Getting your hormones tested every now and then is a good idea to see where your hormones are at and if your health is regressing or improving.
Getting test results can be somewhat confusing, but it gets real easy to understand when you can see the bigger picture and then it’s easy to know what to focus on for maximal improvements.
I’m going to go specifically over LH, FSH, total testosterone, free testosterone, estrogen and DHT and I will address different ratios and levels and what causes it and how to fix it.
Here we go:
Luteinizing hormone (LH)
LH is secreted by the pituitary to signal the testes to make more testosterone.
If LH is high and testosterone is low, this could indicated testicular dysfunction, that for some reason, the testes is not responding to the LH. The reason for that could be due to excess stress (cortisol), inflammation, heavy metals, testicles being too hot, reduced blood flow in the testes, a tumor in the testes, dysfunctional mitochondria in the Leydig cells or chemicals (plastics, herbicides, pesticides, supplement excipients, endocrine disruptors found in consumer wares such as deodorant, shampoo, lotion, etc.) that blocks LH’s action.
A few ways to improve this is to:
- Lower inflammation. Excess omega 6, phosphate (found in high amounts in grains, starches, veggies & meats), iron (think fortification), chronic elevated HPA axis and a low anti-oxidant rich diet can increase excess inflammation.
- Eating natural foods will automatically help to lower omega 6. Avoid all baked goodies and food that’s fried in vegetable, nut or seed oils, with macadamia oil, olive oil, coconut oil and cocoa butter being the exceptions.
- Eat more calcium rich foods, such as leafy greens and dairy, egg shell calcium or bone meal to balance the phosphate with calcium.
- Remove refined and enriched flour from your diet.
- Consume more anti-oxidant rich foods, such as cocoa powder, berries, fruits, etc.
- Cut out all endocrine disruptors and replace them with natural products.
- Natural substitutes include natural bar soaps for washing and shaving. Castile soap for washing hands, body and hair. Essential oils for deodorant (not all essential oils smell “girly”). Cocoa butter, mango butter, lanolin, aloe vera for lotion and aftershave.
- Drink (and wash with) filtered water.
- Get air filters if the air in your area is polluted.
- Improve blood flow
- Ginkgo Biloba, horse chestnut, aspirin, vitamin E, etc., are excellent for enhancing blood flow to the testes. They also protect the testes against oxidative stress and can improve mitochondrial function.
- Improve mitochondrial function in the testes
- Eating a healthy diet with lots of anti-oxidants will improve mitochondrial function in the testes.
- Following a proper exercise program will improve mitochondrial function.
- Shining red light for 5-10 minutes of the testes daily or every other day will significantly improve mitochondrial function.
- Intermittent fasting has been shown to improve testicular sensitivity to LH.
If LH and testosterone are (very) high, this could indicate that the pituitary is overstimulated and that the hypothalamus is not sensing the elevated testosterone or that estrogen and DHT are really low. Estrogen is the most potent inhibitor of LH secretion, followed by DHT. If both are very low, LH could be naturally elevated, but if they (estrogen and DHT) are moderately high and LH is still way above normal, then the pituitary might have a tumor that is secreting too much LH. In that case, growth hormone, TSH, FSH, ACTH, prolactin, etc., would all be elevated as well.
If LH is low and testosterone is high, this would be the ideal scenario and you shouldn’t be worried.
Follicle stimulating hormone (FSH)
FSH signals the Sertoli cells of the testes to increase sperm production. LH is necessary for testosterone production, whereas FSH is necessary for fertility. Ideally you also want FSH low (with optimal functioning testes ofc), as an excess of FSH stimulates the aromatase and can lower LH and testosterone production.
We, as men, all want our total testosterone to be through the roof. As a side note, if your goal is to add more muscle, having 1000ng/dl+ testosterone will not enable you to build muscle faster than if you had 500-600ng/dl testosterone. Upping your testosterone past a certain point will mainly have mental benefits as opposed to physical benefits.
Lowering cortisol, estrogen, serotonin and prolactin will additionally enhance the mental benefits of high testosterone.
> How to increase total testosterone
Free testosterone has always been thought to be the active form of testosterone and that all the rest is useless. Well that is not true.
Testosterone, once released from the testes, binds to albumin and sex hormone binding globulin (SHBG). Both of these carrier proteins prevent testosterone from being detoxified by the liver, so it enhances the half-life of testosterone in the body.
Secondly, albumin is only weakly bound to testosterone, so testosterone can still be freed from it and enter a cell and act on its receptor.
Recently it’s been discovered that certain cells contain SHBG receptors and if a SHBG bound to a testosterone binds to the receptors it will be internalized in the cell and exert an action. Insulin is also able to lower SHBG, allowing testosterone to become free and enter the cells.
So in truth, all forms of testosterone can still be used and exert an action.
But let’s go over how to increase free testosterone.
Both albumin and SHBG are produced in the liver. Low albumin and SHBG could indicated compromised liver function and reduced health.
Estrogen is a potent inducer of SHBG synthesis and insulin lowers SHBG. Diabetics with hyperinsulinemia usually have low SHBG and elevated free testosterone.
If your free testosterone is low, check for albumin and if that is normal (not low), then check for estrogen.
If estrogen & prolactin are low, but SHBG is high, a high protein diet, low carb diet, thyroid hormones, inflammation (TNFα), high HDL, overtraining and/or under-recovery are also able to increase SHBG.
> How to increase free testosterone
Estrogen has 15+ metabolites and can be created from DHEA, androstenedione and testosterone. Some research indicate that testosterone has to firstly be converted to androstenedione before being aromatased. Androstenedione is the most easily aromatased steroid in the body.
Estrone is created from DHEA and estradiol is created from androstenedione/testosterone.
Estrone-sulfate would be the best measure to measure long term estrogenic activity in the body. A one time measure of estradiol isn’t very helpful, but if it is high (and especially if you’re experiencing high estrogen symptoms), you might want to investigate some more and have estrone-sulfate and cortisol checked.
High estrone-sulfate will show you if you’re estrogen dominant and cortisol will show you if the elevated estrogen is due to excess stress. Insulin resistance, excess adipose tissue, inflammation and elevated insulin are also able to stimulate more aromatase.
> How to inhibit the aromatase
If cortisol is also high, you can get dive deeper down that path as well and do a DUTCH test (24 hour urinary test for steroid metabolites) as well as a thyroid panel (TSH, total and free T4 and T3, rT3, thyroid anti-bodies and thyroid peroxidase).
Low testosterone and high estrogen could indicate excess inflammation, poor diet, poor sleep, excess stress (elevated cortisol) and/or hypothyroidism.
High testosterone and high estrogen could indicate normal-ish thyroid function, but elevated stress, excess fat stores and/or too much estrogenic compounds in the diet or environment.
High testosterone with low estrogen would be the desired state. If you experience low estrogen symptoms, you might have an excess of endocrine disruptors, low DHEA and/or low progesterone.
Additionally, the DUTCH test tests for 10 different estrogen metabolites, so you can actually see what’s happening to estrogen in your body. It tests E1 (estrone), E2 (estradiol), E3 (estriol), 2-OH-E1 (2-hydroxyestrone), 4-OH-E1 (4-hydroxyestrone), 16-OH-E1 (16-hydroxyestrone), 2-Methoxy-E1, 2-Methoxy-E2, 2-OH-E2 (2-hydroxyestradiol), 4-OH-E2.
Estrogenic hormones, estrone (E1), estradiol (E2), and estriol (E3), are metabolized in the C-2, C-4, or C-16 pathways by a series of oxidizing enzymes in the cytochrome P450 family in the liver, resulting in 2-hydroxyestrogen (2-OH-E), 4-hydroxyestrogen (4-OH-E) and 16-hydroxyestrogen (16α-OH-E), respectively.
This is important because 4-hydroxy metabolites are thought to be harmful and cancerous, whereas the 2-hydroxy metabolites are the “safe” metabolites of estrogen, although the 2-hydroxy metabolites inhibit the synthesis of dopamine and increase prolactin and can promote oxidative stress.
Increasing COMT, which metabolizes these estrogens, has a protective effect. Increasing methylation with B-vitamins and COMT with magnesium has a protective effect by lowering these metabolites.
Additionally, Nrf-2 upregulators (quercetin, kaempferol, cruciferous vegetables, goldenberry extract, sulforaphane, α-Lipoic acid, curcumin, aromatase inhibitors, etc), gamma-tocopherol and pomegranate can protect against the toxic effect of estrogen (R).
DHT can be created from a few hormones, but testosterone is one of the main ones. Ideally we want DHT to be high when testosterone is also high.
If testosterone is moderately elevated or low while DHT is high, then things might not be optimal, or DHT is elevated to be protective. In that case, check for thyroid function, insulin & IGF-1. All three of those are able to significantly increase the synthesis of DHT. DHT could also be elevated to counter elevated estrogen and cortisol.
High thyroid function is good (and desired), unless you’re hyperthyroid, which in that case you might want to slow down thyroid, but only if it’s an issue.
Elevated IGF-1 is great for tissue repair, muscle growth, beard growth and so on, but too high levels and especially the dysregulation of IGF-1 could lead to excess growth, such as with tumors and cancer. Foods such as milk, high GI carbs, colostrum, vitamin D, zinc, DHEA, eggs, magnesium, selenium, etc., are all able to increase IGF-1 and improve IGF-1 handling in the body (if IGF-1 is too low). If you’re eating a healthy diet and training hard (not overtraining) I would not be worried about higher IGF-1.
Insulin is also a very anabolic hormone, but too high levels could indicated insulin resistance and could prevent proper fat loss. If Hb1Ac is below 5.2% and homa IR is normal, then you don’t have to worry about insulin.
If testosterone is high, but DHT is low, then check for things that might be inhibiting DHT synthesis and eliminate those from your diet.
The DUTCH test can also test for reduced metabolites, such as androsterone (5α reduced metabolite), etiocholanolone (5β reduced metabolite), 5α & 5β-androstanediol and lastly DHT. This way you can also more or less see what is happening to your DHT. For instance, your DHT might be low, but androsterone might be high and androsterone is the main pool for DHT synthesis. So if you need DHT, androsterone can easily convert to DHT.
That’s it for this article. If you still have question about your blood tests please leave a comment below, or you can contact me for coaching and I can help you interpret you bloods and give suggestions where to focus on.
As always, thanks so much for reading my article.
If you found it helpful and insightful please like and share so others can also benefit from this information and feel free to leave a comment down below if you have any questions for me.
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4 thoughts on “How to interpret your testosterone blood-test results in order to focus on what’s most important”
Can you please help with why my total t is great but my free t and cortisol and SHBG are terrible?
Total testosterone: 759
Bioavailable test: 13%
Free T4: 1.17
Vit D: 66.4
Do you want to schedule a call to talk about it? It would be the best way to discuss things.
Hi, I have low LH and FSH and low/normal test levels. I couldn’t find this scenario and what to do in your article.
Here’s the bloodwork. (my doc was stupid and forgot DHT and estrogen…) And I have PFS btw.
FSH 2.5 U/L 1.5 – 12.4
LH 2.3 U/L 1.7 – 8.6
test 16.63 nmol/L 8.64 – 29 (480 ng/dl)
SHBG 41.9 nmol/L 18.3 – 54.1
free test 0.299 nmol/L 0.198 – 0.619
It could be that either prolactin, estrogen, or serotonin is suppressing them.