Letters to the Editor: Mistaken Hormone, Lab Values
When Labs Mistake Pregnenolone for Progesterone
Dear Dr. Tennant,
I had the pleasure of hearing you speak at Practical Pain Management’s pain conference in La Jolla this past December. I was most interested in the link you established between decreased hormone levels and the difficulty in pain management. I have ordered the hormone you suggested, but am getting push back from laboratories regarding pregnenolone testing. I am being told that it is the same as progesterone. I would appreciate any information you may have on how to order pregnenolone levels properly.
Thank you in advance for you assistance.
—Mike Dayton, MD
Dear Dr. Dayton,
When I first started ordering pregnenolone blood levels, I got more than “push back.” One young woman called me and wondered whether I was really an MD, because a real MD would know that a “pregnancy test” is done with a urine specimen. Over time, I became the recipient of a stack of worthless “progesterone” tests, mostly for “menstruating males.”
I solved this problem using 3 measures:
1. I called my local laboratories and adroitly informed them that pregnenolone and progesterone are, indeed, quite different
2. I sent them copies of some of the compendiums from laboratory texts showing them that both hormones exist
3. I wrote on the lab request, “I want pregnenolone, not progesterone”
Dr. Dayton, you imply a very valid point in that ignorance and fear reign regarding hormone testing and treatment. It will take a long learning curve to educate on pregnenolone and some of the other new hormone concepts. Indeed, hormone testing and treatment in the field of pain management is futuristic. Science, however, is marching forward. For example, pregnenolone is a neurosteroid produced in the central nervous system as well as in the adrenals and gonads. Thus, it is critical for neurogenesis and pain control.
Best wishes always,
—Forest Tennant, MD, DrPH
Reconciling Various Lab Values
I am a physical medicine and rehabilitation doctor, fellowship trained, and working in interventional spine/pain management at Ann Arbor Spine Center in Michigan. I look forward to reading Practical Pain Management and find it one of the most helpful resources that I have to improve my ability to help my patients. I read your July 2012 article, “Hormone Testing and Replacement in Pain Patients Made Simple,”1 and have started to test regularly. I am just starting to replenish deficient hormones and adjust treatment of pain accordingly. What I am having some difficulty with is reconciling the values that I am getting back from the various labs because they report values with different units. I have calculated based on the units listed with the normal values mentioned in the article and they don’t seem to match very well. I am wondering whether you can direct me to the reference(s) you use for normal values of these hormones or provide me with more information along these lines.
—Andy Egger, MD
Ann Arbor Spine Center
Ann Arbor, Michigan
Dear Dr. Egger,
You bring up one of the most frustrating aspects of hormone testing and replacement, and that is the great variance among laboratories. At this time, it is only possible to compare values from one laboratory and not between laboratories. Laboratories don’t all use the same equipment or standards, so their ranges and even units may vary. As a general guideline that has some universality, I have provided normal values from Conn's Current Therapy (Table 1).2
Thanks for the compliment, and let us know about some of your experiences.
—Forest Tennant MD, DrPH