Understanding Your Bloodwork: Free vs. Total Testosterone (And Why Your Doctor Missed It)

If I had a dollar for every time a patient walked into our clinic here in Southlake holding a lab report and looking confused, I’d be retired on a beach somewhere.

The story is almost always the same.You feel terrible. You have no energy, your workouts are going nowhere, and your libido has vanished. You go to your primary care doctor. They draw some blood. A few days later, you get the call:

"Everything looks normal! Your testosterone is 400. You’re fine."

But you don't feel fine. You feel like you’re running on fumes.

Here is the frustrating reality of modern medicine: Most standard blood panels are designed to catch disease, not to optimize health. They are looking for the bottom 2.5% of the population. If you aren't dying, you’re "normal."

At Magnolia Functional Wellness, we don't care about "normal." We care about optimal. And the biggest mistake I see in men’s health is looking at Total Testosterone while ignoring the number that actually matters: Free Testosterone.

The "Gross vs. Net Income" Analogy

To understand your labs, you have to understand basic economics.

Think of Total Testosterone as your Gross Income.Let’s say you make $200,000 a year. On paper, that looks great! You’re rich!

But now, let’s look at your taxes, your mortgage, your student loans, and your overhead. This is SHBG (Sex Hormone Binding Globulin). SHBG is a protein produced by your liver that binds to sex hormones. It acts like a magnet. When testosterone sticks to SHBG, it becomes biologically inactive. It’s handcuffed...it can’t enter your cells...it can’t build muscle...and it can’t help your brain focus.

Free Testosterone is your Net Income. It’s the cash you actually have in your pocket to spend at the grocery store.

I see guys in Southlake all the time who have high "Gross Income" (Total T of 600 or 700) but their "Taxes" (SHBG) are so high that they are living paycheck to paycheck biologically. Their Free T is in the gutter.

If your doctor only checked your Total T, they looked at your salary and assumed you were wealthy, without realizing you’re drowning in debt.

Why Is My SHBG So High?

This is where the detective work happens. If we see that your Free T is low despite decent production, we have to ask why your body is binding it all up.

Common culprits include:

• Insulin Resistance: High blood sugar often messes with SHBG.
• Liver Stress: Since SHBG is made in the liver, alcohol consumption or fatty liver can skew the numbers.
• Aging: As we get older, SHBG naturally creeps up, stealing more of our available testosterone.
• Thyroid Issues: If your thyroid is sluggish, your hormone transport suffers.

This is why "cookie-cutter" medicine fails. You can’t just throw testosterone at the problem if you don't understand the mechanism.

The Magnolia Functional Wellness Difference

When you come to see us in Southlake, we don't run the "budget special" lab panel. We run a comprehensive look under the hood.

Here is what we look for (and what you should ask for):

1. Free Testosterone (Direct or Calculated) This is the holy grail. We want to know exactly how much fuel is available for your receptors. If this number is low, I don't care how "normal" your Total T is—we treat the symptoms.

2. Estradiol (Sensitive) Testosterone converts to estrogen. You need some estrogen (it protects your brain and joints), but you don't want too much. Many men with "belly fat" have high estrogen because fat cells contain an enzyme that eats up testosterone and spits out estrogen. It’s a vicious cycle. We measure this to make sure you’re balanced.

3. Thyroid Panel (TSH, Free T3, Free T4) Symptoms of Low T and Hypothyroidism look almost identical. Fatigue? Check. Weight gain? Check. Brain fog? Check.If we fix your testosterone but ignore a sluggish thyroid, you’ll still feel tired. We check the whole system.

4. PSA (Prostate Specific Antigen) Safety first. Before we start any therapy, we ensure your prostate health is solid.

How to Read Your Own Labs

When you get your results back, look at the reference range.If the range for Total Testosterone is 264–916 ng/dL (a common range), and you are at 300, the lab flags you as "Normal."

But ask yourself: Do you want the testosterone levels of an 85-year-old man? Because that is who is at the bottom of that range.

At Magnolia, we aim for the upper quartile for your age group. We want you operating at peak efficiency, not just "getting by."

Stop Guessing. Start Measuring.

If you have been told you are "fine" but you know something is off, trust your gut.

You know your body better than a reference range does.

At Magnolia Functional Wellness, we treat the patient, not the paper. We sit down with you, explain every single marker, and build a plan that fits your life. Whether that’s TRT, peptide therapy, or just a lifestyle overhaul, it starts with getting the right data.

Let’s stop looking at Gross Income and figure out what’s actually in your wallet.

‍