question from a user
Free T vs total. Do you focus on one over the other? I have mid teens shbg and run my total test around 1000-1100. This puts my free test 2-3x the max range. I’ve always wondered which is more important? Meaning with lower shgb would run run total test lower to bring free test down or focus on the total and ignore the free?
AlphaMD's Answer
Yes and no. Total Testosterone is a great way to decide if someone strictly has low Testosterone by the value being below normal & can easily point to primary or secondary hypogonadism when looking at age and ballparking SHBG. Since SHBG doesn't play a big role in determining treatment itself when someone has low T, this means in many cases we don't need free T for these types of folks if treatment progresses as anticipated.
Where free T comes more into play would be when someone with primary or secondary hypogonadism doesn't respond to treatment like expected & we want a bit of a bigger picture or when someone has relative hypogonadism.
Free T is a more exact value and more important, but in practice Total T tends to be just fine for initial diagnosis. Given that, we tend to test for Total first since most people prefer to save the extra money
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