From the Guidelines
Your lab results indicate normal testosterone levels, but elevated SHBG, which may affect the availability of testosterone for your body to use, however, your free testosterone remains adequate, and no medication or treatment is necessary based on these results. Your total testosterone is normal at 20.1 nmol/L, and your calculated free testosterone is also within normal range at 278 pmol/L, as per the guidelines for the diagnosis of testosterone deficiency, which suggest using a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone 1. The slightly elevated albumin (46 g/L) is likely not clinically significant. The high SHBG (71 nmol/L) suggests that more of your testosterone is bound and less is freely available, though your free testosterone remains adequate.
Key Findings
- Total testosterone: 20.1 nmol/L (normal)
- Free testosterone (calculated): 278 pmol/L (normal)
- SHBG: 71 nmol/L (elevated)
- Albumin: 46 g/L (slightly elevated)
- DHEA-S: 5.6 µmol/L (normal)
Clinical Implications
The diagnosis of testosterone deficiency requires both a low testosterone measurement and the presence of select symptoms and/or signs, as stated in the guidelines 1. Since your total testosterone level is above the threshold of 300 ng/dL, and your free testosterone is within the normal range, you do not meet the criteria for testosterone deficiency. However, if you're experiencing symptoms like fatigue, decreased libido, or mood changes, follow up with your healthcare provider to rule out other underlying conditions. SHBG can be elevated due to factors like liver health, thyroid function, or certain medications, and maintaining a healthy weight, moderating alcohol consumption, and regular exercise may help optimize your hormonal balance naturally 1. Regular monitoring of these values would be reasonable if you have ongoing concerns.
Recommendations
- No medication or treatment is necessary based on these results
- Follow up with your healthcare provider if you're experiencing symptoms
- Maintain a healthy lifestyle to optimize hormonal balance
- Regular monitoring of testosterone levels if concerns persist, as recommended by the guidelines for patients with a history of certain conditions, such as unexplained anemia, bone density loss, or diabetes 1.
From the Research
Clinical Significance of Laboratory Results
The laboratory results of a 37-year-old male, including a total testosterone level of 20.1 nmol/L, free testosterone (calculated) of 278 pmol/L, hyperalbuminemia (Albumin: 46 g/L), elevated Sex Hormone-Binding Globulin (SHBG: 71 nmol/L), and a normal Dehydroepiandrosterone Sulfate (DHEA-S: 5.6 µmol/L) level, can be analyzed as follows:
- Testosterone Levels: The total testosterone level of 20.1 nmol/L is considered low, as the normal range for adult males is typically between 8.7 and 35.4 nmol/L, but can vary depending on the laboratory and measurement technique 2. The free testosterone level of 278 pmol/L is also an important consideration, as it represents the biologically active form of testosterone.
- SHBG and Testosterone: The elevated SHBG level of 71 nmol/L can affect the interpretation of testosterone levels, as SHBG binds to testosterone and reduces its bioavailability 3, 4. The relationship between SHBG and testosterone is complex, and further evaluation may be necessary to determine the clinical significance of these results.
- Hyperalbuminemia: The elevated albumin level of 46 g/L may not have a direct impact on the interpretation of testosterone and SHBG levels, but it can be an indicator of overall health and nutritional status.
- DHEA-S Levels: The normal DHEA-S level of 5.6 µmol/L suggests that the adrenal glands are functioning normally, and this result can help to rule out certain underlying conditions that may affect testosterone production.
Potential Implications and Next Steps
Based on these laboratory results, the following potential implications and next steps can be considered:
- Hypogonadism: The low total testosterone level and elevated SHBG level may indicate hypogonadism, a condition characterized by low testosterone production 5, 2. Further evaluation and testing may be necessary to confirm this diagnosis and determine the underlying cause.
- Testosterone Replacement Therapy: If hypogonadism is confirmed, testosterone replacement therapy (TRT) may be considered as a treatment option 6, 5, 2. However, the decision to initiate TRT should be based on a comprehensive evaluation of the patient's symptoms, medical history, and laboratory results.
- Monitoring and Follow-up: Regular monitoring of testosterone and SHBG levels, as well as other relevant laboratory tests, may be necessary to assess the effectiveness of treatment and adjust the therapeutic plan as needed 6, 2.