T Nation

Normal Total Test, High Free Test

A little background on me. 38, been on trt for 7 years except a recent 6 month period while trying to get wife pregnant. During this recent 6 months off trt, I was taking 5,000iu hcg 3/week and half a pill of clomid (forgot the dose) daily. My wife then got pregnant and I waited 6 weeks before continuing trt. During the 6 weeks after the wife first tested positive for pregnancy, I only continued the clomid.

Then a few weeks ago I finally decided to go back on trt. I went back to my normal dose of 0.8 ml test cyp per week. I got labs done and my total test is fine but in big red letters, my free test is high. That has me a little worried. I understand that I don’t have all the labs you folks want in the sticky and I’ll work on that. I did not think I would ever post something here. This is what my labs look like:
Testosterone, Total and Free
Testosterone, Total 725
Testosterone, Free 205.7 H pg/mL 35.0-155.0
Estradiol 41

Is this something caused by the hcg or clomid? Should I be concerned? My next doc appointment isn’t for a few weeks but the big red letters is stressing me out.

Its not that bad mate, things should level out. Stick to the TRT till next doc appointment.
The main thing is do you feel ok ? you’re stressing out just. Get your doctor to retest in a few weeks.

Stay the course, there’s nothing wrong with Free T over the ranges absent of symptoms. The only symptoms I would associate with very high Free T is high estrogen, you would know if estrogen was high.

However the benefits only go to your heart, testosterone is cardio protective and men in the higher percentile ranges have the least heart problems.

Treat the symptoms not the numbers.

If you are feeling good, you’re fine, 205 is not crazy high. Your free testosterone percentage is 2.84, which is very good. My total test was 902, free 220. Your SHBG is likely lower, freeing up more of your testosterone.

Just posted an update to my case, the other day. You are sorta like myself, normalish Total T but thank god for our HIGH FREE T! High-ish for me. LOL :))))

Testosterone Total 18.3 nmol/L 6.1-27.1
Testosterone Free Calculated 565 pmol/L (110-660)
Testosterone Bioavailable Calculated 13.2 nmol/L (2.8-15.5)
Estradiol 130 pmol/L (40-160)
SHBG 14 nmol/L (13-89)

That was at trough too… It’s all in our low SHBG. Mine’s only one point above lowest normal range. Yikes. LOL

What I wonder is, at what point does it become detrimental to heart function. Is there a set point for everyone, like X level causes slow deterioration in cardiac function or is it genetically individual, like Tim acquires dialated cardiomyopathy on 200mg/wk and derp acquires it on 10,000mg/wk. Currently we have no idea as to what the set point is for testosterone and cardiovascular complications, what we do know though is (like you stated) there is a trend towards higher testosterone levels (within reason, say 300-1200ng/do) being associated with lower rates of cardiovascular disease. However men do tend to have higher LV mass and rates of cardiovascular disease in general when compared to women, yet less incidence of cerebrovascular disease and osteoporosis (esp after menopause for women). I believe these differences ARE sex hormone linked to some extent, as cardiac myocytes contain androgen receptors, men have bigger muscles than women on average, they also have bigger hearts, both contain androgen receptors (and a ton of other receptors), coincidence? I think not.

The incidence of increased cardiovascular disease in men can be explained by A: men generally taking more chances than women when it comes to diet or lifestyle decisions (rec drug use etc), also potentially androgen mediated and the decreased level of osteoporosis in middle aged men compared to middle aged women is likely androgen mediated (menopause=low estrogen and testosterone, estrogen and androgens help maintain and increase BMD, thus men still have androgens (albeit not as much) and a woman’s estrogen production plummets to damn near zero with menopause). Androgens in physiologic concentrations may also play a neuroprotective effect, leading to lower rates of cerebrovascular disease.

With all the fear mongering surrounding this class of medication (androgens/anabolic agents), we probably won’t ever have a definitive conclusion as to at what point health risks outweigh benefits. I think it’s a fair point to assume that doses like 500mg/wk in a normal individual over time will pose health risks long term (the extent of these risks are largely unknown, however I don’t buy that it’s extremely deadly, I def believe it increases the chance of SCD and cardiovascular abnormalities however I believe the risks are slightly blown out of proportion, for a healthy young male (not me) acute exposure to supraphysiologic doses of testosterone is relatively harmless as can be seen in various pieces of literature (although most studies lack follow ups, so that’s an issue lol)

Many experts agree that the levels go too low and the studies show CVD much higher in the ranges. SHBG concentrations also play a big role.

I agree there are too many variables to be able to nail down a range at which CVD occurs in men.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men