Dr. Abraham Morgentaler

Right. So SHBG is, the beauty of free testosterone is it's unrelated to whatever SHBG is doing. So SHBG is binding up a lot of the testosterone that gets measured in that blood test. But the free testosterone is just hanging out doing its thing. So it is whatever it is. It's either low or it's normal, or potentially it could be high if you're on treatment. So it's unrelated.

Right. So SHBG is, the beauty of free testosterone is it's unrelated to whatever SHBG is doing. So SHBG is binding up a lot of the testosterone that gets measured in that blood test. But the free testosterone is just hanging out doing its thing. So it is whatever it is. It's either low or it's normal, or potentially it could be high if you're on treatment. So it's unrelated.

But what it means is that women who have been on birth control pills, and women in general tend to have higher SHBGs than men do, it means that their total testosterone is even less reliable in women than it is in men. And so in order to properly interpret what a man's status is, you either need to get a free testosterone test, or we always measure SHBG.

But what it means is that women who have been on birth control pills, and women in general tend to have higher SHBGs than men do, it means that their total testosterone is even less reliable in women than it is in men. And so in order to properly interpret what a man's status is, you either need to get a free testosterone test, or we always measure SHBG.

And you can actually, there are these online calculators. You just put in the SHBG value, the testosterone value, and it'll spit out a number for you for the free testosterone.

And you can actually, there are these online calculators. You just put in the SHBG value, the testosterone value, and it'll spit out a number for you for the free testosterone.

Yeah. I mean, so what happens is that the total testosterone number when SHBG is generous or high is unreliable. It's going to look like it's fine when the person is really deficient, right? But if you give testosterone, the free will go up and the total also goes up.

Yeah. I mean, so what happens is that the total testosterone number when SHBG is generous or high is unreliable. It's going to look like it's fine when the person is really deficient, right? But if you give testosterone, the free will go up and the total also goes up.

And so when I have somebody where there's a discrepancy, so most of the time when there is a man who has a lot of symptoms, we say, oh man, his blood tests are for sure going to show low levels of testosterone. And his total comes back within the normal range. It's almost always explained by having low levels of free testosterone. which usually goes along with generous levels of SHBG.

And so when I have somebody where there's a discrepancy, so most of the time when there is a man who has a lot of symptoms, we say, oh man, his blood tests are for sure going to show low levels of testosterone. And his total comes back within the normal range. It's almost always explained by having low levels of free testosterone. which usually goes along with generous levels of SHBG.

The treatment is the same. The treatment is the same. And the goal of treatment is not to get the total testosterone into the normal range. The goal is to improve the symptoms that the man is having and hopefully resolve them. And they will resolve if it's hormone-related.

The treatment is the same. The treatment is the same. And the goal of treatment is not to get the total testosterone into the normal range. The goal is to improve the symptoms that the man is having and hopefully resolve them. And they will resolve if it's hormone-related.

But because these guys with elevated or generous SHBG levels already may have good total levels, I always tell the patient, and I put it in the record because other doctors will see these notes, that the total testosterone is likely to be very high with treatment because we're treating a free testosterone level.

But because these guys with elevated or generous SHBG levels already may have good total levels, I always tell the patient, and I put it in the record because other doctors will see these notes, that the total testosterone is likely to be very high with treatment because we're treating a free testosterone level.

Yeah. I have a very prominent patient who has a lot of doctors, and he's just like that. His total testosterone is fine. His doctors didn't think he needed anything. His free testosterone was low. And his total testosterone was mid-range normal. I don't remember the exact number. It's many years ago since we've started treating him. Let's say it was 500, yeah?

Yeah. I have a very prominent patient who has a lot of doctors, and he's just like that. His total testosterone is fine. His doctors didn't think he needed anything. His free testosterone was low. And his total testosterone was mid-range normal. I don't remember the exact number. It's many years ago since we've started treating him. Let's say it was 500, yeah?

And most people say, oh, that's robust, right? But he had all the symptoms. He had low free testosterone. So we treated him, and all his symptoms got better. It's interesting. This is a man who you and I would think that everything he's done, he should be on top of the world. But he wasn't. He's a guy like everybody. And when testosterone is low, he wasn't who I thought he would be.

And most people say, oh, that's robust, right? But he had all the symptoms. He had low free testosterone. So we treated him, and all his symptoms got better. It's interesting. This is a man who you and I would think that everything he's done, he should be on top of the world. But he wasn't. He's a guy like everybody. And when testosterone is low, he wasn't who I thought he would be.

He was really struggling. Yeah. And life is hard. It just is, right? We have challenges every day, whether you have small children, elderly parents, difficult relationships, work. Life is hard. And what I see testosterone doing for a lot of people even if they're not like out and out miserable, is they lose what I call the critical 5%.

He was really struggling. Yeah. And life is hard. It just is, right? We have challenges every day, whether you have small children, elderly parents, difficult relationships, work. Life is hard. And what I see testosterone doing for a lot of people even if they're not like out and out miserable, is they lose what I call the critical 5%.