Health Assessment Report
ExampleTestosterone & hormone panel · 8 biomarkers
Patient details
- Name
- Mark Bakker
- Gender
- Male
- Age
- 41 years
- Date of birth
- 04-09-1984
Test details
- Test Date
- 11-06-2026
- Report date
- 14-06-2026
- Location
- Rotterdam Centrum
- Laboratory
- Star-SHL
8
Total Markers
6
In Range
2
Needs Attention
Overall Assessment
Your total testosterone of 16.8 nmol/L sits in the middle of the reference range. On that number alone you would have no abnormality at all. Your free testosterone, however, is low (0.21 nmol/L) and your SHBG is raised (62 nmol/L) — and those two belong together.
SHBG binds testosterone in the blood. What is bound is not available to your tissues. With a raised SHBG the total can therefore look normal while the working fraction falls short. That is exactly the pattern here, and it is why this panel measures both.
Key Findings
Free testosterone low (0.21 nmol/L)
AttentionBelow the 0.25 lower limit. This is the fraction actually available to muscle, bone and the central nervous system. Reduced energy, loss of libido and difficulty maintaining muscle are the symptoms that fit.
SHBG raised (62 nmol/L)
AttentionAbove the 54 upper limit. This explains the gap between your normal total and your low free testosterone. SHBG rises with thyroid overactivity, liver disease, markedly low body weight and with age.
LH and FSH normal — the signalling works
GoodLH 4.2 U/L and FSH 3.8 U/L are within range, so the pituitary is driving the testes normally. That rules out a primary pituitary problem and makes the picture more benign.
Hematocrit and PSA are fine
GoodHematocrit 0.46 L/L and PSA 0.8 µg/L. These are the standard safety checks before any testosterone treatment, and both are normal.
Detailed Analysis
Hormones
AttentionThe core picture is a normal total testosterone (16.8 nmol/L) alongside a low free testosterone (0.21 nmol/L) and a raised SHBG (62 nmol/L).
Roughly two per cent of the testosterone in your blood circulates freely; the rest is bound to SHBG and albumin. Only the free and weakly albumin-bound fractions are biologically active. A raised SHBG shifts that balance, which makes the total read more favourably than the situation warrants.
LH and FSH are normal, meaning the signal from the pituitary is intact. Your estradiol of 98 pmol/L is likewise normal and consistent with these testosterone values.
Hematology
NormalYour hematocrit is 0.46 L/L, within range. This is the most important safety value in testosterone therapy, which can raise it and thicken the blood. The starting point here is favourable.
Tumor Markers
NormalYour PSA is 0.8 µg/L, well below the 3.0 limit. PSA is checked before and during testosterone treatment. This value calls for no further investigation.
Recommendations
Find the cause of the raised SHBG first
A raised SHBG is a finding, not a diagnosis. Have thyroid function (TSH and free T4) and liver values measured before treatment is discussed. Where a cause is identifiable, addressing it often resolves the free testosterone on its own.
Repeat the test fasting and before 10am
Testosterone follows a clear daily rhythm, peaking in the early morning. A single abnormal reading is never enough to base treatment on. Repeat the measurement on a second morning, fasting, before 10am.
Discuss the result with your GP or an andrologist
Testosterone therapy is a long-term treatment with its own risks and with consequences for fertility. This result is a reason for a conversation, not for starting on your own.
Next Steps
Have the test repeated on a second morning, together with TSH, free T4 and liver values. With those results in hand it will be clear whether the raised SHBG has an identifiable cause.
Then contact your GP. This report does not replace a consultation and is not on its own an indication for treatment.
Your Test Results
Hematology
1What It Measures
Hematocrit is the share of your blood volume made up of red blood cells. Blood consists broadly of plasma and cells. Red blood cells account for by far the largest part of the cellular fraction. A hematocrit of 0.45 l/l therefore means 45 percent of your blood volume is red cells. The measurement used to be made by spinning blood and reading off the red cell layer. Modern cell counters work differently. They calculate the value from the red cell count multiplied by the mean cell volume, the MCV. Star-shl lists the method for this test literally as "Berekening", meaning calculation. That explains a property which is often missed. Any measurement artefact that shifts the MCV shifts your hematocrit with it. Reference values differ per laboratory and per method. Star-shl publishes the values below for hematocrit (code BH01, EDTA blood). The laboratory cites the Handboek medische laboratoriumdiagnostiek as its source. <table><thead><tr><th>Group</th><th>Reference value (l/l)</th></tr></thead><tbody><tr><td>Men</td><td>0.40 – 0.50</td></tr><tr><td>Women</td><td>0.35 – 0.45</td></tr><tr><td>Children 1 – 5 years</td><td>0.35 – 0.45</td></tr><tr><td>Children 5 – 10 years</td><td>0.36 – 0.47</td></tr><tr><td>Children 10 – 15 years</td><td>0.38 – 0.49</td></tr></tbody></table> Children therefore sit in a different band from adults. Newborns run well above that band in the first months. Always use the range printed on your own report. A useful rule of thumb links hematocrit and haemoglobin. The hematocrit percentage is roughly three times the haemoglobin in g/dl. The Netherlands, however, reports haemoglobin in mmol/l. Convert first: mmol/l times 1.61 gives g/dl. If the ratio still deviates sharply, that is itself a signal.
Lifestyle Tips
The largest gain sits in the conditions around the measurement itself. On the day of the draw, drink what you normally drink. Anyone arriving dehydrated gets a result describing their fluid balance rather than their blood. Smoking is the most modifiable cause of a structurally raised value. Carbon monoxide occupies part of the haemoglobin, so the body increases production. After quitting, the value falls gradually, because red cells live about 120 days. Expect months rather than weeks. Untreated sleep apnoea works along the same route. If loud snoring, breathing pauses and daytime sleepiness sound familiar, discuss it with your doctor. It is one of the most frequently missed causes of a persistently high value. At the low end, diet mainly helps by supplying building blocks. Iron, vitamin B12 and folate are needed to make red blood cells. A varied diet usually covers that requirement. Do not start supplements on your own initiative for a low value. Without a demonstrated deficiency it does not help, and iron accumulates in the body. Finally, exercise improves circulation but does not raise your hematocrit. With endurance training the value even falls slightly through plasma volume expansion. That is a favourable adaptation, not a deficiency.
Hormones
6What It Measures
This test measures the total amount of testosterone in your blood, reported in nmol/l. It includes both testosterone bound to proteins like SHBG and albumin, and the small fraction of free, unbound testosterone available for immediate use.
Lifestyle Tips
Regular resistance training, adequate sleep, stress management, and a balanced diet with sufficient zinc and vitamin D may support healthy testosterone levels. Limiting alcohol consumption could also be beneficial. Consult your healthcare provider for personalized guidance.
What It Measures
This test measures the fraction of testosterone not bound to proteins like SHBG or albumin. Free testosterone represents roughly 1-3% of total testosterone but is the most biologically active form. Your healthcare provider may compare this with total testosterone for a complete picture.
When Levels Are Low
Some people may experience persistent fatigue, decreased muscle mass, low mood, reduced libido, or difficulty concentrating when free testosterone is low. Weight gain and decreased bone density could also suggest insufficient bioavailable testosterone. A healthcare provider can help assess your symptoms.
Lifestyle Tips
Regular resistance training, adequate sleep, stress management, and maintaining a healthy body weight may support healthy testosterone levels. Ensuring sufficient zinc and vitamin D intake could also contribute positively. Always discuss supplementation or significant lifestyle changes with your healthcare provider.
What It Measures
SHBG is a protein made in the liver. Its full name is sex hormone binding globulin, and that name describes exactly what it does. It binds sex hormones and carries them through the blood. SHBG does not bind every hormone equally tightly. Testosterone is bound firmly, oestradiol distinctly more loosely. Hormone attached to SHBG is not active. It cannot enter the cell and does nothing while bound. Only the free fraction, plus the portion loosely bound to albumin, is available to the tissues. An SHBG test therefore does not measure a hormone. It measures the transport capacity around it. That distinction matters. SHBG is not itself a sex hormone and causes no symptoms of its own. It does determine how a hormone result must be read. Results are expressed in nanomoles per litre (nmol/l). The reference values below come from the manufacturer of the Roche Elecsys assay. They derive from 415 men and 343 women. The cohort consisted of healthy adults without obesity, not pregnant, and taking no contraceptives or relevant medication. <table><thead><tr><th>Group</th><th>Reference value</th></tr></thead><tbody><tr><td>Men, 20-49 years</td><td>18.3 – 54.1 nmol/l</td></tr><tr><td>Men, 50 years and older</td><td>20.6 – 76.7 nmol/l</td></tr><tr><td>Women, 20-49 years</td><td>32.4 – 128 nmol/l</td></tr><tr><td>Women, 50 years and older</td><td>27.1 – 128 nmol/l</td></tr></tbody></table> Note the age boundary in both columns. SHBG is age-banded in both sexes, and in men the value rises over the years. The upper limit for men therefore moves from 54.1 to 76.7 nmol/l. Read an older man against the younger band and a normal value looks raised. Reference values also differ between laboratories and analyser platforms. With SHBG that is not a detail: different laboratories use noticeably different bands. Always go by the reference values printed on your own report.
When Levels Are High
A high SHBG likewise causes no symptoms by itself. What counts is its effect on free hormone and the cause behind it. With a high SHBG a larger share of testosterone sits bound. Free testosterone falls as a result, while the total value looks normal or even high. Someone can therefore have symptoms consistent with little active testosterone, alongside a reassuring total on paper. The most common causes are readily traced. Oral oestrogens raise SHBG markedly, so the combined pill and oral hormone therapy; delivery through the skin does not. An overactive thyroid raises it as well. Then liver cirrhosis, anorexia and prolonged severe energy restriction. And SHBG rises with age, particularly in men. A raised SHBG is therefore rarely the conclusion. It is the signal that free testosterone must be calculated before anything meaningful can be said about hormone status.
Lifestyle Tips
SHBG is not a value you steer directly. It reflects your metabolism, your thyroid function, your liver function and your medication. Anyone wanting to see SHBG change has to change that underlying situation. The strongest levers sit with a reduced SHBG. A low SHBG is associated above all with excess weight and insulin resistance, acting through a chronically raised insulin level. Improving insulin sensitivity generally goes together with a rising SHBG. Weight loss, more movement and more muscle mass all work along that same route. Alcohol and fatty liver disease are a second lever. SHBG is made in the liver, so liver function matters. On the other side sit factors you should not treat as lifestyle. A raised SHBG caused by the pill or by oral hormone therapy is a normal, expected effect of that medicine. It is not a problem to be solved. Never change a prescribed medicine yourself in order to influence a blood value. Always discuss that with your doctor first. A single SHBG result also says less than the direction across several measurements. If you change something, measure again after a few months, under the same conditions and preferably at the same laboratory.
What It Measures
This test measures the concentration of luteinizing hormone in your blood. LH is produced by the anterior pituitary gland and works together with FSH to regulate the reproductive system, including gonadal steroid production and gamete maturation.
Lifestyle Tips
Maintaining a healthy weight, managing stress, and ensuring adequate sleep may support balanced LH levels. Extreme exercise or very low body fat can sometimes disrupt pituitary hormone production. Consult your healthcare provider for guidance.
What It Measures
This test measures the concentration of follicle-stimulating hormone in your blood. FSH is released by the pituitary gland and stimulates the ovaries to produce eggs or the testes to produce sperm. Your healthcare provider may interpret FSH alongside LH and sex hormones for context.
Lifestyle Tips
Maintaining a healthy weight, managing stress, and ensuring adequate nutrition may support healthy pituitary function and FSH regulation. Avoiding excessive exercise that could disrupt hormonal balance is also important. Always discuss concerns about your reproductive health with your healthcare provider.
What It Measures
This test measures the concentration of estradiol (E2) in your blood. Estradiol is produced primarily by the ovaries in women and in smaller amounts by the testes and adrenal glands in men. Your healthcare provider may use this result alongside other hormone levels.
Lifestyle Tips
Maintaining a healthy weight, regular physical activity, and a balanced diet rich in fibre and cruciferous vegetables may support healthy estrogen metabolism. Limiting alcohol intake and managing stress could also contribute to hormonal balance. Always discuss lifestyle changes with your healthcare provider.
Tumor Markers
1What It Measures
PSA measures the total blood concentration of prostate-specific antigen, a serine protease enzyme produced almost exclusively by prostate cells. Elevated blood PSA may reflect a larger prostate volume, inflammation, or increased cellular permeability.
Lifestyle Tips
Maintaining a healthy weight, regular physical activity, a diet rich in vegetables and fruit (particularly lycopene-containing tomatoes), and limiting red and processed meat may support prostate health. Always discuss prostate health concerns with your healthcare provider.
Assessed by a BIG-registered doctor
This report was prepared by a BIG-registered doctor. It does not replace a personal medical consultation. Always consult your general practitioner if you have questions.