Relationship betwen Total testosterone and Free

[Enfuego129]

Fellas, I have had several blood tests done since April and I have a question about the relationship between total and free testosterone . In all tests my total testosterone has come in at or below bottom of the normal reference range 250 to 1100. Within those same blood tests I have also seen my free testosterone at or above the reference range of 1.5 to 2.2. I have attached a simple spreadsheet for those of you that may have questions about other bloodwork done.

Could someone please explain what is happening or causing this.

[marcus300]

Total testosterone is the amount of test in your blood no matter what it is bound to, free testosterone is the test what is floating around what can be actively used. What are you using?

[Enfuego129]

Total testosterone is the amount of test in your blood no matter what it is bound to, free testosterone is the test what is floating around what can be actively used. What are you using?

Nothing is being used by me since 5/1/2010. I was being treated by my GP for hypogonadism who eventually referred me to an Endo. This Endo took me off of the supplemental Androgel (10 gr) my GP prescribed because the recommended bloodwork for this diagnosis wasnt done by my GP. FYI, the Endo also wanted to see what my body was doing on its own. I have posted almost all my recent bloodwork for review by the board. I think I added that information after you posted this reply.

Do you see something that concerns you?

[Enfuego129]

Marcos, the orientation on the spreadsheet has been edited to make it easier to read.

[Enfuego129]

Bump for some one else to give their opinion.

[lovbyts]

What's the question? It seems you have low test levels. The endo should be able to straighten this out for.

[stevey_6t9]

i dont know if theres a relationship, but free test is what really matters.

you may have low SHBG, check your E2 it may be low.

ive read theres a small correlation between them.

[Enfuego129]

First I am new to TRT, my question is why is my free coming in above the reference range when my total is always low. I want to know why free is high.

[PPC]

First I am new to TRT, my question is why is my free coming in above the reference range when my total is always low. I want to know why free is high.

Agree that low SHBG and E2 should be checked out. Have you checked your albumin? Free T is not bound to albumin. Maybe your's is low? Just going by general consensus here, but SHBG optimally needs to be from about 15-25.

Do you have syndrome X? Type 11 diabetes can cause low SHBG but there can be other reasons for it.

Sometimes adding T3 (cytomel ) can raise SHBG. But that's a whole new journey and I would only do that if it was warranted.

[Enfuego129]

Agree that low SHBG and E2 should be checked out. Have you checked your albumin? Free T is not bound to albumin. Maybe your's is low? Just going by general consensus here, but SHBG optimally needs to be from about 15-25.

Do you have syndrome X? Type 11 diabetes can cause low SHBG but there can be other reasons for it.

Sometimes adding T3 (cytomel) can raise SHBG. But that's a whole new journey and I would only do that if it was warranted.

Now were are getting somewhere. I am unsure what syndrome X is but will research it here, my blood sugar levels are normal.

FYI, my current GP and Endo are not worth their salt and will be replaced when my insurance will allow me to switch from my current HMO to a PPO. Until then they are unfortunately controlling my destiny unless I am willing to pay out of pocket.

[zaggahamma]

wont low shbg be beneficial or does the patient want some test to be bound...i've never grasped that aspect ...
my thought process agrees with lovbyts..
and enfuego...like i told you in pm's, how are you feeling?

[Enfuego129]

wont low shbg be beneficial or does the patient want some test to be bound...i've never grasped that aspect ...
my thought process agrees with lovbyts..
and enfuego...like i told you in pm's, how are you feeling?

I feel like crap, and cant lose weight regardless of activity, mostly tired and irritable but lacking the energy to do the things I want to do. Diet could still use some improvement but isn't terrible.

I know all of you have told me to switch doctors but I am stuck with this guy until what my insurance company calls "open enrollment".

JP, you have given me great advise all along and I hope to find a receptive and educated doctor but my present insurance complicates things. One illustration I can offer is that I have BCBS HMO....this HMO like all others require you to go to your GP who refers you to specialists that are part of that plan. All the Endos on this plan are out of the same practice / office and are familiar with my case. I am screwed until I either switch to a PPO or pay out of pocket. Proper treatment by a qualified doctor will require several prescriptions which I cannot afford.

If you viewed the attached bloodwork I think it clearly states the case that I should be getting supplemental T. I requested all the bloodwork after 5/1/2010 to prove to the Endo that the 333 on that date was an anomaly. He agreed to do four other free and available tests to show an average. If the Endo had his way on 5/1/2010 he would have recommended to my GP to stop all treatment because I was within the "normal range"

[zaggahamma]

we're all glad to help...do whatever it takes to get test...can u get refills on the androgel that you used before?

serious malpractice going on here imo

very sad

[Enfuego129]

we're all glad to help...do whatever it takes to get test...can u get refills on the androgel that you used before?

serious malpractice going on here imo

very sad

Possibly malpractice, but Endo is saying that he needs to see what my "normal" levels are before recommending TRT. I think switching from the HMO to the PPO will open a lot of doors including getting me back to my original doctor who will treat me properly and will be open to suggestions.

FYI, I switched to the HMO for the well baby care. At the time I thought I was healthy and didn't care who my doctor was since I never saw a doctor before this diagnosis.

[zaggahamma]

Possibly malpractice, but Endo is saying that he needs to see what my "normal" levels are before recommending TRT. I think switching from the HMO to the PPO will open a lot of doors including getting me back to my original doctor who will treat me properly and will be open to suggestions.

FYI, I switched to the HMO for the well baby care. At the time I thought I was healthy and didn't care who my doctor was since I never saw a doctor before this diagnosis.

didnt you get bloodwork done before the first quack gave u androgel ? of course you did...THERES THE FN "normal fn levels" where the f is the mystery??????????????????????????????????????????? ??

[Enfuego129]

didnt you get bloodwork done before the first quack gave u androgel ? of course you did...THERES THE FN "normal fn levels" where the f is the mystery??????????????????????????????????????????? ??

Yes but the the blood work I had done was only for total and free Testosterone , Thyroid function and PSA. All were requested by me because of the tired no energy, irritable, depressed condition I had at my annual physical.

As it was explained to me the Endo, took me off of the Androgel to get my body back to its "normal state" so he could test for FSH, LH, TSH and Prolactin levels. None of which were done by my GP when he put me on the Androgel. The Endo further explained that the low T levels can be caused by a pituitary tumor. I guess some of those seperate blood tests were to indicate if more testing or a CT was needed.

Hope this explanation has helped you understand how I got here. Please remember I do not have the knowledge of HRT you have so some of my questions may seem stupid but this is me looking for guidance and knowledge to fight with the GP and Endo for comprehensive care.

[marcus300]

First I am new to TRT, my question is why is my free coming in above the reference range when my total is always low. I want to know why free is high.

To my understanding Free testosterone is determined by how much SHBG is present, while albumin production tends to be stable. SHBG is controlled by various other hormones including estrogen,progesterone and thyroid which are hormones that increase SHBG, the other hormones what reduce SHBG are Test,DHEA,insulin ,growth hormone and other androgens.

So having a blood test showing what your free test levels will also show the sum of all these above hormones, in your case the ones what increase SHBG which would show up higher free test levels. It may well be one of the other hormones within this group what is increasing your free levels ie low estrogen or low thyroid or low progestrone. I doubt it will be one of the hormones what reduce SHBG because from your blood work you have low total test. The higher free test simply tells you something is wrong in one of the above areas, so my advice is get more bloodwork done on these other hormones and if your Endo is good he will advice the best course of action, but overall your test levels are low and you need treatment, HRT IMHO.

[Enfuego129]

To my understanding Free testosterone is determined by how much SHBG is present, while albumin production tends to be stable. SHBG is controlled by various other hormones including estrogen,progesterone and thyroid which are hormones that increase SHBG, the other hormones what reduce SHBG are Test,DHEA,insulin ,growth hormone and other androgens.

So having a blood test showing what your free test levels will also show the sum of all these above hormones, in your case the ones what increase SHBG which would show up higher free test levels. It may well be one of the other hormones within this group what is increasing your free levels ie low estrogen or low thyroid or low progestrone. I doubt it will be one of the hormones what reduce SHBG because from your blood work you have low total test. The higher free test simply tells you something is wrong in one of the above areas, so my advice is get more bloodwork done on these other hormones and if your Endo is good he will advice the best course of action, but overall your test levels are low and you need treatment, HRT IMHO.

Thanks for taking the time to write your explanation. It has helped me understand a little what might be going on.

[rmacgurn]

Thanks for taking the time to write your explanation. It has helped me understand a little what might be going on.

I read this tread and did not see anyone say it but "normal" free to total test is about 2% u are in the 1.8-2.48% range but, not knowing your age or any stats any more comment is hard.
If your were doing trt and the goal was say 800 then you can use 2% of that as an indication of your free test goal. (care to use correct measurement units). your most recent test show about 2.37%. So if your total was say 800-850 range I would expect your free to be about 150-160 or so. As others have said you could have an issue with SHBG, but I doubt it. With your levels this low and not knowing FSH, LH or E2 levels hard to say much more meaningful. lastly your free is not high, just higher then 2% but remember you total test is low....the labs ranges are 250-1100 that is a wide range of 400% from min to max, most now think it is best to stay in the top quadrant of these ranges so that is 887-1100 on this labs ranges. And remember each lab varies base on the patients it tests over time, these ranges are nothing more than 2 standard deviations from the median. That is for all patients healthy and sick...

[Enfuego129]

I read this tread and did not see anyone say it but "normal" free to total test is about 2% u are in the 1.8-2.48% range but, not knowing your age or any stats any more comment is hard.
If your were doing trt and the goal was say 800 then you can use 2% of that as an indication of your free test goal. (care to use correct measurement units). your most recent test show about 2.37%. So if your total was say 800-850 range I would expect your free to be about 150-160 or so. As others have said you could have an issue with SHBG, but I doubt it. With your levels this low and not knowing FSH, LH or E2 levels hard to say much more meaningful. lastly your free is not high, just higher then 2% but remember you total test is low....the labs ranges are 250-1100 that is a wide range of 400% from min to max, most now think it is best to stay in the top quadrant of these ranges so that is 887-1100 on this labs ranges. And remember each lab varies base on the patients it tests over time, these ranges are nothing more than 2 standard deviations from the median. That is for all patients healthy and sick...

Rmacgurn, please check the first post on this subject FSH and LH is included in bloodwork from 5/1/2010. Doctor and Endo have not done a E2 blood test. Regarding stats, I am unsure what you might need. I am 43 Y/O male who weighs 255 with a BMI of around 33%. My cholesterol and blood sugar are in normal range with no other known health issues. Regarding body composition I agree mine is not good but I do work out both cardio and resistance at a moderate intensity.

[n00bs]

Bump for some one else to give their opinion.

How is the depression going ?


I dont like endos find an anti aging dr they will be able to actually help you...

I believe you have alot in the states.

Frustrating that they never ran e2 and SHBG or even DHT, your test could simply be converting into e2 for whatever reason (liver issues perhaps)...

Once you get full labs we will be able to see more..

Thyroid and adrenals can also mimick hypogonadism in men...

Its a fairly big picture when you are secondary andnot always easy to work out... I chose to ****it and just go on treatment.. It isnt going to kill you. You are older and your natural T levels will be diminishing might as well have optimal T levels for the rest of your life.

Dont be afraid of TRT.

Frustrating your endo took you off gel... If you went to see the doc for depression and he gave you prozac then saw a phsyc would they take you off those meds? No...

[Enfuego129]

Depression isn't too bad but I don't think my head is in as good a place as it was when I was on the gel. I plan on calling the Endo's office to see if he will order the SHBG bloodwork. FYI, about three years ago I went to the doctor for treatment for depression. We tried five different meds over two years none of which did anything. Sometimes the side effects were worse than the depression symptoms. Hindsight, the depression may have been caused by low T since the Androgel made my head feel better than I could remember.

[n00bs]

Depression isn't too bad but I don't think my head is in as good a place as it was when I was on the gel. I plan on calling the Endo's office to see if he will order the SHBG bloodwork. FYI, about three years ago I went to the doctor for treatment for depression. We tried five different meds over two years none of which did anything. Sometimes the side effects were worse than the depression symptoms. Hindsight, the depression may have been caused by low T since the Androgel made my head feel better than I could remember.

Mate you need a good dr..

Look up Dr John crisler if you are in the states www.allthingsmale.com

He will help you! Dont mess aorund with amateurs.

[rmacgurn]

How is the depression going ?


I dont like endos find an anti aging dr they will be able to actually help you...

I believe you have alot in the states.

Frustrating that they never ran e2 and SHBG or even DHT, your test could simply be converting into e2 for whatever reason (liver issues perhaps)...

Once you get full labs we will be able to see more..

Thyroid and adrenals can also mimick hypogonadism in men...

Its a fairly big picture when you are secondary andnot always easy to work out... I chose to ****it and just go on treatment.. It isnt going to kill you. You are older and your natural T levels will be diminishing might as well have optimal T levels for the rest of your life.

Dont be afraid of TRT.

Frustrating your endo took you off gel... If you went to see the doc for depression and he gave you prozac then saw a phsyc would they take you off those meds? No...

Very good points and advice, the blood sugar or thyroid could be a factor in the weight, and energy, to many variables to say without more blood work. and again a single fasting glucose test is unless your level is like 85 or less does not really tell you enough. Endo's tend to use the full range on blood work as A oK (test 250-1100), when it is not like i said before best to push to the top 25% of the range to fell your best.
You say med cartio work, what does that mean to you. i do a med. level but that is like 40min two days a week and 20 min the other three, always to keep my pulse at 140 +-5, and i am 57. that keeps my bf% always under 10% currently 8.5%. but i also take GH 2iu a day. and trt at 900-1000 level last year.

[zaggahamma]

Mate you need a good dr..

Look up Dr John crisler if you are in the states www.allthingsmale.com

He will help you! Dont mess aorund with amateurs.

i've heard only good things about him

[n00bs]

i've heard only good things about him

Yes he is not a quack i have not dealt with him but have simply read alot of his infomation studied it myself.. And met alot of helpful people on the forums there who are all going through the same thing...

He is light years ahead of other dr's and endos... I see people rpeorting that endos dont get tests (that even i know) are needed for a diagnosis and its jsut ridiculous.

When a forum full of random people get together and know more then dr's something is totally wrong!

[Vettester]

Enfuego, I'm a little late to the party on this one, been traveling today. Not much I can say that hasn't been said on the causes. The SHBG and albumin factors were hit spot on, and the amount of information provided on this thread pretty much makes it a "must see" for anyone studying up on HRT.

Even though the information provided was priceless, I was still kind of scratching my head (it itched anyway) about your spreadsheet. Then rmacgurn hit it on post #19! (I think you deserve a reputation point for that BTW). I was basically going to say the same thing. Normal free "T" should and can be around 2%. In fact I've seen ranges from 1% to 2.7% ... So great if you're hitting 2.3 or 2.4.

So, as others have also stressed, your attention and emphasis needs to be on that "Total T" number and getting that score in the satisfactory zone. Plus the E2, IGF and other pertinent tests need to be addressed. Have you really taken the time to investigate what it would cost to do this out of pocket with a place that can treat you properly? You might be surprised. I've been through the same thing my friend. It was truly frustrating because I'd rather just do a 1 stop shopping program with my primary and pocket the extra $$. However, that was just one big happy illusion. After my doc crashed me (like yours is doing) I knew hard choices needed to be made. However, I discovered those hard choices were actually easy choices when it comes to my health and I crossed over.

[Jadam]

I agree with Vetteman, there was a lot of great info in here! Glad I came in to read it.

Good luck with things, Enfuego.

[Enfuego129]

Enfuego, I'm a little late to the party on this one, been traveling today. Not much I can say that hasn't been said on the causes. The SHBG and albumin factors were hit spot on, and the amount of information provided on this thread pretty much makes it a "must see" for anyone studying up on HRT.

Even though the information provided was priceless, I was still kind of scratching my head (it itched anyway) about your spreadsheet. Then rmacgurn hit it on post #19! (I think you deserve a reputation point for that BTW). I was basically going to say the same thing. Normal free "T" should and can be around 2%. In fact I've seen ranges from 1% to 2.7% ... So great if you're hitting 2.3 or 2.4.

So, as others have also stressed, your attention and emphasis needs to be on that "Total T" number and getting that score in the satisfactory zone. Plus the E2, IGF and other pertinent tests need to be addressed. Have you really taken the time to investigate what it would cost to do this out of pocket with a place that can treat you properly? You might be surprised. I've been through the same thing my friend. It was truly frustrating because I'd rather just do a 1 stop shopping program with my primary and pocket the extra $$. However, that was just one big happy illusion. After my doc crashed me (like yours is doing) I knew hard choices needed to be made. However, I discovered those hard choices were actually easy choices when it comes to my health and I crossed over.

Vetteman thanks for weighing in on this subject. My inexperience with HRT is really holding this thread back. What is obvious to most of you is confusing to me. I will continue to research all replies here to better understand what is being taught here. Regarding your reply, hitting the 2.3 to 2.4 % normal / free testosterone is a good thing. What will happen to that number if my total T is increased with supplemental T? Also, if the normal / free % is above range wont my Endo say you are fine even with low total T? Which provides ammunition to withhold supplemental T?

[Enfuego129]

Very good points and advice, the blood sugar or thyroid could be a factor in the weight, and energy, to many variables to say without more blood work. and again a single fasting glucose test is unless your level is like 85 or less does not really tell you enough. Endo's tend to use the full range on blood work as A oK (test 250-1100), when it is not like i said before best to push to the top 25% of the range to fell your best.
You say med cartio work, what does that mean to you. i do a med. level but that is like 40min two days a week and 20 min the other three, always to keep my pulse at 140 +-5, and i am 57. that keeps my bf% always under 10% currently 8.5%. but i also take GH 2iu a day. and trt at 900-1000 level last year.

Regarding my cardio I do 3 to 4 days per week of cardio with my HR in the 70 to 80% max hr. I follow each cardio session with another hour of circuit type resistance to keep my HR up through that part of the workout.

[n00bs]

Vetteman thanks for weighing in on this subject. My inexperience with HRT is really holding this thread back. What is obvious to most of you is confusing to me. I will continue to research all replies here to better understand what is being taught here. Regarding your reply, hitting the 2.3 to 2.4 % normal / free testosterone is a good thing. What will happen to that number if my total T is increased with supplemental T? Also, if the normal / free % is above range wont my Endo say you are fine even with low total T? Which provides ammunition to withhold supplemental T?

Most endos will go off total t (god knows why)..

And even if he refuses you treatment because you are 10 points off the barminimum of a ridiculous scale then he is not the sort of uneducated person you want treating your problems...

SHBG binds to sex hormones

Total test is all testosterone even that bound to shbg albumin and other peptides.

Free test is unbound and bioavailable..

The higher your SHBG the more test you will need, however shbg usually is increased by oestrogen..

Oestrogen is made from testosterone in fat cells from an enzyme called aromatase..

Im not sure if you guys can get FAI tests done (free androgen index) it measures the percentage of well.. free androgens like the name states...

Supplemental transdermal T will increase t levels unless you have a major thyroid issue.

But it will be best to get adrenals and thyroid sorted and checked to make sure it is not them mimicking hypogonadism..

Hope some of that makese more sense to you then it did before.



EDIT:

Thats alot of "cardio" work.. Now doubt cortisol will be all over the shop and not helping because of it cortisol.. If you have adrenal issues this will worsen the problem.

[Enfuego129]

Most endos will go off total t (god knows why)..

And even if he refuses you treatment because you are 10 points off the barminimum of a ridiculous scale then he is not the sort of uneducated person you want treating your problems...

SHBG binds to sex hormones

Total test is all testosterone even that bound to shbg albumin and other peptides.

Free test is unbound and bioavailable..

The higher your SHBG the more test you will need, however shbg usually is increased by oestrogen..

Oestrogen is made from testosterone in fat cells from an enzyme called aromatase..

Im not sure if you guys can get FAI tests done (free androgen index) it measures the percentage of well.. free androgens like the name states...

Supplemental transdermal T will increase t levels unless you have a major thyroid issue.

But it will be best to get adrenals and thyroid sorted and checked to make sure it is not them mimicking hypogonadism..

Hope some of that makese more sense to you then it did before.



EDIT:

Thats alot of "cardio" work.. Now doubt cortisol will be all over the shop and not helping because of it cortisol.. If you have adrenal issues this will worsen the problem.

n00bs, good post and thanks for putting it in layman's terms for me.

[Enfuego129]

Ok, so here is what I have learned so far

1. Dr Crissler is one of the best in the HRT business
2. That I should request additional bloodwork (SHBG, E2 and Albumin)
3. That high SHBG and or high E2 levels may be causing the low total testosterone test scores I have consistently had.
4. That low estrogen, a hypothyroid condition and low progesterone all may play a part in raising my Free Testosterone.
5. Testosterone, DHEA, insulin and growth hormone levels all play a part in lowering SHBG

If I am wrong on any of the above straighten me out. In the meantime I am going to call my insurance to check on when the next open enrollment period is and call Dr Crislers office.

[Vettester]

Vetteman thanks for weighing in on this subject. My inexperience with HRT is really holding this thread back. What is obvious to most of you is confusing to me. I will continue to research all replies here to better understand what is being taught here. Regarding your reply, hitting the 2.3 to 2.4 % normal / free testosterone is a good thing. What will happen to that number if my total T is increased with supplemental T? Also, if the normal / free % is above range wont my Endo say you are fine even with low total T? Which provides ammunition to withhold supplemental T?

You will find the percentage of free will remain relevant to the total as seen from previous tests, even at higher levels. Might fluctuate a little back and forth, as you've seen already.

To ease your concern, take a look at your spreadsheet. You will see that the biggest deviation on your free % was when your Total "T" hit 319 (2.48 highest) and when your Total "T" was 290 (1.8 lowest). Think about it, 290 was your 2nd highest score for Total, but was your lowest on free %. Your free % was higher than that when your Total "T" was at 179 (1.98).

Again, as others have stressed ... Your real issues are with your medical team. Having to feel like you need ammunition to get treated properly means you're on the defense with these guys, and that usually ends in failure at your expense. They probably won't change ... The question is, will you?

[zaggahamma]

Most endos will go off total t (god knows why)..

And even if he refuses you treatment because you are 10 points off the barminimum of a ridiculous scale then he is not the sort of uneducated person you want treating your problems...

SHBG binds to sex hormones

Total test is all testosterone even that bound to shbg albumin and other peptides.

Free test is unbound and bioavailable..

The higher your SHBG the more test you will need, however shbg usually is increased by oestrogen..

Oestrogen is made from testosterone in fat cells from an enzyme called aromatase..

Im not sure if you guys can get FAI tests done (free androgen index) it measures the percentage of well.. free androgens like the name states...

Supplemental transdermal T will increase t levels unless you have a major thyroid issue.

But it will be best to get adrenals and thyroid sorted and checked to make sure it is not them mimicking hypogonadism..

Hope some of that makese more sense to you then it did before.



EDIT:

Thats alot of "cardio" work.. Now doubt cortisol will be all over the shop and not helping because of it cortisol.. If you have adrenal issues this will worsen the problem.

yes,
it is an available test...and i had it done...by an endo's order (at his office) and was told mine was way too high (all on 10mg ed of androgel )....i said..."but i feel great" and he says "yes, cuz your doing too much"....

thats when i moved on

[n00bs]

yes,
it is an available test...and i had it done...by an endo's order (at his office) and was told mine was way too high (all on 10mg ed of androgel )....i said..."but i feel great" and he says "yes, cuz your doing too much"....

thats when i moved on

Wow thats sad,

I have an FAI of 233.3% thats 133.3% over range... But i still feel like shit because my IGF-1 is low...

It amazes me how these "trianed professionals" only look at 1 number and have a fetish with it.

My total and free test is well within range but because my SHBG is so low it puts the FAI out... The same could of been true for you?

[alexb266]

Hey, I was just wondering how to post a new thread? Ive looked in the FAQ and cant find anything, thanks. What I was trying to find out was if anyone had gotten gear from Advanced ******* and was it good, and without problems?

[zaggahamma]

Hey, I was just wondering how to post a new thread? Ive looked in the FAQ and cant find anything, thanks. What I was trying to find out was if anyone had gotten gear from Advanced ******* and was it good, and without problems?

go to forums home


click on hormone replacement, anti aging, alternative medicine...

near the top left you'll see NEW THREAD

BINGO!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

[Spartans09]

Shbg is what binds to test and renders it useless thus reducing your total free test. You don't want shbg elevated.

[rmacgurn]

Most endos will go off total t (god knows why)..

And even if he refuses you treatment because you are 10 points off the barminimum of a ridiculous scale then he is not the sort of uneducated person you want treating your problems...

SHBG binds to sex hormones

Total test is all testosterone even that bound to shbg albumin and other peptides.

Free test is unbound and bioavailable..

The higher your SHBG the more test you will need, however shbg usually is increased by oestrogen..

Oestrogen is made from testosterone in fat cells from an enzyme called aromatase..

Im not sure if you guys can get FAI tests done (free androgen index) it measures the percentage of well.. free androgens like the name states...

Supplemental transdermal T will increase t levels unless you have a major thyroid issue.

But it will be best to get adrenals and thyroid sorted and checked to make sure it is not them mimicking hypogonadism..

Hope some of that makese more sense to you then it did before.



EDIT:

Thats alot of "cardio" work.. Now doubt cortisol will be all over the shop and not helping because of it cortisol.. If you have adrenal issues this will worsen the problem.

Just one minor correction or clarification to this post, free test and bioavailable are not the same. Free is unbound and bioavail includes what is called losely bound. As such it is a bit more sensitive measure. Not all labs offer it so you can use free if they do not. No a biggy but trying to be factual here. best suggestion here is continue your education and find a good doctor...