Free Testosterone and Albumin

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    Free Testosterone and Albumin


    My free Testosterone is low - below range, SHBG is midrange and Albumin is highish but well within range - 45 (35-50)g/L ......If the highish Albumin is binding my Free T, how can I lower Albumin?

    Isnt high albumin caused by dehydration? This doesnt work with me, because I drink a lot of water. Is there any other reason why Free T would be so low?

    Can low Free T be caused simply by not producing enough T naturally?

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    I don't think that is the best plan of action. While dehydration can cause elevated albumin levels it is dilutional, add water and returns to normal. If I am not mistaken, albumin bound Test is considered bioavailable. Although elevated albumin may effect free Test I think the binding is weak and it is still considered active.

    I look forward to Dr. John's response.
    Give a man a fish, feed him for a day. Teach a man to fish, feed him for life. Lao Tse 6th century BC
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    BUMP - anyone?
    •   
       

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    Quote Originally Posted by Dr. John
    "albumin is highish but well within normal range"

    So what on earth are you even thinking about it?
    Yes, your right. I shouldnt be worried about the Albumin at all since it is normal. Thanks for setting me straight on that and if high Albumin means im healthy then Ive got nothing to worry about there.

    Im just curious to know where my free T is and why its low. How can SHBG and Albumin be normal, yet Free T is still low? Because from what ive seen, if Free T is low, SHBG is usually high because its binding your Free T.

    Since Albumin bound T is loosley bound and considered bio-available, does this mean that you can have normal bio-available T but still have low Free T?
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    Quote Originally Posted by jaydee
    My free Testosterone is low - below range, SHBG is midrange and Albumin is highish but well within range - 45 (35-50)g/L ......If the highish Albumin is binding my Free T, how can I lower Albumin?

    Isnt high albumin caused by dehydration? This doesnt work with me, because I drink a lot of water. Is there any other reason why Free T would be so low?

    Can low Free T be caused simply by not producing enough T naturally?
    If you have done them from the same blood sample, post:
    Total Testosterone
    Free T
    SHBG
    Albumin
    units, ranges and which lab.
    also post other if you have
    E2, DHT etc
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    Total T: 18 ref (10 - 33) nmoL/L
    Free T: 47 ref (60 - 130) pmol/L
    SHBG: 29 ref (13 - 71) nmoL/L
    Albumin: 42 ref (35 -50) g/L (this one is a little lower, i found a more recent one)
    Oestradoil: 105 ref (40 - 250) pmol/L
    DHT: 2.3 ref (2 -20) not sure what the units was for that one.
    Free Androgen Index: 62 ref (18 - 90) dont know the units for this either.
    Prolactin: 160 ref (<500) mIU/L
    LH: 2 ref (<9) U/L
    FSH: <2 ref (<10) U/L

    QML pathology in Australia. You might not be familiar with them.
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    Quote Originally Posted by jaydee
    Total T: 18 ref (10 - 33) nmoL/L
    Free T: 47 ref (60 - 130) pmol/L
    SHBG: 29 ref (13 - 71) nmoL/L
    Albumin: 42 ref (35 -50) g/L (this one is a little lower, i found a more recent one)
    Oestradoil: 105 ref (40 - 250) pmol/L
    DHT: 2.3 ref (2 -20) not sure what the units was for that one.
    Free Androgen Index: 62 ref (18 - 90) dont know the units for this either.
    Prolactin: 160 ref (<500) mIU/L
    LH: 2 ref (<9) U/L
    FSH: <2 ref (<10) U/L

    QML pathology in Australia. You might not be familiar with them.
    Using
    Albumin=4.2g/dL
    SHGBG=29nmol/L
    Testosterone=18nmol/L=519ng/dL
    conversion using:
    http://www.get-back-on-track.com/en/tools/umrechner.php
    I calculate your Free and bioavailable Testosterone using
    Free & Bioavailable Testosterone calculator
    FreeT=12ng/dL=120pg/mL=416pmol/L
    BioT=275ng/dL
    ============================== =====
    You either have FreeT ok or may want to raise it to about
    160pg/mL=16ng/dL=555pmol?
    that should happen when your
    T=660ng/dL=22.9nmol/L
    ============================== ===============
    Many labs still come up with wrong FreeT's if you believe this:
    http://jcem.endojournals.org/cgi/reprint/86/6/2903.pdf
    ----------------------------------------------------------
    I am not a doctor, I just play with calculators.
    Even the calculators I used could be improved if you come up with friendly equations for this 2006 work that adjusts for (new?) findings on SHBG (that there is two of them).
    http---://www.atypon-link.com/WDG/doi/pdf/10.1515/JLM.2006.050?cookieSet=1
    You still may look at Fig 2, upper part.
    -----------------------------------------------------------
    Your DHT look low, if you are going to use gel or cream (I use Androgel) put some on scrotal area that should raise it.
    But you may want to start with HCG first, 100IU/day and see what happens. This and reduction of E2 may do the trick.
    -----------------------------------------------------------
    Not sure about E2
    When done at LabCorp range is:
    Estradiol, sensitive-(3-70)pg/mL
    then the goal is to get it to 20pg/mL
    that is bottom 25%
    if I follow that thought with your range
    40-250
    40+(250-40)/4=92.5
    your E2=105
    little bit too high (not really that much), when you start reducing it, your TotalT should raise (good think).
    Following Phil's good experience use one tablet daily (or less)
    Indolplex with DIM (120mg of 25%DIM =30mg DIM)
    PhytoPharmica Indolplex with DIM
    but I use 2 pills of (link below), my body weight 160#
    Dual-Action Cruciferous Vegetable Extract With Resveratrol & Cat's Claw, 60 Vegetarian Capsules
    it contains 14mg DIM, their advice - one pill for up to 160# body weight then more
    it have I3C and other E2 fighting supplements.
    ------------------------------------------------------------
    hopefully others will chime in with concrete advice.
    specially about:

    Free Androgen Index: 62 ref (18 - 90) dont know the units for this either.
    Prolactin: 160 ref (<500) mIU/L
    LH: 2 ref (<9) U/L
    FSH: <2 ref (<10) U/L

    ------------------------------------------------------------
    What are you complaints?
    What are you already taking and how long, drugs, supplements?
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    Ive got my treatment set out with Dr John so that side's taken care of. I was just curious about this Free T with everything else normal thing because I never understood it and Dr John just answered it pretty well I think.

    Janz - wow talk about comprehensive. The only other question I have is - is the bio-available T within range? - bio T = 275ng/dL. I noticed there was no reference range. Thanks to both of you.
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    Quote Originally Posted by Dr. John

    DO NOT put TD's on your scrotum.
    Yes, I am familiar with the "blow torch" effect.....LOL.
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    Quote Originally Posted by Dr. John

    P.I.S.S.= Post Internet Stress Syndrome
    I understand where your coming from. I had to leave a forum recently for that very reason.
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    Quote Originally Posted by jaydee
    Ive got my treatment set out with Dr John so that side's taken care of. I was just curious about this Free T with everything else normal thing because I never understood it and Dr John just answered it pretty well I think.

    Janz - wow talk about comprehensive. The only other question I have is - is the bio-available T within range? - bio T = 275ng/dL. I noticed there was no reference range. Thanks to both of you.
    Welcome, like I said I just put together some numbers, I am not a doctor.
    ----------------------------------------------------------
    You cant get much better than Dr John
    within the limits set by him, please share your experience.
    For example, how much detailed back up information he gives you to make you understand why he want you do whatewer he wants you to do.
    Researchers, doctors, and us, we are learning by experience of others, so it is important to share information.
    I am originally from Poland, my moter in law died of breast cancer. Doctors newer told her she had a cancer, I hate that.
    ----------------------------------------------------------
    bioT=275ng/dL
    do not have a range, but keep starring at bottom of Fig 2 of

    http---://www.atypon-link.com/WDG/doi/pdf/10.1515/JLM.2006.050?cookieSet=1
    it is somewhere in that area.
    I think you want to be at about (4000-5000)pmol/L
    but do not know how to convert yours
    bioT=275ng/dL=XXXXpmol/L

    somebody chime in please

    ----------------------------------------------------------
    http://www.labcorp.com/cme/pdf/CME_T...ticle_1167.pdf
    •Androgen Index Calculation. The concentration of testosterone in the
    various free and bound forms is essentially a function of total testosterone
    concentration and the relative concentrations of SHBG and albumin. It
    can be predicted that increased SHBG will decrease the concentration of
    both free and bioavailable testosterone for a given total testosterone concentration.
    Many clinicians use a calculated free androgen index to estimate
    physiologically active testosterone.5,6 This index is typically calculated
    as the ratio of total testosterone divided by SHBG and multiplied by
    100 to yield numerical results comparable in free testosterone concentration.
    5,22-24 Alternatively, more complicated mathematical algorithms can
    be used to estimate the percentage of free testosterone from the SHBG
    concentration alone or in combination with albumin concentration.5,6
    The precision of these algorithms is subject to the combined errors of the
    individual tests performed, but a number of authors have shown them to
    be useful in the assessment of testosterone status.5,2
    -----------------------------------------------------------
    Adrenals and thyroid may play a role, how are they?
    -----------------------------------------------------------
    .
    .
    You had or still have some mean fires down under,
    hope you stay safe.
    .
    ------------------------------------------------------------
    Have to go dancing with beautifull girls,
    somebody have to do it.
    Hmm I am 67 and the more I look the nicer they are.
    .
    Be back in 4 hours.
    .
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    Quote Originally Posted by JanSz
    Many labs still come up with wrong FreeT's if you believe this:
    http://jcem.endojournals.org/cgi/reprint/86/6/2903.pdf
    My endo said he doesnt run Free T anymore cause "its a random number generator" I think slowly slowly labs will stop doing it, as it was left out on my last blood test so I think even pathologists are aware of this.


    Quote Originally Posted by Dr. John
    There is just so much bad info being presented on blogs and Message Boards these days. Sometimes it makes it harder to treat patients properly, or wastes time for the practitioner who must straighten out bad Internet advice.
    And I am guessing even then, straighting out advice would raise more issues, like going in a loop. That would explain a bit.
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    Quote:
    Originally Posted by JanSz
    ============================== =====
    You either have FreeT ok or may want to raise it to about
    160pg/mL=16ng/dL=555pmol?
    that should happen when your
    T=660ng/dL=22.9nmol/L

    ------------------------------------------------

    Quote Originally Posted by Dr. John
    You cannot predict things like this. Why? One reason is that androgen and estrogen levels change SHBG concentration.
    So right, so what to do,?
    My understanding...
    whatewer is done (raising androgen or lowering E) do it in small steps, right?
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    Quote Originally Posted by Dr. John
    That's great! I think I will start using that line.

    But you MUST run the Bioavailable T.
    What is the desirable range for Bioavailable T?
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    Quote:
    Originally Posted by JanSz
    What is the desirable range for Bioavailable T?

    Quote Originally Posted by Dr. John
    There isn't one per se. It's different for everyone.
    Indeed the range looks quite wide, 40-250
    ----------------------------------------------------------
    I have found this at LabCorp, may help.
    Testosterone, Free and Weakly Bound

    Testosterone, Free and Weakly Bound (done by selective precipitation of SHBG with ammonium sulfate)
    Reference Interval
    % free and weakly bound: male: 9.0% to 46.0%, female: 3.0% to 18.0%
    Free and weakly bound: male: 40.0-250.0 ng/dL, female: 0.0-9.5 ng/dL
    ============================== ==============
    And at QuestDiagnostisc I think they just calculate Bioavailable T, can't locate their reference interval.
    Testosterone, LC/MS/MS

    Free, Bioavailable, and Total Testosterone

    ▪ Total: LC/MS/MS

    Free: calculated based on constants for the binding of testosterone to SHBG and albumin

    Bioavailable: calculated based on constants for the binding of testosterone to SHBG and albumin

    ============================== ===============
    but on page 239 and top of page 240... of EndoManual 3rdEd 2004
    http://www.questdiagnostics.com/hcp/...3rdEd_2004.pdf
    they make allowance for pregnancy.
    ============================== ================
    tonns of units conversion
    page 310-315
    http://www.questdiagnostics.com/hcp/...3rdEd_2004.pdf
    bioAvailT-- ng/dL multiply by 0.0347 to get nmol/L
    FreeT----- pg/mL multiply by 3.47 to get pmol/L
    TotalT----- ng/dL multiply by 0.0347 to get nmol/L
    -----------------------------------------------------------
    but only this 2006 paper holds that there is two types of SHBG
    and
    ""Conclusions: There is evidence that Calc2 affords reliable
    FT and BAT derivation from assayed TT, SHBG, and
    albumin making direct FT and BAT measurements unnecessary
    in most cases.""

    http--://www.atypon-link.com/WDG/doi/pdf/10.1515/JLM.2006.050?cookieSet=1

    ""The mass action law-based calculation
    methods for free testosterone (FT) and ‘‘bioavailable’’ testosterone
    (BAT) – routinely used for assessing androgen
    disorders – rely on the supposition that the sex hormone
    binding globulin (SHBG) molecule contains one steroid
    binding domain (SBD). However, recent biochemical
    investigations revealed that this molecule actually comprises
    two SBDs.
    This necessitates new equations
    (Calc2) for FT and BAT calculation.""
    ----------------------------------------------------------
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    Quote Originally Posted by jaydee
    My free Testosterone is low - below range, SHBG is midrange and Albumin is highish but well within range - 45 (35-50)g/L ......If the highish Albumin is binding my Free T, how can I lower Albumin?

    Isn't high albumin caused by dehydration? This doesnt work with me, because I drink a lot of water. Is there any other reason why Free T would be so low?

    Can low Free T be caused simply by not producing enough T naturally?
    high albumin is indication of your body trying to detoxify a hidden toxins. Where do you work and what do you do at work, Dehydration is could also be indication of altered inuslin imbalances or adrenal fatigue despite proper water intake. Might have dr investigate your Hga1c this will give a better indcator of blood sugar level vs serum reading. What are your other test readings cholesterol, triglcyerides, WBC ect. In order to fully uderstand we need a more clincal picture to what is going on not just bits and pieces

    http://www.ingentaconnect.com/conten...00001/art00041
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    Quote Originally Posted by hardasnails1973
    high albumin is indication of your body trying to detoxify a hidden toxins. Where you you work and what do you do at work. Dehydration is could also be indication of altered inuslin imbalances or adrenal fatigue despite proper water intake. Might have dr investigate your Hga1c this will give a better indcator of blood sugar level vs serum reading. What are your other test readings cholesterol, triglcyerides, WBC ect. In order to fully uderstand we need a more clincal picture to what is going on not just bits and pieces
    High Albumin is an indicator of detoxification. I didnt know that. I am currently doing a long slow detox with my GP (not Dr John), so it makes sense. Ive got everything else pretty well covered with my GP as far as cholesterol, triglcyerides, insulin....etc....she's very thorough.
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    Quote Originally Posted by jaydee
    High Albumin is an indicator of detoxification. I didnt know that. I am currently doing a long slow detox with my GP (not Dr John), so it makes sense. Ive got everything else pretty well covered with my GP as far as cholesterol, triglcyerides, insulin....etc....she's very thorough.
    So then this would be indication that what ever she is doing is working What type of dr is she and what are you doing for detoxification. If she is a naturopath. Standard process/ metagenics products would be there first choice. Has she looked into leaky gut? Doing myers cocktail with a 10 mgs methycobolamin 5 mgs leucovarin 6 grams gluthione IV push with makes you feel like a million bucks that for sure!!
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    Quote Originally Posted by hardasnails1973
    So then this would be indication that what ever she is doing is working What type of dr is she and what are you doing for detoxification. If she is a naturopath. Standard process/ metagenics products would be there first choice. Has she looked into leaky gut? Doing myers cocktail with a 10 mgs methycobolamin 5 mgs leucovarin 6 grams gluthione IV push with makes you feel like a million bucks that for sure!!
    Good point Dr John...it isnt high. When I originally posted this thread I was going by a blood test done a few months back which was a little higher, but still it wasnt out of range so nothing to worry about.

    Hardasnails, she's a GP who's done 5 years of Homeopathy. We checked the guts and food allergies and found a few things we can fix. Its too involved to go through here and I dont want to give away my identity.....lol...its very specific treatment. I can PM you if you want.
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    Quote Originally Posted by jaydee
    Good point Dr John...it isnt high. When I originally posted this thread I was going by a blood test done a few months back which was a little higher, but still it wasnt out of range so nothing to worry about.

    Hardasnails, she's a GP who's done 5 years of Homeopathy. We checked the guts and food allergies and found a few things we can fix. Its too involved to go through here and I dont want to give away my identity.....lol...its very specific treatment. I can PM you if you want.
    You can pm me but i am a poor SOB and did not pay to recieve, but i am sure from other boards you know you can contact me

    So good she is treating you for leaky gut, dybiosis, you got an candida going on down there too bro, histamines/glutamate are probably out of the charts via urine test, undermethylated, adrenal fatigue, hypothyrioid, gaba/serotonin in the dumper

    probably doing the elimnation diet SCD, glutemine, colstrum, NAG, EPO,

    Did she run neurotranmistters, organic acids and amino urine analyisis

    You get bored bro read up on aspergers syndrome and DNA polymorphism i have an idea that these are 2 keys to the puzzle that medical community have not even started to investigate and probably whats keeping DR john clientele growing
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    LOL....im a poor SOB after getting all this testing done too. I did a urinary amino acid profile, Functional Liver Detoxification Profile, Hair Mineral Analysis, a GOOD gut flora test and salivory cortisol.

    I feel a lot better though for having them done, I dont know where id be now if I didnt get this stuff looked at and treated properly.

    This kind of medicine I find really interesting, since Ive been apart of it and I think we will see a lot more of it in the future. Will definately read up on the aspergers and DNA stuff. I will send you a PM too.
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    Quote Originally Posted by jaydee
    LOL....im a poor SOB after getting all this testing done too. I did a urinary amino acid profile, Functional Liver Detoxification Profile, Hair Mineral Analysis, a GOOD gut flora test and salivory cortisol.

    I feel a lot better though for having them done, I dont know where id be now if I didnt get this stuff looked at and treated properly.

    This kind of medicine I find really interesting, since Ive been apart of it and I think we will see a lot more of it in the future. Will definately read up on the aspergers and DNA stuff. I will send you a PM too.
    On your urine AA analyisis your dr may have over looked the methyation factor that could be hidden. It took me several months to master on how to read it and understand out all the hidden variables overlooked. Look at ratio to cysteine to methionne and that will tell you if your methioine was low then you are undermethylated which can be simple balanced with active form b-12, folonic acid as i have been emphasisiing on here. Where whas your lliver pathways blocked gluthione, sulfuration,?
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    Check your PMs, its all in there.
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    Quote Originally Posted by hardasnails1973
    So then this would be indication that what ever she is doing is working What type of dr is she and what are you doing for detoxification. If she is a naturopath. Standard process/ metagenics products would be there first choice. Has she looked into leaky gut? Doing myers cocktail with a 10 mgs methycobolamin 5 mgs leucovarin 6 grams gluthione IV push with makes you feel like a million bucks that for sure!!
    How to find the right doctor is a big question.
    Wonder if you could offer guidance in this hardasnails1973,
    specially one near ZIP 07054.

    Searching on "myers cocktail" brought this extreme case.
    Disciplinary Action against Kenneth O'Neal, M.D.
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    Quote Originally Posted by jaydee
    Check your PMs, its all in there.
    If I knew how to send PM to you, I would.
    Your way seems succesful,
    I am also interested in a way that you address your health problems.
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    Quote Originally Posted by JanSz
    If I knew how to send PM to you, I would.
    Your way seems succesful,
    I am also interested in a way that you address your health problems.
    As a rule, look for a doctor who is familiar with leaky guy syndrome. Usually (not always), these doctors are also up to speed with toxicity issues as well. You should be able to google one in your country. Having said that Ive noticed that not all countries have these kind of doctors too.
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    Quote Originally Posted by Dr. John
    This is why I completely stay away from any sort of IV treatments--even though I hear numerous claims of their benefits. In fact, I advise a very conservative list of oral vitamins and nutrients. Just a good base of well-proven supplements. Nothing freaky--not everything that comes down the pipe at our conferences. As time goes on, the wisdom of that philosophy is proven over and over again.

    BTW, as I always say: "Veggies are your best friend".
    I couldnt agree more with that. I got an IV of magnesium (at least thats what i was told it was) and I will never EVER let a doctor do that to me again.
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    Quote Originally Posted by jaydee
    I couldnt agree more with that. I got an IV of magnesium (at least thats what i was told it was) and I will never EVER let a doctor do that to me again.
    It some times work for different people but if you have a valid deficeincy and absorption problems then it could be one way around it..
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    Quote Originally Posted by Dr. John
    This is why I completely stay away from any sort of IV treatments--even though I hear numerous claims of their benefits. In fact, I advise a very conservative list of oral vitamins and nutrients. Just a good base of well-proven supplements. Nothing freaky--not everything that comes down the pipe at our conferences. As time goes on, the wisdom of that philosophy is proven over and over again.

    BTW, as I always say: "Veggies are your best friend".
    Define Vegies that you approve.
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    Quote Originally Posted by jaydee
    As a rule, look for a doctor who is familiar with leaky guy syndrome. Usually (not always), these doctors are also up to speed with toxicity issues as well. You should be able to google one in your country. Having said that Ive noticed that not all countries have these kind of doctors too.
    I live 25 miles west of Manhattan New York.
    There is no shortage of doctors per square mile.
    I would like to find good doctor.
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    Quote Originally Posted by JanSz
    I live 25 miles west of Manhattan New York.
    There is no shortage of doctors per square mile.
    I would like to find good doctor.
    there is a good dr i think his name is dr biamontee he deals with candida, leaky gut, copper toxitiy, and liver detoxification

    The Biamonte Center for Clinical Nutrition | Candida Treatment
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    Quote Originally Posted by Dr. John
    As it says, Quest Bio T is via Liquid Chromatography tandem Mass Spectroscopy.
    I am not in favor of calculated ANYTHING.
    The addition of a second steroid binding domain doesn't mean a second SHBG (unless you include the ABP in the testes). And, by the concept of a biomarker, is unimportant--unless there is variability across the population with respect to number of SBD's.

    I think there is also a third binding protein, coded by the same gene that translates for SHBG and ABP, but it hasn't amounted to anything thus far.
    Sorry, please reread their description, I posted below the whole essay and colored the applicable text for ease of reading.
    My understanding still is that their (QuestDiagnostic's) FreeT and BioT are calculated.
    Testosterone, LC/MS/MS
    -----------------------------------------------------------
    Testosterone, LC/MS/MS

    Test Summary

    See also Test Application and Interpretation section of The Quest Diagnostics Manual: Endocrinology Test Selection and Interpretation.

    Clinical Use

    Diagnose and monitor hyperandrogenic disorders such as polycystic ovary syndrome in women with alopecia, acne, and hirsutism

    Diagnose and monitor therapy in patients with androgen secreting neoplasms and congenital or non-classical (late-onset) adrenal hyperplasia

    Determine androgen status in children with precocious or delayed puberty, ambiguous genitalia, or unexplained virilization

    Diagnose testosterone deficiency in men

    Monitor prostate cancer therapies (gonadotropin-releasing hormone analogs and antiandrogens)

    Clinical Background


    Testosterone is produced by the testicular Leydig cells in males and by the adrenal glands (25%), ovaries (25%), and peripheral conversion of circulating androstenedione (50%) in females.1 In both males and females, the majority of circulating testosterone is protein bound. Sex hormone binding globulin (SHBG), the major binding protein, binds 60% to 70% of the testosterone in circulation. The remaining testosterone circulates weakly bound to other proteins, primarily albumin, and as free (not bound to protein) testosterone. Albumin-bound testosterone accounts for 30% to 40% of the testosterone in circulation, and free, approximately 2%.

    Testosterone bound to SHBG is biologically inactive because of the strong affinity between SHBG and testosterone. Free testosterone is biologically active, as is albumin bound (due to weak albumin-testosterone binding). Albumin-bound and free testosterone, together, are frequently referred to as the biologically active or bioavailable fraction. In most situations, the bioavailable fraction increases as total testosterone increases or as SHBG decreases.

    In utero, testosterone is necessary for the development of male genitalia in 46,XY fetuses.2 After birth, the serum concentration in boys remains approximately twice that of girls until puberty. In boys, a more than 10-fold increase during puberty leads to the development of secondary sexual characteristics, whereas in girls, a 2-fold increase leads to the development of pubic and axillary hair.3 In women, serum testosterone concentration is approximately 5%-10% of that in men and is thought to be important in the maintenance of bone mineral density, mood, and libido.1,4 In men, testosterone is necessary for the maintenance of spermatogenesis, secondary sexual characteristics, bone density, muscle mass, and libido and is thought to play a role in memory recall.5

    Recent evidence suggests traditional immunoassays are unable to accurately quantitate the low serum testosterone concentrations found in women and children,6,7 in men with androgen deficiencies,8 and in patients undergoing antiandrogenic therapies.8 Liquid chromatography tandem mass spectrometry (LC/MS/MS) has recently emerged as the method of choice for measuring testosterone in these populations because of markedly increased sensitivity and specificity.6,8 Additionally, turbulent flow LC/MS/MS, as used in this assay, requires lower sample volume and provides greater sensitivity than liquid/liquid or derivatization LC/MS/MS.9

    Individuals Suitable for Testing


    Women and children with suspected androgen excess

    Newborns with ambiguous genitalia

    Children with evidence of precocious or delayed puberty

    Men with suspected testosterone deficiency

    Men with prostate cancer treated with gonadotropin-releasing hormone analogs and antiandrogen therapies

    Specimen Requirements


    Refrigerated serum (no-additive red-top tube) is preferred. Heparinized plasma (green-top tube) is acceptable. Serum collected in serum separator tubes (SST) is unacceptable.

    Total Testosterone (Women and Children): 0.5 mL; 0.18 mL minimum.

    Free and Total Testosterone: 0.9 mL; 0.38 mL minimum.

    Free, Bioavailable, and Total Testosterone: 2.8 mL; 1.3 mL minimum.

    Method


    Total Testosterone (Women and Children)

    Turbulent flow liquid chromatography tandem mass spectrometry (LC/MS/MS)

    ▪ Analytical sensitivity: 1.0 ng/dL

    ▪ Analytical specificity: no cross-reactivity with 30 testosterone-related steroid compounds
    Reportable range: 1.0 to 2000 ng/dL

    ▪ CPT Code*: 84403

    Free and Total Testosterone
    ▪ Total: LC/MS/MS

    ▪ Percent free: equilibrium dialysis

    ▪ Free: calculated based on total and percent free

    ▪ Aliases: testosterone index, dialyzable testosterone

    ▪ CPT Codes*: 84403, 84402

    Free, Bioavailable, and Total Testosterone
    ▪ Total: LC/MS/MS

    ▪ Free: calculated based on constants for the binding of testosterone to SHBG and albumin

    ▪ Bioavailable: calculated based on constants for the binding of testosterone to SHBG and
    albumin

    ▪ SHBG: immunochemiluminometric assay (ICMA)

    ▪ Albumin: spectrophotometry

    ▪ Aliases: free, weakly bound, and total testosterone

    ▪ CPT Codes*: 84403, 84270, 82040

    Reference Range


    See Tables 1, 2, and 3.

    Interpretive Information


    Testosterone is elevated in infants with congenital adrenal hyperplasia secondary to 21-hydroxylase or 11-hydroxylase deficiencies, conditions that cause masculinization of the genitalia in female fetuses.2,12 Serum testosterone concentrations may also be increased or decreased in other disorders associated with ambiguous genitalia in newborns (Table 4).14,15 In adolescent children, elevated testosterone may be diagnostic of precocious puberty, whereas a decreased concentration may be indicative of hypogonadism in boys.3

    In women, elevated serum testosterone commonly manifests as alopecia, severe acne, hirsutism, and/or menstrual disturbances. Elevations can result from androgen-secreting tumors of the adrenal gland or ovary, polycystic ovary syndrome, late onset congenital adrenal hyperplasia, or Cushing‘s syndrome.16

    In men, decreased testosterone levels may be due to primary testicular failure (associated with elevated LH and FSH) or secondary hypogonadism (associated with decreased LH and FSH), or treatment of prostate cancer with gonadotropin releasing hormone analogs or antiandrogens.17 Elevated testosterone levels may result from androgen-secreting tumors of the adrenal gland, late onset congenital adrenal hyperplasia, or Cushing‘s syndrome.5

    Medical conditions altering serum concentrations of SHBG or albumin (eg, obesity or cirrhosis) may affect the total testosterone level, though free and bioavailable testosterone may remain normal. Additionally, certain hirsute females may have a normal total testosterone level while their free and bioavailable testosterone are elevated. Testosterone results should be interpreted in conjunction with other laboratory and clinical findings.

    References


    Burger H. Androgen production in women. Fertility and Sterility. 2002;77(Suppl 4):3-5.

    American Academy of Pediatrics: Evaluation of the newborn with developmental anomalies of the external genitalia. Pediatrics. 2000;106:138-142.

    Grumbach M, Styne D. Puberty: Ontogeny, neuroendocrinology, physiology, and disorders. In: Wilson, Foster, Kronenberg, et al. eds. Williams Textbook of Endocrinology. 9th ed. Philadephia, PA: W.B. Saunders Company; 1998:1550-1625.

    Snyder P. Editorial: The role of androgens in women. J Clin Endocrinol Metab. 2001;86:1006-1007.

    Griffin JE, Wilson JD. Disorders of the testes and the male reproductive tract. In: Wilson, Foster, Kronenberg, et al. eds. Williams Textbook of Endocrinology. 9th ed. Philadephia, PA: W.B. Saunders Company; 1998:819-875.

    Taieb J, Mathian B, Millot F, et al. Testosterone measured by 10 immunoassays and by isotope-dilution gas chromatography-mass spectrometry in sera from 116 men, women, and children. Clin Chem. 2003;49:1381-1395.

    Herold D, Fitzgerald R. Immunoassays for testosterone in women: better than guessing? Clin Chem. 2003;49:1250-1251.

    Wang C, Catlin DH, Demers LM, et al. Measurement of total serum testosterone in adult men: comparison of current laboratory methods versus liquid chromatography-tandem mass spectrometry. J Clin Endocrinol Metab. 2004;89:534-543.

    Grant RP, Cameron C, Mackenzie-McMurter S. Generic serial and parallel on-line direct-injection using turbulent flow liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom. 2002;16:1785-1792.

    Forest MG, Sizonenko PS, Cathiard AM, et al. Hypophyso-gonadal function in humans during the first year of life: I. Evidence for testicular activity in early infancy. J Clin Invest. 1974;53:819-828.

    Forest MG, Cathiard AM, Bertrand JA. Total and unbound testosterone levels in the newborn and in normal and hypogonadal children: use of a sensitive radioimmunoassay for testosterone. J Clin Endocrinol Metab. 1973;36:1132-1142.

    Bolton NJ, Tapanainen J, Koivisto M, et al. Circulating sex hormone-binding globulin and testosterone in newborns and infants. Clin Endocrinol. 1989;31:201-207.

    Lee IR, Lawder LE, Townend DC, et al. Plasma sex hormone binding globulin concentration and binding capacity in children before and during puberty. Acta Endocrinol. 1985;109:276-280.

    Nelson C, Gearhart J. Current views on evaluation, management, and gender assignment of the intersex infant. Nature Clinical Practice Urology. 2004;1:38-43.

    Hershlag A, Peterson C. Endocrine Disorders. In: Berek J, Adashi E, Hillard P, et al. eds. Novak‘s Gynecology. 12th ed. Baltimore, MA: Williams and Wilkins; 1996:833-886.

    Migeon C, Wisniewski A, Gearhart J. Syndromes of abnormal sex differentiation: a guide for patients and their families [Johns Hopkins Hospital, Baltimore, MD Web site]. May, 2001. Available at Johns Hopkins Children's Center: Specialties. Accessed December 28, 2004.

    Leibowitz RL, Tucker SJ. Treatment of localized prostate cancer with intermittent triple androgen blockage: preliminary results in 110 consecutive patients. Oncologist. 2001;6:177-182.



    *The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed.

    This test was developed and its performance characteristics determined by Quest Diagnostics Nichols Institute. It has not been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. Performance characteristics refer to the analytical performance of the test.


    Content reviewed 03/2006

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  33. Running with the Big Boys
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    Do i hear that foregner 4 song player in the back ground "I got too much time on my hands"

    No under we are running around with low testosterone its all the stress we put our selves under.. LOL
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    Quote Originally Posted by hardasnails1973
    there is a good dr i think his name is dr biamontee he deals with candida, leaky gut, copper toxitiy, and liver detoxification

    The Biamonte Center for Clinical Nutrition | Candida Treatment
    Thank you, I will check.
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    Quote Originally Posted by Dr. John
    I recently had results come back from Quest's Nichols Institute which provided Total T, Free T, albumin and SHBG, but they could not provide Bio T due to "insufficient sample size". Were it truly a calculated value, and all necessary parameters in place, how could that be?
    How recent, on bottom of ther protocol is a date 3/2006.
    Possibly before that time they worked differently,
    ie; similar to way described it that letter of complaints I posted on the other thread.
    http-----://jcem.endojournals.org/cgi/reprint/86/6/2903.pdf

    I am sure there are other explanations.
    --------------------------
    The more I look at this the more I want to switch from LabCorp to QuestDiagnostics.
    But LabCorp is lined up with LEF and that holds me, at least for now.
    ============================== ==============
    Edited: you got results from Quest's Nichols Institute ,
    my references are for Quest Diagnostics
    , similar names, can be misleading.
    What Quest Diagnostics says, strikes me as the way to go.
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    Quote Originally Posted by hardasnails1973
    Do i hear that foregner 4 song player in the back ground "I got too much time on my hands"

    No under we are running around with low testosterone its all the stress we put our selves under.. LOL
    I believe that was a Styx song
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    Quote Originally Posted by biker340
    I believe that was a Styx song
    Too much "juke box hero" for me
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    Quote Originally Posted by Dr. John

    Of course, white potatoes should be eaten in extreme moderation.
    Whats the deal with white potatoes? I ran it by the nutrition section but they just said they are a higher GI food. Is there more to it than that?
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    Quote Originally Posted by jaydee
    Whats the deal with white potatoes? I ran it by the nutrition section but they just said they are a higher GI food. Is there more to it than that?
    Hi glycmic = excessive inuslin production which for person insulin resistance adrenal faigue means NOT GOOD
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    Thanks 1973. Regarding the original topic, IF free T is low due to being bound by somthing, if I added Testosterone, would this just get bound up as well or would somthing else happen here where the Free T would bounce back.
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