Explore how to increase free testosterone safely and lower SHBG with oxandrolone (Anavar). A novel approach to the management of free testosterone in men.
In this article, we'll look at the vital function of testosterone in your health, with an emphasis on free testosterone and its influence on your overall well-being. You'll learn about sex hormone-binding globulin (SHBG) and how oxandrolone (Anavar) can boost testosterone levels.
What is free testosterone? What is total testosterone?
Testosterone, the primary hormone in males, is essential for many body processes, ranging from preserving bone density and muscle mass to influencing mood and energy levels.
Consider testosterone in two forms: free testosterone and total testosterone. Total testosterone is akin to the total amount of money in your bank accounts—it is the total quantity circulating in your blood. However, much of this is "bound" to proteins, notably albumin and sex hormone-binding globulin (SHBG), and isn't immediately available for use by your body. It’s like money in a fixed deposit; it's there, but you can't immediately utilize it.
Free testosterone, on the other hand, is like the cash in your wallet—it's only a small portion (about 2–5%) of your total testosterone, but it's readily available for your body to use whenever needed. This free testosterone, along with the portion bound to albumin, makes up what's known as bioavailable testosterone. This is the testosterone that's active and can influence your body, affecting everything from muscle strength to your mood. 
Measuring testosterone levels: free testosterone and its importance.
In the more advanced testosterone treatment centers, clinicians have been focusing on measuring both total and free testosterone to fully understand serum testosterone levels in a male patient and their symptoms. The International Society for Sexual Medicine's 2015 guidelines and the current American Urologic Association Guidelines (AUA) recommends measuring total testosterone in morning blood samples for diagnosing testosterone deficiency, while Japanese clinical guidelines stress the measurement of free testosterone levels. This is because free testosterone is believed to give a more accurate picture of the effects of testosterone in the body, aligning with the free hormone theory, which states that only free testosterone is biologically active.
Men who present for a workup of Low T symptoms tend to follow free testosterone levels. For instance, a male patient who presents with symptoms of Low T can have a normal serum total testosterone level and low free testosterone level. In another clinical scenario, a male patient can present with Low T and have a low total testosterone and a low free testosterone level.
There are many testosterone clinical guidelines that vary depending on region and medical specialty. For the most part, all testosterone clinical guidelines and recommendations align in the diagnosis of testosterone deficiency in a man whose total testosterone level is less than 250-300 ng/dL, while also including free testosterone measurement into the diagnostic equation.
Measuring free testosterone can be complex, with equilibrium dialysis (EqD) being the most accurate but resource-intensive method. Despite these challenges, accurately assessing free testosterone is essential. Factors like diet, sleep, exercise, and stress can all influence total testosterone levels and could lead to a misdiagnosis if only total testosterone is measured.  
What is a low free testosterone level?
For all men, the normal range of free testosterone is 66-309 pg/ml (229-1072 pmol/L) and 120-368 pg/ml (415-1274 pmol/L) for those aged 19–39, as determined through EqD. Low free testosterone in symptomatic men is often indicated by levels below 1.5 ng/dl as determined through radioimmunoassay or by calculated levels under 100 pg/ml. 
To calculate your free testosterone, online tools like the ISSAM Free Testosterone Calculator are available, requiring albumin, SHBG, and total testosterone inputs. However, this should not replace professional healthcare advice.
What is SHBG, and how does it affect free testosterone levels?
SHBG in your body binds to sex hormones like testosterone, affecting its availability. SHBG is essential because it allows testosterone to be stored and transported around the body where it can utilized. 98 percent of circulating testosterone is bound to SHBG. SHBG is primarily synthesized in the liver . When testosterone is bound to SHBG, it isn’t accessible for use by your tissues, impacting the level of free, active testosterone. A delicate balance exists between SHBG and free testosterone; high SHBG levels can decrease available free testosterone, potentially leading to low testosterone symptoms, even with normal total testosterone levels. When SHBG levels are low, it activates an increase in the release of Luteinizing Hormone (LH) from the pituitary gland to increase testosterone production until free testosterone levels are reestablished.
We know there is a significant mechanism of action of SHBG that coincides with the activity level of testosterone. In a rare example, as demonstrated in a paper by Vos et al., a male patient had a mutation causing a defective SHBG protein to accumulate in cells and was not able to bind testosterone. The male patient had no detectable SHBG levels on laboratory measurement; total serum testosterone levels were low, yet free testosterone levels were adequately maintained. Development of male sexual characteristics and sperm production proceeded without issue, yet the patient had symptoms of low testosterone. The findings provided evidence that SHBG is important for testosterone to exert its anabolic activity in the body.
Recent studies highlight that men with type 2 diabetes showing low total testosterone (<12 nmol/L) and high SHBG (>35 nmol/L) face an increased mortality risk, independent of age. This risk emphasizes the importance of monitoring both total and free testosterone for overall health surveillance. 
What is oxandrolone (Anavar)?
There are currently six anabolic hormones that the FDA approves for use in the United States: Testosterone, Nandrolone, Stanozolol, Danazol, and Oxandrolone.
Oxandrolone, commercially available as Anavar, is a unique synthetic oral anabolic steroid with more anabolic and less androgenic activity when compared to testosterone, effectively promoting muscle growth by increasing muscle protein synthesis and upregulation of the androgen receptor in skeletal muscle. Oxandrolone is available in several tablet doses, the recommended starting dose is 1.25 mg for women and 2.5 mg for men. In the intensive care unit (ICU)/ Burn Unit setting, where muscle catabolism (muscle breakdown) is more prevalent due to patient inactivity and state of critical illness, Oxandrolone dosing begins at 5mg to 10mg twice daily. Oxandrolone in this particular setting helps to maintain weight, improve lean body mass, prevent muscle breakdown, increase bone mineral density, improve wound repair, and reduce mortality.
Oxandrolone (Anavar) use is generally considered to be one of the milder steroid regimens. Oxandrolone is a derivative of DHT and not Testosterone. Oxandrolone is not reduced to estradiol as testosterone is by aromatase, making oxandrolone an attractive oral anabolic steroid that does not raise estradiol levels. Notably, low doses of oxandrolone are less likely to increase liver enzymes, a common concern with steroid use, but higher doses might pose greater risks.  
How does oxandrolone improve free testosterone levels?
Understanding how to increase free testosterone often involves addressing the question, "How do you lower your SHBG?" Oxandrolone plays a significant role in this process by reducing the levels of SHBG, though not as dramatically as other steroids like stanozolol or danazol, thus indirectly increasing the amount of testosterone available for your body's use. There are two prevailing theories as to how oxandrolone increases free testosterone and lowers SHBG:
1) Oxandrolone undergoes first-pass metabolism in the liver after ingestion and may decrease hepatic synthesis of SHBG.
2) Oxandrolone has a higher binding affinity for the androgen receptor and displaces testosterone from SHBG to increase circulating free testosterone.
Clinical trials demonstrate oxandrolone's efficacy in this capacity. A 12-week study on older males found that a daily 20 mg dosage of oxandrolone improved lean body mass, muscular growth, and strength significantly. These men outperformed the control group in terms of lean body mass gain (an average of 3 kilos) and strength increases in various workouts. Notably, while increases in muscle mass and strength recovered to baseline after quitting oxandrolone, decreases in total and trunk fat were sustained. This demonstrates oxandrolone's potential for short-term muscular and strength gains and long-term fat reduction, with the caveat that anabolic gains are not sustained post-treatment. 
A study of men with HIV and low testosterone levels who were treated with testosterone and oxandrolone discovered that while oxandrolone gave some advantages, it also decreased testosterone and SHBG levels, leading to erectile dysfunction. After stopping oxandrolone, testosterone levels often returned to normal, with some men seeing symptom improvement. This shows that while oxandrolone might be beneficial, it can also disturb the body's regular hormone production processes and should thus be taken with caution. 
Furthermore, oxandrolone has been used in the treatment of inflammatory bowel illnesses such as Crohn's disease and ulcerative colitis as part of a plan to rectify hormonal imbalances that contribute to these diseases, potentially alleviating symptoms and attaining remission in difficult cases. 
Oxandrolone (Anavar) Use.
Oxandrolone can be a great tool for raising free testosterone and helping with certain conditions, but it must be used responsibly and under medical supervision. If you're wondering how to take Oxandrolone or have issues regarding testosterone management, consider contacting REGENX Health for professional advice and individualized treatment.