I agree with what Mike Wheeler has said but am surprised no
SHBG measured particularly in light of use of the DPC free testosterone
assay which has received a very bad press. (See Vermeulen et al JCEM 84:
3666;1999, Rosner JCEM 82: 2014; 1997,Winters et al Clin Chem 44: 2178;
1998).When was sample taken relative to last dose of testosterone. I have
several normal eugonadal men with total testosterones of this level in the
afternoon and even some eugonadal men with total testosterones not much
higher than this in early A.M.
I am now convinced after many years of study and self-doubt and criticism
that it is mandatory to have an estimate of binding protein influence when
assessing male gonadal status.See the concensus statement from the
andropause expert group from The Endocrine Society (Bethesda).
Michael Diver
Senior Lecturer
--On 20 September 2002 09:40 +1000 Bruce Campbell
<[log in to unmask]> wrote:
> A 37 year old male patient with post-traumatic hypopituitarism is on
> hormone replacement. Testosterone replacement is oral testosterone
> undecanoate 120 mg twice daily which is about twice the usual dose.
> Clinically he seems well androgenised. Free testosterone (DPC) is 11
> pmol/L (28 - 93) and total testosterone (Abbott Architect) is 6.4 nmol/L
> (11 - 40).
>
> Does anyone have suggestions regarding what may be going on here?
>
> Bruce Campbell
>
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> Bruce Campbell FRCPA FAACB
> Sullivan Nicolaides Pathology
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