The blood test: which line is which organ

A male hormone panel is a set of answers to different questions, printed on one sheet so people treat it as one answer. Total testosterone is what the Leydig cell and the injection put into the blood. SHBG is the liver protein that binds most of it. Free testosterone, properly calculated from total, SHBG and albumin, is the small unbound fraction. LH and FSH are the pituitary's questions to the testis: one for testosterone, one for sperm. Oestradiol is what aromatase made. Prolactin is the lactotroph, under dopamine. Haematocrit is the marrow. ALT, AST, GGT and bilirubin are not one 'liver score'. Read them as sentences. A single flag, without the sentence next to it, is how a normal squat becomes a liver scare and a real cholestasis gets filed under training.

In short. The panel is several organs talking at once. Testosterone, the pituitary, oestradiol, prolactin, red cells and the liver are different sentences. Do not average them into a vibe.

Draw testosterone in the morning if you are measuring what you make. The diurnal swing is real, and an afternoon number looks like a deficiency on a man whose morning was fine. Liquid chromatography with mass spectrometry beats the older immunoassays, which cross-react. On an exogenous androgen the total can be anything the dose and the timing decide, and LH will be low, because the hypothalamus has stopped asking. High LH with low testosterone is the opposite picture: the pituitary is shouting and the testis is not answering. That is primary failure, not suppression. SHBG decides how much of the total is free. The SHBG essay is the long version. The short version is that a low SHBG from an oral, from insulin resistance, or from a crushed oestradiol will make a mediocre total look falsely generous if you only stare at the free fraction.

In short. Morning testosterone, by mass spectrometry if you can. Low LH means you are suppressed. High LH with low testosterone means the testis is the problem. SHBG changes how much of the total is free.

Oestradiol in a man needs the assay that can see it. Standard immunoassays were built for the female range and wander at male concentrations. A falsely high number starts an aromatase inhibitor. Anastrozole binds CYP19A1, the aromatase, and the Leydig-cell testosterone that would have become oestradiol does not. A falsely low reading reassures someone whose joints are already telling the truth. Tamoxifen occupies the oestrogen receptor in breast tissue as an antagonist and can act as an agonist in bone. Prolactin needs a rested morning sample. Stress, a meal and nipple stimulation move it. One spiked result is a reason to repeat, not a reason to start a dopamine agonist. FSH is the forgotten line. LH can return while FSH stays flat, and sperm take months either way. A man who cares about fertility reads FSH and a semen analysis, not just the testosterone he feels.

In short. Male oestradiol needs a proper assay. Prolactin needs a calm repeat if it is up once. FSH, not just testosterone, is the line that tracks sperm.

ALT and AST live in muscle as well as liver. A hard session, especially one with a lot of lowering, dumps them into the blood for several days. GGT and bilirubin do not come from a squat. If ALT is up, GGT is normal and you trained, you have a muscle story until proved otherwise. If bilirubin and GGT are up, particularly on a 17α-alkylated oral, you have a liver story. Haematocrit and haemoglobin sit beside them because the same androgen drives red cells. HDL is the lipid that androgens pull down fastest. LDL and triglycerides still matter, and a pretty HDL from a year ago does not describe the month you added an oral. PSA is a prostate line, worth a baseline in older men before androgens, and not a number you interpret from a single gym forum screenshot.

In short. ALT rises after hard training because muscle contains it. GGT and bilirubin point more honestly at the liver. Haematocrit and HDL belong on the same form as the hormones.

Timing is part of the result. A peak drawn two hours after an injection is not a trough drawn before the next one, and neither is the morning you produce on your own. Comparing them as if they were one experiment is how dose arguments start. Name the assay, the hour, the last injection, the last session, and whether you were fasted and watered. Then the numbers are allowed to mean something. The essays next to this one take each line apart: SHBG, oestradiol and the enzyme that makes it, prolactin, haematocrit, the follicle. This page is the index. The index is not the diagnosis.

In short. Write down when you injected, when you trained, and whether the number is a peak or a trough. The same hormone at two times of day is two different facts.

An enanthate or cypionate injection is not a flat line. The blood level rises over the first day or two and falls across the rest of the week. Draw at the peak and you are looking at the top of a hill. Draw on the morning before the next injection and you are looking at the trough, which is the number that tells you whether you are ever actually low. Comparing a peak on one ester to a trough on another, or to a healthy man's 8 a.m. sample, is how arguments about 'high' and 'low' start. Undecanoate is slower. Propionate is a daily swing. Gel is a daily swing of a different shape, higher in the hours after it goes on the skin. Write the ester and the hour on the form or the form is a photograph of an unknown moment.

In short. Testosterone injections rise and fall. A blood test the day after the jab is the peak. A blood test the morning before the next one is the trough. They are not the same fact, and neither is a gel measured at a random hour.

Free testosterone, done properly, is a calculation from total testosterone, SHBG and albumin. The free-androgen index, total divided by SHBG, is a shortcut that falls apart when SHBG is very low or very high, which is exactly the men this sport produces. Albumin is usually assumed at 43 grams per litre. If albumin is actually low, from illness or a poor diet, the assumption is wrong and the free number moves. Creatine kinase belongs next to ALT. CK is the muscle enzyme. If CK is in the thousands and ALT is mildly up, you trained. If CK is normal and ALT, GGT and bilirubin are up, you did not. Lipids need a fast. A non-fasted triglyceride is a meal. HDL is the androgen-sensitive one and it does not care whether you fasted. Read HDL beside the haematocrit. They are two tissues answering the same ligand.

In short. Calculate free testosterone from total, SHBG and albumin. The free-androgen index is a rough ratio and it lies when SHBG is crashed. CK next to ALT tells you if the 'liver' result was a workout. HDL does not need you to have fasted.

The shortest set that answers the usual questions is: total testosterone by mass spectrometry, SHBG, albumin, LH, FSH, oestradiol by mass spectrometry, prolactin, full blood count, fasted lipids, and ALT, AST, GGT, bilirubin. Add ferritin if haematocrit is high or donations have been happening. Add TSH if prolactin is up or energy is inexplicably flat. Add a semen analysis if fertility is the question, because FSH is a hint and sperm are the fact, on a seventy-to-ninety-day clock. None of this is a personality test and none of it needs to be drawn the morning after a vomit-inducing leg day. Sit down, be watered, be fasted for the lipids, tell the phlebotomist the last injection and the last session, and keep the paper. A trend across three draws beats one dramatic screenshot.

In short. Mass-spec testosterone and oestradiol, SHBG, LH, FSH, prolactin, a full blood count, fasted lipids, and liver tests that include GGT. Add ferritin if the blood is thick, and a semen test if you care about sperm. Three calm draws beat one dramatic one.