Care with Roscoe Nelson, MD, board-certified urologist.
Where "normal" comes from
The reference range on a lab report is usually the middle 95 percent of results from people a laboratory considered healthy. By construction, five percent of perfectly well people land outside it, and landing inside it only says you resemble the group they measured. Nobody in that process asked at what level people sleep well, hold muscle or think clearly. And because the group is drawn from the general population, the range drifts as that population gets heavier and less well. Normal tracks the sample. It does not track health.
Why I read a panel differently
Urology reaches further than most people realize. The adrenal, the parathyroid, the hypothalamus, the pituitary and the gonads are all endocrine organs, and I have spent three decades on top of that in hormones, sexual medicine and metabolic health. That leaves me fluent in several systems that are usually read separately by different people.
That separation is the problem. Each specialist studies their own slice and treats the rest as background, so a pattern spanning three slices passes through all three unseen. Thyroid moves the binding protein that decides how much testosterone is usable. Insulin resistance lowers that protein and raises the conversion of androgens to estrogens in fat. Cortisol suppresses the brain's signal to the gonads. Iron and vitamin D hide under fatigue that gets pinned on hormones. One number at a time, each looks fine. Together, a pattern usually shows.
I also report results against optimal ranges through a partnership with Labstro: the same result on two lines, where you sit in the population and where people actually function well. Optimal ranges are interpretive, drawn from the literature, experience and judgment, and they carry more uncertainty than a lab range. I would rather say that than pretend otherwise. What they give you is a starting point for a real conversation.
Worth a second look if
- Your labs were called normal and nothing changed for you
- Treatment was started from a single draw
- Only a total was measured when the free level or the binding protein would have changed the reading
- Results conflict with each other or with how you feel
- Two clinicians have told you two different things
- A biopsy, a procedure or long-term therapy is on the table and you want it read properly first
Bring everything: prior results with dates and reference ranges, imaging and pathology reports, your medication and supplement list, and the question you actually want answered. Do not change a treatment while you wait for the review unless your current clinician tells you to.
In person, and by video for urology
Hormonal and metabolic second opinions happen in person in Draper. Complex urologic second opinions, including complicated PSA situations and biopsy decisions, are also available by telehealth in Utah, Arizona, Florida, Georgia, Illinois, Indiana, Michigan, North Carolina, Ohio and Pennsylvania. Some questions still need an exam. A second opinion may confirm the original plan, suggest another, or point to what is still missing before a decision. I do not practice general urology and I do not treat prostate cancer, so reviewing a decision is not the same as taking over the care.
Peri opens Late 2026. The waitlist is for opening news, not for records. The waitlist hears first.