T Nation

Free Testosterone Levels Confusion

Good day to everyone. This is my first post, I decided to sign in, because I can’t find answers to some question.

I’m thinking about treating low testosterone, of course. Which is why I’m posting here.

I have pretty much all ‘stereotypical’ symptoms.

There are only handful of doctors with decent idea in my country, so I would need to make quite a journey to reach one.

So before I go, I want to learn as much as I can.

Basically, what’s bugging me is free testosterone levels checking/diagnosis.

There are free testosterone tests around.

Most of them claim that average range is about 40 - 250 pg/ml or 4-25 ng/dl. Which makes it about 1%-4% of total testosterone, which is how it’s supposed to be.

However, some studies

like MMA fighter tests here

And

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1442-2042.2005.01143.x

Show range of levels that are literally 10 times smaller.

From what I’ve seen, those are values which people on these boards are reporting as well.

Free T tests that I have available in Poland likewise show those small values as reference range. Like, 1 t- 28.2 pg/ml as reference ranges.

Are there some different methods that produce concentrations order of magnitude lower?

I’ve found something like this, and it seems there are some faulty methods out there, unfortunately.

Or are those references values just from old, ill men, and are out of whack?

I’m confused.

Thanks for any help.

The whole world is confused with regards to testosterone and testing, you must take into account environmental factors which can block hormone receptors, similar to thyroid resistance.

The direct immunoassay is worthless for Free T, equilibrium dialysis or ultrafiltration are the most accurate when measuring Free T. There is a lot of bad information and worthless testing methods out there that make this process much more difficult for docs and patients alike.

I don’t blame docs for not wanting to go down the rabbit hole that is TRT, you have to invest a lot of time weeding through all the bullshit.

You’re probably better off calculating the Free T from your Total T and SHBG.

Hopefully, you can find a doctor who will focus on that over the lab number.

Good move. Get the LC/MS/MS for total and equilibrium ultrafiltration immunochemiluminometric assay for free testosterone.

Liquid Chromatography Mass Spectrum (LC/MS) does not get any more accurate. The authoritative test.

I would have to know my albumin levels then… More and more tests.

I don’t even know what kind of test I have taken, there’s no info. Guess I may try phoning the laboratorium and try to squeeze it out of them.

Don’t know if I can find this LC/MS anywhere near.

I plan or doing so, but as above, it will be bit of a hassle…

I’m not sure what to do, because I have all the symptoms suggesting that something failed right at puberty, since I even have rather minimal beard right now, high pitched voice and almost invisible Adam’s apple.

My testosterone level’s are all sketchy.

At around 28 years of age, I’ve taken one test, 278 ng/dl Which is abysmal, from what I gather, most 70+ year old guys have more.

But then, later I’ve taken two more , ended up being 420 and 475, which are low too, but somehow within acceptable ranges. So I dunno if anyone would recommend TRT after all.

AFAIU, such changes are weird, one result 170% of the other. Small differences are of course normal, but this?

Some of my other results are/where at 30-31(right now) yo:

Free T 11,8 and 10.62 pg/ml

DHEA-S 501 µg/dl
SHBG 35.83 nmol/l
TSH 2,257 µgIU/ml
FT3 3.09 pg/ml
FT4 0.99 ng/dl
FHS 1.75 mIU/ml
LH 5.17 mIU/ml
Estradiol 27 pg/ml
prolactine 11.41 ng/ml
PSA total 0.357 ng/ml

If this is any help.

Thanks for help.

Testosterone levels are reported to fluctuate as much as 140-200ng/dL throughout the day. Plus, those fluctuations are greater in younger men than older men.

Regardless, for you, “acceptable ranges” are irrelevant. You did not go into detail regarding your “stereotypical symptoms” but you are not happy with the way you feel which is not acceptable to me and you are a young guy. It would not be acceptable for an older guy, but at least he presumably had a good run. Sounds as though you’ve been dealing with this forever.

The key for you will be finding a doctor who does not operate inside the “normal” range mindset. Good luck.

I just need to offer a contrary opinion on this. Yes, there are several methods available, and some may be better than others. However, in my experience, the direct method is a reliable method and is better than not running the test at all. Let’s not get into an argument about this. I’m just offering the OP my experience as someone who has high SHBG and very low Free-T (without TRT). Below is a graph of my experience with the the Direct method. There is amazing linearity with the dose of T administered and Free T. One would not expect this if the test were as bad as some would make it out to be.

My most recent labs using the Quest Liquid Chromatography Mass Spectrum (LC/MS) test my total T was 1361 ——Free T was 19 (188.6pg) —-bio available 379.7 —-SHBC 43—Albumin 4.4

The T was high but everything else with the high normal spec. I guess the 19 is still good and honestly not sure about bio-available T number other than it’s about 3/4’s to the top of normal range on sheet (high normal).

I sure expected my Free T to be higher with that at Total T number.

Also this is on MedQuest Cream 20%/200mg tested around 4.5 hours after morning application. This was really just a test dosage to see how I feel there and if my energy/mood would increase/improve. I’m lowering back to around 900-1000 T total I felt about the same there so need to run that higher level.

I have some more questions.

The guy I’m considering going to have written an article somewhere in 2007.

He basically states that the ratio of TT (in ng/ml) and LH (in IU/ml) being lower than 1.0 indicates that T is too low. Regardless of total concentration.

In my case the ratio would be about 0.6 to 0.9

Have you heard anything about it?

Furthermore, is standard albumin in serum test accurate enough to calculate free test from it?

Is testing etrogen/estradiol levels worth it? Read that they can have huge influence on mood as well.

Also, is there a place where I can read about immunochemiluminometrics, and all other assays? It’s hard to find anything just by googling.