Total Testosterone and SHBG are measured and free testosterone is estimated from these measurements.
ok so how accurate is this test. this is what my local hospital does and insurance pays 100%
or my md can send nest lab test to quest and my insurance pays 50%
Here's a copy of the three tests that I recently had.
Testosterone serum 880 ng/dL range 264 - 916
Free T 32.3 pg/mL range 6.6 - 18.1
SHBG 39.7 range 19.3 - 76.4
Total Testosterone and SHBG are measured and free testosterone is estimated from these measurements.
ok so how accurate is this test. this is what my local hospital does and insurance pays 100%
or my md can send nest lab test to quest and my insurance pays 50%
Regarding accuracy of Free Testosterone (measured)
Equilibrium Dialysis is considered the gold standard and Ultrafiltration is the next best method......both are costly!
As I have stated many times most are using the cheaper direct immunoassay or tracer analog which have been shown to be inaccurate.
You need to find out what assay your local hospital uses compared to what assay Quest uses and I would say you have a much better chance that your local hospital is using the gold standard Equilibrium Dialysis or Ultrafiltration as oppose to a lab such as Quest which most likely would test using the inaccurate direct immunoassay.....mind you Quest does offer Ultrafiltration.
Labcorp also offers Equilibrium Dialysis or Ultrafiltration.
Choose the lab which tests FT using Equilibrium Dialysis or Ultrafiltration.
Forget relying on the inaccurate direct immunoassay testing method if you truly want to know where your FT level sits.
Again if one does not want to pay to have FT tested than they can easily access the newer calculated TruT Free Testosterone Calculator by FPT....."TruT™ provides the most accurate estimates for free testosterone" and is on par with results obtained using the gold standard Equilibrium Dialysis.
Here's a copy of the three tests that I recently had.
Testosterone serum 880 ng/dL range 264 - 916
Free T 32.3 pg/mL range 6.6 - 18.1
SHBG 39.7 range 19.3 - 76.4
Unfortunately as I stated before Vince LOL.....you are using the wrong testing method for FT.....the direct immunoassay which has been shown over and over to be inaccurate.
Your FT levels are by no means high (almost double the top end of the reference range using the direct immunoassay).
If we take your TT 880 ng/dL,SHBG 39.7 nmol/L and Albumin 4.3 g/dL (mean)than yourFT is 30.26 ng/dL (top of the reference range 16-31 ng/dL)
So much for slippery SHBG and FT levels twice the top end of the reference range!
If you have a hard time accepting this.....than spend the $$$ on Equilibrium Dialysis or Ultrafiltration.....than get back to me on how the results compare to the direct immunoassay!
The free t is a send out to arup labs. Online it didn’t state if it was a ultra filtration. It listed what is said above. I’ll post a link on my lunch break
Unfortunately as I stated before Vince LOL.....you are using the wrong testing method for FT.....the direct immunoassay which has been shown over and over to be inaccurate.
Your FT levels are by no means high (almost double the top end of the reference range using the direct immunoassay).
If we take your TT 880 ng/dL,SHBG 39.7 nmol/L and Albumin 4.3 g/dL (mean)than yourFT is 30.26 ng/dL (top of the reference range 16-31 ng/dL) View attachment 7672
So much for slippery SHBG and FT levels twice the top end of the reference range!
If you have a hard time accepting this.....than spend the $$$ on Equilibrium Dialysis or Ultrafiltration.....than get back to me on how the results compare to the direct immunoassay!
The free t is a send out to arup labs. Online it didn’t state if it was a ultra filtration. It listed what is said above. I’ll post a link on my lunch break
*Total Testosterone and SHBG are measuredandfree testosterone is estimated from these measurements
Interpretive Data The concentration of free testosterone is derived from a mathematical expression based on the constant for the binding of testosterone to sex hormone binding globulin (SHBG).
Notice beside the Calculate box Explanation and examples
When you click on Explanation and examples
This will show up at the top of the screen with an example of the calculation below.
Please find below an example of a calculation. The background on the validation of this method can be found: “J Clin Endocrinol Metab 84:3666-3672, 1999 – A critical evaluation of simple methods for the estimation of free testosterone in serum”
“J Clin Endocrinol Metab 84:3666-3672, 1999 – A critical evaluation of simple methods for the estimation of free testosterone in serum”
TruT™ by FPT
The novel, FDA-registered TruT™ algorithm uses modern understanding of molecular interactions to improve the accuracy of free-T calculations.
Why TruT™?
The only FDA-registered free testosterone calculator
Improved biophysical characterizations have have suggested the importance of models that consider allosteric coupling of testosterone with dimeric SHBG.This model, as implemented by TruT™ provides the most accurate estimates for free testosterone.
Commonly available free testosterone calculators(issam.ch, nebido.com, pctag.uk)use models of testosterone:SHBG binding(proposed by Vermeulen et al. and Sodergard et. al)which were developed before the crystal structure for SHBG:T complexes were available.These models assume that the two SHBG monomers behave identically in binding testosterone. Detailed experimental data show that the "simplified linear model is erroneous." References.
The Endocrine Society has issued position statements which highlights the laboratory- and operator-dependent variability inherent in direct free testosterone measurements. For this reason they advocate for indirect "calculator" based methods References.
TheTruT™calculator provides the ideal solution byusing measurements of total testosterone, SHBG, and albumin to calculate free testosterone while taking into account the complex, non-linear allostery in SHBG's association with testosterone.TruT™is the only calculator available that uses this more complex formulation. References
Current problems with accurate free testosterone determination
Current methods for measuring free testosterone (fT) are technically challenging and not accurate. The widely used direct immunoassay and tracer analog techniques for measuring fT have been shown to be inaccurate. Equilibrium dialysis, the reference method against which other methods are compared, is labor-intensive and cumbersome, and therefore has had limited clinical adoption. As an alternative, free testosterone can be computed from the total testosterone, SHBG, and albumin concentrations. Recently, Endocrine Society’s Expert Panel acknowledged the experimental problems in fT measurements and concluded that "...the calculation of free testosterone is the most useful estimate of free testosterone in plasma..." However, we have demonstrated that even the calculated fT values derived from the prevailing equations, based on linear law-of-mass action models or empiric equations, differ systematically from free testosterone measured by equilibrium dialysis by as much as 40%.
Improved TruT™ Companion Diagnostics
Based on the fundamental discovery of testosterone partitioning, our team has developed an accurate free testosterone determination method. While examining the mechanistic origin of this systematic inaccuracy in free testosterone values using the linear model of SHBG:testosterone association,we discovered that the SHBG dimer exhibits conformational allostery in binding testosterone. Our TruT™ companion diagnostic, incorporating the correct parameters and non-linear dynamics in T:SHBG associationhas resulted in a framework for accurate determination of free testosterone values.
The TruT™ algorithm improves the accuracy of free-T calculations, reducing the potential for misdiagnosis, and better informing providers when designing treatments.
Current diagnostics, including the most widely used tracer analog method, have been shown to be inaccurate and its use is not recommended. Equilibrium dialysis is widely considered the reference method but most care providers and commercial laboratories do not offer equilibrium dialysis assays due to operational complexities in performing the assay and difficulties automating the procedure.Recognizing the practical difficulties that clinicians face in obtaining accurate measurement of free testosterone by equilibrium dialysis,an expert panel of the Endocrine Society concluded that "...calculated free testosterone, using high quality testosterone and SHBG assays, is the most useful clinical marker".
Our patent protected, novel TruT™ companion diagnostic framework provides accurate determination of free testosterone concentrations.This algorithm is based on experimental data demonstrating that testosterone’s binding to SHBG is a multi-step process involving an allosteric interaction between the two binding sites on the SHBG dimer. Estimates of free testosterone derived incorporating the allosteric coupling of SHBG monomers within the dimer provide accurate determination of free testosterone without systematic deviation from values obtained using equilibrium dialysis.
As you can see the Vermeulen method was developed before the crystal structure SHBG:T complex was known.
Commonly available free testosterone calculators (issam.ch, nebido.com, pctag.uk)use models of testosterone:SHBG binding(proposed by Vermeulen et al. and Sodergard et. al)which were developed before the crystal structure for SHBG:T complexes were available.These models assume that the two SHBG monomers behave identically in binding testosterone. Detailed experimental data show that the "simplified linear model is erroneous." References.
So the calculated free testosterone you are having done through ARUP Laboratories is using the Vermeulen linear law-of-mass-action model.....which is not going to be accurate.
Your best bet if you care about truly knowing what your FT level is would be to get the gold standard Equilibrium Dialysis or Ultrafiltration which are costly or simply getting TT (LC/MS-MS), SHBG and Albumin and use the newer calculated TruT Free Testosterone Calculator by FPT .....online for free!
These would be the 2 options from Labcorp for accurate blood testing:
