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What do these testosterone levels indicate?

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Posted on Mon, 30 May 2016
Question: Thank you for writing back. My total testosterone level was normal at 586 /dl but the three numbers below that were not normal: testosterone free 31.2 pg/ml, testosterone available 62.7 ng/dl, and sex hormone binding globulin 93 nmol/L What do these numbers mean? L'm taking 200xx by injection every two weeks and have had one so far. I'm still feeling very bad. Can you clarify these figures for me?
doctor
Answered by Dr. Naval Mendiratta (2 hours later)
Brief Answer:
Result interpretation

Detailed Answer:
Good evening there

I have gone through your results and will try to explain it forward:

1. Your total testosterone is fine...But it can be normal as it is a sum of all other fractions put together. The same goes for your testosterone Available which is again in normal limits

2. But your free testosterone is low, which means it is unable to exert the necessary action needed. Which may explain the cause of your fatigue

3. For SHBG( sex horomone binding globulin) the levels are raised. When the levels are high it is more indicative that the testosterone is tightly bound to globulin( a protein in the body) and this prevents the normal action of testosterone. Probably that s why the total testosterone is high and free one is low.

I guess you will have to give it a bit of time to act. Since the production of testosterone is connected to the hypothalmus( brain), it takes time to revert back to normal. Maybe you can re check these levels at the end of 2 months therapy to see if they are improving or not...

Do let me know for more queries

Hope the information was useful

REgards
Dr Naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Naval Mendiratta (2 hours later)
Thank you, Dr Naval, for your explanation of my lab numbers, but I must correct you on my testosterone available of 62.7 ng/dL. It is low, not normal, as the range is between 110.0 and 575.0 ng/dL. That's what it says on my lab report. Does that change anything? Even though it's normal, are we trying to raise my total testosterone number so it raises everything else? Do we want the SHBG level to go down? I want an understanding as to what I'm dealing with because I want to get better. What are these injections supposed to do? Thanks.
doctor
Answered by Dr. Naval Mendiratta (20 hours later)
Brief Answer:
Management of low testosterone

Detailed Answer:
Good evening Sir

Sorry for the late reply. Had a long duty today

Oh k, I didnt have the reference range for your Lab, so thought it was normal. Although the management remains the same.

As of now, your free testosterone and Available one are both low. The total might be correct, but then again total testosterone is not a specific investigation as the levels can fluctuate during the day. So if the free and available one are low along with High SHBG, our aim is to increase the free one so it can act on it s receptors and produce the desired effect and lower the levels of SHBG. SHBG tightly binds to available testosterone reducing the amount needed to act through.

These injections will provide the free testosterone to exert it s effect.

Since this was the only abnormal findings in your lab report, it is worth looking at it.. and correcting it. If your symptoms still dont improve after 2-3 months of therapy, we will have to try different medications. SO i would suggest we take it step by step and see how things work out.

Hope the information was useful

Do let me know for more queries

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Naval Mendiratta (18 hours later)
Thank you. I'm beginning to understand what has to happen to correct the problem. It will take time as I've waited over three years feeling this bad. Please tell me--have you encountered a patient with similar lab results? If so, what happened? Is mine a rare situation? After 2-3 months, how can I get in touch with you to tell you how I'm doing? Thank you.
doctor
Answered by Dr. Naval Mendiratta (12 hours later)
Brief Answer:
Further course

Detailed Answer:
good evening there

It is a very common problem at older age to have declining testosterone levels and have a feeling constant fatigue and tiredness... We have dealt with patients in the past and some of them do feel better with treatment.

To be honest, there is still 30 % chance this may not be the cause. But since we have all the other results normal. it is worth treating testosterone deficiency first before we jump to other findings and subject you to more investigation.. At times, it is tough to figure things out. So I would suggest not to worry since other things are normal and continue taking treatment and let's c how it works out. You will improve over course of time..Just have a little faith

Oh you can always reach me here by typing my name...

Hope it suffices the information you need

feel free to ask me more queries

regards
dr naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Naval Mendiratta (4 days later)
I will trust your expertise and be optimistic about the results. I would hope that I will feel some results within 3 months. Some people don't think I feel this bad because it's been going on for so long and I've had so many tests. It took a long time for me to come forth and admit that I feel so bad. I couldn't stand it any longer. Thank you for all of your help and I will keep you updated on my progress.
doctor
Answered by Dr. Naval Mendiratta (23 hours later)
Brief Answer:
Further course

Detailed Answer:
Good evening Sir

Well, I can understand as only you can experience this way and only your quality of life gets compromised. Not everyone understands it especially if they have not been through it. We see patients daily and that s why we can understand what goes wrong.

I hope that you feel better and back to your usual self. Meanwhile, while the treatment takes its time, I would suggest you start a bit of Meditation/Indian Yoga as well, as it will help de stress your mind as well. Also, develop a hobby of your own..something which you always wanted to do but could not, and give time to it...

Let both the things go side by side and we can expect a better outcome

Take care

Regards
Dr Naval
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Naval Mendiratta

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What do these testosterone levels indicate?

Brief Answer: Result interpretation Detailed Answer: Good evening there I have gone through your results and will try to explain it forward: 1. Your total testosterone is fine...But it can be normal as it is a sum of all other fractions put together. The same goes for your testosterone Available which is again in normal limits 2. But your free testosterone is low, which means it is unable to exert the necessary action needed. Which may explain the cause of your fatigue 3. For SHBG( sex horomone binding globulin) the levels are raised. When the levels are high it is more indicative that the testosterone is tightly bound to globulin( a protein in the body) and this prevents the normal action of testosterone. Probably that s why the total testosterone is high and free one is low. I guess you will have to give it a bit of time to act. Since the production of testosterone is connected to the hypothalmus( brain), it takes time to revert back to normal. Maybe you can re check these levels at the end of 2 months therapy to see if they are improving or not... Do let me know for more queries Hope the information was useful REgards Dr Naval