218 Testosterone But Doc Says not Hypogonadism

River Rat said:

Thanks. I am not sure why New York does not allow individuals to order tests through Defy. If I am willing to pay, what is the issue. I am very puzzled as how the dr can say I do not have hypogonadism with multiple total testosterone tests of 218 and 228. Just because my Bioavailable T is 59, the Dr says I do not have hypogonadism. I really do not understand how this works. If total testosterone is 228 and Bioavailable is 59, what would a best guesse of my SHBG. I found a SHBG calculator and it calculated a SHBG of around 60 which is high. I was thinking my SHBG would be low.

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Because NY is a socialist nanny state chit hole that knows what's best for you. Just a guess

You should be able to use services offered here or Life Extension, but better yet, contact the NY doc recommended and take it from there.

While i life in NJ I had tests done in NJ and NY (ordered by Defy) and never had a problem at all.

So I just spoke with the folks at Defy and sent them all of my labs. The gentlemen on the phone was very nice and did state the NY might be difficult as far as labs go but I will give it a try.

They told me the same (probably other patient feedback). The Labcorp one on 65 Broadway never even blinked when I handed in my order.

River Rat said:

I have hesitated as I believed that Defy could not order labs in New York State. Based on a previous comment, this might not be true. I am going to see if LabCorp will run labs ordered from Defy.

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Dude, I live in NYC and use Defy and get blood work all the time so please stop bringing this up.

frankwhite said:

Dude, I live in NYC and use Defy and get blood work all the time so please stop bringing this up.

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Real nice. Just looking for help and stating exactly what was told me from 2 different staff members from Defy within the past week. I thought this was a public forum to obtain help and advice. Just sharing information...

River Rat said:

I will call Labcorp tomorrow to see if they will draw blood based on Defy Lab orders. I am not sure who I spoke with at Defy but they said I would have to go to a neighboring state.

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IMO I would try NY first, if Labcorp refused then I would go to a neighboring state.

I have read the legal case NY filed against DirectLabs, I don't think it would apply do Defy as they are Doctors and the tests they order are within the scope of their work

New York case against DirectLabs.

https://ag.ny.gov/sites/default/fil...e/new/2015-10-6_DirectLabs_AOD_15-168_ERC.pdf

Now if New York had some law against telemedicine, that would be more applicable to your concern.


I would never accept the words of someone I called at a place like Labcorp (or any big business, which includes Defy) to be reliable on any sort of legal matter, you are talking to some clerk that honestly has no what they are talking about. You are asking questions outside of their limited expertise.


When you get to the point where Defy is going to order the tests, then you will find out if they will order from NY or not. I assume they will, then go to labcorp, don't ask foolish questions of the clerk signing you in (like is this legal?) and just try it and see how it goes.

If for some strange reason labcorp doesn't want to draw blood, then contact Defy and go to another state.

Or better first try another LabCorp location > as said no problems NY Downtown
(or the one time I went to NJ - Defy cautioned me about NY and NJ and never had any problem)

I live in NY and have had it go both ways. Labcorp accepted me twice then denied me after that at the same location. I now have to go to CT for labs. It seems to be at the discretion of the individual location.

So does anyone have logical reason why my Total T is 218 (low) but my Bioavailable is 59 (low normal). I would think that my Bioavailable would be low as well.

River Rat said:

So does anyone have logical reason why my Total T is 218 (low) but my Bioavailable is 59 (low normal). I would think that my Bioavailable would be low as well.

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Yes the Total T <> Free T relation is influenced by i.e. the SHBG for me my T on TRT is 915 (Top of Range) but my Free T is 15 (not even middle of Range - different range than from your lab obviously)
http://www.issam.ch/freetesto.htm
The lower the SHBG the higher the Free T (everything else being equal)

blitzen said:

They told me the same (probably other patient feedback). The Labcorp one on 65 Broadway never even blinked when I handed in my order.

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That's the location I use. Never refused me.

blitzen said:

Yes the Total T <> Free T relation is influenced by i.e. the SHBG for me my T on TRT is 915 (Top of Range) but my Free T is 15 (not even middle of Range - different range than from your lab obviously)
http://www.issam.ch/freetesto.htm
The lower the SHBG the higher the Free T (everything else being equal)

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Thanks for the information.

So I thought I would give everyone an update. I have sent my current labs to Defy and they are going to provide me with additional tests required.

I had my appointment with the Endocrinologist and was informed that even though my Testosterone was clearly low (218) on multiple occasions that my Bioavailable T (59) is within the normal range of (40-250). Therefore she would not prescribe T. Seeing that my Urologist has already prescribed T injections, I am going to resume testosterone injections and see if it helps make me feel better. I am going to proceed with getting Defy all my labs and get any additional required for them to give me on opinion on my TRT protocol of 100mg per week.

River Rat said:

So I thought I would give everyone an update. I have sent my current labs to Defy and they are going to provide me with additional tests required.

I had my appointment with the Endocrinologist and was informed that even though my Testosterone was clearly low (218) on multiple occasions that my Bioavailable T (59) is within the normal range of (40-250). Therefore she would not prescribe T. Seeing that my Urologist has already prescribed T injections, I am going to resume testosterone injections and see if it helps make me feel better. I am going to proceed with getting Defy all my labs and get any additional required for them to give me on opinion on my TRT protocol of 100mg per week.

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I didn't expect a different outcome, clearly the doctors within your insurance network are all of the same caliber. All three of my endos were evenly unskilled and clueless, you basically have to leave that network to access doctors of a different caliber. I'm certain we've discussed how direct measuring Free T has it's problems.

These doctors are not making decisions based on experience, but blindly following guidelines and are behaving as if they are robots. I bet they would still consider you normal if you were 5 points above the ranges. Zero critical thinking, the world isn't black and white, it has shades of grey.

Systemlord said:

These doctors are not making decisions based on experience, but blindly following guidelines and are behaving as if they are robots. I bet they would still consider you normal if you were 5 points above the ranges. Zero critical thinking, the world isn't black and white, it has shades of grey.

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I agree. I find it interesting that they require 2 lab tests indicating Low Total T but refused my treatment based on 1 Bioavailable T test that show I have a whopping 59. Why even waist the time and money on a total T test if she was not going to use the results as a basis of a diagnosis.

On a positive note, I am moving forward and not backwards.

River Rat said:

I agree. I find it interesting that they require 2 lab tests indicating Low Total T but refused my treatment based on 1 Bioavailable T test that show I have a whopping 59. Why even waist the time and money on a total T test if she was not going to use the results as a basis of a diagnosis.

On a positive note, I am moving forward and not backwards.

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Regardless of a good percentage of the idiotic gps/endos/uros there is a reason guidelines are in place.

What we have in this whole CESSPOOL of trt treatment is one end of the spectrum where the clueless gps/endos/uros are relying on reference ranges that no one can seem to agree upon what would truly be considered low t let alone reference ranges and on top of that denying trt to a patient because their testosterone is borderline low or low/normal even though the patient is clearly experiencing low t symptoms.

Than you have the other end of the spectrum full of the nut bars and CHARLATANS starting men on trt at insanely high doses and over prescribing aromatase inhibitors let alone treating men that have average to descent levels that really have no issue with low t and have other factors contributing to what they think are low t symptoms such as dysfunctional thyroid or adrenal glands, unhealthy lifestyles ( excess stress (mental/physical), lack of sleep. poor diet, obesity (excess body fat), abuse of alcohol/recreational drugs and so on.

So many men suffer from low t and have difficulty getting treated let alone finding a knowledgeable doctor and there are also many men whom want to jump on trt thinking testosterone is going to cure all their ailments when in fact it is not their testosterone levels causing them issues it is related to an unhealthy lifestyle or other health factors.

There are reasons why most doctors will want to test a patients total t more than once on different days in a fasted state in the early am.


There are inherent challenges in testosterone measurement due to:

- health status of patients at time of testing (acute illness)
- circadian rhythms in testosterone production
- intra-individual variability
- inconsistencies in the assays themselves

Scroll to end of page 17 and look over the beginning of page 18 and as far as inconsistencies in the assays scroll to end of page 13 and look over pages 14-16 and you will see what testing methods for various assays regarding total t, free t, estradiol are considered GOLD STANDARD and the variation in accuracy between different assays.



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Scroll to page 5 and look under heading- Technical remark.

Systemlord said:

I didn't expect a different outcome, clearly the doctors within your insurance network are all of the same caliber. All three of my endos were evenly unskilled and clueless, you basically have to leave that network to access doctors of a different caliber. I'm certain we've discussed how direct measuring Free T has it's problems.

These doctors are not making decisions based on experience, but blindly following guidelines and are behaving as if they are robots. I bet they would still consider you normal if you were 5 points above the ranges. Zero critical thinking, the world isn't black and white, it has shades of grey.

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You make some great points but do understand that that a great deal of the research studies in the literature regarding testosterone is done by highly respected and knowledgeable endocrinologists.

Eberhard Nieschlag, Hermann Behre, Michael Zitzmann, Shalendar Bhasin, Shehzad Basaria and Christina Wang to name a few!

Without the science/research where would we all truly be.

madman said:

Regardless of a good percentage of the idiotic gps/endos/uros there is a reason guidelines are in place.


Scroll to end of page 17 and look over the beginning of page 18 and as far as inconsistencies in the assays scroll to end of page 13 and look over pages 14-16 and you will see what testing methods for various assays regarding total t, free t, estradiol are considered GOLD STANDARD and the variation in accuracy between different assays.

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Thanks for the post Madman. Very good read and pretty informational. It further confirms that there are no hard and fast rules and the Drs need to use judgement in prescribing testosterone. its not a one size fits all..