It’s great to see people posting actual scientific data and not just the “we say take lots of T and lots of thyroid and you’ll be good as new, prove me wrong… oh, you can’t? See, I’m right” that we hear here a lot. So thanks for that @readalot
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Haha, I’m sure there’s a whole lot more if you keep digging.
As a side note… I’m the other weird one with SHBG comparable to BKB’s, I was at 151 just before starting TRT and, I believe, even higher than that a few months prior. I literally had “high” total T and a “low” free T on the same test, but I didn’t test SHBG then because I didn’t know what I was doing. 6 months later I had gone down further on both tests, so I was at least “normal” and low at the same time, not high and low.
Simultaneous high and low, that’s gotta be a first! Haven’t heard that before, bro — that is so nuts. The human body is such a complex thing.
Big thanks to finasteride for making it possible
Lol, finasteride and ketogenic diets out here ruining lives!
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As you probably know, the “direct” RIA free T is trash and only a windsock for what the true free T level is. But alot of doctors are comfortable with it since it gives them an indication of where a guy is (not on an absolute scale, but on a relative scale, relative to the true scale). A lot of guys (rightfully so) are completely confused by this as the RIA test correlates with free T but actually isn’t measuring free T. It will read only a fraction of the gold-standard dialysis free T test and has its own reference range. I have spent countless hours discussing free T, total T and SHBG relationship and the current online calculators (Tru-T vs Vermeulen). The CDC is currently working on a harmonization program so that reference labs all get the same number for Total T, free T, SHBG, etc.
In your case, you had high high SHBG and hence your TT was “high” while measured free T using RIA “direct” method was low (if I understand you correctly). In reality, I argue with the other nerds on if we actually really know what the true free T is. I tend to gloss over this unless someone really wants to know.
High SHBG guys are truly screwed unless they have a PhD in this stuff or have a Dr. who is truly knowledgeable on all this. Look at your calculated free T using the two quickly available online calculators if you don’t have a doctor who orders equilbrium dialysis free T:
The Tru-T calculator bills itself as the second coming of you know who but typically overestimates dialysis results by 50% up to 100%. Vermeulen (the first calculator) typically over by 10-20%. So in reality, you were probably closer to 5-6 ng/dL on free T going by the empirical comparisons of Vermeulen calculations vs dialysis free T data. The direct RIA free T test you shared above is 7.2 pg/mL or 0.72 ng/dL. 0.72 / 6 = 12% and 0.72/5 = 14.4%. So direct RIA method comes out about 12-14% of what the actual dialysis number would be which is about par for the course with this assay.
In summary, a poor guy with high SHBG:
Total T = 1077 ng/dL
SHBG = 151 nmol/L
- “Direct” RIA free T comes back = 0.72 ng/dL (0.067% of total T)
- Calculated free T by Vermuelen = 7.57 ng/dL (0.7% of free T)
- Calculated free T by Tru-T = 25.3 ng/dL (2.35% of free T)
- Actual free T as measured by equilibrium dialysis probably 5-6 ng/dL (0.46-56% of free T)
So what’s the average guy to do if he really wants to understand his free T status? You can even argue about the validity of indirect vs direct equilbrium dialysis measurements and which one is correct if they don’t match. In short, it gets complicated.
EDIT: as I posted below, if you take the RIA result and multiply by 6.7:
0.72 ng/dL * 6.7 = 4.8 ng/dL which is very close to the range of 5-6 ng/dL I estimated would be shown via equilbrium dialysis. So if you want to convert your free T (via direct RIA) number to what it would be if your physician actually had ordered an appropriate test, then multiply by 7 not 10.
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I tried to use the TruT calculator somewhere along the way and it always had super high results so I always wondered about that. Good to hear you agree it’s way off, esp for high SHBG situations. The first one is at least in the ballpark of my free T test results so I guess that’s a good thing. Either way… pretty interesting stuff.
One note: Labcorp has the units screwed up on that particular test, so it’s really 7.2ng/dl
Thanks for bringing this up. Many try to rationalize this and I completely understand why. I understand why you say that but the units aren’t screwed up. Those are the actual units.
Example report:
Guys decided to shift the scale by 10 to try and make sense of the results. You can go over to Excel male and see the endless walls of text me and another guy spent on that. Labcorp would not screw up the units on the test. As you dig into the bowels of the organization, you have people who understand this very well. Yes, a quick rule of thumb is to multiply the results by 10 or change the units from pg/mL to ng/dL but technically this is not correct. If you plot the direct RIA free T data against dialysis data they will be correlated but not a parity correlation with slope of 10 and no intercept. In reality the slope is typically 5-7.
In recent years, the RIA method has been criticized by
some experts as inaccurate due to substantial numerical
discrepancies between RIA and EqD results, and too heavily
influenced by either TT [7] or by SHBG [8]. The numerical
differences lead to confusion in interpreting clinical results
and can complicate efforts to establish biochemical standards
for the diagnosis of TD. Based on these issues, some experts
advocate that the RIA method should not be used in clinical
care and that conclusions of previous research studies
utilizing the RIA method may not be valid [9]. Nonetheless,
RIA remains in widespread use and some authors have argued
it provides clinically meaningful information in men when
interpreted using an assay-specific reference range [10].
Currently, there is a paucity of data directly comparing the
two methods against the gold standard in a clinical population
of men. Our goal in this study is to examine the relationships
between RIA, cFT, EqD, and TT in a population of men
presenting to an outpatient andrology clinic.
Wow, that is pretty shocking, good to know
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Good lord… guy with a FT of 350pg/ml. Supreme genetics to the max
I’d probably need around 200mg IM test Cyp/wk to reach a FT of 350pg/ml.
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Just a regular ole TRT protocol 
. What was the thread where they were coming up with new names for these types of TRT?
Can’t say I’m familiar, brother. I know it sounds unreasonable, but I’ve just accepted my body — with SHBG so high — is an outlier. I could be deceiving myself, but an unusual approach seems warranted.
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The most powerful drug on earth to lower SHBG is Stanozolol, but nasty powerful side effects
I’ve flirted with Winnie and tried Danazol, which worked for lowering SHBG but didn’t really impact the way I felt. I know taking exogenous T is already somewhat rolling the dice in terms of long-term health (not that I’m too concerned about it), so I’m hoping to minimize the number of compounds I’m taking.
Just feels like the more stuff you introduce, the more you risk, you know? Winnie/Danazol doesn’t seem like a long-term solution.
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I agree 100%
Excellent. And most dont understand that oxandrolone or stanozolol or danazol will drop your shbg but you wont come ahead in terms of free T despite all the misinformation out there. I’ve reviewed this in detail on here.
My thread referred to above was not with someone like you in mind. Keep up the great work with the body recomp!
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I didn’t write that thread with guys like @bkb333 in mind. But for most, your point is well taken.
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Thank you for taking the time to clarify. Got it. @bkb333 started (pre-TRT) at free T ~5-7 ng/dL from what I gathered above. With his initial astronomically high SHBG, he really pushed his Test dosage to increase free T. His SHBG has come down markedly. So key question now would be if lower dosages than 200 mg/week equivalent would continue to hold down his SHBG and put his free T in a position to resolve symptoms. He mentioned he feels much better at these high levels (~40 ng/dL free T) you cite above @wanna_be. He appears to understand what blood markers to look out for when running these on paper “supra” dosages. In a perfect world I’d be curious how he felt on free T levels of 15, 20, 25, 30 ng/dL but that would require methodical work. @bkb333 have you scanned this space between 15-30 ng/dL on free T? My apology if you have covered this in detail above. I see in the middle of this whole thread where the balance between performance and longevity was discussed.
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