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Low free test level.
Aug 20, 2011

Hi Nelson. I am a 50 yo male on Viread, Isentress and Viracept. I have an undetectable VL and my CD4's are at 375. My total cholesterol is a little high at 211. I am very happy that my total testosterone is at 705 ng/dL, but my free is 14.5 pg/mL. These numbers are WNL. My total test is actually on the high side for someone my age. I am not on TRT. I am concerned about my free test level. The lab says it's WNL but I understand it is actually desirable to have the free level at 5% of the total. This would be 35 for me and mine is only 14.5. I tend to think this is true because even though my total test is on the high side, I have a very low sex drive and low muscle tone. Should my free test level be higher? If so, could this be accomplished? I don't think TRT is required because my free test is on the high side. Thank you for your help.

Response from Mr. Vergel

As we age, our total testosterone may remain "normal" while the bio-available testosterone that actually does the work is low. This happens due to the increase of sex hormone binding globulin (SHBG) (a protein that attached to testosterone and renders it useless. HIV infection and age make SHBG go up, so we have less active testosterone to do its job.

Ask the doctor what method he or she used to run the free testosterone test since there is a wide variability among several.

The four main methods presently used for analyzing free testosterone are:

* Direct, Free Testosterone by Direct Analog/Radioimmunoassay (RIA) * Testosterone Free by Ultrafiltration (UF) * Testosterone Free by Equilibrium Tracer Dialysis (ETD) * Testosterone Free and Weakly Bound by Radioasssay (FWRA)

The latter three test methods are older, more complicated methods that are technically demanding. The direct RIA test has a number of commercial test kits available, and they are better used in today's automated equipment, making this test less tedious and requiring a smaller (less) sample. These advantages have convinced many laboratories and clinics to prefer direct RIA testing for free testosterone.

Having said this, I doubt that you need testosterone supplementation at those levels. I would look into your thyroid function, sleep pattern, medication list (some medication kill sex drive and can cause muscle loss).

You may want to visit my web site testosteronewisdom.com I have a consultation page there

Nelson



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