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Why We Always Test Total T

Discussion in 'Random Thoughts from Dr. John' started by Dr. John Crisler, Apr 15, 2015.

  1. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Once on TRT, Total T tells you how much is getting, and staying, in. Free T is better for telling how much you have to use.
     
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  2. KYinchampaign

    KYinchampaign Member

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    I'm not sure how much you'd be will to bleed out here... I'll ask anyway[biggrin]

    In relationship to one's Total Testosterone. If one has a range that you as a physician find appropriate, yet he has high urinary testosterone levels. I'm guessing here, this would be a hypermetabolizer?

    How would one go about addressing this?
    Quercetin a possible solution?

    Thanks
    Kirk
     
  3. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    I am never shooting for any particular range. Everyone has their own sweet spots.

    We find inappropriately high T concentrations in the urine of men who are hyperexcreters. Hypermetabolizers have elevated Et and An in their urine.

    Bot are compared to where serum levels fall within their own range.
     
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  4. KYinchampaign

    KYinchampaign Member

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    Malapropism has been of my misworded grammar as of lately. With finals coming up, this isn't such a good thing... [o_O]

    No hints on the quercetin[arghh]

    Thank you Dr. Crisler.
     
    Last edited: Apr 17, 2015
  5. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Quercetin has been shown to decrease urinary excretion of testosterone. It also has many other health benefits, as it is a powerful antioxidant. It also boosts IGFBP-3, which is though to decrease cancer risk by supporting the p53 apoptotic mechanism.
     
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  6. Desert Eagle

    Desert Eagle Banned

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    That's good knowledge right there. Hey Docy J [thumbsup]
     
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  7. KYinchampaign

    KYinchampaign Member

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    Thank you for the extended information, beyond the original question!

    Much appreciated.
     
  8. Jimstigator

    Jimstigator Member

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    Excellent info! I have always shot for the higher end TT numbers, with disregard for FT. At an SHBG of 20-22, I'd imagine I would feel just fine with TT levels below other guys.

    -Jim
     
  9. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    You got it!
    ...and watch out for your estrogen level. That's the other edge of that sword.
     
  10. Jimstigator

    Jimstigator Member

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    Estrogen... my nemesis.

    I now get testosterone and SHBG. Estrogen is the same? For the sake of my understanding... lets say two guys got their estrogen tested via Labcorp Estradiol Sensitive #140244 and both resulted in a 28 (8-35). Guy 1 has a SHBG of 20, guy 2 has an SHBG of 40. Could guy 1 potentially feel the impacts of that estrogen level greater than guy 2? Guy 1 might actually feel high estrogen sides whereas guy 2 is in a sweet spot?

    Maybe the more direct question: is the estrogen test #140244 similar to a TT reading in that SHBG isn't factored in yet, or is it similar to a FT reading where SHBG has done its binding and we are seeing the end result?

    Thanks!
    Jim
     
    Last edited: Apr 23, 2015
  11. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Oh, yes. I see this every day in clinical practice.
     
  12. wondering

    wondering Active Member

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    Does this correlate with Thyroid as well - Total T4 and T3 vs Free T4 and T3.
     
  13. BJE

    BJE Active Member

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    I always shoot for the upper half of the free T range, and with the high SHBG which I have my total T is often over the top of the range.
     
  14. BadassBlues

    BadassBlues Super Moderator Staff Member Super Moderator

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    Perhaps it would be a good thing to consider testing for free estradiol levels?

    http://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=36169

    Reference Range(s)
    Estradiol, Free
    Female
    Follicular Stage 0.43-5.03 pg/mL
    Mid-Cycle Stage 0.72-5.89 pg/mL
    Luteal Stage 0.40-5.55 pg/mL
    Postmenopausal ≤0.38 pg/mL
    Adult Male ≤0.45 pg/mL
    Estradiol
    Female
    Follicular Stage 39-375 pg/mL
    Mid-Cycle Stage 94-762 pg/mL
    Luteal Stage 48-440 pg/mL
    Postmenopausal ≤10 pg/mL
    Adult Male ≤29 pg/mL
     
  15. Mountain Man

    Mountain Man New Member

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    What role does SHBG play in finding that "sweet spot"? My SHBG is on the higher side of being in range. My clinic uses Quest and there scales different from most numbers I see on forums. I feel better around 1000-1200 total T. My lab has an upper range of 1.5 Free T and I feel better at 1.5-1.6. Is it advisable to run higher on total and free T if I feel good and numbers are ok? How much attention should I pay to SHBG inj trying to determine that sweet spot?
     
  16. BadassBlues

    BadassBlues Super Moderator Staff Member Super Moderator

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    SHBG binds both testosterone and estrogen, transcortin binds progesterone and corticosteroids. I mention this because the elusive "sweet spot" involves more than just a single hormone level. People seem to feel as though they should be "primed and ready" 24/7/365. That is an unreasonable expectation as our body has other functions that require certain systems to take a back seat while they are being performed. Neurotransmitters are influenced by hormonal activity and balance. Neurotransmitters have a major effect on both emotional and physical aspects. Overall health and emotional well being play a major role. If those two factors are out of whack, there is no sweet spot to be found.

    Short story, we have our up's and downs. It's a natural and normal occurrence.

    It's the free, unbound hormones that activate their respective receptors. SHBG and transcortin limit the levels of free, active hormonal activity. Each of us is different and although we can generalize things a bit by having a "range" to use as a gauge, it still does not apply to everyone. Receptor sensitivity varies by individual. Some are fully functional and do well with relatively low levels, some need more.

    You are at the high end of physiologic testosterone levels and it results in your free testosterone also being at the high end. You should have your DHT tested to see just how effective that free testosterone is on your androgen receptors.

    The short answer is that you should be aware of your SHBG levels as they will help to guide you. SHBG levels will change as your hormone levels rise and fall, so chasing a number is fruitless and costly.
     
  17. wondering

    wondering Active Member

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    Curious, why do you not feel the same for Thyroid? Dr. M always measures Total T4 and Free T3 and I believe considers Total T4 the most important. He equates it to Total Test.

    My last labs showed:
    TSH 2.26 (.27 - 4.20)
    Total T4 6.2 (4.6 - 12) - in bottom quartile
    Total T3 90 (80-200) - again very low
    Free T4 1.1 (.9 - 1.7) - this number has been at 1.3. just a month prior on same dose of Thyroid meds
    Free T3 2.7 (2.0 - 4.4) - this blood draw was morning, prior to taking Armour, so is a trough figure.
    Thyroid Peroxidase Ab 7 (0 - 33) - does any presence of antibodies indicate Hashi's or affect treatment?
    Thyroglobulin Ab <20 (0 - 40)

    Also have always had very low SHBG..would this also predict low Thyroid binding as well? This indicate I need more Total Thyroid hormones relative to Free Thyroid levels?

    My morning temps have fluctuated the last week between 96.9 and 97.1. This morning was 96.7.

    I have had such extreme anxiety so saw a local doc who looked at these labs and upped my Levothyroxine another 25mcg. I am also on Armour. He did this and gave me some Ativan. I said ok on the Thyroid increase as I was so desperate for the Ativan .

    Dr. J - you might be able to figure out who I am by the extreme anxiety comment as I have spoken to you about 3 times in the last month.
     
    Last edited: Nov 20, 2016
  18. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Total T4 tells us how much is getting in, for those on thyroid medication. Free T3 is the most important, as it is how much we actually have to work for us.

    Low SHBG is strongly associated with anxiety in men. I see it all the time.

    Unique to your case is low SHBG, as thyroid medication usually prevents that.

    It's tough to add more thyroid to someone with anxiety, for fear of causing more. But your body temp means it's not getting in. That is due to Adrenal Fatigue.

    You need to up your doses of thyroid.
     

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