Strangely high Free T, even though Total T is rather average

[Sloth]

Hello everyone!

I have been reading these forums quite a bit lately, amazing content with lots of useful information, but now I hope to also get some individual help/answers.

I'm 33 and I have been on TRT (35mg EOD SubQ, equaling 122.5mg per week) for 3 months, and on hCG (200 IU EOD, 700 IU per week) for 2 months. Recently I got my blood-work done and here are the results (including reference ranges):

Total T: 6.38 ng/ml (2.41 - 8.27)
SHBG: 51.53 nmol/l (14.7 - 44.9)
Free T: 44.40 pg/ml (3.84 - 34.2)

I find it extremely strange how Free T is so high even though Total T is rather average considering my dosage. Even more strange considering how SHBG is high as well.

Note that I'm barely noticing any real improvements of my low T symptoms, most things remained the same (low energy, low libido, irritability, lack of focus ...), just performance in the gym is up slightly, but even that's barely noticeable.

Also note that before I started TRT, my blood work was similarly strange (Free T much higher in relation to low Total T, even though SHBG was high):

Total T: 3.34 (2.41 - 8.27)
SHBG: 42.03 (14.7 - 44.9)
Free T: 12.1 (3.84 - 34.2)

Does anyone have any idea what might be going on? How I should interpret these results? Sadly I don't have any truly knowledgeable doctors available, so I don't get much help there.

Should I ask for a higher dosage? But shouldn't my very high Free T be enough?

Thanks!
Regards,
Sloth

Oh, some other results:
DHT: 616 pg/ml (300 - 850)
TSH: 1.28 mIU/L (0.35 - 4.94)
T4: 16.46 pmol/L (9.01 - 19.05)
T3: 4.23 pmol/L (2.63 - 5.70)
TPSA: 1.168 &#956;g/L (< 4.0)
Estradiol: 43 ng/L (11-44)
DHEA-S: 12.6 &#956;mol/L (4.6 - 16.1)

 

[johndoesmith]

Hello everyone!

I have been reading these forums quite a bit lately, amazing content with lots of useful information, but now I hope to also get some individual help/answers.

I'm 33 and I have been on TRT (35mg EOD SubQ, equaling 122.5mg per week) for 3 months, and on hCG (200 IU EOD, 700 IU per week) for 2 months. Recently I got my blood-work done and here are the results (including reference ranges):

Total T: 6.38 ng/ml (2.41 - 8.27)
SHBG: 51.53 nmol/l (14.7 - 44.9)
Free T: 44.40 pg/ml (3.84 - 34.2)

I find it extremely strange how Free T is so high even though Total T is rather average considering my dosage. Even more strange considering how SHBG is high as well.

Note that I'm barely noticing any real improvements of my low T symptoms, most things remained the same (low energy, low libido, irritability, lack of focus ...), just performance in the gym is up slightly, but even that's barely noticeable.

Also note that before I started TRT, my blood work was similarly strange (Free T much higher in relation to low Total T, even though SHBG was high):

Total T: 3.34 (2.41 - 8.27)
SHBG: 42.03 (14.7 - 44.9)
Free T: 12.1 (3.84 - 34.2)

Does anyone have any idea what might be going on? How I should interpret these results? Sadly I don't have any truly knowledgeable doctors available, so I don't get much help there.

Should I ask for a higher dosage? But shouldn't my very high Free T be enough?

Thanks!
Regards,
Sloth

Oh, some other results:
DHT: 616 pg/ml (300 - 850)
TSH: 1.28 mIU/L (0.35 - 4.94)
T4: 16.46 pmol/L (9.01 - 19.05)
T3: 4.23 pmol/L (2.63 - 5.70)
TPSA: 1.168 &#956;g/L (< 4.0)
Estradiol: 43 ng/L (11-44)
DHEA-S: 12.6 &#956;mol/L (4.6 - 16.1)

Hey man, I can understand why this is confusing.

Unless these are calculated free testosterone results, which they don't appear to be, they seem to be a free testosterone assay(another word for "test"). Free testosterone assays can be somewhat unreliable, and can give odd results.

Seeing as you had both SHBG and total test, I was able to calculate your free test, and it should make much more sense.

pre TRT: 5.73 ng/dl
Now: 10.5 ng/dl

I usually use a range for this of 9-26, I don't know that it's necessarily correct, but it seems to work.

If you add in some other information, it'd help to create more productive and helpful conversation.

1. When were these taken relative to injection?
2. Do you happen to have copies of the full results? Sometimes little details can be left off, and it'd be to your benefit to have everyone have these.
3. You seem to have a knowledgeable and progressive doctor, do you trust him/her?
4. Height, weight, symptoms, and ANY improvements you've seen.

 

[Sloth]

Hey man, I can understand why this is confusing.

Unless these are calculated free testosterone results, which they don't appear to be, they seem to be a free testosterone assay(another word for "test"). Free testosterone assays can be somewhat unreliable, and can give odd results.

Seeing as you had both SHBG and total test, I was able to calculate your free test, and it should make much more sense.

pre TRT: 5.73 ng/dl
Now: 10.5 ng/dl

I usually use a range for this of 9-26, I don't know that it's necessarily correct, but it seems to work.

If you add in some other information, it'd help to create more productive and helpful conversation.

1. When were these taken relative to injection?
2. Do you happen to have copies of the full results? Sometimes little details can be left off, and it'd be to your benefit to have everyone have these.
3. You seem to have a knowledgeable and progressive doctor, do you trust him/her?
4. Height, weight, symptoms, and ANY improvements you've seen.

Oh, I see, I had no idea these can be so unreliable. It actually makes a whole lot of sense. Yes, this is Free Testosterone Assay. Here's a screenshot of the results:



1. They were taken in the morning, on my injection day, right before my injection.
2. See above, hopefully the photo is visible.
3. Sadly, the dosages/protocols are mostly based on my own suggestions.
4. 6'3 (190cm), 183lbs (83kgs) (I have very thin frame/skeleton)
Symptoms and improvements:
- Low energy >>> No improvement at all.
- Low libido >>> Very minor improvement.
- No morning wood in years >>> I've had a few now in the first couple weeks, not anymore (perhaps due to elevated estradiol).
- Bad mood in general >>> Some improvement, I seem to be a bit more cheerful.
- Very limited muscle mass and poor strength >>> Slight improvements both in mass and strength (following the same program as before - around 2 years).
- Bad fat distribution >>> The one truly noticeable improvement. Slowly losing fat where I was almost unable before (in my case thighs, hips, ass).

 

[Sloth]

Other results:
(sorry for different language, but most names are extremely similar, with the exception of maybe Iron - '&#381;elezo')

 

[johndoesmith]

Oh, I see, I had no idea these can be so unreliable. It actually makes a whole lot of sense. Yes, this is Free Testosterone Assay. Here's a screenshot of the results:



1. They were taken in the morning, on my injection day, right before my injection.
2. See above, hopefully the photo is visible.
3. Sadly, the dosages/protocols are mostly based on my own suggestions.
4. 6'3 (190cm), 183lbs (83kgs) (I have very thin frame/skeleton)
Symptoms and improvements:
- Low energy >>> No improvement at all.
- Low libido >>> Very minor improvement.
- No morning wood in years >>> I've had a few now in the first couple weeks, not anymore (perhaps due to elevated estradiol).
- Bad mood in general >>> Some improvement, I seem to be a bit more cheerful.
- Very limited muscle mass and poor strength >>> Slight improvements both in mass and strength (following the same program as before - around 2 years).
- Bad fat distribution >>> The one truly noticeable improvement. Slowly losing fat where I was almost unable before (in my case thighs, hips, ass).

Hmm, this is interesting, I've never seen SHBG rise with the start of TRT. Usually SHBG decreases.

Does "protsi" mean free?

You were consistently on the same protocol for the entire 3 months right?

Your free testosterone is fairly low still, that may explain a few things, like why you haven't noticed much improvement.

You're also on a protocol that'd be recommended for someone who has LOW SHBG. I'm not sure that more frequent injections would be a bad thing for someone with high SHBG, though, so can't recommend changing to less frequent injections.

It may just be that you need a dose increase.

 

[Sloth]

Hmm, this is interesting, I've never seen SHBG rise with the start of TRT. Usually SHBG decreases.

Does "protsi" mean free?

You were consistently on the same protocol for the entire 3 months right?

Your free testosterone is fairly low still, that may explain a few things, like why you haven't noticed much improvement.

You're also on a protocol that'd be recommended for someone who has LOW SHBG. I'm not sure that more frequent injections would be a bad thing for someone with high SHBG, though, so can't recommend changing to less frequent injections.

It may just be that you need a dose increase.

Yes, "prosti" does indeed mean free.

2 months with HCG, before that about a month only on T. T dosage was the same, though.

Regarding free testosterone: how is it possible for the assay to be so wrong, though? How can it be possible for the assay to show 4 TIMES the calculated value?

I heard that weekly injections could be better to lower SHBG a bit, but would the difference be substantial? EOD seems to have many other benefits ...

Should I bump the dosage by like 1/3? More?

And again, thanks for the help! Much appreciated!