"Everything looks normal" doesn't mean everything is optimal. Here's how to read your lab work beyond the reference range—and advocate for better care.
You get your lab results back. Everything is marked "normal." Your doctor says you're fine. But you don't feel fine.
This scenario plays out thousands of times a day, especially for Black women. The problem isn't that your labs are lying—it's that "normal range" doesn't tell the whole story.
Normal ranges are population averages, often based on research that didn't include enough Black women. They're designed to catch disease, not optimize health. And they leave a massive gap where dysfunction lives quietly for years before it becomes diagnosable illness.
This guide will teach you how to read your own lab results, understand what the numbers actually mean, and identify patterns your doctor might miss.
Understanding Lab Reference Ranges
Every lab test comes with a "reference range"—usually shown as low and high values. If your result falls within that range, it's marked "normal." Outside that range, it's flagged.
But here's what most people don't know: reference ranges are typically created by testing a sample population and taking the middle 95%. That means 5% of healthy people will always fall outside the "normal" range. It also means you can be in the bottom 10% of "normal" and still be told everything is fine.
⚠️ CRITICAL CONTEXT
Reference ranges vary by lab, age, sex, and sometimes race. Two labs can give you different ranges for the same test. Always compare your results to the specific reference range printed on your lab report—not general guidelines you find online.
Normal vs. Optimal
Normal: The range where most of the population falls. Doesn't indicate disease.
Optimal: The tighter range associated with best long-term outcomes, lowest disease risk, and peak function.
Example: Fasting glucose of 99 mg/dL is "normal" (under 100). But optimal for longevity is 70-85 mg/dL. At 99, you're one point away from pre-diabetic territory—yet you'd be told everything is fine.
"Reference ranges catch disease. Optimal ranges prevent it."
The Standard Lab Panels (And What They Actually Tell You)
Comprehensive Metabolic Panel (CMP)
Tests kidney function, electrolyte balance, blood sugar, and liver enzymes. Usually ordered as part of annual checkups.
Fasting Glucose
Standard Normal
70-100 mg/dL
Optimal for Longevity
70-85 mg/dL
Red flags: Consistently above 85 mg/dL suggests early insulin resistance. Above 100 is pre-diabetic. Above 126 (fasting, two separate tests) is diagnostic for diabetes.
Creatinine
Standard Normal
0.6-1.2 mg/dL
What to Watch
Rising trend over time
What it means: Measures kidney function. Rising creatinine (even within normal range) may signal declining kidney filtration. Important for Black women, who have higher rates of kidney disease.
ALT & AST (Liver Enzymes)
Standard Normal
10-40 U/L
Optimal
10-25 U/L
Red flags: Elevated liver enzymes can indicate fatty liver disease, inflammation, or medication side effects. If yours are climbing (even if still "normal"), investigate why.
Lipid Panel
Measures cholesterol and triglycerides. Critical for cardiovascular risk assessment.
Total Cholesterol
Standard Guideline
Under 200 mg/dL
Context Matters
Look at HDL ratio, not just total
What it means: Total cholesterol alone doesn't tell you much. You need to look at the breakdown: LDL, HDL, and triglycerides.
LDL Cholesterol ("Bad" Cholesterol)
Standard Target
Under 100 mg/dL
Optimal
70-100 mg/dL
Important: LDL particle size matters more than total LDL number. Ask for an NMR LipoPro test or ApoB test for deeper insight. Large, fluffy LDL particles are less harmful than small, dense ones.
HDL Cholesterol ("Good" Cholesterol)
Standard Target
Above 40 mg/dL
Optimal for Women
Above 60 mg/dL
Why it matters: HDL transports cholesterol out of arteries. Higher is better. Exercise, omega-3s, and limiting refined carbs can raise HDL.
Triglycerides
Standard Normal
Under 150 mg/dL
Optimal
Under 100 mg/dL
Red flags: Elevated triglycerides often signal insulin resistance, excess sugar/alcohol intake, or metabolic dysfunction. If above 100, investigate diet and metabolic health.
Triglyceride-to-HDL Ratio
How to calculate: Divide triglycerides by HDL. Optimal is under 2. Above 3 suggests insulin resistance. This ratio is one of the best predictors of cardiovascular risk and metabolic health.
Thyroid Panel
Tests thyroid function. Critical for metabolism, energy, mood, and reproductive health.
TSH (Thyroid Stimulating Hormone)
Standard Normal
0.4-4.0 mIU/L
Optimal
1.0-2.0 mIU/L
Important: TSH alone is not enough. If you have symptoms (fatigue, weight gain, hair loss, cold sensitivity), request a full thyroid panel: Free T3, Free T4, Reverse T3, and thyroid antibodies (TPO and TgAb).
Free T3 & Free T4
What they mean: T4 is storage form of thyroid hormone. T3 is active form. Low Free T3 with normal TSH can indicate conversion problems. High Reverse T3 can block T3 receptors.
Thyroid Antibodies (TPO, TgAb)
Why they matter: Elevated antibodies indicate autoimmune thyroid disease (Hashimoto's or Graves'). Can be present for years before TSH becomes abnormal. If you have antibodies, monitor regularly and address root causes (gut health, stress, nutrient deficiencies).
BIOCULTURAL HEALTH PERSPECTIVE
Black women are more likely to be dismissed when reporting thyroid symptoms. If you have symptoms (fatigue, weight changes, mood issues, hair loss) but your TSH is "normal," insist on a full thyroid panel. TSH alone misses many thyroid problems, especially subclinical hypothyroidism and conversion issues.
Complete Blood Count (CBC)
Measures red blood cells, white blood cells, hemoglobin, and platelets. Screens for anemia, infection, and blood disorders.
Hemoglobin
Standard Normal (Women)
12.0-15.5 g/dL
Optimal
13.5-15.0 g/dL
Red flags: Low hemoglobin indicates anemia. Common in women due to menstruation. Check ferritin (iron storage) to identify cause. High hemoglobin may indicate dehydration or other issues.
MCV (Mean Corpuscular Volume)
What it means: Size of red blood cells. Low MCV suggests iron deficiency. High MCV suggests B12 or folate deficiency. Helps identify the type of anemia.
White Blood Cell Count (WBC)
What it means: High WBC can indicate infection, inflammation, or stress. Low WBC may indicate immune suppression, nutrient deficiencies, or bone marrow issues. Context matters—look at the differential (neutrophils, lymphocytes, etc.).
Tests Your Doctor Might Not Order (But You Should Request)
These tests aren't always included in standard panels, but they provide critical information for longevity and early disease detection:
Hemoglobin A1c (HbA1c)
Reflects average blood sugar over 2-3 months. More stable than fasting glucose. Optimal: Below 5.3%. Request this even if fasting glucose is normal.
Fasting Insulin
Measures insulin levels. Can be elevated years before glucose rises. Optimal: Below 5 µIU/mL. Above 10 indicates insulin resistance. Not routinely ordered—you must request it.
Vitamin D (25-Hydroxyvitamin D)
Critical for immune function, bone health, mood. Black women are at high risk for deficiency. Optimal: 40-60 ng/mL. "Sufficient" is defined as 30 ng/mL, but research suggests higher is better.
Ferritin
Iron storage. Low ferritin causes fatigue, hair loss, brain fog before anemia appears. Optimal: 50-100 ng/mL. Many doctors only check hemoglobin—request ferritin separately.
High-Sensitivity C-Reactive Protein (hs-CRP)
Measures inflammation. Optimal: Below 1.0 mg/L. Above 3.0 indicates high cardiovascular risk. Can be elevated by recent illness—retest if high.
Homocysteine
Amino acid linked to cardiovascular disease and cognitive decline. Optimal: Below 7 µmol/L. Elevated levels may indicate B-vitamin deficiencies (B6, B12, folate).
"Lab work is a snapshot, not a story. Track trends over time, not single data points."
How to Track Your Labs Over Time
One set of labs tells you where you are right now. Multiple sets over months and years tell you where you're heading.
Create a personal health binder or digital file:
- Request copies of all lab results (you're legally entitled to them)
- Organize by date and test type
- Track key biomarkers in a spreadsheet or app
- Note any symptoms, lifestyle changes, or medications at the time of each test
Look for trends, not just single results:
- Is your fasting glucose slowly climbing (even if still "normal")?
- Are your liver enzymes rising?
- Is your HDL dropping?
- Is your TSH creeping up?
These trends are early warning signs. Don't wait until a number crosses into "abnormal" to take action.
What to Do When Your Doctor Dismisses Your Concerns
Black women's health concerns are routinely minimized. Here's how to advocate effectively:
1. Bring your own data. Show your doctor the trend. "My fasting glucose has gone from 82 to 95 over two years. That concerns me."
2. Use specific language. "I'd like to request a fasting insulin test and HbA1c to assess for early insulin resistance."
3. Ask for documentation. "Can you note in my chart that I requested this test and you declined? I'd like it on record."
4. Request a copy of your labs. Always. Even if your doctor says everything is fine, you should see the actual numbers.
5. Get a second opinion. If your doctor consistently dismisses you, find a new provider. Your health is too important.
6. Consider direct-to-consumer testing. Companies like WellnessFX, Inside Tracker, and Function Health offer comprehensive lab panels without a doctor's order. Not ideal long-term, but useful for baseline data.
Red Flags That Warrant Immediate Follow-Up
- Fasting glucose above 100 mg/dL
- HbA1c above 5.7%
- Triglycerides above 150 mg/dL
- HDL below 40 mg/dL
- hs-CRP above 3.0 mg/L
- TSH above 3.0 mIU/L (especially with symptoms)
- Ferritin below 30 ng/mL or above 200 ng/mL
- Vitamin D below 30 ng/mL
- Hemoglobin below 12.0 g/dL
- Creatinine rising over time (even if in normal range)
- Liver enzymes (ALT/AST) rising over time
If any of these apply, don't wait for your next annual checkup. Schedule a follow-up appointment and bring your data.
Your Lab Work Action Plan
Next time you get lab work:
- Request a copy of the full report (not just "everything is normal")
- Compare each result to optimal ranges, not just standard ranges
- Add the results to your personal health tracker
- Look for trends compared to previous labs
- If something is out of optimal range, research what it means and what might improve it
- Bring specific questions to your next appointment
- If your doctor dismisses your concerns, advocate harder or find a new doctor
Your lab results are yours. You have the right to understand them, question them, and use them to make informed decisions about your health. Don't settle for "everything looks normal" when you know something is off.
Trust your body. Track your data. Demand better care.
NEXT IN THIS SERIES
Wearables & Trackers: A Practical Guide
From smartwatches to CGMs, learn which devices actually provide useful data, how to interpret what they're telling you, and which metrics are worth tracking daily.
Read Next Article