Contains identifiable patient information. Not for release to the patient in this form.
The panel organised in one place, with the discrepancies and open questions flagged, so you can rule on what's real and what gets said to Henry. Every finding below has a concur / don't concur box — mark them as you go and hit Copy my responses at the top when you're done. Nothing is published to Henry's dashboard until you have.
Gemma — this isn't me second-guessing the clinical picture. It's the panel pulled apart and laid next to Henry's Tanita series so nothing gets read in isolation, with four results the lab flagged that don't appear anywhere in the Stride letter, and a set of questions the numbers raise that only you can settle.
A fair amount of it turns on how the sample was taken — and since you took it, you know things the report doesn't record. Those questions are marked in green boxes throughout. They're the ones I genuinely can't answer.
The decisions are yours. Where I've set out a line of reasoning it's so you can see what's driving a question rather than just be asked it cold — take it apart wherever it's wrong.
| Step | Detail |
|---|---|
| Drawn | Tue 21 Jul 2026, 18:00 — by Dr Gemma Lewis |
| Posted | Immediately — Station Road post box, Hatton DE65 5EH |
| Received at Inuvi, Gloucester | Thu 23 Jul 2026, 09:37 |
| Authorised | Thu 23 Jul 2026, 16:51 |
| Total transit | 39 h 37 min |
Posted Tuesday evening, almost certainly after that day's final collection, so realistically collected Wednesday and delivered Thursday morning. That's an ordinary postal trajectory, not a failure by anyone — it's simply what a posted phlebotomy kit involves. Worth stating plainly because it's the innocent explanation for two things further down, and I don't want it read as criticism of the service.
The one consequence worth noting: the sample sat in a post box and a mail centre overnight in late July. Ambient temperature over that period is unknown and unrecordable.
Because you drew it, the collection time is a verified fact rather than a field someone typed. That's load-bearing: testosterone, cortisol and serum iron all follow diurnal curves, and an 18:00 draw is not interchangeable with a 9am one. Several results below are interpretable only because that timestamp is solid.
Alongside all of it, the clinical context from his Tanita series on the day: 34.3% body fat, 80.4 kg skeletal muscle (97th centile for UK men 20–29), visceral rating 14, 188 cm, and week 7 of tirzepatide — the draw sits between the 16 Jul scan (130.7 kg) and 23 Jul (129.9 kg).
| Marker | Result | Reference | Note |
|---|---|---|---|
| Glycaemic | |||
| Random glucose | 4.8 | 3.5–7.9 mmol/L | Normal |
| HbA1c | 30 | <42 mmol/mol | Excellent given body fat |
| Bone / inflammation | |||
| Calcium | 2.82 H | 2.20–2.60 mmol/L | See §4.1 |
| hs-CRP | 4.13 H | <1.00 mg/L | See §4.3 |
| Magnesium | 1.08 H | 0.70–1.00 mmol/L | Not in the Stride letter |
| Renal | |||
| Urea | 6.5 | 2.5–7.8 mmol/L | Normal |
| Creatinine | 120 | 60–120 µmol/L | At ceiling |
| Sodium | 143 | 133–146 mmol/L | Upper half |
| Chloride | 95 | 95–108 mmol/L | At floor |
| eGFR | 76 L | >90 ml/min/1.73m² | See §4.4 |
| Potassium | not reported | — | Absent — see §5 |
| Lipids | |||
| Cholesterol | 4.41 | <5.00 mmol/L | Normal |
| Triglycerides | 0.63 | <2.30 mmol/L | Excellent |
| HDL | 1.21 | 0.90–1.70 mmol/L | Low-mid |
| LDL | 2.92 | <3.00 mmol/L | Normal |
| Non-HDL | 3.20 | <4.00 mmol/L | Normal |
| Apolipoprotein B | 0.89 | <1.00 g/L | Normal |
| Apolipoprotein A1 | 1.13 L | >1.25 g/L | The actual abnormality |
| ApoB/A1 ratio | 0.8 H | <0.7 | Driven by low A1 |
| Lipoprotein(a) | 7.02 | <75 nmol/L | Very favourable |
| Liver | |||
| Total protein | 79 | 60–80 g/L | Near ceiling |
| Albumin | 52 H | 35–50 g/L | Key to §4.1 |
| Globulin | 28 | 19–35 g/L | Normal |
| ALT | 33 | <45 U/L | Normal |
| ALP | 88 | 30–130 U/L | Normal |
| AST | 45 | <45 U/L | At ceiling — §4.5 |
| GGT | 21 | <55 U/L | Low |
| Bilirubin | 14 | <22 µmol/L | Normal |
| Iron | |||
| Iron | 29.8 | 10.0–30.0 µmol/L | At ceiling |
| UIBC | 32.4 | 12.0–43.0 µmol/L | Normal |
| TIBC | 62 | 45–81 µmol/L | Normal |
| Transferrin saturation | 48 H | 25–45 % | Not in the Stride letter — §4.6 |
| Ferritin | 258 | 30–442 µg/L | In range |
| Thyroid / adrenal | |||
| TSH | 2.390 | 0.270–4.200 mIU/L | Normal |
| Free T3 | 5.2 | 3.1–6.8 pmol/L | Normal |
| Free T4 | 19.9 | 12.0–22.0 pmol/L | Normal |
| Total T4 | 116 | 59–154 nmol/L | Normal |
| TPO antibodies | 20.6 | 0.0–34.0 kIU/L | Negative |
| Thyroglobulin Ab | 15.6 | 0.0–115.0 kIU/L | Negative |
| Cortisol | 179 | 133–537 nmol/L (6–10am) | Range is for a morning draw — §4.9 |
| Sex hormones | |||
| DHEA-sulphate | 5.75 | 5.73–13.40 µmol/L | On the floor |
| LH | 5.4 | 1.7–8.6 IU/L | Normal |
| FSH | 2.5 | 1.5–12.4 IU/L | Low-normal |
| Prolactin | 331.0 H | 86.0–324.0 mIU/L | Not in the Stride letter — §4.7 |
| SHBG | 41.6 | 18.3–54.1 nmol/L | Mid-range |
| Testosterone (total) | 14.10 | 8.64–29.00 nmol/L | Low third for age |
| Free androgen index | 33.9 L | 35.0–92.6 % | Below range |
| Free testosterone | 0.2275 | 0.1980–0.6190 nmol/L | ~6th centile of range |
| Vitamins | |||
| Active B12 | 95.0 | >37.5 pmol/L | Good |
| Folate | 20.8 | >7.0 nmol/L | Good |
| 25-OH vitamin D | 83 | 50–250 nmol/L | Replete |
| Haematology — 20/20 in range | |||
| Haemoglobin | 149 | 130–180 g/L | Normal |
| Red cell count | 5.10 | 4.40–6.50 ×10¹²/L | Normal |
| Haematocrit | 0.440 | 0.400–0.520 L/L | Normal |
| MCV | 86.1 | 80.0–100.0 fL | Normal despite transit |
| MCHC | 338 | 320–360 g/L | Normal — reassures on storage |
| Platelets | 267 | 150–450 ×10⁹/L | Normal |
| White cell count | 8.4 | 3.0–11.0 ×10⁹/L | No infection signal |
| Neutrophils | 4.2 | 2.0–7.5 ×10⁹/L | Normal |
| Lymphocytes | 3.50 | 1.50–4.50 ×10⁹/L | Normal |
Remaining indices (MCH 29.1, RDW 12.3, MPV 12.6, monocytes 0.54, eosinophils 0.07, basophils 0.020) all in range, omitted for length.
The lab flagged calcium high at 2.82. It also flagged albumin high at 52 — and the Stride letter mentions neither the albumin nor any adjustment, reporting the raw calcium and recommending GP review on that basis.
On the standard adjustment (Ca + 0.02 × [40 − albumin]) that's 2.58; on a 0.025 factor, 2.52. Both inside range. Supporting a haemoconcentration reading rather than four separate abnormalities: total protein 79 against a ceiling of 80, magnesium high, serum iron at its ceiling, sodium in the upper half.
Adjustment formulas are population approximations and were designed principally for low albumin — 2.58 is inside range but not comfortably. There's circularity too: if stasis or dehydration lifted both values, the formula may be right for the wrong reason. No ionised calcium was done, and a genuinely raised calcium at 21 means primary hyperparathyroidism until excluded.
How long was the tourniquet on, and how was his hydration that evening? Those two facts probably decide this one, and neither is recorded anywhere.
Total testosterone 14.10, free testosterone 0.2275 (about the 6th centile of the quoted range), free androgen index below range at 33.9, DHEA-S sitting exactly on its floor at an age when it should be near peak. LH 5.4 and FSH 2.5 are both normal — the axis is unelevated rather than driven, which points away from primary testicular failure. At 34.3% body fat, adipose aromatase activity is the obvious candidate.
Two things push the true value above what's printed: the verified 18:00 draw, well down the diurnal curve; and the mildly raised prolactin, which suppresses the same axis.
SHBG is 41.6, mid-range — obesity more typically lowers it, so that doesn't fit the story neatly, though it's consistent with an HbA1c of 30 and no hyperinsulinaemia. And no oestradiol was measured, which is the one result that would have confirmed the mechanism.
He's 21, training hard, and about to read "low testosterone" on his own dashboard. Stride's letter invites him to "discuss this with a GP for their consideration", which in practice is one search away from private TRT. The wording in §7 is written specifically to close that door — it's the part of this I'd most like you to rewrite in your own words.
With 44 kg of fat mass and a visceral rating of 14, an elevated CRP is expected rather than puzzling — adipose tissue drives hepatic production directly. White cell count is entirely normal at 8.4 with normal neutrophils, which argues against active infection though not a recent one.
Was he unwell in the days around 21 July, and had he trained heavily beforehand? Both lift CRP, and either would change whether this is worth re-measuring or just noise.
Their letter recommends a QRISK3. QRISK3 isn't validated below 25, so it can't be calculated for him — worth knowing before he asks a GP for one.
Creatinine-based eGFR assumes average muscle bulk, and he carries 80.4 kg — 97th centile. Creatinine is a muscle-turnover product, and his urea is unremarkable at 6.5, where a renal cause would more usually move both.
76 is stage G2, which is only CKD alongside another marker of damage — and no urine ACR was done, so albuminuria hasn't been excluded. At his body fat, obesity-related glomerular change isn't a silly thought even at 21. The muscle explanation covers the creatinine; it doesn't license calling the kidneys fine.
ALT 33, GGT 21, bilirubin 14, ALP 88, all comfortably normal. AST sits at 45, right at the ceiling, giving an AST:ALT ratio of about 1.4 — the reverse of the pattern MASLD usually shows, and with a notably low GGT, in someone doing resistance work three or four times a week. AST is abundant in skeletal muscle.
This matters because his body composition report flagged fatty liver as the risk worth a baseline test. That question now has a reassuring answer, which given what he's carrying is worth telling him plainly. A CK on any repeat would confirm the muscle origin.
Iron 29.8 over TIBC 62 gives 48%, above the 45% threshold conventionally used to trigger iron-overload screening in men. Ferritin is 258 — in range, upper-middle for 21, and inflated to some degree by the CRP.
The haemoconcentration argument from §4.1 doesn't rescue this one. Serum iron runs higher in the morning and falls across the day, so an 18:00 draw works against the finding rather than explaining it. Recent dietary or supplemental iron is the more plausible benign explanation.
It's the one result where the benign reading being wrong has long-term consequences — silent at 21, damaging at 45 — and the one the Stride letter doesn't merely omit but contradicts, stating his iron status "was also very good".
Had he eaten before you drew it, and is he taking anything iron-containing?
Two per cent above the upper limit — in isolation, noise. Venepuncture stress, a recent meal, sleep or exercise all do this, and macroprolactin would be worth considering before anything else. The only reason it's here is that it sits next to a suppressed androgen picture and prolactin suppresses that axis, so whether it's contributing or coincidental changes what §4.2 means. Not mentioned in the Stride letter.
Stride present the ApoB/A1 ratio as conferring increased cardiovascular risk. Taking it apart: ApoB is 0.89 against a ceiling of 1.00, so atherogenic particle count is fine; triglycerides 0.63 are excellent, notably so at 34% body fat; and Lp(a) is 7.02 against a threshold of 75 — largely genetic, fixed for life, and a good card to hold. The raised ratio comes entirely from ApoA1 at 1.13, i.e. low HDL, which is the parameter obesity reliably depresses and which responds to fat loss and aerobic work.
Telling a 21-year-old he carries raised cardiovascular risk on the back of a low HDL, without mentioning an Lp(a) of 7, reads as a misleading summary of the same data — but that's a framing judgement rather than a factual one, so it's yours.
Magnesium mildly above range, unmentioned in the letter. Supplementation or the same haemoconcentration are the obvious candidates — you'd know what he's taking.
Cortisol 179 was reported against a range the report itself labels 6–10am, on a sample drawn at 18:00. The letter says it was "within the normal range at the time of the test", but the range quoted isn't the one that applies to an evening draw — which suggests the letter was written without reference to the collection time. Not a concern in itself; it's included because it bears on how much weight the rest of the letter carries.
The U&E gives urea, creatinine, sodium, chloride and eGFR. No potassium and no bicarbonate; I've verified it's genuinely absent rather than something I missed.
Potassium leaks from red cells during prolonged storage, and labs commonly suppress the result rather than report a value they can't stand behind. A sample posted Tuesday evening and received Thursday morning, sitting in a post box overnight in July, is exactly that scenario. The lab's own note warns that prolonged EDTA storage affects MCV, HCT, RDW, MPV and MCHC and that delays "adversely affect the WBC count and Diff". His indices came back normal so the count appears to have survived, but the missing potassium fits. It may equally just not have been on the requisition.
Henry's dashboard currently tells him the panel includes "HbA1c, fasting glucose & insulin — your tirzepatide baseline". It measured random glucose and HbA1c: no insulin, and the glucose wasn't fasting. Nothing is lost clinically given an HbA1c of 30, but the copy promises something that wasn't delivered and I'll correct it when I publish.
Oestradiol would have confirmed or refuted the mechanism behind §4.2. CK would settle whether the ceiling AST is muscle. A urine ACR would tell us whether the eGFR sits alongside real damage. All three cheap, all three close a question this panel opened.
Conditions matter as much as contents: 09:00, fasted, well hydrated, no training in the preceding 48 hours, minimal tourniquet. Most of the ambiguity above comes from draw conditions rather than the assays — and given §5, a courier or walk-in route rather than the post would remove the storage question entirely.
| Test | Closes | When |
|---|---|---|
| Calcium + albumin + PTH (± ionised) | §4.1 | Soon |
| Fasting iron studies | §4.6 | Soon |
| U&E incl. potassium + bicarbonate | §5 | Same draw |
| Urine ACR | §4.4 | Same draw |
| Creatine kinase | §4.5 | Same draw |
| Prolactin ± macroprolactin | §4.7 | Same draw |
| 9am testosterone, free T, SHBG, oestradiol, LH, FSH | §4.2 | Defer |
| hs-CRP | §4.3 | Defer |
| Cystatin C, fasting insulin | §4.4, §5 | Optional |
The calcium and iron questions want answering sooner; the androgen and CRP results are more useful later, since they're tracking a moving target and a week-12 repeat gives a meaningful delta against lower body fat. That implies two draws rather than one — worth it, or do it all at once and accept a less informative androgen result?
This is the text proposed for the reserved "Stride Bloods" slot, written for a 21-year-old. The full numbers go in a table underneath — nothing is hidden from him, this only controls the framing.
Your bloods are largely good, and one result answers the exact question your scan raised. Your liver is completely normal. Carrying the visceral fat you started with, fatty liver was the realistic risk, and your liver enzymes say it hasn't happened. Blood sugar excellent, triglycerides excellent, thyroid normal, vitamin D, B12, folate and iron stores all good, and a full blood count normal across all twenty markers.
Your testosterone came back in the lower part of the normal range. Two things about how it was taken: it was drawn at six in the evening, and testosterone is highest first thing and drops through the day. A morning sample would likely read higher.
The bigger point is why it's low. Body fat converts testosterone into oestrogen and turns down the signal from the brain telling the testes to make more. At the body fat you started with, lower testosterone is the expected consequence — and that's what this looks like, because the signalling hormones from your brain came back completely normal. Nothing is broken. It's being turned down by the fat, and it turns back up as the fat comes off. You're 15.8 kg into exactly that.
So the treatment is the programme you're already on. Worth saying plainly: if you go looking online you'll find people selling testosterone and "test boosters" for exactly this reading. At 21, taking testosterone would switch off your own production and affect your fertility, possibly permanently — to fix something your own training and weight loss are already fixing. Don't. We'll retest at nine in the morning once you're further down.
Your calcium came back above range. Before that worries you: a blood protein called albumin was also high, and calcium has to be corrected for it before it means anything. That correction brings your calcium back inside normal. High albumin usually just means you were a little dehydrated when the sample was taken — common on the medication you're on, and the evening draw fits. It still needs repeating properly to be sure: morning, fasted, plenty of water. A recheck, not an investigation.
Your inflammation marker (CRP) is raised at 4.13 — body fat drives this one directly, so it should fall as the fat does. Were you unwell, or had you trained hard, in the days before the test? Both push it up.
Your iron saturation is slightly above range. Iron stores themselves are fine, and a non-fasting sample can throw this up — but it's worth a proper fasting repeat rather than assuming. Nothing to do meanwhile.
Your eGFR — a kidney filtering estimate — reads 76 where the lab wants above 90. That calculation assumes an average amount of muscle, and you have 80.4 kg, more than 97 out of 100 men your age. Muscle produces creatinine, which the estimate is based on, so a lot of muscle makes it read low with nothing wrong. We'll add a urine test to confirm.
I don't intend to publish the criticism of the Stride letter. Henry has read it and it's the only clinical opinion he's had; telling him it missed four flagged results undermines his confidence without giving him anything actionable. Everything I disagree with is handled by just saying the more accurate thing above. Say if you'd rather he was told explicitly — there's a fair argument that he's an adult and entitled to know.
Their letter tells Henry to arrange a GP appointment about the calcium and to have his blood pressure checked. Neither has happened, and no result from this panel has reached his registered practice. Whatever we conclude about the albumin, a private panel has flagged a result with an explicit recommendation to see a GP, and that's currently sitting unactioned in a PDF.
Two questions: does the repeat go through his own practice — which also gets it onto his NHS record — or privately with a copy sent to them? And his blood pressure genuinely hasn't been measured, which is a real gap and a free one to close.