How to read your hormone test results
The Nimbus Men’s Health & Wellness Test evaluates 11 different markers related to testosterone. Before we dive into what each marker relates to and why we test it, we must talk about reference ranges.
Reference ranges are the bracketed numbers you see next to the lab value result. These ranges were derived from healthy people of various ages and backgrounds. They serve as “population normals.” Most healthy people will fall between a specific range of values. Certain disease states or health imbalances can cause values to increase or decrease outside of that range. However, a value outside of the normal range does not necessarily mean something is wrong, nor does a value inside the normal range mean everything is fine. Interpreting lab values is an art, and at Nimbus, we combine the marker values with symptoms. Our questionnaires directly link to the importance of the 11 markers we test. Our physicians integrate the laboratory values with how you feel to determine the best course of action. We utilize prescription medication, lifestyle medicine, and vitamins to personalize your treatment plan to achieve unparalleled results.
Now that we have explained the reference ranges, we can talk more about the 11 biomarkers: Albumin, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), Sex Hormone Binding Globulin (SHBG), Total Testosterone, Prostate Specific Antigen (PSA), Free Testosterone, Estradiol, High Density Lipoprotein (HDL), Low Density Lipoprotein (LDL), and Total Cholesterol.
Albumin is a protein made by the liver that makes up nearly half of the protein in our blood. Its primary function is to carry various molecules throughout the body to their site of action. SHBG carries the majority of Testosterone in our bodies (more on that shortly). Changes in albumin levels can impact how much free testosterone is available for our cells. Low albumin levels are associated with liver disease, heart failure, stress, thyroid disease, kidney disease, malnutrition, inflammation, and certain auto-immune diseases.[1] Elevated levels are less commonly seen and usually indicate dehydration. Albumin levels are part of our panel because Free Testosterone is calculated utilizing Albumin and SHBG.[2]
FSH and LH are two hormones released by the brain that inform the testes to make sperm and testosterone.[3] LH is the more important hormone to evaluate overall hormone health. Low levels of LH can be caused by malnutrition, chronic illness and stress, pituitary issues, and genetics.[4] Elevated LH levels with low testosterone indicate the testes are not responding to the brain signal to increase testosterone. Measuring LH values helps our physicians determine the root cause of low testosterone levels. Men with LH levels that are higher in the normal range may not respond as well to clomiphene therapy.[5]
SHBG is a protein made by the liver that circulates testosterone, estradiol, and dihydrotestosterone in the body. Approximately 55% of the total testosterone is bound to SHBG, with the rest attached to proteins like albumin. Only 1% to 3% of the total testosterone exists as free testosterone. SHBG levels can be decreased with obesity, low thyroid levels, insulin resistance, inflammation, and excess sugar intake.[6][7] SHBG levels increase with age, liver disease, low insulin levels, malnutrition, and decreased hormone levels. The free hormone hypothesis says that only the free hormone is available to interact with our cells. Typically, when SHBG is increased, the body responds by increasing LH to make more total testosterone, increasing the free portion. When testosterone levels decline, the body does the opposite; SHBG levels decrease to increase free testosterone. We evaluate SHBG in this light to see how the body responds to testosterone changes and consider whether disturbances in SHBG are part of the root cause of testosterone abnormalities.[8] For example, if SHBG levels are elevated, and total testosterone levels are normal, there may be symptoms of low testosterone present. Evaluating SHBG levels allows our practitioners to take a holistic view of testosterone levels.
Total testosterone measures the overall testosterone level and includes the portion free in the bloodstream and bound to proteins like SHBG and albumin. Free testosterone is calculated from total testosterone, SHBG, and albumin levels and represents the portion available to interact with our cells. The causes of low testosterone include medications, obesity, HIV, inflammatory diseases, chronic disease, pituitary disorders, genetics, aging, nutrient deficiencies, trauma to the testicles or brain, and previous mumps infection.[9] At NImbus, we evaluate testosterone levels in addition to a clinically validated questionnaire to look for manifestations of low testosterone. We do not believe it is sufficient to treat lab values; we treat you as an individual based on your situation and biomarkers. There are several different methods we can use to normalize testosterone levels. We believe in a multimodal approach that combines prescription medication, lifestyle medicine, and vitamins.
HDL, LDL, and Total Cholesterol might seem like they are out of place on the panel, but they are linked to our hormones and overall health status. HDL has numerous biological benefits, including antioxidant capacity, increasing blood flow through nitric oxide, immune system regulation, and anti-inflammatory effects.[10] Low testosterone is associated with increased LDL and decreased HDL. The combination of low HDL and high LDL is a proven risk factor for cardiovascular disease (CVD), the number one killer of Americans.[11] Administering testosterone increases HDL and lowers LDL.[12] However, this does not appear to reduce CVD risk, nor does it seem to increase it.[13],[14]. To learn more about lipids and their regulation, check out this podcast (https://www.theghwellness.com/the-truth-about-cholesterol/).
Finally, we have PSA. PSA is a blood marker used for prostate health. PSA levels increase as we age, with prostate inflammation, prostate growth, and prostate cancer. Therapies that increase testosterone may increase PSA levels; however, a review of many studies found that this was only true with the injectable form of testosterone replacement therapy. This increase was minimal and was not clinically significant.[15] We monitor PSA levels on treatment to monitor for potential adverse effects.
[1] Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and Clinical Significance. JPEN J Parenter Enteral Nutr. 2019;43(2):181-193. doi:10.1002/jpen.1451
[2] Ly LP, Handelsman DJ. Empirical estimation of free testosterone from testosterone and sex hormone-binding globulin immunoassays. Eur J Endocrinol. 2005;152(3):471-478. doi:10.1530/eje.1.01844
[3] Ramaswamy S, Weinbauer GF. Endocrine control of spermatogenesis: Role of FSH and LH/ testosterone. Spermatogenesis. 2015;4(2):e996025. Published 2015 Jan 26. doi:10.1080/21565562.2014.996025
[4] Kazmi SRH, Can AS. Luteinizing Hormone Deficiency. [Updated 2021 Sep 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562219/
[5] Guay AT, Jacobson J, Perez JB, Hodge MB, Velasquez E. Clomiphene increases free testosterone levels in men with both secondary hypogonadism and erectile dysfunction: who does and does not benefit?. Int J Impot Res. 2003;15(3):156-165. doi:10.1038/sj.ijir.3900981
[6] Selva DM, Hogeveen KN, Innis SM, Hammond GL. Monosaccharide-induced lipogenesis regulates the human hepatic sex hormone-binding globulin gene. J Clin Invest. 2007;117(12):3979-3987. doi:10.1172/JCI32249
[7] Edmunds SE, Stubbs AP, Santos AA, Wilkinson ML. Estrogen and androgen regulation of sex hormone binding globulin secretion by a human liver cell line. J Steroid Biochem Mol Biol. 1990;37(5):733-739. doi:10.1016/0960-0760(90)90358-r
[8] Laurent MR, Hammond GL, Blokland M, et al. Sex hormone-binding globulin regulation of androgen bioactivity in vivo: validation of the free hormone hypothesis. Sci Rep. 2016;6:35539. Published 2016 Oct 17. doi:10.1038/srep35539
[9] Kumar P, Kumar N, Thakur DS, Patidar A. Male hypogonadism: Symptoms and treatment. J Adv Pharm Technol Res. 2010;1(3):297-301. doi:10.4103/0110-5558.72420
[10] Jomard A, Osto E. High Density Lipoproteins: Metabolism, Function, and Therapeutic Potential. Front Cardiovasc Med. 2020;7:39. Published 2020 Mar 31. doi:10.3389/fcvm.2020.00039
[11] Monroe AK, Dobs AS. The effect of androgens on lipids. Curr Opin Endocrinol Diabetes Obes. 2013;20(2):132-139. doi:10.1097/MED.0b013e32835edb71
[12] Thirumalai A, Rubinow KB, Page ST. An update on testosterone, HDL and cardiovascular risk in men. Clin Lipidol. 2015;10(3):251-258. doi:10.2217/clp.15.10
[13] Corona G, Rastrelli G, Di Pasquale G, Sforza A, Mannucci E, Maggi M. Testosterone and Cardiovascular Risk: Meta-Analysis of Interventional Studies. J Sex Med. 2018;15(6):820-838. doi:10.1016/j.jsxm.2018.04.641
[14] Shores MM, Walsh TJ, Korpak A, et al. Association Between Testosterone Treatment and Risk of Incident Cardiovascular Events Among US Male Veterans With Low Testosterone Levels and Multiple Medical Comorbidities. J Am Heart Assoc. 2021;10(17):e020562. doi:10.1161/JAHA.120.020562[15] Jarvis TR, Chughtai B, Kaplan SA. Testosterone and benign prostatic hyperplasia. Asian J Androl. 2015;17(2):212-216. doi:10.4103/1008-682X.140966