Quote Originally Posted by plainview View Post
Well to bring this thread full circle I received an unexpected phone call from my Dr.’s office this past monday and They called to tell me my testosterone labs came back normal. So I logged on to the portal and it appears my Dr. Ran two sets of labs for T. An immunoassay as well as an LC MS/MS comprehensive for T. I think he was only gonna run the immunoassay until the nurse came in to draw blood and I started asking her about which T test he ordered so she drew a plain red top just incase. This result was exactly what I would have expected.

total t 971 250-1100
Free T 144 46-224
Bioavailable 316 110-575
SHBG 34 10-50
Albumin 4.8 3.6-5.1

seems the consensus is that the lc ms/ms is the standard for testing T and the immunoassay can overestimate T. If anyone has any influence with their Dr or a say in their treatment, then I would never let them use the immunoassay method for a T lab. Of course most know that doesn’t tell the whole story anyway. So in the end my dr. Agreed to allow me to stay on my previous dose of 120mg a week rather than cut me back to 60mg every 5 days which only amounts to 84mg a week.
My next puzzle is the fact that my SHBG went up from what has always been 15-22 to 34. Don’t know if this is good bad or otherwise but I know my free T at peak would be pretty high even at 100-120mg a week when it was lower. Now it’s just a little above the middle which theoretically could call for a dose increase if anything. I was briefly looking to see what could have changed that and it appears through one paper I found that rezveratrol can increase SHBG. Guess that results in smoother more consistent Free T levels. I would think that would be a desired effect.
A couple of thoughts.

1) The LC/MS/MS assay is technically a better assay for T, but it is also more expensive. If Insurance is footing the bill, that's OK. But if you're footing the bill (as I often do with extra labs) then I go with the standard immunoassay. Guys who are on higher doses of T (e.g., bodybuilders) and expect Total T to be higher than 1500 ng/dL and they want to know the exact amount over 1500, then they should go with the LC/MS/MS test method. If you expect results <1500, then the immunoassay is a good less expensive choice.

2) The LC/MS/MS chatter gets messy because for E2 it is by far the better choice. There is much more cross-reactivity with the E2 immunoassay than there is with the T assay. Personally, I would never use the E2 immunoassay even if they call it "sensitive".

3) Bioavailable T is also a good choice. Not sure what test method is used, but my doc runs it in addition to Total and Free and it always seems to parallel the Free T quite well.

4) My SHBG bounces around a little too. It's always high, but just how high seems to vary a bit. Not sure exactly what causes this, but I've seen it too.

Overall, I think your protocol is sound, Cutting back just a little and increasing the frequency might smooth things out, but then again, I always tell my doc when she suggests changes to my protocol that I don't want to try to fix what isn't broken!