Interesting - beginning to find where my prob lies...

[Ruper]

While we know Albumin is the main binding protein, I wonder if that really is what is changing so much? Like you said, you albumin is only high normal, not way above normal.

Personally I didn't see the numbers adding up. From this link http://www.issam.ch/freetesto.htm using the 'normal' numbers I don't see how your SHBG of <5 can even bind 33% of total T.

Of couse in your situation, the 'normal' calculations might be meaningless.

Now a few things I did read over the weekend:

1. the binding affinity of SHBG can be different in different people
2. normally a lot of the SHBG is unbound, which is why there is such a strong buffering mechanism - i.e. you increase TT and %FT normally would stay the same because there is a lot of extra SHBG to bind the extra T.
3. there are other proteins besides albumin. Again these are not normally important, and I could not find much research on them. But their concentrations and binding affinities are not set in stone. Also most of the time, most of the albumin is unbound.

On point #2 if there is not a lot of free SHBG, then you would expect bioT to go though the roof as you increase TT. Perhaps this is happening and some overcompensation with binding proteins (possibly not albumin) is occuring or more albumin is bound that normal.

Just my thoughts. Could be incorrect of course.

I know I've said this in the past, but none of my lab results fit the above model either (free and bioT are much lower than with that calculation), which is a good reasaon for getting TT, FT, bioT etc.. rather than guessing.

http://www.dpcweb.com/documents/news...ts/zb170-b.pdf

[ASaxon]

Originally Posted by Ruper

Personally I didn't see the numbers adding up. From this link http://www.issam.ch/freetesto.htm using the 'normal' numbers I don't see how your SHBG of <5 can even bind 33% of total T.

I think you’re not using the correct units because the math does add up.

From a previous post he said his Albumin was:

My albumin levels are high normal though 46noml/l (35-50) I didnt think this would be causing this problem?

Converting this to g/L for the calculator you get a value of 4.57333g/L with a range of 3.4 to 5.

Putting in SHBG of 5 nmol/L and a Total T of 10.5 nmol/L yields:

Free Testosterone: 2.12 nmol/L = 20.2 %
Bioavailable Testosterone: 7.18 nmol/L = 68.3 %

Which is close to what his actual bioavailable test showed:

TT: 10.5 nmol/l (5.5-22)
FT 64.2 pmol/l (49-149)
Bioavailable T: 7.07 nmol/l (4-9)

My SHBG is <5nmol/l (17-75)

Plus, I think that calculator on that website has an error when you select the units of measure. It says his FT is 2.12 nmol/L but that doesn’t make sense at 20% free T (LOL). If it was 2.12 ng/dl that would make more sense as that would be 73.5 pmol/l which is close to what his actual test showed.

Originally Posted by Ruper

3. there are other proteins besides albumin. Again these are not normally important, and I could not find much research on them. But their concentrations and binding affinities are not set in stone. Also most of the time, most of the albumin is unbound.

My understanding is that these other binding proteins account for a very small amount of total binding and would have to be WAY out of normal (by orders of magnitude of 10 or 100 times) to account for driving free T down so much. Also, if some other binding protein was that far out of whack I would think that the primary disorder causing the problem would be rather easily detected with other standard routine tests.

So I still think the math is right...it all adds up to me.

[Ruper]

Originally Posted by ASaxon

So I still think the math is right...it all adds up to me.

OK, I guess I stand corrected. I haven't gone through the math in detail, but I got confused between g/L and g/dL on the albumin. Mainly because my albumin range was 3.2-5.1 - and I assumed g/dL since that was the one than came up with any reasonable answer for freeT (given my other levels). I can't remember if I actually looked at the lab report for the units though.

Also a range I've seen for instance:

http://www.bloodbook.com/ranges.html

g/L - ref range 30-50 -

http://en.wikipedia.org/wiki/Referen...on_blood_tests


So I guess I'm still confused. Are you sure the albumin is in g/L?

Am I missing something really obvious?

[ASaxon]

Now I'm confused, you are right that Albumin is in g/dL not g/L. I read the units incorrectly on my lab report. But the conversion was right 46 nmol/L converts to 4.57333 g/dL. Plugging that into the calculator you get:

Albumin: 4.57333 g/dL
SHBG: 5 nmol/L
Testosterone: 10.5 nmol/L

Free Testosterone: 0.369 nmol/L = 3.51 %
Bioavailable Testosterone: 9.17 nmol/L = 87.3 %

Since his measured BioT was 7.07 nmol/L that would mean that something doesn't add up. SHBG would have to be higher than 5 to bring BioT down to 7 nmol/L. In fact, it would have to be around 16.

I'm wondering if we're just guessing at his albumin and SHBG rather than using values that were actually measured from the same blood draw. Hmmmm... Perhaps Zadok can clarify where the Albumin and SHBG values came from. Did they come from the same blood test draw or are we guessing based on previous tests?

[zadok]

Yes you are correct, Albumin was one month ago and SHBG was 2 weeks before the testosterone tests. I have not changed any dosages during that time, so i thought everything should be the same. Although it quite possibly is not

[ASaxon]

Usually, from my experience, BioT tests come back with SHBG and Albumin because usually are calculated values. They can measure BioT directly but they don't normally do that because of the expense since the calculated values are just as accurate. Curious that they didn't give you SHBG and Albumin from that test. How was the test done, was it a direct measurement of BioT or was it a calculated value? My BioT tests always come back with TT, BioT and SHBG.

I do agree that SHBG usually doesn't fluctuate much as my SHBG has remained at the bottom ref. range marker through all my tests so I wouldn't imagine that this fluctuates all that much. But a swing from 5 to 16 isn't all that much so perhaps that's the difference.

[Ruper]

OK, either way I think to really understand what is happening as you increase TT, you need to get EVERYTHING at various (even more than just two) TT levels. Then you might see one of the other factors changing dramatically (probably not albumin).

The fundamental problem still somewhat confusing because to actually reduce freeT while increasing TT significantly would entail a huge change in SHBG (with albumin constant). As ASaxon said, this sounds very unusual. I've only had two SHBG results, but with wildly different TT, and they came within 10% of each other (TT-250, SHBG-50; TT-1458, SHBG-55).

But you really need a series of complete lab tests as you change and stabilize dosages. Piecing together bits from different tests over the course of months when you obviously have something strange going seems like it is only going to lead to more confusion.

[Ruper]

Actually, my two results never added up using the calculator, I had to put in much larger SHBG values to get the 'measured' freeT.

Test 1

TT - 252
FreeT% 0.94
SHBG - 50
Albumin 4.7

I need to put in SHBG=88 to get that %FreeT

The only 'problem' with this test was that they messed up a couple of the bood samples, so I went back a few days later. They re-drew 3 out of the 7 test tubes I had taken and I don't know for sure that the above tests all came from the exact same draw. At the time it was not important for analysing the results.

Test 2
TT - 1458
FreeT% 1.47
SHBG - 55
Albumin 4.6

I need to put in SHBG=76 to get that %FreeT

This was definitely from the same draw.

[pmgamer18]

Originally Posted by zadok

Phil,

Thanks for the reply

I know that TT is too low, but like I have explained before if I raise my TT anymore than what it is FT goes down. I am most comfortable this way, until i find the cause of the problem

Estrogen is not a problem. this has been discounted from every angle E2, total E, E1, E3 have all been measured and are ok. Just to make sure i have experimented with all types of estrogen control - symtoms only worsen.

Like i said above Bioavailable test is too high. I can gaurantee you that if i was to raise my TT to high normal, say 20nmol/l then Bioavailable test would become about 80% of this FT would be low and SHBG would still be exceptionally low.

Zadok

Read this link it is full of info on using herbs to get Free T up higher.
http://www.geocities.com/bill3320/hormones.html

[Ruper]

Originally Posted by ASaxon

Now I'm confused, you are right that Albumin is in g/dL not g/L. I read the units incorrectly on my lab report. But the conversion was right 46 nmol/L converts to 4.57333 g/dL. Plugging that into the calculator you get:

Albumin: 4.57333 g/dL
SHBG: 5 nmol/L
Testosterone: 10.5 nmol/L

Free Testosterone: 0.369 nmol/L = 3.51 %
Bioavailable Testosterone: 9.17 nmol/L = 87.3 %

Since his measured BioT was 7.07 nmol/L that would mean that something doesn't add up. SHBG would have to be higher than 5 to bring BioT down to 7 nmol/L. In fact, it would have to be around 16.

I'm wondering if we're just guessing at his albumin and SHBG rather than using values that were actually measured from the same blood draw. Hmmmm... Perhaps Zadok can clarify where the Albumin and SHBG values came from. Did they come from the same blood test draw or are we guessing based on previous tests?

OK, so they were from different tests. But to get those numbers SHBG would have to be 12 and albimin 3.6 (to get both bio and freeT%).

Now that would show quite a variability.


I have to say though, I've now put a number of peoples posted labs through that calculator and many do not fit it at all. Many require much larger SHBG.