The Lab Test Is Not Quite Right (Testosterone) @BarbellMedicine

Uploaded May 2026 | Updated September 2026, 2 weeks ago

Most of the testosterone in your blood is bound to a protein called SHBG, and the test most clinics order — total testosterone — measures the part your tissues can't actually use. That's why a guy with obesity can come in with a total of 230 ng/dL and a perfectly normal bioavailable level. It's also why a 70-year-old can come in with a "normal" total and an actually low bioavailable.

Dr. Jordan Feigenbaum and Dr. Austin Baraki explain how testosterone is bound in the blood, when free or bioavailable testosterone actually adds information, and how to read a SHBG result that contradicts the total. From Episode 2 of our Signal book launch series.

Pre-order our book, Signal: barbellmedicine.com/signal

Watch the full episode on the channel: youtube.com/watch?v=Gz9utAEx9-w&feature=youtu.be

Chapters:

00:00 What "total testosterone" actually measures
01:18 SHBG, albumin, and the 2% that's free
02:55 Why bioavailable matters more than total
04:30 SHBG runs LOW: obesity, T2DM, hypothyroidism
05:45 SHBG runs HIGH: aging, hyperthyroidism, liver
07:10 Case: total 230, low SHBG, normal free — does this guy need TRT?
10:30 The wellness-clinic version of this case (and why it fails)
12:20 What changes when you add LH, FSH, SHBG to the second draw

Resources & links

Signal — Feigenbaum & Baraki (Barbell Medicine, 2026): coming soon

Episode 1 (Is the Testosterone Crisis Real?): youtube.com/watch?v=dm5FxIw-I7Y&feature=youtu.be

Training Plateau Action Plan (free): barbellmedicine.com/training-plateau-action-plan

Barbell Medicine programs and consultations: barbellmedicine.com

To support us and get ad free listening, plus special product discounts, and exclusive content, go to supercast.barbellmedicine.com

pubmed.ncbi.nlm.nih.gov/20554979
pubmed.ncbi.nlm.nih.gov/29562364
pubmed.ncbi.nlm.nih.gov/18308002
pubmed.ncbi.nlm.nih.gov/16670164
pubmed.ncbi.nlm.nih.gov/19112025
pubmed.ncbi.nlm.nih.gov/18838208
pubmed.ncbi.nlm.nih.gov/27210182
pubmed.ncbi.nlm.nih.gov/10523012
pubmed.ncbi.nlm.nih.gov/33739153
pubmed.ncbi.nlm.nih.gov/40066943
pubmed.ncbi.nlm.nih.gov/26075486

The Lab Test Is Not Quite Right (Testosterone)

The Novice / Intermediate / Advanced Model Is Wrong

Is Obesity a Willpower Problem? The Biology of Weight, Diets, and GLP-1s

Are GLP-1s Cheating? What the Drugs Actually Do

Menopause, Part 1: What It Actually Is and the 24-Year WHI Correction

What the Menopause-Content Space Gets Right and Wrong

One 121-patient study led to 18 million prescriptions. Then the valves failed.

$On a low-protein diet? Thats exactly when to lift. These are often older patients already losing muscle, and strength and physical function predict who stays independent, who avoids a fall and a fracture, and who lives longer better than almost any number on a lab report. Push their protein down to protect a lab value and you can speed up the muscle loss that shapes the rest of their life. So if someone truly has to restrict protein, thats exactly the person who should be lifting. A 2001 trial out of Tufts put older kidney patients on a low-protein diet and had half of them do resistance training. The ones who trained built muscle and got stronger on that same restricted diet. The ones who only dieted lost strength.$

$Body Composition, Bone, Brain, & the Fitness Changes (Data vs the Influencers) I Menopause Part 3 Most women in 2026 are told menopause affects everything, the weight, the belly fat, the bones, the heart, the brain, and that the fix is hormones, supplements, and a proprietary protocol. The data tell a different story. Menopause does some of it, but not all of it. Dr. Jordan Feigenbaum and Dr. Austin Baraki — with OB-GYN Dr. Loraine Baraki at the clinical changes — put real numbers on what menopause actually does to body composition, cardiometabolic healh around the final menstrual period, bone, cognition, and sleep. Then the single biggest modifiable lever against what actually kills postmenopausal women — which isnt a hormone. This is Episode 3 of Barbell Medicines four-part menopause series. TIMESTAMPS 01:23 Intro 02:45 Body composition & the SWAN study 04:16 How much weight gain is really menopause? 06:55 The answer: about 1.5 kg 08:14 Subcutaneous vs visceral fat 11:08 Why waist beats weight (and body-fat %) 17:21 Does menopause crash your metabolism? 19:02 Clinic: MHT for body composition 23:51 Dr. Loraine Baraki — MHT, weight & testosterone 27:29 The cardiometabolic shift: cholesterol at the FMP 30:18 Insulin resistance & metabolic syndrome 33:12 Blood pressure & 10-year heart risk 34:54 Clinic: the estrogen crisis lipid panic 39:13 Bone: the advice vs the data 40:34 Why DXA misses most fractures 41:24 LIFTMOR: lifting heavy with low bone density 44:47 The LIFTMOR results 46:53 Lifting vs Pilates, and falls 52:17 Clinic: Should I be deadlifting? 56:14 Cognition & brain fog 57:50 Why brain fog is mostly a sleep problem 59:17 Clinic: brain fog, night sweats, broken sleep 1:03:06 Depression & dementia in midlife 1:05:43 Does hormone therapy protect the brain? 1:08:53 Clinic: Am I getting early dementia? 1:13:19 Dr. Loraine Baraki — the timing hypothesis & the brain 1:16:15 What actually kills postmenopausal women 1:17:31 Fitness: the biggest mortality lever 1:20:21 Strength, power & grip 1:25:15 Clinic: where to start when youre overwhelmed 1:30:41 The detraining problem 1:32:38 Trained vs untrained: whats recoverable 1:34:53 The actual plan 1:39:48 Takeaways RESOURCES Subscribe to BBM Plus: https://barbellmedicine.supercast.com/ Coaching & templates: https://www.barbellmedicine.com/ STUDIES Greendale, SWAN body composition: https://doi.org/10.1172/jci.insight.124865 Lovejoy, visceral fat in the transition: https://doi.org/10.1038/ijo.2008.25 Pontzer, energy expenditure across life: https://doi.org/10.1126/science.abe5017 Karppinen, metabolism in midlife women: https://doi.org/10.1093/eurjpc/zwad177 Matthews, lipids & the transition: https://doi.org/10.1016/j.jacc.2009.10.009 Janssen, menopause & metabolic syndrome: https://doi.org/10.1001/archinte.168.14.1568 El Khoudary, AHA statement on midlife women: https://doi.org/10.1161/CIR.0000000000000912 Greendale, SWAN bone loss: https://doi.org/10.1002/jbmr.534 Siris, low BMD & fractures (NORA): https://doi.org/10.1001/jama.286.22.2815 Watson, LIFTMOR: https://doi.org/10.1002/jbmr.3284 Kemmler, EFOPS 16-year: https://doi.org/10.1097/GME.0000000000000720 Kistler-Fischbacher, MEDEX-OP: https://doi.org/10.1002/jbmr.4334 Sherrington, exercise & falls (Cochrane): https://doi.org/10.1002/14651858.CD012424.pub2 Greendale, SWAN cognition: https://doi.org/10.1212/WNL.0b013e3181a71193 Kravitz, sleep in midlife women: https://doi.org/10.1016/j.ogc.2018.07.008 Cohen, Harvard Moods & Cycles: https://doi.org/10.1001/archpsyc.63.4.385 Bromberger & Kravitz, mood & menopause (SWAN): https://doi.org/10.1016/j.ogc.2011.05.011 Livingston, Lancet Commission on dementia: https://doi.org/10.1016/S0140-6736(24)01296-0 Shumaker, WHIMS (estrogen+progestin): https://doi.org/10.1001/jama.289.20.2651 Espeland, WHIMS (estrogen-alone): https://doi.org/10.1001/jama.291.24.2959 Gleason, KEEPS-Cog: https://doi.org/10.1371/journal.pmed.1001833 Henderson, ELITE: https://doi.org/10.1212/WNL.0000000000002980 USPSTF, HT for primary prevention: https://doi.org/10.1001/jama.2022.18625 Mandsager, fitness & mortality: https://doi.org/10.1001/jamanetworkopen.2018.3605 Kodama, fitness & mortality meta-analysis: https://doi.org/10.1001/jama.2009.681 Momma, muscle-strengthening & mortality: https://doi.org/10.1136/bjsports-2021-105061 Araújo, power vs strength & mortality (CLINIMEX): https://doi.org/10.1016/j.mayocp.2025.02.015 Leong, grip strength & mortality (PURE): https://doi.org/10.1016/S0140-6736(14)62000-6 Troiano, accelerometer activity: https://doi.org/10.1249/mss.0b013e31815a51b3 Fleg, aerobic-capacity decline (BLSA): https://doi.org/10.1161/CIRCULATIONAHA.105.545459 Janssen, skeletal muscle mass across adulthood: https://doi.org/10.1152/jappl.2000.89.1.81 Pollock, master athletes & aerobic capacity: https://doi.org/10.1152/jappl.1987.62.2.725 Latella, strength across ages in powerlifters: https://doi.org/10.1007/s40279-023-01962-6$

Sleep Deprivation How It Sabotages Your Diet

Your Testosterone Doesnt Have to Decline With Age