So we know that the free testosterone is the most important, even more so than the total testosterone. As men age, free testosterone goes down while total testosterone remains the same. SHBG, or sex hormone-binding globulin, increases, causing free testosterone levels to fall. While estrogen is most often recognized as the culprit behind such falls, the influence is minimal and a little bit misunderstood. Oral estrogen passes through the liver in women, resulting in increased SHBG. On the other hand, transdermal estrogen has no effect on SHBG. Because men do not take oral estrogen, estrogen in general cannot be the one responsible for the majority of SHBG level increase. Instead, causes for this increase can simply be attributed to age, alcohol use, obesity, lack of exercise, and medications. Now of course, once this information is known, you’ll be wondering about how SHBG can be treated. An increase in SHBG can be treated in one of two ways. It may be that SHBG levels must somehow be lowered or testosterone must be added. By raising free testosterone levels, total testosterone may increase by two to three times the normal levels. While some patients feel that raising total testosterone levels will be harmful, it’s actually the opposite effect. It’s very beneficial.

*By following the guidelines of a natural hormone replacement program, you should be able to get your free testosterone levels back to optimal range and not worry about your total testosterone levels. Make sure your provider is well versed in hormone replacement treatment, otherwise you will run the risk of a misdiagnosis. You must be careful of the difference between what is considered normal and what is considered optimal. Medicine finds that getting levels up to that of a younger age, say 20 or 30 years old, would be optimal. However, it is important to keep in mind that normal for someone older, say in their 60s or 70s, is not normal for someone younger who is in their 20s or 30s. The goal is not to be younger. The goal is to reach the optimal level so you are able to function at your best regardless of your age. While various labs may publish materials to indicate otherwise, 40 is the optimal level and 40 is thus the goal level to aim for. Many labs may consider 40 to be too high, but as it is the level found in young adults, it is the level that you should strive to reach for.

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