Thread: Question for HRT guys......Total Test vs. Free Test

I had bloodwork done at my last physical and am now scheduled to see an endo for low test. I looked over the results and they read as follows:

Testosterone, serum - 629 ng/dL = [range = 249-836 ng/dL]
Free testosterone (Direct) - 7.8 pg/mL = [range = 9.3 - 26.5 pg/mL]

For the guys on HRT, did your endo base treatment off of total test, or free test? It seems to me that free test is the important one.

I've been reading more about it, just trying to get a feel for what to expect and figure out what questions I need to ask. All other bloodwork looks great, all other values are right in the middle of the range. BP was 97/58.

If total test is normal and free test is low, could there be another treatment to free up the bound test or is it more likely they will prescribe HRT?

Free test is the hormonal gold, the rest is bound by sex hormone binding globulin and unavailable to the cells. Free Test is available to work it's job, with your age and total test results you will not get HRT in my opinion, at least not from my endo

Proviron is touted to free bound testosterone.

Originally Posted by mickdoo

Free test is the hormonal gold, the rest is bound by sex hormone binding globulin and unavailable to the cells. Free Test is available to work it's job, with your age and total test results you will not get HRT in my opinion, at least not from my endo

What other options are available besides HRT? If free test is more important than total test, I feel like something should be done? I definitely have symptoms of low test.......no libido, lethargy, etc.

how old are you?

Proviron binds to SHBG forcing more testosterone into the blood. It is used exactly for your proposed problem. It's a way around TRT. It's also very good for sex drive. It s not very anabolic though.

Originally Posted by glycomann

how old are you?

27.

Originally Posted by glycomann

Proviron binds to SHBG forcing more testosterone into the blood. It is used exactly for your proposed problem. It's a way around TRT. It's also very good for sex drive. It s not very anabolic though.

I thought Proviron binds to the aromatase enzyme preventing test from being turned into estradiol. I know that SHBG and estradiol are related and if your estrogen is too high it could cause SHBG to be too high as well. Is that how Proviron works, kind of indirectly frees test? Or am I mistaken?

seriously , go to an endo and tell him your concerns and symptoms. The hormonal system is very delicate and needs proper care

Originally Posted by mickdoo

seriously , go to an endo and tell him your concerns and symptoms. The hormonal system is very delicate and needs proper care

I am bro, I have an appointment on Thursday with an endo. I was just asking for other people's experiences.

Mine based off of total test, I had a 251 and got 400mg a week of watson.

Originally Posted by Jbud

Mine based off of total test, I had a 251 and got 400mg a week of watson.

It makes sense to base it off total test if that's low, but if it's normal and free test is low, that presents a curious situation.

Originally Posted by crg914

I had bloodwork done at my last physical and am now scheduled to see an endo for low test. I looked over the results and they read as follows:

Testosterone, serum - 629 ng/dL = [range = 249-836 ng/dL]
Free testosterone (Direct) - 7.8 pg/mL = [range = 9.3 - 26.5 pg/mL]

For the guys on HRT, did your endo base treatment off of total test, or free test? It seems to me that free test is the important one.

I've been reading more about it, just trying to get a feel for what to expect and figure out what questions I need to ask. All other bloodwork looks great, all other values are right in the middle of the range. BP was 97/58.

If total test is normal and free test is low, could there be another treatment to free up the bound test or is it more likely they will prescribe HRT?

Originally Posted by glycomann

Proviron is touted to free bound testosterone.

Yes, Proviron makes more free test available by binding to SHBG, usually raising it around 20%.

Originally Posted by crg914

It makes sense to base it off total test if that's low, but if it's normal and free test is low, that presents a curious situation.

Most endos/urologists/docs will base their treatment off of total test. This is usually because they aren't educated about best practices since test is scheduled the way it is thus hardly any research is done. My prior endo did recognize free test although only when it was convenient for him to use it as an excuse not to prescribe the amount I wanted. A good doc will base treatment off the way you feel, not so much the numbers of either level. If you are prescribed 100mg/week, and you still feel crappy with the numbers reading in the middle of the range, the doc shouldn't be afraid to use more, even though levels may go above normal. My current doc thankfully knows this. From a technical perspective, your numbers along with the way you feel suggest you need some supplementation as I would bet you probably have a high level of SHBG seeing that your free test is below normal.

Originally Posted by saudades

Yes, Proviron makes more free test available by binding to SHBG, usually raising it around 20%.



Most endos/urologists/docs will base their treatment off of total test. This is usually because they aren't educated about best practices since test is scheduled the way it is thus hardly any research is done. My prior endo did recognize free test although only when it was convenient for him to use it as an excuse not to prescribe the amount I wanted. A good doc will base treatment off the way you feel, not so much the numbers of either level. If you are prescribed 100mg/week, and you still feel crappy with the numbers reading in the middle of the range, the doc shouldn't be afraid to use more, even though levels may go above normal. My current doc thankfully knows this. From a technical perspective, your numbers along with the way you feel suggest you need some supplementation as I would bet you probably have a high level of SHBG seeing that your free test is below normal.

Thanks for the reply.

Can you suggest a tactful way to talk with the doctor if he seems pig-headed, or would it likely be easier to just hunt for a doctor that understands the situation fully?

Also, as someone who has been on HRT and has a good endo, are there any points or questions you think are important to bring up that may be easily overlooked? I have read quite a bit over this last week and have some good info and good question prepared, but any advice you could give would be appreciated.

Also, is Proviron OK to take without supplemental test? I've only read of people using it with a cycle. Wouldn't it shut you down at least a little bit?

If a doc seems to be pig-headed about it, you probably won't get anywhere with him because he more than likely has preconceptions about steroids. IMO, it's easier to look for a doc that understands the problem and is willing to help.

I think major points to bring up for you is the fact that free test is below normal and the way you feel/symptoms of low testosterone you are experiencing.

Yes, proviron is okay by itself if needed. It can shut down normal test production a little, but it does bring up free test which brings up your sex drive.

Thanks for the advice Saud. Appt is tomorrow morning. Will update with progress.

Let us know how it goes. Good luck!

So it went pretty well. They drew 5 more vials of blood to test for SHBG, LH, FSH and prolactin. I got the impression the Dr. was pretty willing to prescribe test. I asked about Proviron and he said they don't use 'run-around' treatments like that, they just supplement with test. He said they should have the results first of next week so I should know something more by then. Will update again with more info when I have it.

Sounds promising. Yeah, most will not do anything but prescribe test. Mainly, I see this sort of thing happen because they're too afraid of the classification and that they might be prescribing something for a use other than what is approved by the FDA. My doc has me on test and halo because he believes in supplementing in both injectable and oral routes. He's also willing to try things. Good luck, bro!

Dr's love lab results and numbers, if your low you are good to go with a script. Now for getting the doseage you desire is a different story. Obviously, you want to be around 1000 total test the upper levels of normal. Now what ever he prescribes you keep telling him that you are not in a therapeutic range , you do not feel better or you feel just a little better not much, then tell him you feel you are not in a therapeutic range where you desire to be , its got to be with in reason though, he will not push you much above 1000.

Originally Posted by mickdoo

Dr's love lab results and numbers, if your low you are good to go with a script. Now for getting the doseage you desire is a different story. Obviously, you want to be around 1000 total test the upper levels of normal. Now what ever he prescribes you keep telling him that you are not in a therapeutic range , you do not feel better or you feel just a little better not much, then tell him you feel you are not in a therapeutic range where you desire to be , its got to be with in reason though, he will not push you much above 1000.

Thanks for the help bro.

Originally Posted by crg914

What other options are available besides HRT? If free test is more important than total test, I feel like something should be done? I definitely have symptoms of low test.......no libido, lethargy, etc.

Trust me on this one bro, get some d-aspartic acid...

Got a call from the endo today. Second blood test results came back and test was still low, and LH was also low. I will be getting a pituitary MRI to ensure there is not a tumor present. I would appreciate any thoughts and prayers that this is nothing serious. Will update with more info when I can. Thanks.

Scary. Could your low test be from your recent cycle?

Originally Posted by meow

Scary. Could your low test be from your recent cycle?

Doubtful. I've only run one cycle and it ended back in September and I did a good PCT. If my pituitary is not producing adequate amounts of LH I wouldn't think that would be because of a cycle.

Originally Posted by crg914

Got a call from the endo today. Second blood test results came back and test was still low, and LH was also low. I will be getting a pituitary MRI to ensure there is not a tumor present. I would appreciate any thoughts and prayers that this is nothing serious. Will update with more info when I can. Thanks.

Just free test is still low or now both readings are low? Normally if there is a tumor in the pituitary, it causes overproduction of a hormone or hormones. My sister had a small tumor removed from her pituitary because it was causing her adrenals to pump out too much cortisol, giving her Cushing's disease.

If your LH is low, that can also be from genetics. My own has been low since I was first tested almost 12 years ago, and I'm pretty sure I don't have a tumor. I would be 80% sure it's not serious for you.

Let us know how it goes.

Originally Posted by saudades

Just free test is still low or now both readings are low? Normally if there is a tumor in the pituitary, it causes overproduction of a hormone or hormones. My sister had a small tumor removed from her pituitary because it was causing her adrenals to pump out too much cortisol, giving her Cushing's disease.

If your LH is low, that can also be from genetics. My own has been low since I was first tested almost 12 years ago, and I'm pretty sure I don't have a tumor. I would be 80% sure it's not serious for you.

Let us know how it goes.

Test and LH are both low. I was doing some reading about it and it seems rare that a pituitary tumor is malignant so that's good. And I also saw what you mentioned, that most often a tumor causes overproduction of hormones. However, in some cases you can have a 'non-functioning' tumor and if it is large enough can reduce hormone production due to compression of the pituitary gland or the 'stalk' connecting it to the hypothalamus. They did tell me my prolactin level was normal was that's good as well. Hopefully it's just genetics and we can proceed with treatment, but I'm still anxious. I hate playing the waiting game.

Update: Just got a call from the endo and they said they didn't find anything abnormal on the MRI and we can proceed with treatment. They are calling in a prescription for test which I will pick up later this week and then I will have another appointment next week to discuss treatment and answer any questions I have. Praise God for this good news!

That's great news!