T Nation

Any Help Looking at My Labs Would be Greatly Appreciated

Well my blood work came back.
Can someone interpret this for me?

I am new to all of this and I am extremely confused.
My total T number along with the other results is confusing me.IMG_20191114_133407_01~2

You have high SHBG, which is killing your free T. Everything else looks dandy. Did your doc suggest any possible reason for the high SHBG? Insulin issues? Liver problems?

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I have a meeting with the doc next Friday. I am not sure what would be the cause. No liver issues. I only drink a few beers a week. Insulin tested good and I do a very low carb diet, so I doubt that is the cause… Thanks

TT is the junk hormone, SHBG decreases FT effectively deactivating it. This isn’t the first time I’ve seen contradictions of FT percentage and bioavailable looking good, FT percentage is to be trusted. You’re more than likely using the Direct Immunoassay testing which provides inaccurate FT measurements.

FT 2-3 percentage is considered normal and you are nowhere near normal. Your liver is cranking out too much SHBG which can be do to genetics, starving yourself or your bodies natural response to low testosterone trying to hold onto what little you have.

It’s TRT or BUST because there is no way to fix this naturally.

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A lot of doctors will fixate on the TT value because of the problems inherent in directly measured FT testing, really all you need to make the low T diagnosis is the TT, astronomically high SHBG and FT percentage.

These are more reliable than the directly measured FT and bioavailable tests.

You will more than likely need to seek private care for TRT, sick care docs only care about in range whether that’s on the high end or the low end of the ranges. The insurance companies are pulling the doctors strings and are deciding who gets treatment, not the doctors.

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Essentially, your SHBG is too high for some reason. Could be diet, could be several other things, could be just high SHBG. You’ll need a serious workup though, and are not likely to get much sympathy from the doctor honestly.

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Thanks for the replies so far. I guess I should gave body and diet info as well
36 years old
155lb
Approximately 15% body fat
Been doing keto since February. Feel great on it.
Lift 5/3/1 four days a week. Usually 1 or 2 days of cardio. Mainly training for OCR races.

I have always felt off and suspected low T. Low libido, not a lot of drive, and a real hard time building muscle no matter how I eat or what supplements I’m on.

Keto diets will increase SHBG and lower FT. Thyroid hormones (T3) decrease as well because your intake of carbs is low.

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Well I just got home from the doc. She said that would not recommend TRT for me. Said that my cholesterol was high and that I should take DHEA and fish oil. Asked her about my high SHBG and she said that it was most likely genetic because all my other labs looked great.

Not really sure where to go from this point. Maybe a second opinion, but that might have to wait until after the holidays since this was not cheap. I hate to just piss away money on another consultation.

Your doctor failed to comprehend the effects very high SHBG can have on FT, the testing for a testosterone deficiency has a long way to go and is still in its infancy, most of all FT testing which has its problems.

There is no way you could have good FT levels with SHBG is the 80’s. I’m used to seeing a contradiction in FT percentage and directly measured FT, usually the FT percentage is very low while directly measured FT is always better.

You need to locate a doctor that lives in the TRT world everyday and not a doctor who gets her feet wet on occasion, but someone who prescribes TRT everyday. This type of doctor will more than likely not be under an healthcare provider. It will be in sports medicine or anti-aging.

How can it be that FT percentage is outside of what’s considered normal, and then have directly measured FT midrange, your doctor should have questioned this because one of these tests is WRONG.

I’m going to fixate on your SHBG levels which is 87.3, which is astronomically high and the low FT percentage which is 1.05% 2-3 percent which is considered normal and conclude directly measured FT can’t be trusted.

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Very likely true. I’d at least contact someone like Defy that will work with you remotely and see if TRT makes sense for you. If your free T is low and you’re having symptoms then it’s worth pursuing.

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Of course she doesn’t.

This is not necessarily wrong, however TRT will increase E2 which is cardioprotective and will often result in better lipid profiles.

Unless your second opinion is through a TRT doctor or clinic, whether in person locally of through the internet, you are likely wasting your time and money. Plenty of guys like you presenting to their GPs with low T symptoms only to find total test to be well up in the range. Problem is they do not consider free testosterone. Yours tested for it (and SHBG) and then ignored the results. A TRT specialist will know you need testosterone. The guys commenting above are right.

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The strange part is that this place does advertise heavily in testosterone optimization, but she seemed completely unconcerned with the high SHBG and tow free T.

My initial consultation with them seemed really promising. She even started how they like to keep guys between 800-1000 total levels OR whatever they feel good at. When my total T came back at 760 she started that most of her patients would be happy to have those numbers.

All in all it seems like they really don’t know how to treat except for measuring total T.

Good times…

That’s nice, but so what? Get your free testosterone up to the top of the range, or even higher, you’ll be happy too.

Sorry about this, must be incredibly frustrating. You can see why some of the guys here go crazy when they hear of this. Good luck moving on, but you need to move on. Maybe talk around to anyone you know on TRT (or suspect is on)? Look around at your gym, guarantee some there are taking testosterone, especially a very “in shape” middle age or older guy. Ask them who they see. Usually they’ll be fine with a (Alright, you look fantastic! What is your secret?) complimentary intro and be vey forthcoming.

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This is designed to draw you into their establishment and it worked, word of mouth is the best way to find a competent clinic to treat you. This is a time and age when hormone knowledge related to male hormones is in its infancy and not all doctors are going to get it right which more than likely has to do with inexperience.

There are a lot of low T clinics out there who make claims, only a select few are good at diagnosing a testosterone deficiency. Some doctors are going to fixate on TT because it’s more reliable than FT testing, but the high SHBG should have made things clear.

After about 10,000 more patients, she’ll figure it out and see a lot of men claiming to be experiencing low testosterone and the common denominator with be high normal TT and high SHBG and low FT percentage.

To add to the complication, there are no standards for testing which is constantly evolving and some labs are using questionable laboratory methods. If you spend enough time on these TRT boards, you’ll see vastly different reference ranges and you take 10 samples of blood and have them tested at different laboratories, you’ll get 10 different results.

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There won’t be 10,000 patients unless she figures it out sooner than later.

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I think the problem is on paper levels look normal, so if the doctor prescribes TRT to someone with normal levels, big brother could come down on her hard and threaten her business, unless she feels she can with a great degree of confidence explain why lifthyrtpeat is experiencing a testosterone deficiency with these levels and is able to back it up with literature.

This is what keeps the lawyers from having any teeth, knowledge is power.

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This is only an issue if filing under the patient’s insurance coverage. A diagnosis of hypogonadism is required and unless the labs are out of range, it is not hypogonadism by definition. If filed, and caught by the carrier, they’ll deny treatment. Do it enough and piss them off, they’ll report you to the Sate Medical Board for fraud.

You can prescribe off label, on a functional basis, with documented symptoms and supporting labs.

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Talked to Defy today. I am going to try a few supplements (DHEA and Boron) to try to decrease my SHBG. I am going to get another blood test in 6 weeks to see if there is an increase in my free testosterone. Hopefully this works, if not he said he will work with me to get treated.

What about your diet?