Free vs. Total testosterone.

Discussion in 'Men's Health Forum' started by chemman, Jan 11, 2010.

  1. Dr JIM

    Dr JIM Member

    And that is the point your trying to equate the numerical values of endogenous TT production from NORMAL males, which occurs in a circadian rhythm to that of WEEKLY administered TRT!

    This is a classic error of many folks using AAS whether it's for TRT or as cyclists, bc the pharmacokinetics are entirely different.

    If your on TRT focus on symptomatic improvement rather than absolute numerical values!

    Oh and its incorrect to state the point of TRT is to reach some arbitrary value of "normal males". The fact is TRT should be used to that extent required to ameliorate the SYMPTOMS of "low T"!

    The latter is a distinction some patients don't seem to understand, so off they go drawing blood tests to find out "what's going on".
    Last edited: Oct 12, 2015
  2. Michael Scally MD

    Michael Scally MD Doctor of Medicine

    Once on TRT, which is going to significantly change: TT, Albumin, &/or SHBG?
    Dr JIM likes this.
  3. tenpoundsleft

    tenpoundsleft Member

    I get the point that symptoms are what you should focus on, but what's wrong about asking about how to interpret blood work? Since the numbers are generated by the tests, they must mean something? If not, why even bother with the test?

    Since the "symptoms" of low T are rather fuzzy (even disputed) and to really figure out where the symptoms kick in, you'd need to monitor blood levels as testosterone (and AI etc) is administered - to develop some kind of baseline for the treatment. Right?

    Ergo, we're back to defining a standard to administer against. How could you not? Without this, doctors would have to operate under some kind of omniscient god mode, knowing exactly what each client needs. Either that, or engage in way more consultations, testing etc than our medical reimbursement system (or the wallets of those who pay ourselves) will support.
    Burrr likes this.
  4. Dr JIM

    Dr JIM Member

    If you want to further confabulate the objective of TRT go ahead but the NUMBERS are a guide fella, nothing more and nothing less, and in many instances "additional testing" serves no purpose but to confound (such as YOUR fT level) the clinical picture!

    Good luck
    Last edited: Oct 12, 2015
  5. tenpoundsleft

    tenpoundsleft Member

    For what it's worth, the "normal" results shown on the WebMD site listed below, suggest that Free Test is roughly 20% of Total Test.

    Total testosterone: Normal results Men
    270-1070 ng/dL (9-38 nmol/L)

    Free testosterone: Normal results Men
    50-210 pg/mL (174-729 pmol/L)

    As you can see above, a roughly 5X multiplier or divisor depending on the direction.
  6. Dr JIM

    Dr JIM Member

    20% really? Are you being serious!

    Is that a WEB MD quote? If so PLEASE POST IT.

    Did you overlook the different units used for YOUR 20% comparison?

    Perhaps it may be "worth it" for you to look up the difference bt a nmol/L and a pmol/L!

    I often ask myself when people of your ilk post rebuttals of this nature why do I even bother responding!

    The answer, so others can learn not to make the same errors, as you have done thru-out this thread.
  7. Dr JIM

    Dr JIM Member

    Oh and incidentally not only is your nmol to pmol an apples to oranges comparison the same applies to your total testosterone value obtained "THREE days after the last injection".

    Bc a value obtained at 3 days will represent a T-c plateau rather than a PEAK LEVEL.

    The the latter is used by convention to determine reference range norms and thereafter patient comparisons for low T.

    What does that mean? It means your current "TRT" dosage is anything but physiological T replacement, and compels me to query whether your Doc knows how to manage "low T" patients OR the more likely scenario your "treating" yourself!
    Last edited: Oct 12, 2015
  8. tenpoundsleft

    tenpoundsleft Member

    Doc, do you wake up every morning with a handful of lemons plugged in every bodily orifice? Or is this your way of letting steam off after having to kiss up to clients in your practice? I do appreciate your expertise, it just comes across rather poorly.

    As you can see from the URL quoted, I was on my phone when I went to search for a reference to the ratio btw Total and Free - and I overlooked the pico versus nano unit difference as well as the peculiar deciliter/milliliter switch in the denominator. In my field at least, it is a bit unusual to switch units like that, and I wasn't looking for it.

    (It's like the medical field on purpose wants to screw with the reader, make themselves feel special for being able to navigate intentionally misleading references - no wonder nurses misread and inject the wrong dosages. And I'm originally an engineer, so not averse to the metric system.)

    Anyway, mea culpa, but it was disclosed. Besides, I had included the units in my quote from the WebMD site, so you could have just made a quick comment on the unit difference, that would have sufficed.

    Looks like the desktop browser goes to a different WebMD page, so here's the link for those on laptops:

    To correct my unit error above, per the "normal" results shown on the WebMD site listed below, "normal" or "expected" Free Test appears to be roughly 2% of Total Test.

    Total testosterone: Normal results Men
    270-1070 ng/dL (9-38 nmol/L)

    Free testosterone: Normal results Men
    50-210 pg/mL (174-729 pmol/L)


    My own ratio (Free 277, Total 883) is right around 3.1% - which seems to be sufficient.
  9. LW64

    LW64 Member

    No, it is excessive.
  10. Dr JIM

    Dr JIM Member

    It would have sufficed to say nothing and allow you to continue your ignorant course of managing your own "lol T".

    However others could have believed you know WTF your doing and have argued from a position of scientific legitimacy yet nothing could be further from the truth.

    It's impossible to reason with clowns of your ilk, and that's why all three of your apples to oranges comparisons were brought to light!

    Bottom line your a fool whom Dr Scally pegged as such from the outset!
  11. tenpoundsleft

    tenpoundsleft Member

    At least I know how to spell. But I'm not a bitter liberal.
  12. tenpoundsleft

    tenpoundsleft Member

    And why would you say that? Not arguing against you, just that the absolute numbers are both within the range suggested. The ratio seems to be a construct that isn't so relevant (if I've managed to decipher Dr Jim's tirades)?
  13. LW64

    LW64 Member

    Free T is supposed to be 1 to 2 percent of Total.

    You just said you're at 3 percent. That's 50 percent higher.
    Dr JIM likes this.
  14. tenpoundsleft

    tenpoundsleft Member

    Absolutely - I was just trying to gauge if a) there's a relevant ratio (and Dr Jim argues otherwise - I think) and b) if there's anything better/worse with a higher Free T level.

    I'm not of the "if some is good, more is better, and too much is perfect" school - that's is more descriptive of my vehicles. My Total T is within my TRT doc's target range, and he's happy with the Free T level - but I'm none the wiser as to whether or not there are any consequences associated with either the relative (1%, 2% or 3%) Free T, or the absolute level. Oh well.
  15. LW64

    LW64 Member

    If you've read the earlier posts in this thread, then you know that lab methods for Free T are UNreliable. See Dr. Scally's, post #3. Nothing has changed in 5 years and it may not ever.

    That means you can not trust your Free T lab results and that includes the range. So, what you do is (and this is also mentioned earlier in this thread) use your Total T lab result (methods are reliable) and SHBG lab result (methods are reliable) in the following calculator (also reliable) to determine your Free T:

    The NORMAL Free T range for the calculator is 10 to 25 ng/dL.

    What this does is provide further guidance, once you already have your Total T in the normal (Total T) range, and want to make further adjustments in dose/frequency to eliminate symptoms WITHOUT going below or above the Free T normal range.

    Last edited: Oct 13, 2015
    Dr JIM likes this.
  16. tenpoundsleft

    tenpoundsleft Member

    Interesting, thanks.

    Sounds like square 1 again however :

    "WARNING! The calculated free and bioavailable testosterone are reliable in most clinical situations, but should not be relied upon in situations with potential massive interference by steroids binding to SHBG; e.g. in women during pregnancy, in men during treatment inducing high levels of DHT (e.g. transdermal DHT, oral testosterone) or mesterolon"

    Which seems to rule it out for those of us on AAS.
  17. MR10X

    MR10X Member

    the ratio changes as you get older.the only way i could get FT in range was to get my TT in the higher part of the range close to 69
  18. LW64

    LW64 Member

    If you're on AAS, then you don't give a shit about normal anything.
  19. MR10X

    MR10X Member

    heres my labs with natural levels,taking no drugs of any kind,,,,

    Attached Files:

  20. Dr JIM

    Dr JIM Member

    This is true in many respects bc there is not much that can be done about one's fT level, primarily bc albumin can't be saturated, unlike SHBG.

    It's been estimated at a TT level of around 10,000ng/dl, 97% of albumin's binding sites remain "open". Thefor affinity of albumin for TT and many other hormones, limits the steady state fT level to around 4-5%