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Table of Contents Testosterone Fractions in Men How SHBG Influences Free Testosterone What Factors Influence Your SHBG Levels? How Do You Know if Your SHBG Levels Are High? How to Lower SHBG and Automatically Increase Free Testosterone Levels? Raise Your Total Testosterone Level Lower Your Estradiol Levels DHEA Supplements Might Help What if My SHBG Levels Are Already Low? Now You Know More About SHBG and the Role It Plays in Your Body!   When people hear about testosterone, they immediately think about muscles, alpha males, confidence, and probably sports cars. This is the most important male sex hormone and one of the most important hormones in the human body. However, this hormone has several fractions. It is influenced by your lifestyle and it can influence how you think and how you feel. For example, too much sex hormone-binding globulin (SHBG) can decrease free testosterone which can lead to low libido and other symptoms.  That is why some men search for ways to decrease SHBG levels. If you are interested in testosterone fractions and how to naturally increase this sex hormone in your body then keep reading. You will find out more about the bioavailability of testosterone and why it plays a vital role in your health. You will also find out how to decrease SHBG levels. Testosterone Fractions in Men If you do a testosterone test, your doctor will mention your average levels. For example, the generally accepted healthy levels of testosterone for men are between 350 ng/dl and 1,100 ng/dl. If you have a total testosterone level under 350 ng/dL, you might be diagnosed with hypogonadism (testosterone deficiency). However, this is the total testosterone level in your bloodstream. This hormone is made up of several fractions and they are important too. For example, there are bound testosterone (bound) and free testosterone (non-bound) levels that circulate through your blood. Total testosterone is made up of these two types of testosterone. Free testosterone makes up for about 2% of your total testosterone levels. This is the one that goes to your muscles, brain, and influences other organs and tissues in your body. The bound testosterone usually attaches to two substances - albumin or SHBG. The amount of testosterone that is bound to albumin is about a third of your total testosterone. The amount of testosterone that is bound to SHBG is approximately two-thirds of your total testosterone. Albumin is a protein and it carries your testosterone through the bloodstream and releases it as it is needed. You often hear the term "bioavailable testosterone". This refers to the amount of testosterone that can be used by your body. Luckily, testosterone bound to albumin can detach if necessary and get used as free testosterone. The one bound to SHBG cannot do that. In this case, the bioavailable testosterone in your body is the sum of free testosterone and albumin-bound testosterone. How SHBG Influences Free Testosterone It's a well-known fact that the levels of albumin in your blood are generally stable. This protein doesn't have massive spikes in quantity for a male adult. On the other hand, SHBG levels can increase and decrease based on various factors. Most importantly, the levels of SHBG influence how much free testosterone you have in your blood. High levels of SHBG are usually associated with low levels of free testosterone. Less testosterone is available for muscles, the brain, and organs. The vice-versa is also true. Lower levels of SHBG are associated with higher levels of free testosterone. This can positively influence your mood and libido. What Factors Influence Your SHBG Levels? Multiple types of factors influence how much SHBG there is in your bloodstream. Aging is one of the most important factors.  As men age, their SHBG levels will naturally go up while the free testosterone levels will go down. However, you can do something about the other factors. For example, liver problems can increase SHBG levels in men of all ages. If you have a fatty liver due to chronic alcohol consumption or other reasons, chances are that your SHBG levels are also higher than normal. This is true for other liver problems such as cirrhosis or cancer. Thyroid problems can also increase SHBG levels. If your thyroid gland is less active or hyperactive, you might start to feel the symptoms of this health issue. Too much estradiol in your body is also responsible for increasing SHBG levels. Obesity and high triglyceride levels are commonly associated with an increase in SHBG levels in the blood. If you are overweight and your lipid profile is not very good, chances are that your overall testosterone levels might drop. Finally, inflammation is another factor that could increase SHBG levels and decrease free testosterone ones. Acute inflammation is good for the body to help you fight diseases. Chronic inflammation, on the other hand, can lead to life-threatening issues and raise your SHBG levels. How Do You Know if Your SHBG Levels Are High? A simple blood test provides the best opportunity to test your testosterone levels accurately. Medical technology got very advanced, and it's possible to find out exactly how much testosterone is flowing through your blood quickly and safely. However, remember that most tests will communicate your total testosterone levels. You should dig a little bit deeper and find out the exact SHBG and free testosterone levels. These are the ones that interest you the most in this case. If the percent of total testosterone that is free testosterone is below 2 percent, then you may have high SHBG. For example, the optimal SHBG levels in adult males are between 10 and 60 nmol/L. If you have more than that, chances are that your free testosterone levels are also smaller than normal. Ask your doctor for assistance if you cannot figure out the SHBG levels independently. Discounted Labs sells several tests, including the SHBG test as part of lab test panels.   How to Lower SHBG and Automatically Increase Free Testosterone Levels? Now that you have learned more about SHBG and how it can influence your body, the next obvious question is to find out a way to decrease SHBG levels. You cannot stop the aging process, but you can do something about the other factors that influence SHBG. Raise Your Total Testosterone Level This is the simplest and often the best method to reduce SHBG and increase free testosterone. If your testosterone levels are low, do something to increase them. For example, you can lose weight, start exercising more often and clean your diet of junk food and processed meals. This will automatically increase your total testosterone level. A fraction of this level is free testosterone, but it's a fraction of something larger than before, so you'll definitely experience its positive effects. Lower Your Estradiol Levels Another way you can reduce your SHBG levels is by lowering the number of estrogens in your body. Estrogens are the maprimaryemale sex hormones but are also needed by the male body. One of the most important estrogens is estradiol. Men have small amounts of estradiol too, but too much can lead to high SHBG levels and even gynecomastia if low testosterone is present. Lowering estrogen levels is possible for men of all ages. For example, you should avoid soy-based products as these have the tendency to increase your blood estrogen levels. At the same time, try to minimize alcohol consumption, exercise more, lose weight if you are overweight, and get plenty of sleep. DHEA Supplements Might Help DHEA or dehydroepiandrosterone, is one of the most abundant steroids in the human body. It's a weak estrogen and androgen hormone. It serves many purposes in the body and it can be sold as a supplement. Some studies show that small doses of DHEA administered to men might decrease SHBG levels. However, more research is needed as increasing the levels of DHEA in the body can have serious side effects in the long run. For example, high levels of DHEA are commonly associated with Parkinson's Disease. This complex neurodegenerative disease can lead to memory loss and poor brain function. If you decide to take DHEA supplements, make sure that you speak with your doctor first. Remember that these solutions might work for people with SHBG levels higher than normal. If your SHBG level is low, you should not worry about lowering it further. What if My SHBG Levels Are Already Low? In this case, your free testosterone levels are optimal and you don't have to do anything to increase them. However, more SHBG is needed too. This could signify an underlying health condition that must be explored further. For example, if you have low SHBG in your bloodstream, you might have a fatty liver or metabolic syndrome. This condition can be caused by excessive alcohol consumption or other factors. A liver problem is usually associated with insulin resistance too. Generally speaking, low SHBG levels are good predictors of diabetes in people of all ages. You must do a blood glucose and a A1c test to see how glucose is processed in your body. If you're pre-diabetic, you can still do something to increase insulin sensitivity and avoid this chronic condition. Now You Know More About SHBG and the Role It Plays in Your Body! Although deciphering the mysteries of testosterone and SHBG is not easy, major medical advancements are made each day. As you can see, too little SHBG is bad, but too much of it is not good either. Patients must aim for an optimal level of SHBG and monitor it closely using a SHBG blood test.    

The internet is full of information on various subjects, but you probably already know that you have to carefully select your health information source. For example, if you're looking for information about men’s health and testosterone replacement therapy, Excelmale.com is probably your safest bet. Table of Contents Join a Growing TRT Forum of Almost 40,000 Members Topics Covered Include TRT, HCG, Erectile Dysfunction, Nutrition, and More Take Advice from Fitness and Nutrition Experts, Dietitians, Medical Doctors, and More Get Educated Through Men’s Health Videos, Articles, Podcasts, Scientific Papers, and More There Is a Dedicated HRT Section for Women Too Best of All - It's Free to Register! A lot of myths and disinformation usually surrounds these subjects. You might end up confused if you're trying to learn about TRT from the wrong places. On the other hand, if you go to the Excelmale.com forum, you can access scientifically proven data and experts' opinions. Created in 2013 by health author and men’s health advocate Nelson Vergel,  ExcelMale.com has become one of the most respected and largest testosterone forums globally. Keep reading to find out what makes Excelmale.com so unique and why you should visit it if you want to learn more about TRT and men's health. Join a Growing TRT Forum of Almost 40,000 Members You might be happy to find out that Excelmale.com is a testosterone replacement forum with a community of almost 40,000 members. This platform is reviewed daily by knowledgeable individuals to moderate it to prevent spamming or abuse carefully. All these people joined Excelmale.com to learn more about male health, fitness, and nutrition. They are real persons with life stories just like yours. You can find so much information on testosterone and other hormonal replacement therapies from people of all ages and different parts of the world. If you're worried about your personal information, then you should relax. This website is monitored continuously and secured with state-of-the-art protection systems. Your information will not be shared, and the moderators carefully check every message to prevent spamming, so you won't be a victim of cyberbullying. Topics Covered Include TRT, HCG, Erectile Dysfunction, Nutrition, and More The broad range of topics covered at Excelmale.com will amaze you. Not only that, this is the best TRT forum you can find on the internet, but you will also learn about the right testosterone TRT test, HCG use to prevent testicular atrophy, TRT side effects, thyroid treatments, PCT, Trimix injections, supplements, exercise, nutrition, and more. The experts who routinely post on Excelmale.com consult scientific papers and journals to give you the most recent and unbiased information out there. You will find out how to interpret some of your bloodwork results, how to optimize your gains, and how to naturally increase testosterone levels. Best of all, the information is conveyed in layman's terms. You will be able to understand the concepts without requiring a medical degree. Nelson Vergel routinely posts the latest information on TRT and other relevant subjects, so you should come back to this TRT forum more often. Take Advice from Fitness and Nutrition Experts, Dietitians, Medical Doctors, and More Most of the members on the Excelmale.com testosterone forums are regular TRT patients or people who are interested in testosterone replacement therapy and anything related to it. However, there is also a plethora of experts regularly posting on this testosterone replacement forum. For example, you might be able to receive advice from experts who work in compounding pharmacies. A compounding pharmacy can create drugs specifically for your needs, helping you get the right dosage at a reduced price. Other experts in nutrition and fitness also post information on how to live a healthier life. Even if you're not thinking of starting TRT soon, the Excelmale.com forum offers a multitude of valuable pieces of advice that can improve your health, so it's worth a visit. Best of all, TRT patients are invited to share some of their results so that others can learn from them. If you're currently under TRT and have a question, you're welcome to post it on the Excelmale.com TRT forum. You can get expert answers from doctors as well as regular solutions from TRT patients just like you. Get Educated Through Men’s Health Videos, Articles, Podcasts, Scientific Papers, and More Some people like to get informed through reading, and others like to watch a video. Many other people also like to listen to podcasts while doing housework. No matter your preferred learning method, you are covered if you visit the Excelmale.com TRT forum. That's because this forum spreads information through multiple channels, including short and long-form articles, eBooks, scientific papers, videos, podcasts, and more. You can watch and read for free, and some of the eBooks provided on Excelmale.com are also free to download. Apart from that, you can also find a transcription of videos for those who prefer to read instead of watching a clip. As the TRT industry is developing, more and more information becomes available to the general public. The Excelmale.com forum is the place where you can find this information and use it to your advantage. There Is a Dedicated HRT Section for Women Too Hormonal replacement therapy (HRT) is increasingly popular in the United States, Canada, and other countries. Although Excelmale.com is mostly a testosterone therapy forum for men, there is a special HRT women section dedicated to female health information. Here you can find more about the latest advancements in hormonal replacement therapy, diagnosis, side effects management, and more. The founders of Excelmale.com don't want women to feel neglected, and they have created this section on the same website. Experts in nutrition, fitness, and endocrinology routinely post articles and videos about hormonal therapies for women. This information could help you if you want to mitigate the effects of menopause or improve the hormonal balance in your body. Best of All - It's Free to Register! You might be happy to find out that it's free to register on Excelmale.com. You have access to all the information presented above with just a few clicks. Even better, you will also receive a free eBook upon registration. This eBook reveals the secrets of how to optimize your testosterone levels! Whether you're an active TRT patient, you're thinking of starting testosterone replacement therapy or want to improve your health, the Excelmale.com forums provide the best place to start. Make sure that you register on ExcelMale.com to join to join the best TRT community online and get weekly updates on the latest news and science on men’s health and productivity.   IMPORTANT: ExcelMale.com is not associated with the site Male Excel. ExcelMale.com was created several years before that site and it is also a trademarked brand.  

Testosterone Replacement Therapy (TRT) has changed the lives of many men around the world.  Like any therapy, it can have great benefits if properly managed but negative side effects if not monitored.  This article will briefly and simply review the different TRT tests that most physicians use to monitor your progress while minimizing potential side effects.   Table of Contents How to Know if You Need TRT Follow Up Lab Tests After Starting TRT Avoiding or Lowering High Hematocrit on TRT Avoiding Low Ferritin and Iron Monitoring the PSA Test on Testosterone Monitoring Estradiol Test on Testosterone Avoiding High Blood Pressure and Water Retention on TRT Monitoring Kidney Function Avoiding High Liver Enzymes Monitoring Thyroid Tests Maintaining Good HDL Levels on TRT Prolactin in Men with Low Testosterone: The Forgotten Hormone Where to Buy Your Own TRT Tests: How to Know if You Need TRT The first thing doctors actually measure before you get on testosterone replacement is your total and free testosterone blood levels to find out if you have low testosterone. They will also ask you a few questions to see if you have low testosterone or hypogonadal symptoms. They include low sex drive, erectile dysfunction, fatigue, low mood, and issues with cognitive capacity and function. So, testosterone replacement therapy includes anything to increase testosterone levels with either injections or creams, gels, pellets, oral, nasal, and other TRT options. Follow Up Lab Tests After Starting TRT Once you get on testosterone replacement, your doctor will have you come back either at week six or eight to run another blood test to see if your dosage needs to be adjusted and/or you may require other medications to monitor or to modulate or change levels like estradiol, hematocrit, etc. The first one obviously is testosterone total and free. You come back at week six or eight, and your total testosterone is not over 500 nanograms per deciliter, your doctor will probably choose to increase your dosage or your frequency of injections in the case of injections. Free testosterone is usually around 2% of total or higher. If you have lower than 2%, your doctor will probably focus on any issues related to high sex hormone binding globulin (SHBG), which is a protein that binds to testosterone and does not free it up for action. Avoiding or Lowering High Hematocrit on TRT Hematocrit is the proportion of red blood cells in the blood. Testosterone tends to increase red blood cells.  Some men don't have that issue, but most men at least have a two to a three-point increase in hematocrit after starting TRT. Hematocrit increases a lot more in men on TRT who have sleep apnea and in smokers since these two can cause oxygen starvation.  High hematocrit can increase the viscosity of the blood and may cause cardiovascular issues. So, the magic number to go for is a hematocrit of 53 or below. When you're getting close to 53, you have to basically donate blood or go for what we call a therapeutic phlebotomy to bring down the red blood cell amount in the blood. And that's very important because as hematocrit goes up, your blood becomes more and more viscous, and your cardiovascular system gets compromised.  It's also very important not to let it go too high because above 52, most blood centers would not accept you as a donor, so you would have to require a special prescription for a therapeutic phlebotomy from your doctor for the blood centers to take your blood and dispose of it later. Keep in mind that donating more frequently than every three months may decrease your ferritin and iron stores considerably, which can cause fatigue and other issues. Here are some hematocrit lab panels, or you can buy them as part of the CBC panel. Avoiding Low Ferritin and Iron When your hematocrit is over 53, and you donate blood frequently than every three months, you can deplete your iron stores which makes you tired, depressed, and with no libido. Blood donations should not be happening that frequently because you'll lose iron. Some doctors will test your iron and your ferritin, and if you have low levels, they will put you on an iron supplement. Discounted Labs sells a blood donation panel that is designed to inform you if you can safely donate blood. Monitoring the PSA Test on Testosterone High PSA, prostate-specific antigen, is the only contraindication for testosterone replacement therapy if it is 4 or above. Obviously, physicians get very concerned that a man with higher PSA may have prostatic cancer, although it could be caused by an infection of your prostate (prostatitis) that could be easily treatable with an antibiotic. So, all high PSA tests do not mean you have cancer, but it could mean that you could have a treatable prostatic infection.  Your doctor may prescribe antibiotics and retest your PSA after your antibiotic cycle is finished.  He or she may need to refer you to a urologist if your high PSA test does not come down.  But if you do have a PSA of four or higher, you are not going to be allowed to use testosterone replacement unless your doctor can actually prove that it's an infection that will eventually be treated so that your PSA can come down. Monitoring Estradiol Test on Testosterone Estradiol (E2) is a very important hormone for men. We need it because estradiol is actually linked to bone health, cognitive functioning, cardiovascular health, even sex drive, and decreased fat mass. Having very low estradiol of under 20 pg/mL is actually not good for you since it can decrease bone density and cause other issues. Having very high estradiol in relation to your testosterone blood level may also have some consequences.  Several studies have different opinions and conclusions on what high estradiol means. About 0.3 to 0.4% of testosterone gets converted into estradiol by the aromatase enzyme. So obviously, the body increases the amount of estradiol as your testosterone goes up. There's nothing wrong with that. Estradiol balances testosterone to keep a better lipid (cholesterol) profile and to keep healthy sperm counts, just to name a few benefits. But what level of estradiol in men is too high? For example, if you have a testosterone level after you start TRT of 700 nanograms per deciliter, obviously, your estradiol is going to be higher than when before you started TRT. Is that cause for concern? Most men on testosterone replacement therapy do not need to take medications to lower estradiol. Estrogen blocker medications like anastrozole (Arimidex) are being overprescribed by many TRT clinics.  Men with a history of gynecomastia or breast enlargement may have issues with gynecomastia again if your estradiol's over 50 pg/ml, but in most studies where men with gynecomastia were followed, a lot of those men had low testosterone while they had high estradiol. A large study in adolescent boys showed that most of the ones with gynecomastia also had high IGF-1.  Some studies have shown that the ratio of testosterone to estradiol is really the important factor to monitor, with ratios over 12 being needed for healthy sperm production in men. But the management of estradiol in men is a very controversial topic as there is not a lot of agreement in the field.  Some doctors insist on keeping an E2 level of 20 to 40 picograms per milliliter no matter how high testosterone levels reach. We have learned in the past three years that the old immunoassay-based estradiol test tends to overestimate estradiol in men. Two studies have shown that the real estradiol value is better tested with a liquid chromatography-mass spectrometry sensitive estradiol assay. So, make sure that if your doctor is going to check your estradiol, you're using the right LC/MS E2 test. Discounted Labs offers several lab panels that contain sensitive estradiol.  Another concern of high estradiol is that some men feel that water retention is an issue, although that has not been proven by any studies. Most men with TRT-related water retention assume that their estradiol is high but fail to get it tested. Avoiding High Blood Pressure and Water Retention on TRT Some men on testosterone replacement therapy tend to have increased blood pressure related to water retention. There are some central nervous system effects that increase blood pressure and heart rate. These men can gain considerable weight during the first weeks of TRT.  Most lose most of that weight after a few weeks of therapy.  Some studies have shown that testosterone may decrease sodium excretion by the kidneys, which makes the body retain water to keep that sodium diluted. Ways to improve blood pressure are to lose weight, take a blood pressure medication, exercise, and decrease excessive sodium intake. Many men assume that their estradiol is high when they experience water retention. That assumption has not proven to be correct. Monitoring Kidney Function The estimated glomerular filtration rate, or eGFR, is a way to measure your kidney function. It's part of what we call a CMP blood test panel, and we are aiming at an eGFR over 60. Anything below that is indicative of a slowdown in the way your kidneys are filtrating toxins from your body. TRT does not really cause a decrease in eGFR. However, a lot of men taking creatine, exercising heavily, or eating very high protein intake tend to probably have artificial increases in creatine that decrease eGFR. You can Google eGFR formula and see how that's calculated. Avoiding High Liver Enzymes Current testosterone replacement therapy options have not been shown to increase liver enzymes; only the old oral forms of TRT used to cause that problem. However, doctors obviously follow it up. A very important distinction to make is that men that are exercising heavily with weights at the gym may artificially  increase in AST and ALT that has nothing to do with toxicity to the liver. Monitoring Thyroid Tests TSH, thyroid stimulating hormone, is also something else that most doctors follow up, although some actually do not. Low thyroid function (hypothyroidism or high TSH) may have the same symptoms as low testosterone. TRT medical guidelines groups around the world recommend different schedules for monitoring men on TRT, and a few of them agree with each other. Rarely do any guidelines mention thyroid function monitoring in men on TRT. TSH levels above 2.5 may indicate that you have hypothyroidism. If you have high TSH, doctors usually tend to use a comprehensive thyroid panel that includes free T3 and free T4, along with antibodies, to see if you have an autoimmune disease like Hashimoto's that may be inducing hypothyroidism. Maintaining Good HDL Levels on TRT High-density lipoprotein or HDL is another one of the variables most affected by testosterone replacement, especially at higher doses. When I say higher doses, anybody using 200 milligrams of testosterone replacement per week — cypionate or enanthate — tend to have a lowering of HDL. Low HDL has been shown to cause cardiovascular issues, so your doctor will always follow your lipids. Testosterone replacement has not really been shown to increase LDL, and there are some studies that show that TRT improves triglyceride blood levels because testosterone tends to improve the way the body metabolizes carbohydrates. There's very little we can do to increase HDL besides aerobic exercise, losing weight, decreasing TRT dose, and taking a supplement. Niacin supplementation is one of the ways to increase HDL, but some people get flushing of the skin and face. Last but not least, the use of anastrozole, an estradiol blocker, can also decrease HDL since estradiol is known to protect HDL levels. Prolactin in Men with Low Testosterone: The Forgotten Hormone Prolactin is not a hormone that is usually measured at TRT baseline or even at follow-up unless you have severe erectile dysfunction, even with good levels of testosterone. Men that have low testosterone at baseline, and I mean low testosterone, very low — under 150 nanograms per deciliter — are probably the best candidates to get a prolactin test. It is a hormone that women and men produce – obviously, women that are lactating produce it at higher concentrations in their bodies because it helps lactation. It also has some other benefits; otherwise, men would not have it. Prolactin has some immune-enhancing benefits and some cardiovascular benefits that are starting to show up in studies. So, prolactin is not an evil hormone, but it can, at higher concentrations, cause erectile dysfunction. The reason for high prolactin could be a benign tumor called pituitary adenoma (diagnosed by MRI), which can be producing a lot of pituitary output for prolactin, and that could actually impair your testosterone replacement therapy benefits. So, it's a hormone that is hardly looked at unless you are a man that has very low testosterone blood levels at baseline or do not respond well (unresponsive erectile dysfunction) after eight weeks or ten weeks of testosterone replacement therapy and/or you are having high prolactin symptoms, like lactation. That's actually a very rare symptom that actually occurs in men with pituitary adenomas. Where to Buy Your Own TRT Tests: DiscountedLabs.com provides very low-cost blood testing in most US states. You don't need to see a doctor because the company has in-house physicians that provide a prescription. After ordering your lab test online, you receive an email with the lab request form that you take to the closest lab near you. Once you go to a lab and get your blood drawn, you receive an email with your results within five to seven business days, depending on the blood test. For more information, visit DiscountedLabs.com   Visit ExcelMale.com to download Nelson's latest book: Beyond Testosterone   Click here for TRT Resources