Lab Results That Are “Normal” But Feel Wrong
One of the most common frustrations patients bring to their first Multigen Wellness consultation sounds like this: “My doctor said my labs are normal, but I feel terrible.” This experience reflects a fundamental limitation of standard reference ranges — they represent statistical population averages, not individual health optimization targets.
Understanding what your hormone labs actually mean, what values to aim for, and why “within range” is not always “within optimal range” can help you have more productive conversations with your healthcare provider and make more informed decisions about treatment.
Testosterone (Total and Free)
Total testosterone: Measures all testosterone in the blood, including protein-bound forms that are not biologically active. Standard laboratory reference ranges are typically 264–916 ng/dL, with some labs using slightly different cutoffs. A man with a total testosterone of 275 ng/dL is technically “within range” but is firmly in the symptomatic low range where most men experience significant quality-of-life impacts.
Multigen Wellness targets a functional optimal range of 700–1,100 ng/dL for men on TRT — consistent with what most men report as their best symptomatic range.
Free testosterone: The small fraction (1–3%) not bound to SHBG or albumin — the biologically active form that enters cells and drives effects. Free T can be low even when total T appears adequate, due to elevated SHBG (which increases with age, thyroid disease, liver disease, and low body weight). This is why total T alone is insufficient for evaluation.
Estradiol (E2)
Estradiol is the primary estrogen in both men and women. In men, it is produced through aromatization of testosterone and is essential for bone density, cognitive function, libido, and cardiovascular health — but excess estradiol in men (often from elevated aromatase activity with high body fat) causes water retention, mood swings, reduced libido, and gynecomastia.
Optimal estradiol range in men on TRT: typically 20–40 pg/mL. Levels above 50 pg/mL often require aromatase inhibitor consideration. For women, estradiol goals vary by treatment phase — premenopausal reference, early follicular phase replication, or symptom-driven optimization.
FSH and LH
FSH (follicle-stimulating hormone) and LH (luteinizing hormone) are pituitary signals. In men, LH stimulates Leydig cells to produce testosterone. Low LH with low testosterone suggests secondary hypogonadism (pituitary signal failure rather than testicular failure). High LH with low testosterone suggests primary hypogonadism (the testes cannot respond to the signal). This distinction matters for treatment choice. In women, FSH above 25–30 IU/L is a marker of declining ovarian reserve and approaching menopause.
SHBG (Sex Hormone-Binding Globulin)
SHBG binds tightly to testosterone (and estradiol), rendering the bound fraction biologically inactive. High SHBG artificially suppresses free T levels even when total T appears adequate. Causes of elevated SHBG include aging, thyroid disease (hyperthyroidism), liver disease, high estrogen, and low insulin levels. Optimal SHBG for men is typically 20–40 nmol/L; values above 60–70 nmol/L often require clinical management.
IGF-1
IGF-1 (insulin-like growth factor 1) is produced by the liver in response to growth hormone stimulation and is the primary clinical surrogate marker for GH axis function. IGF-1 testing is used to assess GH status in adults rather than direct GH measurement (because GH is pulsatile and brief, making spot measurements uninformative). Optimal IGF-1 for adults on peptide/GH therapy: upper quartile of the age-adjusted reference range.
Thyroid Panel: TSH, Free T4, Free T3
TSH alone is inadequate for thyroid evaluation. TSH above 2.0 mIU/L may indicate subclinical hypothyroidism in symptomatic patients, even within the laboratory “normal” range of up to 4.5. Free T3 — the cellular-level active hormone — is the most clinically relevant thyroid marker but is rarely included on standard panels. Low normal Free T3 with normal TSH and T4 is a pattern commonly found in symptomatic patients who have been told their thyroid is “fine.”
Want a comprehensive review of your current hormone labs or guidance on which tests to request? Call Multigen Wellness at (800) 259-0015. Our providers translate lab numbers into actionable clinical insight.