High shbg, High total testosterone and low free testosterone

Eskopena1 · Saturday at 4:11 AM

Im a 27 year old male. I did hormone bloodtests. SHBG was 99 nmol/l, free testosterone 369 pmol/l and total testosterone 40,7 nmol/l. Im feeling fatigued and unmotivated all the time, what could be done to this?

madman · Saturday at 9:54 AM

Eskopena1 said:
Im a 27 year old male. I did hormone bloodtests. SHBG was 99 nmol/l, free testosterone 369 pmol/l and total testosterone 40,7 nmol/l. Im feeling fatigued and unmotivated all the time, what could be done to this?

You are hitting a high TT 1173.8 ng/dL (40.7 nmol/L) with very high SHBG but it is not a given that your FT would be low.

The only way to know where your FT level truly sits is to have it tested using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.

If you do not have access to such, highly doubtful if you live in the US than you would need to rely upon the linear law-of-mass action Vermeulen (cFTV).

Seeing as you are from Finland chances are you would need to use/rely upon the calculated method.

No one should be using/relying upon the known to be inaccurate direct immunoassays.

What method was used to test your free testosterone?

Always post the method used/reference ranges.

Although your TT inflated due to high SHBG if we use the linear law-of-mass action Vermeulen to calculate your FT with a high TT 1173.8 ng/dL, very high SHBG 99 nmol/L and Albumin 4.3 g/dL your FT 12.9 ng/dL would still be in a healthy range very close to where a healthy young male would sit cFTV 13-15 ng/dL.

Free & Bioavailable Testosterone calculator

Most healthy young males would be hitting a cFTV 13-15 ng/dL or better yet tested using the most accurate assay the gold standard Equilibrium Dialysis 10-12 ng/dL and this is a daily short-lived peak to boot!

Just keep in mind if you had your FT tested using the most accurate assay it may be slightly lower but even then you are most likely still hitting a FT above 10 ng/dL which would be just below the mean 12 ng/dL.

Now if you had it tested using the most accurate assay and your FT falls in what would be considered the grey zone 5-9 ng/dL than you may be one who struggles with low-T symptoms.

FT <5 ng/dL would be considerd low.

FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.

FT 10-15 ng/dL would be healthy.

FT 20-25 ng/dL would be high-end/high.

Top-end FT 25 ng/dL would for those OUTLIERS that sit in the 95th PERCENTILE and again this is a DAILY SHORT-LIVED PEAK to boot!

The daily trough would be 20-30% lower!

Dr. Morgentaler who is considered the father of testosterone with decades of experience (research/clinical experience) in the field would treat a man with symptoms of T deficiency and a FT<10 ng/dL.

With all that being said you still need more thorough blood work which would include estradiol, DHT, prolactin, LH/FSH, PSA, full thyroid panel, 4 point cortisol, VIT D, DHEA, lipids, CMP, CBC and iron/ferritin.

Top it off that any dysfunction thyroid/adrenals can easily mimic low-T symptoms.

Need to look into this deeper before jumping to any conclusions here!

Thread 'Age-stratified reference ranges for directly measured (ED LC-MS/MS) serum free testosterone in healthy men'

May 11, 2024

Just to be clear up any confusion this is Fiers camps data for mFT reference ranges not the harmonized reference range being worked on by the CDC.

*Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies

* mFT levels were measured in 867 men using ED LC-MS/MS as previously reported (1). Subsequently, 95% reference ranges were determined using the non-parametric method

Reference: 1. Fiers T, Wu F, Moghetti P, Vanderschueren D, Lapauw B, Kaufman JM. Reassessing Free-Testosterone...

*Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies

* mFT levels were measured in 867 men using ED LC-MS/MS as previously reported (1). Subsequently, 95% reference ranges were determined using the non-parametric method

Reference: 1. Fiers T, Wu F, Moghetti P, Vanderschueren D, Lapauw B, Kaufman JM. Reassessing Free-Testosterone Calculation by Liquid Chromatography–Tandem Mass Spectrometry Direct Equilibrium Dialysis. J Clin Endocrinol Metab. 2018;103(6). doi:10.1210/jc.2017-02360

We present 95% mFT age-stratified reference ranges. These reference ranges show an expected, decreasing trend of mFT with aging. Lower limits and median mFT decrease at a remarkably stable rate of, on average, 12% per decade up into the 6th decade of life. However, in the upper limit, a marked decrease of 25% occurs after 39 years, followed by smaller decreases of 6% per decade in older age categories.

Age category (years)	Median mFT (ng/dl)	95% mFT reference range (ng/dl)
18-29 (n=140) 30-39 (n=252)	12.0 9.8	6.7-25.3 4.9-18.5
40-49 (n=207)	8.1	4.3.14.2
50-59 (n=146)	7.1	3.8-12.8
60-69 (n=126)	6.4	3.4-11.7
70-79 (n=125)	5.6	2.7-8.7

Conclusion

We have determined mFT reference ranges in healthy men aged 25 to 79. These reference ranges are a first step to improving the framework for further development and integration of free testosterone measurements and calculations in clinical practice.

Thread 'Importance of free testosterone measurement in assesssing androgen disorders'

Jun 15, 2025

As usual Nelson's house is where it's at!

Importance of free testosterone measurement in assessing androgen disorders

Thursday, March 27, 2025 at 1:00 PM Eastern Daylight Time.

event.on24.com

Testosterone imbalances affect men, women, and children differently. In males, testosterone deficiency (hypogonadism) can lead to low libido, fatigue, and muscle loss, while excess may contribute to aggression and cardiovascular risks. In females, testosterone excess (hyperandrogenism), often associated with polycystic ovary syndrome (PCOS) or adrenal disorders, can cause excess hair growth, weight gain, and menstrual irregularities. In children...

Eskopena1 · Sunday at 5:00 AM

Thanks for the answer!

I believe the free testosterone was calculated using Andersons method.

Free testosterone reference range at the lab I did the bloodwork: 220-800 pmol/l
Total testosterone reference range: 9.2-31.8 nmol/l
SHBG reference range: 18-54 nmol/l

I have bloodwork from 6 months to 1 year ago, the bloodwork were:

FSH: 7.4 U/l, reference range: 1.5-12.4 U/l

T4-V: 13,0 pmol/l, at some point it was 20.1 pmol/l. Reference range: 9-19 pmol/l

E2: 0,10 nmol/l, reference range: 0.15 nmol/l upper limit

LH: 3,4 U/l, reference range: 1-9 U/l

Ferritin: 127 ug/l, reference range: 30-195 ug/l

TSH: 1,6 mU/l, reference range: 0,4-4.5 mU/l

D vitamin: 154,98 nmol/l, reference range: lower limit: 50 nmol/l

Cortisol 2 years ago: 302 nmol/l, reference range: 133-540 nmol/l

Do you think there is a need to lower the shbg level?

Vince · Sunday at 2:57 PM

Thread 'Does magnesium decrease SHBG?'

May 7, 2024

Does magnesium decrease SHBG?

Magnesium binds SHBG in a nonspecific mode, leading to an uncompetitive inhibition with T in binding SHBG and to a subsequent enhancement of Bio-T availability. The binding is accompanied by a magnesium release (or uptake) with a corresponding heat effect around in magnitude 17 kJ/mol [92].Mar 3, 2014

National Center for Biotechnology Information › pmc