Lab Analysis: Greg O'Gallagher
What to look for in labs to tell if someone is "natty" or not
The following is a limited lab analysis of Greg O'Gallagher’s (@gregogallagher) labs based on screenshots I obtained from the following video by Derek on his More Plates More Dates YouTube channel.
I hope this post helps explain what to look for in labs to tell if someone is taking exogenous testosterone or other androgens, or not.
This comes up as Greg recently posted this picture on Twitter, making everyone ask if he’s “natural” or not.
For context, I don’t really care. If you follow me on Twitter (@BowTiedLoon) you’ll see that I’m completely fine with well informed and reasonably monitored use of anabolic steroids. I’m also highly in favor of people doing testosterone replacement when needed (and I generally have lower thresholds than your average endocrinologist, who is likely okay with a man having a total testosterone of 350 ng/dL).
First in the video, Greg shares the following lab results from 2016:
To make this easier to look at, you can use unitslab.com to convert the total testosterone and estradiol to more standard units:
Total testosterone = 617.2 ng/dL
Estradiol = 24.5 pg/mL
Now, when someone is taking exogenous testosterone or other androgens, this will result in negative feedback on the hypothalamus and anterior pituitary, resulting in suppression of GnRH, LH, and FSH, as show in this graphic from my post Male Sex Hormones, Part 2.
Because of negative feedback inhibition, we can interpret the LH results as follows:
Natural: LH typically in normal range
Taking exogenous testosterone or other androgens: LH below the normal range, often suppressed to undetectable levels (eg <0.2 UI/L)
Interestingly, as Derek briefly notes in his video, Greg’s DHEA-S level was slightly high (converts to 504.7 µg/dL, which is just barely above the optimal range that I use [300-500 µg/dL]). While DHEA-S does have some androgenic activity, and it’s possible that he could be supplementing DHEA-S, this would just not account for a significant effect on physique).
Conclusion based on the limited labs from 2016 = natural.
Following this, they discuss a number of more recent labs (around April 2021, when the video was published).
Here, we see a total testosterone level at 515.8 ng/dL, with a free testosterone of 21.97 ng/dL. As mentioned in my prior post (Male Sex Hormones, Part 1), free testosterone is more important than total testosterone, as it is the active form. Greg’s level is quite good, although some (including myself), would often try to optimize this to be over 24 ng/dL.
The reason that Greg has such a good level of free testosterone with a relatively unimpressive total testosterone at 515.8 ng/dL is because his sex hormone-binding globulin (SHBG) is at an optimal level at 31.1 (I suggest that the optimal range is typically 20-40 nmol/L). If his SHBG level were higher, he would bind up additional testosterone, resulting in a lower free testosterone level. (A whole post on SHBG and how it is controlled is coming soon).
In terms of analysis, again his LH and FSH levels are in the normal range, which again suggests natural testosterone production.
Now’s lets look at a few other clues (although none of these will be specific, looking at the big picture helps):
The complete blood count (CBC) is one of my favorite parts of lab analysis, since so many interesting patterns arise.
In the case of exogenous testosterone/androgens, many (but not all) men develop polycythemia, or increased red blood cell production, because this is stimulated by testosterone.
The clue to look for is often a hematocrit over 50%, which typically occurs due to some secondary cause (medication or some illnesses).
Of note, it’s always possible that Greg is donating blood/doing phlebotomy on a regular basis to avoid polycythemia, however, if he were doing this, I would expect his total iron stores to become depleted over time, resulting in a ferritin level much lower than 154 mg/mL. (Again, this is a nonspecific finding, but part of the bigger picture).
Next, exogenous testosterone typically results in a lower HDL level. While an HDL level of 56 mg/dL is fairly average (and is a level that can be seen on people who are on TRT/androgens), the fact that it’s not low (i.e., under 40 mg/dL), again fits with someone who is natural.
Last, it’s worth noting that exogenous testosterone/androgens can increase prostate specific antigen (PSA). Again, not all men who are on these will have a PSA elevation (and especially not at Greg’s age), but it’s worth pointing out.
Conclusion: Based on lab data, Greg appears to be natural.