Hormonal Health
By Samir Levin · June 7, 2026 · 7 min read
Most men walking around with suboptimal testosterone have normal total testosterone on their bloodwork. Their doctor tells them everything is fine. They feel terrible anyway.
The problem is what doctors typically don't measure — and what those missing numbers reveal about why the total number is meaningless without the context.
Here is the complete panel for a male biohacker interested in hormonal optimization and longevity. Each marker is explained with why it matters and what the optimal range is — not the lab reference range, which is designed to identify disease, not optimize function.
1. Total Testosterone
Lab reference: 300–1000 ng/dL (varies by lab)
Optimal: 600–900 ng/dL
Without context from free T, SHBG, and LH, this number tells you very little. A man at 700 ng/dL with high SHBG may have less bioavailable testosterone than a man at 500 ng/dL with low SHBG.
2. Free Testosterone
Lab reference: 47–244 pg/mL (age-dependent)
Optimal: Top quartile for age, typically 150–250 pg/mL in the 30–50 range
Only unbound (free) testosterone enters cells. If total T is normal but free T is low, SHBG is the culprit. This is the number that actually predicts symptoms.
3. SHBG (Sex Hormone Binding Globulin)
Optimal: 20–35 nmol/L
SHBG binds testosterone (and DHT) and renders it biologically inactive. High SHBG (>45) is endemic in middle-aged and older men and dramatically reduces free T. Causes: insulin sensitivity (high SHBG correlates with low insulin), thyroid dysfunction, liver disease, and simply aging. Low SHBG (<15) can indicate insulin resistance and is associated with metabolic syndrome.
4. LH (Luteinizing Hormone)
Optimal (if not on exogenous T): 3–8 IU/L
LH is the pituitary signal that drives testicular testosterone production. Low LH with low T = secondary hypogonadism (HPT axis problem). High LH with low T = primary hypogonadism (testicular problem). This distinction changes the entire treatment approach.
5. Estradiol (E2)
Optimal for men: 20–30 pg/mL (sensitive assay)
The most underappreciated male hormone. Men need estradiol — it supports bone density, libido, cardiovascular health, and cognitive function. Too high (>40): water retention, mood instability, gynecomastia risk, libido reduction. Too low (<15): joint pain, poor libido, cognitive fog, bone density loss. The "low estrogen" side effects from overcorrection with AIs are as problematic as high estrogen.
6. FSH (Follicle Stimulating Hormone)
Critical for fertility assessment and testicular health evaluation. Elevated FSH with low testosterone indicates primary testicular failure. FSH is also a sensitive marker for spermatogenesis — relevant for men on TRT who care about fertility.
7. Prolactin
Optimal: 3–15 ng/mL
Elevated prolactin suppresses LH and FSH, causing secondary hypogonadism. Causes: pituitary adenoma (prolactinoma), certain medications (antipsychotics, metoclopramide), hypothyroidism, chronic stress. Any man with low T and unexplained LH suppression needs prolactin checked.
8. Fasting Insulin
Optimal: <5 mIU/L (most labs say <25 is "normal" — this is a disease threshold, not optimization)
Fasting insulin is the single most sensitive early marker for metabolic dysfunction. Chronically elevated insulin drives SHBG down, increases aromatization (testosterone → estrogen), promotes inflammation, and accelerates aging. Most people with "normal" glucose already have elevated insulin — the pancreas is working overtime to compensate.
9. HbA1c
Optimal: 4.8–5.2%
Three-month average blood glucose. Below 5.7% is "normal." Below 5.3% is actually optimal. Above 5.6% in a non-diabetic indicates insulin resistance in progress.
10. Homocysteine
Optimal: <8 μmol/L (lab normal is <15, which is not optimal)
Homocysteine is a byproduct of methionine metabolism. Elevated levels cause endothelial damage — it's one of the most reliable independent markers for cardiovascular risk. Highly responsive to B6, B12, and folate supplementation. Chronically elevated homocysteine is common in individuals with MTHFR mutations (methylation defects).
11. Lp(a) — Lipoprotein(a)
Optimal: <30 mg/dL
Lp(a) is genetically determined and is the most underdiagnosed cardiovascular risk factor. Unlike LDL, it is not meaningfully lowered by statins. It is a modified LDL particle that promotes both atherosclerosis and thrombosis. Above 50 mg/dL represents clinically significant risk. Most conventional lipid panels do not include it — you have to request it specifically.
12. hsCRP (High-Sensitivity C-Reactive Protein)
Optimal: <0.5 mg/L
The most accessible marker for systemic inflammation. Below 1.0 is "low risk." Below 0.5 is genuinely anti-inflammatory. Above 3.0 is high inflammatory load — significantly increases cardiovascular and all-cause mortality risk. Elevated hsCRP is almost always addressable: it responds to sleep quality, dietary changes, omega-3 supplementation, and exercise.
13. Fibrinogen
Optimal: 200–300 mg/dL
A clotting factor and acute-phase protein. Elevated fibrinogen (>400) indicates ongoing inflammation and hypercoagulable state. Relevant for anyone on nattokinase/serrapeptase protocols — fibrinogen is one of the primary targets of nattokinase and should normalize during treatment.
14. Free T3 (fT3) — not just TSH
Optimal: Mid-to-upper range (3.5–4.0 pg/mL in most assays)
TSH tells you what the pituitary thinks the thyroid should be doing. fT3 tells you what the thyroid is actually delivering to cells. Reverse T3 (another marker worth adding) tells you how much of that T3 is being converted to an inactive form that blocks receptor sites. Normal TSH with low fT3 is "normal thyroid disease" according to most labs but is associated with fatigue, cold intolerance, cognitive fog, and weight gain. This gap is where most thyroid dysfunction goes undiagnosed.
For the complete interpretation guide — what each result means in combination, what to do with abnormal numbers, and how to use these results to design a personalized protocol — see the Testosterone Optimization Protocol.
BloodworkTestosteroneSHBGLp(a)HomocysteineInsulinBiomarkersLongevity