High Testosterone, Low Free T What Joe’s Bloodwork Revealed

24 Oct 2026 · 1 min

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In this brief medical commentary, Dr. Anne Truong reviews the laboratory results of a patient named Joe. She identifies three key abnormalities: anemia caused by low iron, a borderline low vitamin D level that can contribute to erectile dysfunction, and a paradoxical hormonal profile where total testosterone is elevated (likely due to testosterone cypionate injections) while free testosterone remains low because most of the hormone is bound to proteins. Dr. Truong explains the clinical relevance of each finding and highlights that free testosterone is the biologically active form, underscoring the need to assess both total and free levels when monitoring testosterone therapy.

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Anemic means that you have low red blood cell count due to low iron. He also has borderline low vitamin D level. If you heard my last few episodes, vitamin D level can contribute to ED as well. Even though he's on testosterone cypionate injection, his blood work still shows that he has low free testosterone, even though his total testosterone is high. But total testosterone is attached to protein, but free is what is active, and that's low.