Relationship betwen Total testosterone and Free

[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.

[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?

[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.

[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?

[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...

[n00bs]

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...

Thank you for that clarification... I do not think we have a specific bioavilable test here in australia... My Doc hasnt mentioned it to me and i have been able to personally find one.

From my understand free test was a measure of what is unbound so that unbound tets is bioaviaalble..

Anyway thanks for the correction.

[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?