Need to understand the relationship between SHBG, Albumin, Free Test and Total test better

[Ardoc]

Can someone help me to understand these relationships?

It "seems" that Free Testosterone and Albumin-bound testosterone are bioavailable and constitute the useful portion of our Total Testosterone.

It also "seems" that Testosterone bound to SHBG is unusable/unavailable.

With this in mind if the SHBG bound test is unusable what is its purpose?

Also when we talk about low SHBG it is likened to having a "faster metabolism" of creating Free T and it has beed said that SHBG carries Test to our cells. This "seems" to imply that the SHBG bound test is released for use under some conditions or at certain times?

I'm not sure i am stating my question clearly but I'm hopeful that it is clear enough to provoke some discussion?

Thank you!

 

[Vince Carter]

Once T is bound to SHBG its done, can't be used as in bind to an androgen receptor (AR) in the body. Unbound, let's say 3% of Total (for discussion purposes) is free and can bind to an AR and do it's work. Bound to albumin is loosely bound and can be used in the body but that's much less apt to occur because it's still bound, partially why Bioavail or Free T is hard to determine with an exact number, it's typically just a calculation on other factors.

 

[Ardoc]

That is the reason for my question ....if a large amount of Test is bound to SHBG, and therefor unusable, why do total Test numbers matter/mean anything? It seems that the unusable amount should be irrelevant?
Although I realize our bodies don't do anything that is irrelevant? Is there an aspect to SHBG bound test that I am missing?

 

[Vince Carter]

That may be the reason that some efforts in HRT shoot for the Free T % and do somewhat negate the Total T numbers but then you can't get the FreeT up without the Total so they can, to a point, go hand-in-hand.

 

[CoastWatcher]

Keep in mind,more testosterone values are a nightmare to interpret. To say there is inconsistency in the results is an understatement. Free/calculated/derived...a constantly moving picture that confuses as much as it clarifies.

 

[Ardoc]

Thanks VC and CW!

I am thinking that in the case of people with low SHBG (as I assume I am and will know in a couple weeks) that maybe the free test number is all I should worry about? I have had barely mid-range TT with FT that was "over-range" granted that was using Canadian LifeLabs tests and what CW has stated as some of the lowest reference ranges in the world.

CW that begs another question, if the reference range is supposed to be based on results for most people, are the Canadian ranges intentionally adjusted down? I thought it was strictly the range of 90% (exclude lowest and highest 5%?) of results obtained?

 

[CoastWatcher]

Thanks VC and CW!

I am thinking that in the case of people with low SHBG (as I assume I am and will know in a couple weeks) that maybe the free test number is all I should worry about? I have had barely mid-range TT with FT that was "over-range" granted that was using Canadian LifeLabs tests and what CW has stated as some of the lowest reference ranges in the world.

CW that begs another question, if the reference range is supposed to be based on results for most people, are the Canadian ranges intentionally adjusted down? I thought it was strictly the range of 90% (exclude lowest and highest 5%?) of results obtained?

My doctor feels that the ranges for total testosterone are *likely* downwardly adjusted. She showed me ranges from other first world countries - ours are among the lowest. Canadian doctors and patients also have to deal with guidelines published by the Canadian medical establishment that look at testosterone therapy with more than a bit of suspicion.

Life Labs, when it was still CML, adopted a new manner of measuring free testosterone, one that sent all results soaring. Nobody, no doctors who knew what they were doing, were happy. Many now send patients to hospital outpatient labs. I test in the US where my free value is high - but not insanely high - and my SHBG is low - but not shockingly so. My levels don't change when I cross the border. Managing to a free testosterone value, as you suggest, is impossible in Canada (and most other places). That's not just my opinion, but my doctor and my urologist (who does not manage my TRT protocol) are both outspoken critics of these test values.

All of of which supports my position that you don't need to fret so about all this. You can make this work with a savvy doctor and patience. Forgive me, but I can't recall if yiu have confidence in your physician. Do you feel your needs are being met.

Oh, let me know if you want me to message a copy of a study done at Queen's University questioning the entire free testosterone issue. All the best.

 

[Vince Carter]

Of note too is lab ranges aren't set by any one but the lab and are simply what that lab sees in the population that it tests. Some of the medical community, Drs, would say 350 is a cutoff, some say 300, for Hypogonadal, but labs would should (for discussion) a low cutoff as 250. Point is is that lab ranges are quite often less than anything optimal. Another instance...TSH reads as in range @ 4.5 or 5.0...NO ONE would want to live with a TSH that high.

 

[Ardoc]

All good points guys!

Yes CW I would greatly appreciate the study!

Regarding my TRT doctor, I will admit she is not the most experienced in male TRT, but she is relatively knowledgable and has some male clients (including a family member) but many more female HRT clients. She is however very progressive, listens to me, reads and considers all the information i give her from Nelson and Dr. Crisler's books as well as this forum and studies listed here. She knows my only goal is health and that I read a lot on this subject so she works with me to continue learning together as we go. She is local for me (Hamilton) and I appreciate her approach. Considering how unknowledgeable most PCP's and specialists are on the subject, I am happy to have found her. She also understands treating the patient and not the numbers.

 

[madman]

I would not rely on free t testing methods in Canada either as there is too much variation. I would say bioavailable is more accurate but most doctors in Canada do not test that. Definitely keep tract of your TT numbers. I am also from Steeltown and knowledgeable doctors prescribing trt are far and few. Hope you are not being treated by Kristina Janicas as she is clueless when it comes to prescribing methods/dosages regarding trt in males!

 

[Ardoc]

Thanks Madman.... she is not my doctor. How do you manage your protocol given the inability to rely on Canadian labs?

 

[Sean Reed]

Here is some information about SHBG's impact upon the relationship of Total Test and Free Test.

The primary purpose of this post is to illustrate the fact that SHBG CAN be mitigated and free test relative to total test CAN be improved.

In this post I discuss the drug called Masteron. However, I DO NOT ADVOCATE THE TAKING OF ANY ILLEGAL DRUG! MY MAIN POINT IS THAT SHBG CAN BE MANIPULATED! The medical community needs to come up with something like Masteron that will safely and effectively reduce SHBG.


The post is purely for information, it is NOT medical advice. The takeaway is that SHBG can be suppressed and free test can be increased without elevating total test (IE injecting more test).

Dr's need to start looking for drugs that will suppress SHBG that are safe and legal.

A drug called Masteron has a powerful impact upon Steroid Hormone Binding Globule, SHBG. SHBG determines receptor affinity. In plain English, that means that adding Masteron to Testosterone makes the testosterone more effective. Adding 300 mgs of Masteron to 400 mgs of Testosterone means that the test will perform like 600 mgs of test, without the added water retention, estrogen and other undesirable side effects. Plus, you have a greater fat loss. How does this all work?

SHBG, which increases after the age of 27, inhibits testosterone. Testosterone circulates in the bloodstream, bound mostly to SHBG. Only 1-2% is “free” and thus biologically available. What Masteron does is it “uncouples” the bound testosterone from SHBG, making it free and therefore biologically active. Think of a parking lot. The spaces are your testosterone receptors. The lot is full of cars. Masteron is like a tow truck that comes in and tows cars away, freeing them up for more results from your testosterone. 400 mgs has the effect of 600 mgs.


Lets look at an example. Your doctor has you on testosterone replacement. You are 45 and have had low test since the age of 40. This condition is very very common. Low testosterone has all sorts of negative health repurcussions. Normal testosterone levels are between 300 and 1100 ng. You want to be at around 1100.. Your doctor wants you around 700-800. To do so he prescribes exogenous test at 180 mgs/week. That amount puts your total test at 760 ng, and your fee test around 10. Adding Masteron increases your free test to 19, Your total test is the same, but your free test, the test you actually use, is much more.

 

[Ardoc]

Thanks Sean. The concern, at least in my case, is LOW SHBG.

 

[CoastWatcher]

Thanks Madman.... she is not my doctor. How do you manage your protocol given the inability to rely on Canadian labs?

It can be done. First of all, you have to relax. You are wound way too tightly around the SHBG and free testosterone values. They are not to be feared, they are to be managed. I have both issues, a total testosterone that, the last time it was absurdly high for a patient with bargain-basement endogenous testosterone levels. My doctor, a very savvy woman, was giggling when we were reviewing the numbers - they made no sense. As for my SHBG, it was reported at 16 - low by any standards. I knew, from being a member here, what the general advice for such situations was, but before I could offer my thoughts, she was describing her approach to such situations - and she was on the mark.

To start, twice weekly injections of slightly smaller amounts of testosterone than I would expect. HCG added later test in six weeks. When the time came round, the free testosterone was sky-high, SHBG slightly lower, total testosterone up, but clearly being burned too quickly. We tested for peak and trough designed an eod schedule, still had less than was wanted, and finally - for e2 control more than anything else (but also to manage SHBG) - started a daily protocol.

All that narrative to let you know there are solutions to what you face. I am thrilled with my results, haven't felt this good in years. I do test in the US, but that's to monitor estradiol. We do note the free testosterone levels that LabCorp sends, but manage to the total testosterone vale AND MOST IMPORTANTLY how I feel.

Obviously your doctor will have specific ideas but it comes down to protocol management and symptoms. Estradiol is a discussion for another day, but don't see this as an impossible obstacle. It isn't.

 

[Sean Reed]

Ardoc: I did not pick that up in your posts, maybe I missed it. You do not have labs, correct?

Hence you do not know your SHBG level, correct? In many many years I have not run into the problem of low SHBG.

The common problems is high SHBG and how to lower it. Low SHBG is kind of like your girlfriend breasts' being to big, LOL.

 

[Ardoc]

Sean I did have my SHBG tested once and it was 11.6 mol/l with a ref range of 10 - 30. At that time i was doing well on weekly injections. I will be testing again in a couple weeks. It seems there are as many (or more) people on this forum who are dealing with low SHBG although I may be paying more attention to those people as I think i'm in that boat. Certainly low-ish when tested.

CW thank you for taking the time to write such a detailed post. Its great that you give so much of your time to the members here!
Contrary to how it may come across I'm not stressed about it I'm just looking for some ideas.
a) Do I aim for high normal TT and accept FT over-range?
b) Do I aim for high normal FT and accept mid-level TT?
c) Do I try other things before moving to daily injections?

I think I just got confused about why I care about TT if a large % of it is permanently bound to SHBG and therefor unusable? Does this SHBG bound Test play another role? It seems like the more you "learn" the more you realize you don't know much about this.

I did well on weekly injections in the beginning when my SHBG was at the low end of normal. Then after i started to feel the benefits less, switched to E3.5D which was good for a time then had to switch to EOD. It "feels" as if my SHBG is decreasing over time? Total speculation and maybe i will be wrong when labs come back.

I am fine with "imperfect" numbers but since they are the sign posts guiding me to where I will feel the best, I'm trying to grasp which values to pay the most attention to as I'm trying to dial in. The only real frustrating part is I was initially lucky and with 120mg 1x/week, I was right at top end of TT and FT and my DHT was way over range and i felt great. It seems now like I have to "chase" the sweet spot continuously. I am ok with this, once I pick the number to target that works the best for me because it sure seems now like getting both TT and FT to the upper-range but not over isn't going to happen.
Did going from EOD to ED make much difference for you?

 

[Sean Reed]

Ardoc: I am going to get to your questions tomorrow. Most Docs are still a step behind when it comes to free test.

It is fascinating that you have low normal SHBG, and that several other posters do as well0 I do not run into that very often. Would you like to trade places?

Excuse my vulgarity, but having low SHBG is akin to having too big of a penis, lol.

Edit: I also need your drug program and history. 120 mg/test a week is low, IMO. However if it put your Free test up where you want it that is good.

I see Dr larry Lipschultz...arrogant but he knows his stuff. He has his bigger guys taking 300 mgs/test/week (injecting twice a week). They are all staying healthy.

How often do you inject your test?

 

[Ardoc]

Thanks Sean.

Nov. 2012 (Canadian lab work - LifeLabs)
120 mg Test 1x/week
.5 mg Adex 2x/week (1 mg total weekly)
250 iu HCG 2x/week (500 iu total weekly
PUT ME AT:
TT 27.4 nmol/l REF: 8.4 - 28.8
FT 82.2 pmol/l REF: 25 - 80
DHT >8600 pmol/l REF: 860 - 3408 (HIGH - exceeded limits of lab test)
SHBG 11.6 nmol/l REF: 10 - 30
Was great for a while then crashed my E2 (should have left out the Adex)

Changed protocols a few times chasing the "sweet spot" (twice/week injections then E2D as results changed and FT rose compared to TT.... segway to....

MAR. 2017 (US lab work - Labcorp)
44 mg Test E2D (154 mg Total weekly)
280 iu HCG E2D (980 iu Total weekly)
PUT ME AT:
TT 433 ng/dl REF: 348 - 1197
FT 16.8 pg/ml REF: 7.2 - 24
E2 33.3 pg/ml REF: 8 - 35
DHT 22 ng/dl REF: 30 - 85 (LOW)

It seems in my case that good results are a moving target and I feel best for a few weeks after adjusting my protocol?

* 300 mg test seems high as 200 is about top end of all discussions I've read here (or anywhere else for that matter).
Were they former AAS users? I am 6'5" and 292 lbs and have worked out fairly consistently since the age of 15 but have not done AAS. ( I realize Test is in that category but I mean for the purpose of creating supra-physiological androgen levels)

I am not concerned about the low SHBG (although it seems that is the impression I am giving .
Just trying to understand that IF i can't have both TT and FT at top end, which one do I aim for getting to top end and which do I let "fall where it may". (i.e.: High normal TT and "over-range" FT -OR- High normal FT and mid-range TT).

I am still curious why we care about TT if so much is SHBG-bound and therefor "useless"?

 

[Sean Reed]

Hi Ardoc,

First, as I mentioned, one of the most well known TRT docs in the world (Larry Lipschultz) is regularly prescribing 300 mgs/week. I am 235 lbs which may be a factor.

I get labs 3-4 times a year which I go over with 2 different docs' (Lipschultz and my FP).

It is absolutely critical to get lab work. All my results indicate I am in excellent health. Part of the reason is can be credited to my training style. I take no rest between sets and do 35 minutes of work with my heart rate in excess of 80% of my VO2 Max. For example my cholesterol is 145 and I eat a lot.

OK, so looking at your Novenber labs and your bodyweight..... I see that you are ...Jesus, freakin' huge! I am a black belt and martial arts instructor....but you would crush me, dang 6'5 292.

Remind me not to get you mad, lol.

OK big guy....120 mg/week is very very low dosage. You will get dipping and spiking (I don't care what anyone says about reported half life's) you will. I suggest an e4d (every fourth day) injection schedule.

Assuming you are healthy, 120 mgs should prove absolutely safe. But the concern is that if you go e4d your total and free numbers will be out of range.

Even so, you need to understand one important thing: The media, especially here in the US has lied about the dangers of steroids. None of their nonsense is supported by the scientific literature. I have an article on this topic.

Why do the media and members of the US Congress lie about steroids? Money and Power.

If we look at the empirical evidence, you will see through all the lies.

That said, yes, switching to e4d or e5d will put you over range, but not enough to risk your health IMO. In fact you are much healthier than someone with Low T.

I have a client to was triple the TT range. We back his dosage down, he still is 20% over the top range but very healthy.

The ranges were created using statistical modeling. As such, they do not automatically mean that you are going to have adverse health outcomes caused by TRT. Eating Cheesecake is more dangerous (I love cheesecake).

Like I said, don't believe the lies of the big drug companies, government, and or the media. The big drug companies make way more money selling you Viagra and anti-depressants when the actually problem is Low T.

I see you crashed your e2. I see that ALL the time! Your body needs some estro....too low and you get ED, YAY!

That can be fixed via adjusting you A Dex. Stay away from Letro, it is an even stronger AI.

I see that your SHBG is low normal. Most of my experience is with high SHBG, which is problematic. Are you having any sides?

OK...in March you started ...wow, injecting 44 mgs of test(enanthate, cyp??) e2d.

TT is low, I would rather see it closer to the top of the range. I would also like to see your Free T higher. My total T is usually around 800-900 and my free T is usually about 10% over the top if I manipulate it with Masteron.

Your E2 is too high. You want to be closer to the bottom of the range.

Here is my conclusion: First, what is your age and health? That is the most important question. next, what is your training and diet like? I need that info.

However, the bottom line is I do not think using 120 mgs e4d presents a health risk to you.

Please keep in mind, I am a PhD, not a REAL doctor (as my wife never tires of telling me, lol). I do not give medical advice, only theoretical advice.

All the best, Sean

 

[ERO]

Ardoc: I am going to get to your questions tomorrow. Most Docs are still a step behind when it comes to free test.

It is fascinating that you have low normal SHBG, and that several other posters do as well0 I do not run into that very often. Would you like to trade places?

Excuse my vulgarity, but having low SHBG is akin to having too big of a penis, lol.

Edit: I also need your drug program and history. 120 mg/test a week is low, IMO. However if it put your Free test up where you want it that is good.

I see Dr larry Lipschultz...arrogant but he knows his stuff. He has his bigger guys taking 300 mgs/test/week (injecting twice a week). They are all staying healthy.

How often do you inject your test?

Low SHBG (below the bottom of the normal range) is not an advantage - ask the many of us on the forum that get little or no benefit out of TRT due to our SHBG being very low. Also, none of us are obese, diabetic or pre-diabetic, which is nearly always assumed to be the cause. Just for fun, Google "Low SHBG TRT."