High Testosterone/SHBG, normal Free Testosterone

[linecon0]

Hello,

I'm a 52M and have had two rounds of blood work done (for annual physical type stuff) and my Testosterone numbers were around this each time:

Testosterone: 1147 NG/DL (high)
SHBG: 88.1 NMOL/L (high)
Free Testosterone: 138 PG/ML (normal)

My doctor is just a primary care type but she was all like, "oh you should go see a urologist about this high testosterone." and she made me an appointment. She is all sort of freaking me out about it. From my research a higher SHBG is not that abnormal for an older guy and Total Testosterone sort of follows SHBG. But since my Free T is normal, I'm thinking what's the big deal?

I do workout 5 times per week, I'm about 5'9" and 170lbs. I'm not on any TRT but do take some amino acids post workout.

Should I be worried?

 

[FunkOdyssey]

Should I be worried?

No, not at all. Your understanding of total T, SHBG, Free T, and their interactions and implications here is correct.

 

[Systemlord]

Should I be worried?

The FT is where the rubber meets the road. It’s comical to hear your doctor’s response to your hormonal panel as if high testosterone is somehow bad.

Now go home and hug both of your parents and thank them for good genetics.

 

[linecon0]

Yeah, I don't understand why she was freaking out. Thanks for the replies. I feel better.

 

[madman]

Hello,

I'm a 52M and have had two rounds of blood work done (for annual physical type stuff) and my Testosterone numbers were around this each time:

Testosterone: 1147 NG/DL (high)
SHBG: 88.1 NMOL/L (high)
Free Testosterone: 138 PG/ML (normal)

My doctor is just a primary care type but she was all like, "oh you should go see a urologist about this high testosterone." and she made me an appointment. She is all sort of freaking me out about it. From my research a higher SHBG is not that abnormal for an older guy and Total Testosterone sort of follows SHBG. But since my Free T is normal, I'm thinking what's the big deal?

I do workout 5 times per week, I'm about 5'9" and 170lbs. I'm not on any TRT but do take some amino acids post workout.

Should I be worried

What lab/testing method was used for free testosterone?

The only way to know where your FT level truly sits would be having it tested using the gold standard Equilibrium Dialysis especially in cases of altered SHBG.

If you do not have access to such (highly doubtful) if you reside in the US than you would need to use/rely upon the calculated linear law-of-mass action Vermeulen (cFTV).

If we take your stellar TT 1147 ng/dL, very high SHBG 88.1 nmol/L and Albumin 4.3 g/dL (default) than your FT 13.9 ng/dL would be healthy.

Free & Bioavailable Testosterone calculator

Most health young males would be hitting a cFTV 13-15 ng/dL.

Also need to keep in mind that cFTV tends to overestimate FT 20-30% when compared against a current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.

You are hitting a healthy cFTV 13.9 ng/dL so it may very well be lower if you had it tested using the most accurate assay the gold standard Equilibrium Dialysis.

Even then it would still be descent.

Your clueless doctor is alarmed by your very high TT which would seem sky-high to the uninformed but it is inflated due to your very high SHBG but even than with such TT your FT would still be descent/healthy!




* However, the Vermeulen formula exhibits suboptimal accuracy and tends to overestimate measured free T by 20–30%.

* Calculated free T using high-quality T and SHBG assays has been considered the most useful for clinical purposes [99]. All algorithms suffer from some inaccuracies, including the variable quality of SHBG IAs [100], not replicating the non-linear nature of T-SHBG binding, different and inaccurate association constants for SHBG and albumin binding [101], and variable agreement with equilibrium dialysis results [99,100]. However, until further developments in the field materialize, the linear model algorithms [in particular, the most used Vermeulen equation [102]] appear to give, despite a small systematic positive bias, acceptable data for the clinical management and research[37,103].

 

[madman]

The FT is where the rubber meets the road. It’s comical to hear your doctor’s response to your hormonal panel as if high testosterone is somehow bad.

Now go home and hug both of your parents and thank them for good genetics.

Good genetics LOL!

Sure his TT may seem stellar let alone his clueless doctor thinks it's alarming but with a stellar TT 1147 ng/dL and very high SHBG his FT is still descent but nothing to brag about!

If we use the calculated linear law-of-mass action method with a stellar TT 1147 ng/dL, very high SHBG 88.1 nmol/L and Albumin 4.3 g/dL (default) than his FT 13. 9 ng/dL would be healthy.

A healthy young male would be hitting a cFTV 13-15 ng/dL.

Also need to keep in mind cFTV tends to overestimate FT 20-30% when compared against a current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.

He is hitting a cFTV 13.9 ng/dL so chances are if he had it tested using the most accurate assay Equilibrium Dialysis than it may very well be lower.