Free T level

[Joe I]

I just got my first blood work back since starting testosterone. My free t went from 28.1 to 319.8! Is that possible?

 

[Systemlord]

I just got my first blood work back since starting testosterone. My free t went from 28.1 to 319.8! Is that possible?

Well you increase your testosterone on TRT, so yes it's possible.

 

[Joe I]

Well you increase your testosterone on TRT, so yes it's possible.

This is free t, not total t, my total t did go up from 134 to 926.

 

[FunkOdyssey]

I just got my first blood work back since starting testosterone. My free t went from 28.1 to 319.8! Is that possible?

Of course it is possible. You're injecting testosterone! What is your protocol as far as dosage and frequency, and when did you take these labs in relation to your last dose / next dose?

 

[Systemlord]

This is free t, not total t, my total t did go up from 134 to 926.

A bit of context, when are you testing labs in relation to your injections?

Mid way between your injections versus trough levels can see a big difference in hormone levels.

If these are trough levels, right before your injections, once weekly, your peak has got to be somewhere in the 1500ng/dL range.

 

[madman]

I just got my first blood work back since starting testosterone. My free t went from 28.1 to 319.8! Is that possible?View attachment 44593

Increasing your TT drives up your free testosterone, estradiol and DHT!

This is a given!

You basically drove your FT through the roof off the hop!

Atleast you had your FT tested using what would be considered the most accurate assay (Equilibrium Dialysis).

Where does your SHBG sit and post up labs for RBCs, hemoglobin and hematocrit.

Big question here is what is your protocol (dose of T/injection frequency) and how many days were labs drawn after your injection?

We always want to test at the true trough (lowest point) before your next injection.

If your labs were done at the true trough then your FT roughly 32 ng/dL is very high which means your peak TT, FT and estradiol will be even higher and may very well be absurdly high depending on your injection frequency.

Big difference between one hitting a very high trough FT 30 ng/dL injecting once weekly vs every 3.5 days vs EOD or daily!

This needs to be kept in mind when looking at where your trough FT sits.

 

[madman]

This is free t, not total t, my total t did go up from 134 to 926.

With a high-end TT 926 ng/dL and very high FT almost 32 ng/dL I would say you have low SHBG.

 

[Joe I]

Increasing your TT drives up your free testosterone, estradiol and DHT!

This is a given!

You basically drove your FT through the roof off the hop!

Atleast you had your FT tested using what would be considered the most accurate assay (Equilibrium Dialysis).

Where does your SHBG sit and post up labs for RBCs, hemoglobin and hematocrit.

Big question here is what is your protocol (dose of T/injection frequency) and how many days were labs drawn after your injection?

We always want to test at the true trough (lowest point) before your next injection.

If your labs were done at the true trough then your FT roughly 32 ng/dL is very high which means your peak TT, FT and estradiol will be even higher and may very well be absurdly high depending on your injection frequency.

Big difference between one hitting a very high trough FT 30 ng/dL injecting once weekly vs every 3.5 days vs EOD or daily!

This needs to be kept in mind when looking at where your trough FT sits.

I'm on 50mg twice a week Sunday morning and Wednesday afternoon, the test was done on Wednesday morning prior to my injection. I inject sub q in my stomach. Is it possible the lab made a mistake? This Dr my pcp didn't order any other labs, I'm see ING a Urologists in a few weeks who will do all the proper labs.

 

[FunkOdyssey]

I'm on 50mg twice a week Sunday morning and Wednesday afternoon, the test was done on Wednesday morning prior to my injection. I inject sub q in my stomach. Is it possible the lab made a mistake? This Dr my pcp didn't order any other labs, I'm see ING a Urologists in a few weeks who will do all the proper labs.

Yes, it is. I don't trust that Quest equilibrium dialysis test anymore. My results have been implausible multiple times now. Get your SHBG level next time so you can calculate your free T with the Vermeulen formula. That's been more consistent in my experience, and it is also the de facto standard that other men are using: better for apples to apples comparisons.

 

[madman]

I'm on 50mg twice a week Sunday morning and Wednesday afternoon, the test was done on Wednesday morning prior to my injection. I inject sub q in my stomach. Is it possible the lab made a mistake? This Dr my pcp didn't order any other labs, I'm see ING a Urologists in a few weeks who will do all the proper labs.

Your labs were done at roughly the true trough which means your peak TT, FT and estradiol will be higher.

Make sure to post a more thorough set of labs when you get them done so we can see where your SHBG, estradiol, RBCs, hemoglobin and hematocrit sit.

Critical point here:

*A diligently conducted equilibrium dialysis assay accurately measures free testosterone

Yes there could be a lab error even when using what would be considered the most accurate assay the gold standard Equilibrium Dialysis as this method is technically demanding/subject to various sources of error and most importantly as of now none of the currently available ED assays are standardized.

*Potential pitfalls of ED are that (a) a membrane or seal may break during the pipetting, resulting in a contamination of the dialysate with a protein-bound analyte; (b) as FH is distributed between the 2 chambers, the equilibrium between protein-bound and FH is continuously reestablished (in the chamber containing biological samples) with new fractions of FH released from the carrier proteins to compensate for the FH migrated into the dialysis buffer; this may result in overestimation of the FH concentration; and (c) some hormones are stable in biological samples while bound to the carrier proteins and may get adsorbed by the surfaces when present in solution in a free form (in the dialysis buffer), resulting in underestimation of the FH concentration.


Also keep in mind not all ED devices are the same.

Some ED devices have even been shown to underestimate FT when compared against “true” value-assigned certified reference materials and gold-standard reference methods.

This will be coming to an end soon enough as the CDC has been working on a standardized FT assay.

This is why we need a standardized free testosterone assay!

*Because FHs are present in biological samples in trace concentrations, highly sensitive and specific methods are required for accurate measurement of FH concentrations

*Assays that are standardized are designed to provide accurate results, traceable to “true” value-assigned certified reference materials and gold-standard reference methods

*Results obtained using standardized methods can be compared across assays, institutions, populations, and past and future test results, thereby improving diagnosis, treatment, and outcomes of patients

If anything for the time being always use the same lab/same assay (most accurate) and if in doubt repeat the test.

Otherwise you would need to use/rely upon the linear law-of-mass action cFTV.

Also keep in mind as of now cFTV tends to overestimate slightly when compared against a standardized Equilibrium Dialysis assay.

To calculate your FT you need to know your TT, SHBG and Albumin.

The calculator is available online for free!

Free & Bioavailable Testosterone calculator

For the most part from what I have seen on here cFTV tends to overestimate slightly when compared against Quest's ED assay although I have seen numerous cases where Quest's ED assay was out to lunch!

Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods - Excel Male TRT Forum

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