High Total & Low Free - Is it Possible?

Pharma / TRT Testosterone Replacement
1

Hi everyone,

I’ve just hit 40 years of age have seen a marked decrease in lean muscle mass over the last four years or so. I used to train heavy in my twenties, but in my thirties I’ve been up and down with my training as I’ve had to juggle family and work. Lately, training has been very difficult, with little gains even though I’ve applied sound training, nutrition, and rest. Clinically, I’m presenting some classic low-T symptoms - fatigue, loss of muscle mass, poor concentration etc…

I’ve had the full battery of tests and came up with some strange numbers:

Total T = 600 ng/dL
Free T = 6.8 pg/ml
Bio T = 156.77 ng/dL
SHBG = 54 nmol/L

Even more strange, I happened to have a Free T test when I was 26 and it was 21.96 pg/ml.

So there is an unusual decline over 14 years, not what you would expect. Total T is fine, but the Free T is quite low and the SHBG is high.

My doctor was ready to try me out on some T-replacement, based on the Free T results and historical decline, but balked when he saw the total T level.

Has anybody had similar confounding results? Any idea what it could mean?

2

It is the BioT that is important, not the free T, which is unreliable.

What is the lab range for the BioT?

3

Bio-T is often around 45% of TT.

TT=SHBG+T + Bio-T
Bio-T = FT + weakly bound T
weakly bound T is mostly albumin+T

When SHBG goes up, there is more SHBG+T and that increases TT

SHBG goes up with age, and if TT is held constant, FT and Bio-T go down.

What can increase SHBG?

  • increased estrogens

SHBG is made in the liver, more estrogens promotes more production. The liver also clears SHBG with bound hormones. If there is a liver problem or the liver is burdened dealing with alcohol or medications, E2 can go up.

You need E2 lab work. *** Read the advice for new guys sticky and note the opening paragraph!***

Labs:

  • CBC
  • fasting cholesterol
  • fasting glucose
  • TSH, fT3, fT4
  • ferritin
  • LH/FSH - must be done prior to starting TRT!
  • TT
  • FT
  • E2
  • DHEA-S
  • PSA if older
  • CRP
  • homocysteine

Also should have a DRE before TRT if older.

4

[quote]seekonk wrote:
It is the BioT that is important, not the free T, which is unreliable.

What is the lab range for the BioT?[/quote]

The original values were in nmol/L which I converted to ng/dl.

In nmol/L:

My Reading = 5.44
Reference Range at Lab = 3.50-15.00.

These reference ranges are also fishy. As far as I can determine, the range is simply all of the labs test results with the top and bottom percentiles chopped off. So it’s a distribution over the total population of people who have gone to have tests. You would imagine that a lot of older men that get tested would represent the lower portion of the reference range, wouldn’t you?

The question is is this value coupled with my symptoms enough to recommend a preliminary course of T-therapy?

5

[quote]KSman wrote:

You need E2 lab work. *** Read the advice for new guys sticky and note the opening paragraph!***

Labs:

  • CBC
  • fasting cholesterol
  • fasting glucose
  • TSH, fT3, fT4
  • ferritin
  • LH/FSH - must be done prior to starting TRT!
  • TT
  • FT
  • E2
  • DHEA-S
  • PSA if older
  • CRP
  • homocysteine

Also should have a DRE before TRT if older.

[/quote]

Thanks for the info KSman.

I did get a full blood work-up, including E2 (Estradiol):

E2 = 127 pmol/L // Reference Range < 157 pmol/L
Cholesterol = 4.76 nmol/L // Reference Range < 5.20 nmol/L
Random Glucose 4.6 nmol/L // Reference Range 3.6-7.0 Normal
FSH = 2 IU/L // Reference Range 2-12 IU/L
LH = 4 IU/L // Reference Range 2-9 IU/L
TSH = 1.37 MU/L // Reference Range 0.30-5.60

I did not get FT3 or FT4. Should I bother to get them done if TSH looks normal?

Also, what about my borderline FSH? It’s right at the bottom of the range.

PSA = .69 ug/L // Reference Range = 0 - 2.50

I got a bunch of hematology that looks normal:

Hemoglobin, hematocrit, RBC, MCV, MCH MCHC, RDW, WBC, Platelets, MFV, Neutrophils, lympocytes, monocytes, Eosinophils, and Basophils.

Also:

Zinc 12.8 umol/L // Reference Range 8.7-19.1 umol/L
Dihydrotestosterone 3399 pmol/L // Reference Rante 860-3406 pmol/L
Prolactin 4 ug/L // Reference Range < 18

It seems like I should go back to my doc and request the following then:

DHEA
CRP
T3
T4
Homocysteine
Ferritin
CBC

6

You have CBC data now: Hemoglobin, hematocrit, RBC, MCV, MCH MCHC, RDW, WBC, Platelets, MFV, Neutrophils, lympocytes, monocytes, Eosinophils, and Basophils

-hematocrit?
-hemoglobin?

E2 is high, leading to estrogen dominance

7

[quote]KSman wrote:
You have CBC data now: Hemoglobin, hematocrit, RBC, MCV, MCH MCHC, RDW, WBC, Platelets, MFV, Neutrophils, lympocytes, monocytes, Eosinophils, and Basophils

-hematocrit?
-hemoglobin?

E2 is high, leading to estrogen dominance[/quote]

KSMan, I’m now a strong believer that I have excess aromatase. From my research, normal TT coupled with low FT and high E2 and SHBG indicate this. Both my E2 and SHBG are high readings.

Do you have any data on what E2 and SHBG should generally be for a male my age?

8

E2=22pg/ml seems to be a good target with AI. You can modulate E2, but can do nothing direct to change SHBG. Lower E2 will lower SHBG. You could try 0.5 mg anastrozole per week in divided doses, after 4 weeks, do E2 lab work and then correct dose as needed. For low dose, you will need a liquid product, search “research chemical anastrozole”.

http://www.unc.edu/~rowlett/units/scales/clinical_data.html

Why do you have high T–>E2?

  • age=40
  • height=
  • waist=
  • weight=
  • what other health issues
  • what meds, Rx or OTC
  • liver markers, AST and ALT
  • what are your body temps and iodine intake, see stickies ‘advice for new guys’ and ‘thyroid basics’

TSH is in normal range. But a better indicator of thyroid [dis]function is body temperatures with the context of history of iodine intake.