T Nation

Post Your Results: Tru-T Calculated Free T vs Equilibrium Dialysis Free T

Please read this study it highlights everything I am attempting to draw awareness too @systemlord @ncsugrad2002

I found a case where a member had “normal” free T, highTotal T and High SHBG. This members lab work never included a direct or ED measured Free T. Instead it only included a “calculated” free T measurement. He was confused why he was experiencing the symptoms he felt… Well I think it safe to say his Free T was not normal and was over estimated. Think about the difference we can make on this subject if we encourage all to stop relying on calculated Free T… there must be many more instances of people who still have no symptom relief thinking their free T is optimal or normal on their protocols only to have lower Free T than they think.

Here is an excerpt below from the thread…

"From my understanding, total T levels are good and so is the % of Free T. What worries me is the high SHBG reading. Wondering if such a high reading is possible due to over training/stresses such as extended sauna use/dehydration etc or there might be a deeper underlying issue.

All the reading I’ve done suggests that high SHBG leads to low free T. What is confusing me is the fact that my Free T result seems to be normal"

For all of you struggling to find balance and symptom relief after some time on a protocol… Please have your Free T measured by Equilibrium Dialysis. Chances are if you have “calculated Free T” values only, you are lower than you think. For an accurate diagnosis of hypogonadism and judgement of how a protocol is going. Directly measured is the gold standard. Pass the word on

A little discussion from that thread.

I would argue when SHBG is high, LH is a better indicator of T status even over the FT value.

Are you referring to diagnosing secondary versus primary hypogonadism? LH on TRT should be non existent. LH is what stimulates the production of T in the leydig cells and exogenous T will cut the feedback loop. What exactly do you mean by “indicator of T status”?

I think that is what you meant… which is correct. High SHBG coupled with low Free T is not grounds for jumping on TRT if LH is optimal (and testes work ie: Total t in range). A better judgement would be to see what the pituitary is pushing in terms of LH in relation to total Testosterone in plasma. However this thread is about symptom relief correlated to Free T numbers and the accuracy of which the free T numbers are derived :slight_smile:

Secondary is a far more common diagnosis, sometimes you will see high SHBG and high LH, high TT, low FT and low E2, in these cases the pituitary gland is working like a champion but unfortunately will not be enough to overcome high SHBG and now the guy is forced to shut down a perfectly good HPTA because the liver is ruining everything.

These guys will usually report calorie restriction and/or keto diets which can increase SHBG because they want to be lean and cut.

Yes or SSRIs/neural stress/ or even severe caloric deficits including fasting and prolonged extreme dieting.

Edit just saw you mention the caloric restriction… lol we are on the same page. We submitted that almost at the same time. Great minds think a like is what they say

Alright here’s the results for the lab tests I have:

5/15:
Total T: 862
Free T (Direct): 6.2
SHBG: 151
Albumin: 4.6
TruT Free T: 17.23

9/10:
Total T: 1500+ (I used 2000 for the calculator)
Free T (Direct): 39.7
SHBG: 90
Albumin: 4.4
TruT Free T: 65

10/17
Total T: 1500+ (I used 1800 for the calculator)
Free T (Direct): 36.4
SHBG: Did not test, used 90
Albumin: Did not test, used 4.4
TruT Free T: 58

1 Like

exactly what I would expect. Thanks @ncsugrad2002.

Looking at the first set of labs Tru-T had you at 17ng/dl… although low not super low. In reality your free T was in the gutter (6ng/dl)

1 Like

I may get some testing done with the other method next time just to see what I get

That would be perfect. As we can see from an individual standpoint the differences between the two. By the way what dosage were you running with each lab?

Roughly:

-Pre TRT
-150mg/day cream
-150mg/day cream

What is e2 and How do you feel? I wonder why your SHBG is so high. Do you have a history of SSRIs?anyways your T levels are fairly high. I’m guessing I’ll need to push my TT near 1000 to get free T towards the top of the range… my pre-TRT Free T was 5ng/dl with a Total of 382… SHBG was 30.

11 pg/mL, normal range of [8-35]
73
55

So… very low to quite high. Had high E2 issues for a few weeks (swollen feet, etc.) but all that went away on it’s own.

I used to take finasteride and then dutasteride, so I think the high SHBG is from those. I’ve seen several others that took them had the same thing happen.

Never took SSRI’s

TT 502.16 ng/dl
Direct Free T 12.1 ng/dl
Tru-T Free T 16.47 ng/dl
SHBG 27
Albumin 4.5

TT 360 ng/dl
Direct Free T 8.2 ng/dl
Tru-T Free T 11.41 ng/dl
SHBG 26
albumin 4.5

TT 467 ng/dl
Direct Free T 10.1 ng/dl
Tru-T Free T 12.27 ng/dl
SHBG 60.4
albumin 4.5

TT 328 ng/dl
Direct Free T 7.2 ng/dl
Tru-T Free T 10.68 ng/dl
SHBG 26
Albumin 4.3

TT 281 ng/dl
Direct Free T 6.2 ng/dl
Tru-T Free T 8.87 ng/dl
SHBG 27
Albumin 4.3

TT 1021 ng/dl
Direct Free T 33.8 ng/dl
Tru-T Free T 39.48 ng/dl
SHBG 16
Albumin 4.2

TT 1238
Direct Free T 27.1 ng/dl
Tru-T Free T 36.9 ng/dl
SHBG 21
Albumin 4.5

1 Like