IS THIS LOW FREE T

[whiting1986]

High guys. So I got my recent blood tests back from Endo.

He says my levels are fine but wanted to run through this forum to see if he's talking BS.

TT is 18.2 nmol/L or 525 ng/dL
FT is 0.25 nmol/ L or 7 ng/dL

I have got high SHBG which is at 62 nmol/L


Symptoms are....
No libido
No drive in life
Low mood
Anxiety has reduced a lot over the last few months.

Supplement stack...creatine, collegen with biotin, folinic acid(have COMT) hydroxy B12(have MTHFR) vit d3 with k2 4000iu

Diet is mostly animal based so beef patties, lots of eggs, avacados, feta cheese, chicken breast, sweet patatoes, natural yoghurt ans nuts, etc.


I would love to get people's Thoughts and there experiences with high shbg and low FT That's if mine is low.

I think I have tried almost everything to lower it and raise it so any input would be great thanks in advance

 

[FunkOdyssey]

High guys. So I got my recent blood tests back from Endo.

He says my levels are fine but wanted to run through this forum to see if he's talking BS.

TT is 18.2 nmol/L or 525 ng/dL
FT is 0.25 nmol/ L or 7 ng/dL

I have got high SHBG which is at 62 nmol/L


Symptoms are....
No libido
No drive in life
Low mood
Anxiety has reduced a lot over the last few months.

Supplement stack...creatine, collegen with biotin, folinic acid(have COMT) hydroxy B12(have MTHFR) vit d3 with k2 4000iu

Diet is mostly animal based so beef patties, lots of eggs, avacados, feta cheese, chicken breast, sweet patatoes, natural yoghurt ans nuts, etc.


I would love to get people's Thoughts and there experiences with high shbg and low FT That's if mine is low.

I think I have tried almost everything to lower it and raise it so any input would be great thanks in advance

My original pre-TRT labs a couple years ago were 600 ng/dl total and 6.5 ng/dl free T with high SHBG. I am benefiting greatly from TRT. 6.5 ng/dl happens to be the threshold where multiple endocrinology organizations will label you hypogonadal based on free T. I don't think the 0.5 ng/dl difference between that and your 7 ng/dl is significant.

So yes, it's low free T -- low enough to seriously consider and probably try TRT with your symptoms. Keep in mind that it doesn't work for 100% of people. Some people with that group of symptoms you reported are just depressed or have some other issue. That free T is pretty low though, so odds are you will feel better on TRT.

 

[madman]

High guys. So I got my recent blood tests back from Endo.

He says my levels are fine but wanted to run through this forum to see if he's talking BS.

TT is 18.2 nmol/L or 525 ng/dL
FT is 0.25 nmol/ L or 7 ng/dL

I have got high SHBG which is at 62 nmol/L


Symptoms are....
No libido
No drive in life
Low mood
Anxiety has reduced a lot over the last few months.

Supplement stack...creatine, collegen with biotin, folinic acid(have COMT) hydroxy B12(have MTHFR) vit d3 with k2 4000iu

Diet is mostly animal based so beef patties, lots of eggs, avacados, feta cheese, chicken breast, sweet patatoes, natural yoghurt ans nuts, etc.


I would love to get people's Thoughts and there experiences with high shbg and low FT That's if mine is low.

I think I have tried almost everything to lower it and raise it so any input would be great thanks in advance

Was your blood work done in the early AM in a fasted state?

Did you have your FT tested using an accurate assay (Equilibrium Dialysis or Equilibrium Ultrafiltration)?

You need to post the testing method (calculated, direct immunoassay, ED, or UF) along with the reference ranges.

The only way to know where your FT level truly sits is to have it tested using what would be considered the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration, especially in cases of altered SHBG.

Most of the endos we consider clueless should still know this as it has been hammered home by the Endocrine Society for years!

Chances are your FT was tested using the calculated linear law-of-mass action Vermeulen (cFTV).

If we plug in your descent TT 525 ng/dL, high SHBG 62 nmol/L, and Albumin 4.3 g/dL (default) your FT 7.22 ng/dL would be close to the bottom-end and far from stellar but not flagged as low.

FT 5 ng/dL or < would be considered low.

Keep in mind that cFTV tends to overestimate when compared to a standardized Equilibrium Dialysis assay so your FT level may very well be somewhat lower.

Either way, your FT level is well under where a healthy young male would sit which would be 13-15 ng/dL when using/relying upon the cFTV method.

Again even though you are hitting a descent TT your FT is sub-par seeing as you have high SHBG.

Also, keep in mind that it would be wise to rule out any dysfunctional thyroid/adrenals that can easily mimic low-t symptoms let alone hinder the effectiveness of a TRT protocol.

Need a more thorough set of labs which should include estradiol, LH/FSH, prolactin, and CBC.

Either way, your FT is far from stellar.

A High-throughput Method for Accurate Measurement of FT in Serum using ED Coupled with ID-UHPLC-MS/MS

Introduction Testosterone is the most abundant circulating androgen in both men and women. It is a biomarker for identifying androgen excess and deficiency, and to monitor their treatment. Measurement of the metabolically active form, free testosterone (FT), has been part of the clinical...

www.excelmale.com

Discrepancies in Four Algorithms for the Calculation of Free and Bioavailable T

https://academic.oup.com/clinchem/advance-article-abstract/doi/10.1093/clinchem/hvad177/7337000?redirectedFrom=fulltext To the Editor: Testosterone (T) binds to sex hormone-binding globulin (SHBG)and albumin (Alb) to form SHBG-T and Alb-T (1). If total testosterone (TT) is low or SHBG...

www.excelmale.com

 

[madman]

High guys. So I got my recent blood tests back from Endo.

He says my levels are fine but wanted to run through this forum to see if he's talking BS.

TT is 18.2 nmol/L or 525 ng/dL
FT is 0.25 nmol/ L or 7 ng/dL

I have got high SHBG which is at 62 nmol/L


Symptoms are....
No libido
No drive in life
Low mood
Anxiety has reduced a lot over the last few months.

Supplement stack...creatine, collegen with biotin, folinic acid(have COMT) hydroxy B12(have MTHFR) vit d3 with k2 4000iu

Diet is mostly animal based so beef patties, lots of eggs, avacados, feta cheese, chicken breast, sweet patatoes, natural yoghurt ans nuts, etc.


I would love to get people's Thoughts and there experiences with high shbg and low FT That's if mine is low.

I think I have tried almost everything to lower it and raise it so any input would be great thanks in advance

Although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Need to have your FT tested using an accurate assay, especially in cases of altered SHBG to know where it truly sits.

This is not done yet.

Much more to come!

Testosterone Assays

Testosterone Assays (2022) Brendan King, MD, Caleb Natale, MD, Wayne J.G. Hellstrom, MD The accurate detection and quantification of serum testosterone levels are necessary for the diagnosis of hypogonadism in men, evaluation of endocrine abnormalities, and monitoring and titration of...

www.excelmale.com

post #11

Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods

Only at Excel, are we gonna take you deep! Clinical Utility and Analytical Aspects of Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods (2022) Mark M. Kushnir, Heather A. Nelson, and Kelly Doyle Background The free hormone (FH) hypothesis states that hormone...

www.excelmale.com

*Equilibrium dialysis (ED) followed by LC-MS/MS is considered the gold standard methodology

*FH concentrations measured by UF-based methods often do not agree with ED-based methods because of UF conditions (temperature, time, centrifugation speed), the type of the UF device (MWC membrane material, material of the of the housing, seal around the membrane, etc.), and inconsistencies in the filtration rate. Therefore, reference intervals are typically not interchangeable across methods for measurement of the same FH

CDC STANDARDIZED TOTAL T and ESTRADIOL ASSAYS and soon to be FREE TESTOSTERONE!

How the CDC Clinical Standardization Programs Are Improving Hormone Tests - AACC.org WHAT PROGRESS HAS CDC MADE WITH STANDARDIZING TOTAL TESTOSTERONE AND ESTRADIOL TESTS? Since HoSt began in 2010, CDC has had more than 350 participants in 15 countries. Participants have shown measurable...

www.excelmale.com

Key Points:

* Limitations of using free testosterone by equilibrium dialysis and calculated free testosterone concentrations in practice are the lack of assay standardization, an accuracy-based quality control program, and a harmonized reference range. Until these limitations are addressed, free testosterone by equilibrium dialysis and calculated free testosterone should use reference ranges established by individual laboratories or their specific assay method

*Currently, the CDC is developing a harmonized method for free T based on calculated free T using REVISED FORMULAE. This may bring the measurement of free T to a referable standard in clinical laboratories and common reference intervals that all clinicians can use

*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




The Need to Harmonize Clinical Laboratory Test Results-----

Laboratory test results are a critical component of patient care. These values help physicians diagnose disease and are critical to developing clinical guidelines that direct treatment options and are instrumental in ongoing efforts to improve and measure the quality of patient care. Most tests report a numeric value for healthcare providers to interpret and the range of numbers reported for a test for a certain condition may vary depending on the method used

Different test methods, however, may report different numeric values for the same condition. Although these test results may be accurate within the context of its own method, this variation can create confusion for physicians and patients. Clinical laboratory test results need to be harmonized so that healthcare providers and the public receive the same numeric result regardless of the method or instrument used or the setting where it was performed

Reference Intervals for Free Testosterone in Adult Men Measured Using a Standardized Equilibrium Dialysis Procedure

Again you heard it here first only at Nelson's ExcelMale! @Nelson Vergel Was going to drop this bomb a few days ago but you let down the curtains early LOL! https://onlinelibrary.wiley.com/doi/abs/10.1111/andr.13310 Reference Intervals for Free Testosterone in Adult Men Measured Using a...

www.excelmale.com

 

[whiting1986]

Although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Need to have your FT tested using an accurate assay, especially in cases of altered SHBG to know where it truly sits.

This is not done yet.

Much more to come!

Testosterone Assays

Testosterone Assays (2022) Brendan King, MD, Caleb Natale, MD, Wayne J.G. Hellstrom, MD The accurate detection and quantification of serum testosterone levels are necessary for the diagnosis of hypogonadism in men, evaluation of endocrine abnormalities, and monitoring and titration of...

www.excelmale.com

post #11

Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods

Only at Excel, are we gonna take you deep! Clinical Utility and Analytical Aspects of Direct Measurements of Free Hormones Using Mass Spectrometry-Based Methods (2022) Mark M. Kushnir, Heather A. Nelson, and Kelly Doyle Background The free hormone (FH) hypothesis states that hormone...

www.excelmale.com

*Equilibrium dialysis (ED) followed by LC-MS/MS is considered the gold standard methodology

*FH concentrations measured by UF-based methods often do not agree with ED-based methods because of UF conditions (temperature, time, centrifugation speed), the type of the UF device (MWC membrane material, material of the of the housing, seal around the membrane, etc.), and inconsistencies in the filtration rate. Therefore, reference intervals are typically not interchangeable across methods for measurement of the same FH

CDC STANDARDIZED TOTAL T and ESTRADIOL ASSAYS and soon to be FREE TESTOSTERONE!

How the CDC Clinical Standardization Programs Are Improving Hormone Tests - AACC.org WHAT PROGRESS HAS CDC MADE WITH STANDARDIZING TOTAL TESTOSTERONE AND ESTRADIOL TESTS? Since HoSt began in 2010, CDC has had more than 350 participants in 15 countries. Participants have shown measurable...

www.excelmale.com

Key Points:

* Limitations of using free testosterone by equilibrium dialysis and calculated free testosterone concentrations in practice are the lack of assay standardization, an accuracy-based quality control program, and a harmonized reference range. Until these limitations are addressed, free testosterone by equilibrium dialysis and calculated free testosterone should use reference ranges established by individual laboratories or their specific assay method

*Currently, the CDC is developing a harmonized method for free T based on calculated free T using REVISED FORMULAE. This may bring the measurement of free T to a referable standard in clinical laboratories and common reference intervals that all clinicians can use

*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




The Need to Harmonize Clinical Laboratory Test Results-----

Laboratory test results are a critical component of patient care. These values help physicians diagnose disease and are critical to developing clinical guidelines that direct treatment options and are instrumental in ongoing efforts to improve and measure the quality of patient care. Most tests report a numeric value for healthcare providers to interpret and the range of numbers reported for a test for a certain condition may vary depending on the method used

Different test methods, however, may report different numeric values for the same condition. Although these test results may be accurate within the context of its own method, this variation can create confusion for physicians and patients. Clinical laboratory test results need to be harmonized so that healthcare providers and the public receive the same numeric result regardless of the method or instrument used or the setting where it was performed

Reference Intervals for Free Testosterone in Adult Men Measured Using a Standardized Equilibrium Dialysis Procedure

Again you heard it here first only at Nelson's ExcelMale! @Nelson Vergel Was going to drop this bomb a few days ago but you let down the curtains early LOL! https://onlinelibrary.wiley.com/doi/abs/10.1111/andr.13310 Reference Intervals for Free Testosterone in Adult Men Measured Using a...

www.excelmale.com

 

[whiting1986]

So yes I was in a fasted state before I had my bloods taking and it was 9.30am.

I have had a few blood tests over the last few years and the levels have been roughly the same around the 0.21- 0.25 nmol/l range.

LH is ok IMO and also FSH.

Not sure if you think something is sticking iut with my results I posted ?

I appreciate your feed back

 

[FunkOdyssey]

So yes I was in a fasted state before I had my bloods taking and it was 9.30am.

I have had a few blood tests over the last few years and the levels have been roughly the same around the 0.21- 0.25 nmol/l range.

Not sure if you think something is sticking out with my results I posted ?

Low free T is sticking out. Low E2 as well. Nothing a little TRT won't fix.

 

[Systemlord]

I have had a few blood tests over the last few years and the levels have been roughly the same around the 0.21- 0.25 nmol/l range.

According to the British Society of Sexual medicine, <0.225 nmol/L qualifies for TRT. A lot of the medical societies around the world are under diagnosing low testosterone.

The cut off should be higher, because countless men are suffering above these cut offs for which TRT in the majority of cases resolves most or all symptoms.

 

[whiting1986]

According to the British Society of Sexual medicine, <0.225 nmol/L qualifies for TRT. A lot of the medical societies around the world are under diagnosing low testosterone.

The cut off should be higher, because countless men are suffering above these cut offs for which TRT in the majority of cases resolves most or all symptoms.

 

[whiting1986]

Thanks for your Input guys. What would be the symptoms of low E2 in men. I thought the lower the better ?

 

[FunkOdyssey]

Thanks for your Input guys. What would be the symptoms of low E2 in men. I thought the lower the better ?

No, you need to do some more research on this. Half the benefits of raising your testosterone are mediated by E2.

Symptoms of low estrogen in men include:

• Fatigue
• Anxiety
• Irritability
• Depression
• Forgetfulness
• Oversleeping or sleeping too often
• Sexual dysfunction
• Water retention
• Bone loss
• Fat accumulation
• JOINT PAIN

 

[whiting1986]

No, you need to do some more research on this. Half the benefits of raising your testosterone are mediated by E2.

Symptoms of low estrogen in men include:

• Fatigue
• Anxiety
• Irritability
• Depression
• Forgetfulness
• Oversleeping or sleeping too often
• Sexual dysfunction
• Water retention
• Bone loss
• Fat accumulation
• JOINT PAIN

Thanks for your reply, it's much appreciated

 

[Systemlord]

Normal healthy male estrogen levels is 25> pg/mL or 91> nmol/L. Under <20 or <73 is starting to get in the unhealthy territory.

I recall a few members with an osteoporosis diagnosis with E2 at 16 pg/mL or 58 nmol/L. After all estrogen is responsible for bone remodeling and bone metabolism.

 

[madman]

Your FT was tested using the calculated method.

You are using/relying upon the cFTV.

As I stated previously.

If we plug in your descent TT 525 ng/dL, high SHBG 62 nmol/L, and Albumin 4.3 g/dL (default) your FT 7.22 ng/dL would be close to the bottom-end and far from stellar but not flagged as low.

FT 5 ng/dL or < would be considered low.

Keep in mind that cFTV tends to overestimate when compared to a standardized Equilibrium Dialysis assay (most accurate) so your FT level may very well be somewhat lower.

Either way, your FT level is well under where a healthy young male would sit which would be 13-15 ng/dL when using/relying upon the cFTV method.




cFTV 7.22 ng/dL

Look over the screenshot of your labs from post #5.

cFT 0.25 nmol/L.

cFTV 0.25 nmol/L

If I was in your shoes and had symptoms then it would be a no-brainer!

 

[whiting1986]

Hi guys just an update.

I have messaged a clinic here in the UK and they have basically said that them numbers are not under the guidelines so they can't prescribe me Trt.

Anyone got any suggestions thanks in advance

 

[whiting1986]

Normal healthy male estrogen levels is 25> pg/mL or 91> nmol/L. Under <20 or <73 is starting to get in the unhealthy territory.

I recall a few members with an osteoporosis diagnosis with E2 at 16 pg/mL or 58 nmol/L. After all estrogen is responsible for bone remodeling and bone metabolism.

So it's clear with my E2 being at 58 it's something to worry about. And also my FT being poor at 0.25 nmol/l. And also my SHBG being 62 nmol/L.

So my question is. Will trt fix all those symptoms ?

Thanks in advance

 

[Systemlord]

So my question is. Will trt fix all those symptoms ?

Yes, very likely. You’re dealing with a government controlled healthcare still living in the Stone Ages as far as TRT is concerned.

No doubt the clinic director is aware of these shortcomings and knows what’s causing your symptoms and simply cannot act.

 

[mooseman109]

Thanks for your reply, it's much appreciated

Add to that list reduced penile sensitivity, at least that happens to me

 

[Seagal]

High guys. So I got my recent blood tests back from Endo.

He says my levels are fine but wanted to run through this forum to see if he's talking BS.

TT is 18.2 nmol/L or 525 ng/dL
FT is 0.25 nmol/ L or 7 ng/dL

I have got high SHBG which is at 62 nmol/L


Symptoms are....
No libido
No drive in life
Low mood
Anxiety has reduced a lot over the last few months.

Supplement stack...creatine, collegen with biotin, folinic acid(have COMT) hydroxy B12(have MTHFR) vit d3 with k2 4000iu

Diet is mostly animal based so beef patties, lots of eggs, avacados, feta cheese, chicken breast, sweet patatoes, natural yoghurt ans nuts, etc.


I would love to get people's Thoughts and there experiences with high shbg and low FT That's if mine is low.

I think I have tried almost everything to lower it and raise it so any input would be great thanks in advance

It seems your are on a very low carb diet. You could try adding more carbs your diet. Or having at least one reload day per week. Long-term keto / very low carb diet can have detrimental impact on SHGB and Thyroid, that is, elevated SHGB with lower free sex hormones and decreased levels of the active thyroid hormone T3.
If you try this, please let us know whether it helped with your symptoms.

 

[Systemlord]

Long-term keto / very low carb diet can have detrimental impact on SHGB and Thyroid, that is, elevated SHGB with lower free sex hormones and decreased levels of the active thyroid hormone T3.

That’s nonsense. That’s exactly what we had 50+ years ago, low-carb diet, mostly meat, eggs, and cheese. The men of the World War II era were NOT on high carb diets, they were on low carb diets and disease rates were much lower.

In the 1920’s heart disease started increasing and as red meat consumption decreased, heart disease and cancer has gone in the opposite direction ^^.

Dementia and Alzheimer’s disease didn’t exist a little over 100 years ago. These are relatively new diseases that didn’t exist in the past.

Humans have never consumed more carbs now than at any time in the past and disease rate is at its highest!

Carbs is not an essential nutrient!

Fats is an essential nutrient the body cannot make itself.

The majority of published medical research today is simply untrue and is merely propaganda, where science ceases to exist.