Low total T, but high Free T, what does that mean?

I had a butt-load of blood-work done and it included a couple testosterone tests. They came back as
Testosterone, Serum (I think this is total) 214 ng/dL. Labcorp shows the good range as 264-916
Free Testosterone (Direct) 32.5 pg/mL. labcorp shows the good range as 6.8-21.5

I've been doing a lot of reading, but I have not yet understood what can lead to a low total T, but a high free T.

Can anyone help me understand?

Also, since free T is high, does that mean I dont need any more T in my life, or since the total is low I should add some?

I dont know how much it matters, but I'm 44, work out frequently, but am obese. All of my other blood-work came out good except low Vitamin D.

Sorry if this was covered elsewhere, I did some searching and reading but didn't see it.

Thanks!

My initial guess is the Free T lab may not accurate. That said, the amount of FT you have is determined by the amount of total test you have in combination with SHBG. SHBG is a protein that transports hormones (T & E) in the blood. The higher the SHBG level the less FT you have. The lower the SHBG level the more FT you can have. A lot of factors can play into this. You mentioned being obese which can influence a low shbg level as can thyroid issues (hypothyroid) and several other issues such as insulin, etc. Take a few minutes and google Metabolic Syndrome as well.

If you have a copy of the blood work, post it up just be sure to redact personal information.

Welcome to the forum!

Whats funny is I originally went to the Doc to get tested for Lyme. She ended up testing for a ton of stuff.

Anyway, rather than try to copy the results and try to make sure I remove all the personal stuff.. I'll just transcribe the results:

B. henselae IgG - negative
B. henselae IgM - negative
B. quintana IgG - negative
B. quintana IgM - negative
M pneumoniae IgG - 2142 U/mL (high)
M pneumoniae IgM - <770 U/mL
E. chaffeensis IgG - negative
E. chaffeenis IgM - negative
HGE IgG - Negative
HGE IgM - negative

ANA direct - negative
RA latex turbid. - <10.0 IU/mL
C-Reactive Protein, Quant - 1.0 mg/L
Sjogrens Anti-SS-A - 0.2 AI
Sjogrens Anti-SS-B - <0.2 AI
CCP antibodies IgG/IgA - 9 units

Sed rate - Westergren - 18 mm/hr (high)

TSH - 2.32 uIU/mL (range - 0.45 - 4.5)
T3 - free - 3.2 pg/mL (range - 2.0 - 4.4)
T4 - free - 1.38 ng/dL (range - 0.82 - 1.77)
RT3 - Serum - 29.7 ng/dL (high) (range - 9.2 - 24.1)
TPO Ab - 13 IU/mL (range - 0-34)
thyroglobulin Antibody - <1.0 IU/mL (range - 0 - 0.9)

CD8-/CD57+ Lymphs - 4.9%
Abs. CD8-CD57+ lymphs - 74 /uL

WBC - 6.3 x10e3/uL
RBC - 5.01 x10e6/uL
hemoglobin - 14.4 g/dL
hematocrit - 41.6%
MCV - 83 fL
MCH - 28.7 pg
MCHC - 34.6 g/dL
RDW - 14.1%
platelets - 197 x10e3/uL
neutraphils - 66%
lymphs - 24%
monocytes - 8%
Eos - 2%
Basos - 0%

about 10 different tests on lyme - negative


Glucose - 94 mG/dL
BUN - 15 mg/dL
Creatinine - 1.01 mg/dL
eGFR - 91 mL/min/1.73
Bun/Creatinine ratio - 15
Sodium - 139 mmol/L
potasium - 4.0 mmol/L
Chloride - 100 mmol/L
CO2, total - 23 mmol/L
Calcium - 9.6 mg/dL
protein, total - 7.3 g/dL
albumin - 4.6 g/dL
globulin, total - 2.7 g/dL
A/G ratio - 1.7
Bilirubin, total - 0.8 mg/dL
alkaline phosphatase - 50 IU/L
AST (SGOT) - 24 IU/L
ALT (SGPT) - 22 IU/L

Candidia IgG - 64 U/mL (high)
candida IgM - <10 U/mL
Candida IgA - 30 U/mL (high)

RMSF, IgG, EIA - negative
RMSF, IgM - 0.23

Hemoglobin A1c - 5.3%

Testosterone, Serum - 214 ng/dL (low)
Vitamin D, 25-Hydroxy - 24.1 ng/mL (Low)
A. phagocytophilum PCR - negative
Testosterone, Free, Direct - 32.5 pg/mL (high)

tTG/DGP Screen - Negative
Antigliadin IgG (native) - 19 units
F004W-IgE Wheat - <0.10 kU/L

Well, they really didn't test what we need to see, such as:

LH/FSH
Cortisol
Prolactin
SHBG

LH/FSH indicate pituitary function and helps determine whether your low T is "Secondary" Pituitary related, or "Primary" testicular related. Or it can be a combination of both. The other test I listed all can impact T levels.

Edit and add in ranges for your Thyroid panels please.

post edited.

I am going to see my primary tomorrow and plan to discuss this all. might even convince him to run the additional tests, though i'm finding it harder and harder to get bloodwork ordered these days. The doc that ran all the tests above was not my primary, but a specialist for Lyme who apparently has no such aversion to testing.

Well, your other thyroid numbers are solid so I'd just keep an eye on it for now. Try to get your doc to get you all the labs discussed. It's important to determine the root cause of your low T before you simply band aid it with TRT. I'm sure you're aware that your weight can and will impact T levels as well. Also remember my comment about metabolic syndrome please.

Regarding your Vit D level, if you're not already supplementing I'd start immediately with 5K IU's per day taken with a meal. Be sure to test it in the future as well to keep your levels in range. Normal range about 30-100.

Also, you should not have to convince your doctor. If you're paying for it and your request is reasonable there's no reason they should turn you down. If they do, find another doctor or pull labs yourself through Discounted Labs or similar.

Thanks. I did start taking some vit D. 50,000 once a week. I'm also taking some meds to clean up the infections i didnt even know I had. I do know the weight is an issue, and the main reason I went to the doc to check for lyme was the laundry list of symptoms that somewhat matched (plus I've had a ton of tick bites over the years). And the low energy, loss of strength and loss of cardio has really put a damper on the weight loss. I'm down about 100 lbs so far (its taken a few years), but I have another 80 or so to go.

I'm tired of being sick and tired, so now I'm following any leads I can. But I also dont want to make mistakes and medicate when i shouldn't, which is why I'm trying to understand how low total T and high free T can even happen.

I'll push for the other tests, and as you suggested just order them myself if needed. (I keep forgetting thats an option)

Good stuff. Glad you already started on D2. Driscol I presume?
Please follow up and post your progress on this thread.

Quote:

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Originally Posted by kelkel

Good stuff. Glad you already started on D2. Driscol I presume?
Please follow up and post your progress on this thread.

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Got soem additional numbers:

SHGB 11 nmol/L (range 10-57)
Prolactin 7.7 ng/ml (range 2.1-17.7)
Creatinine conc 356 mg/dL (no range given)
Cortisol/cre ratio 9.8 mcg/g Cr (range 1.0 - 119) (thats a huge range!)
FSH 1.0 mIU/ml (range 1.4-181.) LOW

For the vit D, its D3 not D2.

IT may be confirmation bias, but I feel like the quality of my sleep is improving slightly and I have a touch more energy. I'm hoping that taking Vit D and clearing up the infection, as well as some supplements is all I will need to bring the numbers back into the normal range. I still dont understand how I can have low total T and high Free T unless one of those tests just had a crap result.

But for now I'm taking Vit D, DHEA, 2 probiotics, and a "testosterone booster" which is really just a little bit of a few vitamins and a couple plants that evidence suggests will only treat symptoms and not the T itself. But the doc suggested it, so I'm giving it a try.

I dont have a followup scheduled until a bit over a month from now, but maybe that will give enough time for the vit D to come back up in my body.

You have high FT due to your SHBG being low. SHBG is what binds T and yours is barely in range therefore you're binding very little.