$30

• Screen for hypercortisolism (Cushing syndrome) or hypocortisolism (adrenal insufficiency; Addison disease)

• Part of the functional evaluation of the HPA (hypothalamic-pituitary-adrenal) axis

• Evaluate symptoms suggestive of cortisol excess (eg, hypertension, hyperglycemia, truncal obesity, purple striae on abdomen)

• Evaluate symptoms suggestive of cortisol deficiency (eg, fatigue, low blood pressure, weight loss, muscle weakness, abdominal pain)

• Evaluate symptoms suggestive of acute adrenal crisis (eg, hypotension, change in mental status, severe pain in lower back, vomiting and diarrhea)

  $30

• Screen for and support a diagnosis of prostate cancer

• Establish a baseline before starting cancer therapy; PSA levels generally correlate with extent of disease.

• Assess and monitor therapeutic response

• Monitor for disease recurrence

• Establish a baseline prior to initiating 5-alpha reductase inhibitor therapy for BPH

  $30

• xclude or "rule-out" VTE (DVT/PE) in patients with a low clinical probability (based on a validated risk score such as Wells criteria)

• Diagnose/monitor disseminated intravascular coagulation (generally as part of a comprehensive DIC profile)

• Screen for disorders of fibrinolysis (primary hyperfibrinolysis)

  $100

Evaluate vitamin C deficiency

$70

• Support a diagnosis of iron deficiency

  • Due to inadequate intake, malabsorption, or altered metabolism

  • Due to blood loss

• Support a diagnosis of iron overload

  • Primary: Hereditary hemochromatosis (HH) where overload is caused by increased gastrointestinal iron absorption (erythropoiesis is normal); excessive iron is deposited in the liver and other organs causing fibrosis if untreated

  • Secondary: Hemosiderosis where iron overload is caused by a variety of conditions including anemias due to ineffective erythropoiesis (eg, thalassemias), repeated blood transfusion, excessive parenteral or oral replacement, etc

• Used to calculate transferrin saturation (TS) to aid in distinguishing iron deficiency from chronic disease when the serum iron is low (transferrin saturation).

• Monitor iron replacement therapy (transferrin saturation)

• Confirm diagnosis of iron toxicity (child overdose via vitamin ingestion) and monitor levels

  $30

• Preoperative screen to assess the integrity of the extrinsic (factor VII) and common pathways (fibrinogen and factors II, V, and X) of coagulation

• Monitor warfarin therapy

  • Warfarin management

  • Warfarin genomics

• Coagulopathy evaluation

• Assessment of liver function

• Assessment of nutritional status

• Assess clotting function

• Screen for factor deficiencies of the intrinsic pathway (prekallikrein, high molecular weight kininogen [HMWK], factors VIII, IX, XI, and XII) and to a lesser extent the common pathway (fibrinogen and factors II, V, and X)

• Monitor unfractionated heparin (UFH) therapy

• Monitor direct thrombin inhibitor therapy (eg, argatroban, bivalirudin)

• Aid in the detection of coagulation inhibitors

  • lupus anticoagulants

  • specific factor inhibitors

  • nonspecific inhibitors

  $40

Drugs which inhibit 5-alpha reductase: Certain drugs (eg, finasteride) used to treat benign prostatic hyperplasia exert their effect by inhibiting 5-alpha reductase, an enzyme in peripheral tissues which converts testosterone to DHT. Therefore, serum DHT may be useful in monitoring treatment with this drug class.

Congenital 5-alpha reductase deficiency: This rare autosomal recessive disorder classically includes a phenotypic male, 46XY infant with hypospadias, a urogenital sinus opening on the perineum, a blind vaginal pouch, and normal appearing testes which may be cryptorchid or in labioscrotal folds.4 With the onset of puberty, plasma testosterone (total and free) values are normal, but dihydrotestosterone values are very low, reflecting the absence of 5-alpha reductase.

$100

• Screen for folate deficiency

• Evaluate symptoms of glossitis, diarrhea, pallor, fatigue, depression

• Evaluate change of mental status, especially in the elderly

• Evaluate megaloblastic, macrocytic anemia

• Evaluate hypersegmented neutrophils and/or oval macrocytes seen on peripheral smear

• Evaluate cause of increased serum homocysteine level

• Part of evaluation for malnutrition (eg, liver disease, alcoholism) or malabsorption (eg, prior jejunoileal bypass for morbid obesity, intestinal blind-loop syndrome, inflammatory bowel disease)

• Assess effectiveness of treatment with folic acid supplementation

$40