Metabolic and insulin signalling
Insulin moves years before glucose does. A perfect glucose alongside a fasting insulin of 14 mIU/L is a compensating picture, not a clean one, and it is the one worth catching.
- Glucose
- Insulin
- HOMA-IR
- HbA1c
Method
What we actually do with your blood work
There is no shortage of companies that will sell you a hundred biomarkers. There is a serious shortage of anyone who will tell you what they mean together. A reference range tells you whether you resemble the population that happened to walk into a laboratory. It does not tell you whether you are functioning well.
Cardiovascular risk, read properly
ApoB counts the particles that actually carry risk, rather than LDL-C alone. Lp(a) is largely genetic and is measured once in a lifetime, which is once more than most people ever have it done.
- ApoB
- Lp(a)
- TG:HDL
- Homocysteine
- Fibrinogen
Inflammation and its sources
Ferritin is an acute-phase reactant and is never read alone. Inflammation is a finding that demands a source, not a number to be lowered for its own sake.
- hs-CRP
- Ferritin with TSAT and CRP
- NLR
Haematology and iron status
Iron deficiency without anaemia is common in endurance athletes and frequently missed, because the haemoglobin looks acceptable and nobody looks further.
- FBC
- Ferritin
- Serum iron
- TSAT
- sTfR
Organ function and training load
A CK of 900 means one thing forty-eight hours after a hard session and something quite different at rest. Interpretation without training context is guesswork.
- ALT
- AST
- GGT
- Creatinine
- eGFR
- Cystatin C
- CK
- LDH
- Urate
Endocrine and recovery capacity
Thyroid beyond TSH, sex hormones read with SHBG, and in women timed to the cycle rather than to whichever morning was convenient.
- TSH
- fT4
- fT3
- rT3
- Total and free testosterone
- SHBG
- E2
- DHEA-S
- AM cortisol
- IGF-1
Three principles of interpretation
Ratios, not single values
Testosterone to cortisol, fT3 to rT3. The relationship between two markers carries information that neither of them carries alone.
Patterns, not flags
The low energy availability picture, suppressed fT3, low IGF-1, suppressed sex hormones, with every marker still inside its reference range, is invisible line by line and unmistakable as a whole.
Trajectory, not snapshots
One draw is a photograph, not a film. Every engagement above Baseline is built around a retest, because the direction of travel is the clinically useful part.
How the blood is drawn matters as much as what is drawn.
A panel taken under the wrong conditions produces numbers that are accurate and meaningless. These conditions are specified in writing before you go.
- Fasted 10 to 12 hours, water permitted
- No hard training in the 48 hours before the draw
- Drawn between 07:00 and 09:00 for cortisol, testosterone and thyroid
- Properly hydrated
- Not within five days of a race
- Female hormone panels on cycle days 2 to 5 unless otherwise specified
- No biotin for 72 hours
- The same laboratory for retests
And what blood cannot tell us.
It will not give us your VO2 max, your body composition, your arterial calcium score, your epigenetic age or what is in a scan. If your question needs those, we say so on the second call rather than pretending a panel can settle it.
The rest of the picture
Blood is one input. It is not the assessment.
The other seven inputs below are gathered in the consultation itself, and several of them regularly outweigh the panel.
Clinical history
Taken properly and at length. Still the highest-yield diagnostic instrument available, and the one most often skipped.
Training and load
Most recovery problems are load problems wearing a costume.
Objective recovery data
The eight-week wearable trend and where it broke, not yesterday's readiness score.
Energy availability
Intake set against training load and body mass, which is where a surprising number of hormonal pictures begin.
Sleep and circadian position
Duration, timing, light exposure and shift pattern, read together rather than as a single number from a wrist.
Medication and supplement audit
Everything taken, at what dose, for how long, including what is interfering with the assay itself.
Symptom and systems review
Explicit red-flag screening. If we find one we say so immediately. That is not a failed consultation, it is the most valuable thing we could have done.
Body composition, where you have it
DEXA or bioimpedance if it already exists, interpreted for what it can and cannot support.