High SHBG

[Gman86]

Maybe slightly off topic (I apologize to the OP if it is) but how accurate have you found this calculator to be? Ive had over 20 blood tests done since starting TRT a few years ago. I ran about 10 of them through this calculator and a few were accurate, and the others were way off. The ones that were off, my FT was always considerably lower on my bloodwork than on the calculator. My SHBG has remained the same.

Very interesting. I LOVE guys like you that verify things through bloodwork. It really progresses TRT forward at a faster rate. I mean just look what one guy figured out due to being a bloodwork fanatic, much like myself. Imagine how quickly we would learn if more people were using their bloodwork(s) in this way. Sounds to me like it’s pretty conclusive that estimated free T is usually off, and usually overestimates. Unless other guys can verify that their free T is mostly higher than when they run their numbers through a calculator.

Is all free T calculators the same? As in do they all give the same free T result?

 

[Vince Carter]

Uhhh...well prior to starting TRT my SHBG was 75. I was placed on a every 3.5 day protocol. The theory was it would lower my SHBG.
And this whole, “high SHBG guys need one or two large doses” is not always correct.

It only lowered my SHBG down to about 65. Not a significant amount at all.

And...those larger doses coupled with hCG shot my E2 up to 75.

I then went to M-W-F protocol and lower doses and ditched the HCG. That lowered my E2 down to the high 30’s. My SHBG is still in the 60’s.

I am now doing EOD injections. Blood work will tell the story, but so far each time I moved to more frequent doses, my overall well-being has improved.

It gets kind of tiring to hear high SHBG guys always need one or two large doses and this will fixed your SHBG issues.

Small issue on this forum is how many of the guys speak in absolutes about things they know little about.

 

[fifty]

Hah that is true. Everyone thinks everyone else is the same as them and their case study of 1 is more pertinent than some studies or doctors who see 1000s of patients. I am guilty of this too.

 

[ta406]

Very interesting. I LOVE guys like you that verify things through bloodwork. It really progresses TRT forward at a faster rate. I mean just look what one guy figured out due to being a bloodwork fanatic, much like myself. Imagine how quickly we would learn if more people were using their bloodwork(s) in this way. Sounds to me like it’s pretty conclusive that estimated free T is usually off, and usually overestimates. Unless other guys can verify that their free T is mostly higher than when they run their numbers through a calculator.

Is all free T calculators the same? As in do they all give the same free T result?

I’ve only found a couple of calculators online and they have all givin me the exact same results.

 

[Gman86]

So I decided to check my free testosterone results, on a couple of my blood tests, versus what a free T calculator would say I had for free T. I got the same exact results as ta406. The calculator vastly overestimates. Like insanely overestimates, in my experience at least.

But I don’t think that matters. Most people aren’t getting their free T numbers from these online calculators. They are usually getting a direct free T through their lab. And even if their lab is using a calculated free T, opposed to direct, I would assume their way of calculating it is more advanced than these online calculators.

 

[Gman86]

Hah that is true. Everyone thinks everyone else is the same as them and their case study of 1 is more pertinent than some studies or doctors who see 1000s of patients. I am guilty of this too.

Exactly. It’s all about everyone working together to compare blood work and anectodal stories/ experiences to find common themes. Then you mix in top doctors chiming in, that have access to hundreds, if not thousands of patients blood works and experiences, and that’s when the real progress happens. It’s all about working together. Definitely can’t take one person’s experience as gospel.

 

[RPellerin]

Uhhh...well prior to starting TRT my SHBG was 75. I was placed on a every 3.5 day protocol. The theory was it would lower my SHBG.
And this whole, “high SHBG guys need one or two large doses” is not always correct.

It only lowered my SHBG down to about 65. Not a significant amount at all.

And...those larger doses coupled with hCG shot my E2 up to 75.

I then went to M-W-F protocol and lower doses and ditched the HCG. That lowered my E2 down to the high 30’s. My SHBG is still in the 60’s.

I am now doing EOD injections. Blood work will tell the story, but so far each time I moved to more frequent doses, my overall well-being has improved.

It gets kind of tiring to hear high SHBG guys always need one or two large doses and this will fixed your SHBG issues.

BigBamBoo,
I am in a very similar situation.
Do you feel any better with EOD injections?
My SHBG has gone from 92 to 67 in 7 months and I don't feel any different.
175mg once a week is causing problems with my E2 and HCT so I am considering more frequent injections.
Won't be making the final decision until I get labs in 3 weeks.

 

[madman]

Maybe slightly off topic (I apologize to the OP if it is) but how accurate have you found this calculator to be? Ive had over 20 blood tests done since starting TRT a few years ago. I ran about 10 of them through this calculator and a few were accurate, and the others were way off. The ones that were off, my FT was always considerably lower on my bloodwork than on the calculator. My SHBG has remained the same.

Equilibrium dialysis is considered the gold standard (Endocrine Sciences) by which all other methods are compared against regarding accuracy of Free Testosterone

500726: Testosterone, Free, Mass Spectrometry... | LabCorp


All other methods whether direct analog immunoassay, Calculated Free T whether Law of mass action (Nanjee and Wheeler, Sodergard, Vermeulen), Empiric formulas (Ly, Sartorius), FAI (Free Androgen Index) all have there flaws.

Out of all the methods I just listed direct analog immunoassay is not recommeneded is it is considered inaccurate by the Endocrine Society.

When using Equilibrium Dialysis (gold standard) and comparing Calculated Free T Methods Law of Mass Action (Nanjee and Wheeler, Sodergard, Vermeulen) although the Vermeulen has been shown to overestimate it is provides the most robust results.....hence it is the one used by most of the Labs (Labcorp).....all Labs in Canada as of the past few years (Canada used to use the direct analog immunoassay which was replaced by the Calculated Free T Law of mass action (Vermeulen method) due to the direct analog immunoassay being inaccurate.

140226: Testosterone Free, Profile I | LabCorp


If I had a choice I would be getting the equilibrium dialysis everytime over the calculated and definitely over the direct analog immunoassay (which is no longer recommended).

Especially in cases of altered SHBG levels.



Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials

 

[madman]

So I decided to check my free testosterone results, on a couple of my blood tests, versus what a free T calculator would say I had for free T. I got the same exact results as ta406. The calculator vastly overestimates. Like insanely overestimates, in my experience at least.

But I don’t think that matters. Most people aren’t getting their free T numbers from these online calculators. They are usually getting a direct free T through their lab. And even if their lab is using a calculated free T, opposed to direct, I would assume their way of calculating it is more advanced than these online calculators.[/QUOTE]


When it comes to Calculated Free T most labs use the Law of mass action Vermeulen method

Same calculater accesable online to the general public.....Morgentaler wrote a recent paper which I posted previously mentioning this and listing the website


Free & Bioavailable Testosterone calculator



This is the only calculated method I am aware of that is recommended.....it is not some childish tool!

 

[Gman86]

Equilibrium dialysis is considered the gold standard (Endocrine Sciences) by which all other methods are compared against regarding accuracy of Free Testosterone

500726: Testosterone, Free, Mass Spectrometry... | LabCorp


All other methods whether direct analog immunoassay, Calculated Free T whether Law of mass action (Nanjee and Wheeler, Sodergard, Vermeulen), Empiric formulas (Ly, Sartorius), FAI (Free Androgen Index) all have there flaws.

Out of all the methods I just listed direct analog immunoassay is not recommeneded is it is considered inaccurate by the Endocrine Society.

When using Equilibrium Dialysis (gold standard) and comparing Calculated Free T Methods Law of Mass Action (Nanjee and Wheeler, Sodergard, Vermeulen) although the Vermeulen has been shown to overestimate it is provides the most robust results.....hence it is the one used by most of the Labs (Labcorp).....all Labs in Canada as of the past few years (Canada used to use the direct analog immunoassay which was replaced by the Calculated Free T Law of mass action (Vermeulen method) due to the direct analog immunoassay being inaccurate.

140226: Testosterone Free, Profile I | LabCorp


If I had a choice I would be getting the equilibrium dialysis everytime over the calculated and definitely over the direct analog immunoassay (which is no longer recommended).

Especially in cases of altered SHBG levels.



Challenges in Testosterone Measurement, Data Interpretation, and Methodological Appraisal of Interventional Trials

Amazing post. Love learning new things like this. Would of probably never known about these differences if it wasn’t for you, so thanks madman for that.

So you’re right, labcorp does offer both the direct and calculated by Vermeulin Equation. But I don’t think anyone is getting the calculated. The reference range for direct is (6.8−21.5) for 40-49 year old men. This is roughly the reference range we see with labcorp. With the labcorp test done by Vermeulen Equation the reference range is
(30.3–183.2) for a 41-50 year old man. I’ve never seen someone have this reference range with their free T when using labcorp.

So even though labcorp offers the calculated free T by Vermeulin Equation, do you think anyone’s actually getting that version done? Seems like everyone’s getting the direct free T from labcorp. And you would probably recommend guys to switch over to the calculated free T test by Labcorp I would assume, correct?

 

[Gman86]

So I just used that calculator you linked, and here are my results compared to my quest results

Labs on 7-9-18
Quest free 13.88 ng/dl
Calculated free 22.4 ng/dl

Quest Bio 303 ng/dl
Calculated Bio 561 ng/dl

Labs on 8-24-18
Quest free 20.16 ng/dl
Calculated free 32.2 ng/dl

Quest Bio 397 ng/dl
Calculated Bio 756 ng/dl

Labs on 10-23-18
Quest free 23.08 ng/dl
Calculated free 36.6 ng/dl

Quest Bio 484 ng/dl
Calculated Bio 915 ng/dl


So it seems like there's a pretty big difference between quest's results and the online calculator, at least for me. It also clearly overestimates, again at least for me.

 

[BenM]

Interesting, I just used the calculator linked above (Free & Bioavailable Testosterone calculator)

My latest bloodwork has:
- Total Test 35.1 nmol/L
- SHBG 69 nmol/L
- Albumin 41 g/L
- Calculated FTe 517 pmol/L

If I'm using the calculator correctly, it gave me a calculated free testosterone number of 0.522 nmol/L = 1.49 % which isn't much different than 517 pmol/L if the online conversion I used is correct?

 

[BigBamBoo]

BigBamBoo,
I am in a very similar situation.
Do you feel any better with EOD injections?
My SHBG has gone from 92 to 67 in 7 months and I don't feel any different.
175mg once a week is causing problems with my E2 and HCT so I am considering more frequent injections.
Won't be making the final decision until I get labs in 3 weeks.

Yes, I feel much more...linear. Less mood swings. And when I was on every 3.5 day injections my E2 skyrocketed and thankfully my high SHBG kept most of the symptoms in check.
No emotional problems, etc. But I did have acne issues, oily skin, bloating and water retention,etc.

Once I went on M-W-F protocol and dropped the HCG I lost 10+ lbs., acne went away, mood leveled out etc.

And now on the EOD protocol, I feel even more “stable”.

 

[Gman86]

Interesting, I just used the calculator linked above (Free & Bioavailable Testosterone calculator)

My latest bloodwork has:
- Total Test 35.1 nmol/L
- SHBG 69 nmol/L
- Albumin 41 g/L
- Calculated FTe 517 pmol/L

If I'm using the calculator correctly, it gave me a calculated free testosterone number of 0.522 nmol/L = 1.49 % which isn't much different than 517 pmol/L if the online conversion I used is correct?

Ya I just input your numbers, and it gave me the same results, which are basically identical to your calculated free T number from your bloodwork. So for you it's definitely spot on. Very interesting.

 

[fifty]

Do the calculators work for labcorp value but not quest? Quest numbers make no sense to me.

 

[Gman86]

Do the calculators work for labcorp value but not quest? Quest numbers make no sense to me.

You just have to make sure the measurement is the same when comparing values. For instance, quest uses pg/ml when measuring their free testosterone. Labcorp uses ng/dl. So just make sure the measurement is the same when comparing values. If not, they have converters on google. Just type in pg/ml to ng/dl converter, for example.

 

[fifty]

I don’t know if it’s that simple. I have seen quest labs that say pg/ml and the ranges and values are quite different to labcorp which also list pg/ml.

 

[fifty]

Quest
Reference Range(s)
AdultMales 18-69yrs (pg/mL) 46.0-224.0
Testosterone, Free (18944)

Labcorp
20 to >59yrs (pg/mL) 6.6-26.5
144980: Testosterone, Free, Direct | LabCorp

 

[Gman86]

I don’t know if it’s that simple. I have seen quest labs that say pg/ml and the ranges and values are quite different to labcorp which also list pg/ml.

Ya you’re probably right. Different labs could also just have different methodologies in which they do their testing, which can result in different results all together I would imagine.

 

[BenM]

Ya I just input your numbers, and it gave me the same results, which are basically identical to your calculated free T number from your bloodwork. So for you it's definitely spot on. Very interesting.

Thanks for the confirmation - good to know.

Based on that my free test number would probably be considered low by some! It's actually at the very high end of the reference range provided by the lab here (reference range is 91-579 pmol/L). Labs before this I was a little higher at 590 pmol/L.

My endocrinologist doesn't think free testosterone or SHBG matters much (sigh)... but he is happy enough with these numbers and hasn't asked me to reduce dose (I don't have any negative side effects or E2 issues that I've noticed, touch wood).... if anything I'd like to bump it up a touch.