Interpretation of Free Testosterone, Estrogen, and Total Testosterone Blood Tests

[Kale]

Found this while researching. Some good info here


One can easily determine if they need testosterone replacement or estrogen suppression by adhering to the following guidelines.

Free Testosterone. Free testosterone blood levels should be at the high-normal of the reference range. We define high-normal range as the upper one third of the reference range. Under no circumstances should free or total testosterone be above the high end of the normal range.

What too often happens is that a standard laboratory "reference range" deceives a man (and his physician) into believing that proper hormone balance exists because the results of a free testosterone test fall within the "normal" range. The following charts show a wide range of so-called "normal" ranges of testosterone for men of various ages. While these normal ranges may reflect population "averages," the objective for most men over age 40 is to be in the upper one-third tes-tosterone range of the 21- to 29-year-old group. Based on the following reference range chart from LabCorp, this means that optimal free testosterone levels should be between 21-26.5 nanogram/dL in aging men.

Reference Intervals for Free Testosterone from LabCorp

* 20-29 years 9.3-26.5 picogram/mL
* 30-39 years 8.7-25.1 picogram/mL
* 40-49 years 6.8-21.5 picogram/mL
* 50-59 years 7.2-24.0 picogram/mL
* 60+ years 6.6-18.1 picogram/mL

An example of how this chart can be deceptive would be if a 50-year-old man presented symptoms of testosterone deficiency (depression, low energy, abdominal obesity, angina, etc.), but his blood test revealed his free testosterone to be 9 picogram/mL. His doctor might tell him he is fine because he falls within the normal "reference range." The reality may be that to achieve optimal benefits, testosterone levels should be between 21-26.5 picogram/mL. That means a man could have less than half the amount of testosterone needed to overcome symptoms of a tes-tosterone deficiency, but his doctor will not prescribe testosterone replacement because the man falls within the "average" parameters. That is why it is so important to differentiate between "average" and "optimal." Average 50-year-old men often have the symptoms of having too little testosterone. Yet since so many 50-year-old men have lower than desired testosterone levels, this is considered to be "normal" when it comes to standard laboratory reference ranges.

The Life Extension Foundation would like to point out that there is disagreement between clinicians and laboratories on the best method for measuring tes-tosterone status. There are different schools of thought as to which form of testosterone should be measured and which analytical procedure provides the most accurate assessment of metabolic activity.

To illistrate this point, the reference values for measuring free testosterone from Quest Diagnostics follow.

Adult Male (20-60+ years): 1.0-2.7% 50-210 pg/mL

Optimal Range: 150-210 pg/mL for aging men without prostate cancer.

We believe that direct testing for free testosterone is the best way to test for testosterone activity, as free testosterone is active testosterone and consists of only 1-2% of total testosterone. Total testosterone can be good for general testing. The four main methods presently used for analyzing free testosterone are:

* Direct, Free Testosterone by Direct Analog/Radioimmunoassay (RIA)
* Testosterone Free by Ultrafiltration (UF)
* Testosterone Free by Equilibrium Tracer Dialysis (ETD)
* Testosterone Free and Weakly Bound by Radioasssay (FWRA)

The latter three test methods are older, more complicated methods that are technically demanding. The direct RIA test has a number of commercial test kits available, and they are better used in today's automated equipment, making this test less tedious and requiring a smaller (less) sample. These advantages have convinced many laboratories and clinics to prefer direct RIA testing for free testosterone. The Life Extension Foundation agrees with this assessment, and therefore uses and recommends the direct free testosterone test with the above-mentioned reference levels.

Consequently, if your doctor tests your free tes-tosterone, be sure you know the analytical method used. If your test results have a reference range as follows, you have probably been tested with one of the other test methods:

Male Reference Range - Test Type

* 66-417 nanogram/dL FWRA
* 12.3-63% %FWRA
* 5-21 nanogram/dL UF or ETD
* 50-210 picogram/mL UF or ETD
* 1.0-2.7% % of free by UF or ETD

No matter what test method is used to determine your free testosterone status, the optimal level (where you want to be) is in the upper one-third of normal for a 20-29 year old male.

Estrogen

Estrogen (measured as estradiol) should be in the mid- to lower-normal range. If estradiol levels are in the upper one-third of the normal reference range, or above the normal reference range, this excessive level of estrogen should be reduced. Labcorp lists a reference range of between 3-70 picogram/mL for estradiol while Quest states a reference range of between 10-50. For optimal health, estradiol should be in the range of 10-30 picogram/mL for a man of any age.

The fact that most aging men have too much estrogen does not mean it is acceptable for a man to have low estrogen. Estrogen is used by men to maintain bone density, and abnormally low estrogen levels may increase the risk for prostate cancer and osteoporosis. The objective is to achieve hormone balance, not to create sky-high testosterone levels without enough estrogen. The problem is that, if we do nothing, most men will have too much estrogen and far too little testosterone.

Total Testosterone

Some men have their total testosterone measured. Standard reference ranges are between 241-827 nanograms/dL for most laboratories. Many older men are below 241. Optimal levels of total testosterone for most men are between 500-827 nanograms/dL. If your levels are lower than 500 nanograms/dL or even a little higher and you still have symptoms, you should check your free testosterone by the Direct (RIA) method.

For other hormone tests, the following are considered to be optimal:

Where You Want to Be - Comment

PSA Under 2.6 ng/mL - (optimal range) Standard reference range is up to 4, but if your level is persistently 2.6 or above, have a blood test to measure the percentage of free vs. bound PSA and a digital rectal exam to help rule out prostate cancer.

DHEA 400-560 mcg/dL - (optimal range) For older men, standard DHEA ranges are very low. It is important for men without prostate cancer to restore them to the youthful range (400-560).

DHT 20-50 nanogram/dL - (optimal range) Reference range is 30-85. DHT is 10 times more androgenic than testosterone and has been implicated in prostate problems and hair loss.

Luteinizing hormone (LH) Age 20-70: 1.5-9.3 mIU/mL 70+: 3.1-34.6 mIU/mL (standard reference ranges) - Under 9.3 mIU/mL - (optimal range) If these levels are high, it is an indication of testicular testosterone production deficiency. LH tells the testes to produce testosterone. If there is too little testosterone present, the pituitary gland secretes more LH in a futile effort to stimulate testicular testosterone production. Testosterone replacement therapy should suppress excess LH levels. Low LH can also be a sign of estrogen overload, since too much estrogen can suppress LH activity. This could mean using an estrogen blocker like Arimidex could solve a testosterone deficiency problem.

Sex Hormone Binding - Under 30 nanomoles/L - (optimal range) Reference range is 13-71 nanomole/L. Excessive binding inactivates testosterone (297).

There are five possible reasons why free testosterone levels may be low-normal (below the upper third of the highest number of the reference range):

* Too much testosterone is being converted to estradiol by excess aromatase enzyme and/or the liver is failing to adequately detoxify surplus estrogen. Excess aromatase enzyme and/or liver dysfunction is likely the cause if estradiol levels are over 30.

* Remember, aromatase converts testosterone into estradiol, which can cause estrogen overload and testosterone deficiency.

* Too much free testosterone is being bound by SHBG (sex hormone binding globulin). This would be especially apparent if total testosterone levels were in the high normal range, while free testosterone was below the upper one-third range.

* The pituitary gland fails to secrete adequate amounts of luteinizing hormone (LH) to stimulate testicular production of testosterone. Total testosterone in this case would be in the bottom one-third to one-half range. (On LabCorp's scale, this would be a number below 241-500 ng/dL.)

* The testes have lost their ability to produce testosterone, despite adequate amounts of the testicular-stimulating luteinizing hormone. In this case, LH would be above normal, and total testosterone would in very low normal or below normal ranges.

* Inadequate amounts of DHEA are being produced in the body. (DHEA is a precursor hormone to tes-tosterone and estrogen) (250).

[juicelee]

good read! sticky?

[zaggahamma]

subscribed

[FallenWyvern]

sticky!

[snapper]

Great education, thanks.

[Bfarley]

Great info. I have some questions about SHBG and Free Test. Here is my breakdown of my labs: I'm 31 years old

Quest Diagnostics:
Total Test: 917 ng/ml
Free Test: 146 pg/ml
SHBG: 32
LH: 7.2
FSH: 2.9
Estradiol: 54

Is my free test low because of higher SHBG and higher Estradiol? How to I increase my free test and lower SHBG & Estradiol?

Thanks for the feedback

[rogue01]

Great info, thanks for the breakdown of the testing methods. It can be confusing how different labs use different methods.

[bigred42]

Great info. I just got mine tested last week. Still waiting to see where I am on the chart.
BIGRED

[Enfuego129]

Fellas, I found some of the above information useful but also confusing.

As I am typing this I do not have my blood work in front of me except for my most recent draw for total and free %. I will gather some of that up if questions arise. My question or confusion is why has my total testosterone come in at 222 when my % of free testosterone come in at 2.37 (reference range 1.5-2.2) From the above article it appears that I may have Estradil binding up my T. Is this an accurate assessment?

If possible give me some topics to search here to help me along. I have to go for three more blood draws in the next month to see where my average levels are before my Endo and GP will consider treatment. For now I am receiving no supplemental T and I feel like shit, possibly worse than ever.

[RTR13]

Hey, sorry for bumping a semi-old thread, but I need some help...

I just got my test results back from the lab at my dr's request. My results are:

Total T: 498 ng/dL
Free T: 11.0 pg/mL

Total T looks good for a 29 year old, but the free t looks a little sketchy to me. Anyone think this might be too low? I've been feeling pretty weak and fatigued for a long time now.

[zaggahamma]

Hey, sorry for bumping a semi-old thread, but I need some help...

I just got my test results back from the lab at my dr's request. My results are:

Total T: 498 ng/dL
Free T: 11.0 pg/mL

Total T looks good for a 29 year old, but the free t looks a little sketchy to me. Anyone think this might be too low? I've been feeling pretty weak and fatigued for a long time now.

just start a new thread bro and you'll get plenty of help

[JuiceBox12]

Subscribe

Thank you for the info! Now once I get a copy of my blood work from my GP I will have an idea about what it is I am looking. I'm also feeling better prepared asking about further testing that would give me a clearer overall picture.

Feeling hopeful of a health future,

JUICEBOX 12

[JuiceBox12]

He put me on cyp, nolvadex , and hCG . I feel like I am on a path to some real answers. Only obstacle now is finding somewhere to fill my Rx of the hCG.

If anybody can help me out I would really appreciate it.


Hope in my eyes,

JuiceBox 12

[Far from massive]

I just read this thread and will reread it several more times, I am a 55 yr male in good health other than being positive for HCV<> Hep C . I was diagnosed with HCV approx 8 yrs ago, at the time my health was excellent although due to working in an office environment and not getting to the gym enough I was about 15 lbs overweight. After being diagnosed with HCV I was placed on interferon/ribaviron therapy. For anyone who is in a simalar situation read read read before starting on this crap which is very unlikely to have a sustained cure 1 in 5 and very likely to have many adverse affects on health ( for me a hemmorage in the optic nerve resulted) anyway back to the point, shortly after stopping treatment with interferon you liver enzymes and HCV viral load skyrocket as the Hep celabrates the cessation of the interferon. During this time I had one of the guys who I eat breakfast with reach out and pinch my tit and wink at me (NICE) it was at that time that I became aware that I had gyno/psuedogyno the only trouble was at the time I had no idea why, now I have a pretty good idea that it was due to the interferon induced viral load rebound.

I would like to thank you for helping me to understand this problem, by the way I am in my 6th day of PCT with L-Dex and Torem and the tissue seems to be dissapating on a daily basis, so hopefully by the completion of PCT most of the gyno/psuedogyno will be a thing of the past.

[Far from massive]

He put me on cyp, nolvadex , and hCG . I feel like I am on a path to some real answers. Only obstacle now is finding somewhere to fill my Rx of the hCG.

If anybody can help me out I would really appreciate it.


Hope in my eyes,

JuiceBox 12

I would hope that either your doc or a major pharmacy CVS etc. would be able to reccomend a solution to your problem...if not google is you friend just make sure the supplier is a legit source not a fly by night.

Did a search for you, try contacting the manufacturer (Genentech) as I am sure they can help you find a RX source for thier product,

Be sure to inject Nutropin at a different recommended place on your body each time. Your doctor or nurse should supervise the first injection and provide training and instruction.

Your doctor is your primary source of information about your treatment.

Please see the full Prescribing Information for Nutropin and Nutropin AQ, available from your pharmacy and at www.nutropin.com, for more about Nutropin and safety.

Questions? Call the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674).

[EASTCOASTKID]

great info thanks

[FormerActionMan]

Looking for input, I am 46 years old and getting ready to retire from Active Duty, my total testosterone is 268 NG/DL, testosterone free is 56 PG/ML.
Also my PSA is 3.81. What do you recommend?
Thanks,
Joe

[steroid.com 1]

Looking for input, I am 46 years old and getting ready to retire from Active Duty, my total testosterone is 268 NG/DL, testosterone free is 56 PG/ML.
Also my PSA is 3.81. What do you recommend?
Thanks,
Joe

Please post this question in the general forum and not this tread. You will be better served that way.

[VMAAG]

No matter what test method is used to determine your free testosterone status, the optimal level (where you want to be) is in the upper one-third of normal for a 20-29 year old male.

To add to this you ALWAYS want to make sure the patient is symptom free. That is the goal. The blood test results are a guide BUT they are NOT the end all and the be all as some people will need to be outside of the optimal ranges to feel good; to feel great whether it's higher or lower. That is most important - how does the patient feel.

[VMAAG]

Looking for input, I am 46 years old and getting ready to retire from Active Duty, my total testosterone is 268 NG/DL, testosterone free is 56 PG/ML.
Also my PSA is 3.81. What do you recommend?
Thanks,
Joe

A PSA of 3.81 is above the desired <2.5 therefore a biopsy would be appropriate before starting T therapy.

[devildog1967]

good post... doc said my free test was normal not optimal ..so now i see why they wont treat me ..lol ..trust the uk

[VMAAG]

good post... doc said my free test was normal not optimal ..so now i see why they wont treat me ..lol ..trust the uk

If you're sufferring from the symptoms of testosterone deficiency and your currecnt doc won't treat you find a doctor who will. Every doc brings to the table their own personal point of view on hrt - you need to find one that is in line with your beliefs.

[tinkr]

You may need to find a compounding pharmacy if you are using the HCG in cream form. They are pretty common. Try Google for your location, or your local pharmacy. Hope this is helpful. : )

[Sky6620]

Great Read, i will be getting bloodwork this week.

[jjambow]

hello new to this site. i have been on cypinate 1cc every two weeks, i got diagnoised with low t, my levels are 252 total, 45 estridol, testos 1.6 on a range of 2.5-8,. now my levels are not rising doc wants to up to 1.25cc every two weeks. i have no sex drive, i have bad anxiety and some depression. is there anything i can do or sholud suggest to get tested, or just go to a hrt specialist. i'm seeing and endo right now and seems like i'm going in circles. basically i feel like major poo. i have been doing this regiment for 3 months and i feel absoluty no better. i heard if they up my amount o cypinate, my estergon will go up according, is this true? and if so what can or should i do about it. like i say i have no sex drive, i no its not my wifes faught, i use to be all over her. this really sucks.

[bass]

hello new to this site. i have been on cypinate 1cc every two weeks, i got diagnoised with low t, my levels are 252 total, 45 estridol, testos 1.6 on a range of 2.5-8,. now my levels are not rising doc wants to up to 1.25cc every two weeks. i have no sex drive, i have bad anxiety and some depression. is there anything i can do or sholud suggest to get tested, or just go to a hrt specialist. i'm seeing and endo right now and seems like i'm going in circles. basically i feel like major poo. i have been doing this regiment for 3 months and i feel absoluty no better. i heard if they up my amount o cypinate, my estergon will go up according, is this true? and if so what can or should i do about it. like i say i have no sex drive, i no its not my wifes faught, i use to be all over her. this really sucks.

Hi JJ, start your own thread in this section so you can get better help. 1cc or 1.25cc every two weeks is not the way to go, you are on a roller coaster doing it every two weeks. you need to split your dose and do it at least once a week, or better yet, split that into twice a week at 50mgs or 1/4 of your total dose! yes your E2 will go us as well but you can control that with AI. go start your own thread so everyone can chime in...

[twbuckin]

I need help. I jsut had my testosterone levels checked. I am 55 years old.,,,

Results:

Free Calc 74 standard range 47-244 pg/ml
%Free 2.2 standard range 1.6-2.9 %
Testosterone 342 standard range 300-890 ng/dl
Sex Hormone Binding Globulin, Serum 23 standard range 11-80 nmol/L

What does this mean?

[zaggahamma]

I need help. I jsut had my testosterone levels checked. I am 55 years old.,,,

Results:

Free Calc 74 standard range 47-244 pg/ml
%Free 2.2 standard range 1.6-2.9 %
Testosterone 342 standard range 300-890 ng/dl
Sex Hormone Binding Globulin, Serum 23 standard range 11-80 nmol/L

What does this mean?

first off welcome to the forum....second...delete by editing this entire post with dots (................)

then start a NEW THREAD....include what your doctor told you that stuff meant

[NateDEEzy]

Call me crazy, but your UNITS for the free testosterone ranges seem to be WAY off.

[lowTestosteroneMale]

You say

Reference Intervals for Free Testosterone from LabCorp

* 20-29 years 9.3-26.5 picogram/mL
* 30-39 years 8.7-25.1 picogram/mL
* 40-49 years 6.8-21.5 picogram/mL
* 50-59 years 7.2-24.0 picogram/mL
* 60+ years 6.6-18.1 picogram/mL

And then say

the reference values for measuring free testosterone from Quest Diagnostics follow.

Adult Male (20-60+ years): 1.0-2.7% 50-210 pg/mL

Optimal Range: 150-210 pg/mL for aging men without prostate cancer.



Since both the ranges are in pg/mL, how can the reference values from two different labs be completely different?

[MRNJ1992]

medco

[rd27]

What's the source for this article? I saw it posted on ************* also (and asked there also), but I can't find the original source.


I ask because I am looking for "good" (good from his perspective) source of optimal ranges (vs reference ranges) to take to my doctor, but a sticky without references doesn't really cut it.


I have seen the LEF "Male Hormone Restoration" article which parallels the above recommendations, but it focuses more on supplements and so feels like its selling rather than informing. Once again, I am trying to think ahead to what my doctor will think of the source.


Thanks!
dave

[VTX1800]

Looking forward to my bw results this week. E2,LH,

[bigelle]

I am wondering how many nano grams per deciliters does one man need for testosterone without being low.

[SheepDog#1]

So glad I found this forum and this thread,,,great post!

Quest Diagnostics;
Test serum = 585 ng/dL
Test Free = 5.7 pg/mL (direct)
PSA = 0.765
IGT-1 = 113 ng/mL
GH = <0.1 ng/mL
Sex HBG, serum = 71.2 nmo1/L

My Dr. wants to put me on a host of , and I want to make sure I take what I NEED, not just what someone wants to sell me..

Here is what he first suggested;
Hoye's: Sermorelin Forte Plus 19.8 mg per vile (qty 3)
Hoye's: Testosterone Cyp/Ena(90/10)200mg/10ml (qty 1)
Hoye's: HCG 5,000 inj. (qty 2)
Hoye's: Anastrozole 1.0mg (qty 20)
Hoye's: Oxandrolone 50mg (troche) (qty 35)
Hoye's: LIV.52 180 ct (liver support) (qty 1
Hoye's: MIC-Combo Ultra Burn. 30ml (liver support/fat burner) (qty 1)
Total cost; $2641.90 w/syringes as well

After telling him I could not afford that right now he took off the GH

Opinions please and thanks...

[MikeShlort]

jkhjkhbfs

[Cam2012]

Great read

[jeff21031]

I am 56 years old...I went doctor and he said my test. was low.....give me advice on how much testosterone propionate to inject...I need dosage please