Hormone restoration



Henry lindner, md



Testing



Please bring any test results or other documentation you have with you to your visit. Dr. Lindner cannot order any tests
prior to a consultation since a doctor-patient relationship has not been established. Local patients should just arrange an
initial office consultation with Dr. Lindner. He will order the appropriate tests which are usually covered by insurance. The
results can be discussed in a second visit. Dr. Lindner can order testing for long distance patients after a formal phone
consultation. If you are in an HMO, then it may be that only tests ordered by the HMO's physicians, or done in the HMO's lab
are covered. Medicare covers tests ordered by Dr. Lindner. Getting your personal physician to order the blood or saliva
tests can be difficult. The physician should not order tests when he/she does not understand their purpose. Even if he/she
agrees to order the tests, he/she may not order all of them or may order them incorrectly. So it is often best to either consult
with Dr. Lindner first and have him order the tests, or self-order them using the links below.

These are the typical initial blood tests, with CPT codes, that Dr. Lindner will order--based on signs and symptoms:

Men:

Total Testosterone 84403
Free and weakly bound (bioavailable) testosterone 84402
DHEAS 82627
TSH 84443
Free T3 84481
Free T4 84439
Hematocrit (Hct) 85014
Vitamin D, 25-hydroxy 82306

Women:
estradiol 82670
Total Testosterone 84403
F+W bound Testosterone 84402
DHEAS 82627
TSH 84443
Free T3 84481
Free T4 84439
Ferritin 82728
Vitamin D, 25-hydroxy 82306


If you are a menstruating woman, estradiol and progesterone tests are usually not necessary as their levels change
drastically from cycle to cycle and within each cycle. However, if you do want to see your luteal-phase hormone levels, you
should test for estradiol and progesterone around 7 days before you expect your next menstrual bleeding to begin. The
best test of free testosterone is not the simple "free testosterone" test that most doctors will order, but a bioavailable or
free-and-weakly-bound testosterone.

Blood Testing
If you have no insurance-coverage for labs or a you have a high deductible, it will save a lot of money by ordering the blood
tests yourself online. The cash price at the laboratory will be much higher. Unfortunately, residents of NY, NJ, MD, MA and
RI cannot self-order blood or saliva testing from most online sites. They can order labs at New Century Labs which uses
Quest.

The best prices for individual tests at this time can be found at BLT System. There a CBC or ferritin is less than $10 each. H
owever they do not yet have convenient panels and do not have the bioavailable testosterone test or free estradiol test.
BLT has the least expensive thyroid testing with their Thyroid Panel Basic. PrivateMDLabs and Walk-in-Lab work with
LabCorp. Health Tests Direct and RequestATest work with both LabCorp and Quest. HealthLabs.com, Accesa Labs and
DirectLabs work with Quest. The least expensive bioavailable (F+W bound) tests are available via LabCorp at Walk-in-Lab
and Request a Test. Free estradiol is available at LabCorp at Walk-in-Lab. The best price for bioavailable testosterone is at
Quest with PrivateMDLabs. Free estradiol tests are also available at Quest via other websites. For all online order sites, you
simply add the tests you want to your cart and then provide payment information. The company will e-mail you a link so you can print out your lab requisition. You take this with you to the LabCorp or Quest site. You'll receive results within a week.
You can e-mail us a .pdf copy of the results or bring a printed copy with you when you see Dr. Lindner.

Testing for Hypocortisolism (adrenal insufficiency) with a Diurnal Saliva Cortisol Profile
Saliva cortisol testing is the best way to assess one's free cortisol levels under normal conditions throughout the day. This
test is necessary for persons with chronic fatigue, widespread pain, fibromyalgia, hypoglycemia, depression, anxiety,
nausea, insomnia, or low blood pressure. Saliva testing is covered by insurance with a doctor's order and a diagnosis of
fatigue/malaise. After your initial consultation, Dr. Lindner can order a saliva cortisol profile to be done at Labcorp or
another lab, and this will be covered by most insurance policies. Do not do a saliva cortisol profile if you've been using any
hydrocortisone cream on your skin in the last 6 months as the results will be abnormally high. Collect four saliva
specimens on a relatively low-stress day like a day-off work or a Sunday. Do not take anti-depressants or amphetamines the
day of the saliva test as these artificially boost levels for hours after the dose (which is one reason that they are so often
prescribed). Your doctor could order saliva cortisol testing this way:

Diurnal Saliva Cortisol--4 specimens 82533 (x4) LabCorp code: 502124 (x4)
30 minutes after awakening, right before lunch, right before dinner, and at bedtime.
Do test on non-working day with lower stress

You can self-order a 4-collection saliva test from Quest for $199 at RequestATest. (You can order LabCorp's saliva profile th
ere also for $399.) For $135 you can self-order ZRT's diurnal cortisol profile. For ZRT you'll only need to collect 2 milliliters of saliva per tube, not half the tube as per the instructions. Saliva cortisol testing can be done at any time during a
menstrual cycle.

In addition to a saliva cortisol profile, a serum DHEAS, a morning serum cortisol 82533 and ACTH test 82024
complete the testing for adrenal insufficiency. Have the blood drawn before 9am. If the AM ACTH is very high it
signifies primary adrenal insufficiency (Addison's Disease). However, in most cases of symptomatic cortisol deficiency the
ACTH is within the reference range, the problem is secondary-central cortisol deficiency--due to inadequate ACTH
secretion. Beware, most endocrinologists think that they can rule-in or rule-out cortisol deficiency with an ACTH stimulation test. This is not true. A normal ACTH stimulation test does not rule out a partial central cortisol deficiency. The ACTH stimulation test is positive only in severe, long-standing central or primary adrenal insufficiency.