Very high total T, low free T but normal/low SHBG?

[Billegitimate]

My wife has been on T for TRT for years now. Great results but feeling it much less lately. Her last couple of lab work results have been interesting. Here's the key parts from the most recent:

Total T 181 ng/dl (8-48)
Free T 2.2 (0-4.2)
SHBG 56.4 (24.6-122)

So total t is very high. Free T is low, especially if you consider the range starting at 0 to be stupid. Should probably be 1 or higher but I don't want to go too far down that path. Finally SHBG is in the bottom half.

Any idea how her total can be so high yet free is low? We specifically added SHBG to the labs so we could figure this out, and instead it's just more perplexing.

The free measurement is direct, not calculated.

Input?

 

[Megatron28]

Maybe also check estradiol, albumin and Bioavailable T?

How much Test is she taking weekly? How old is she? Is she post menopausal? If not, when were these labs taken in respect to her menstrual cycle?

What is her body fat %?

 

[Billegitimate]

Maybe also check estradiol, albumin and Bioavailable T?

How much Test is she taking weekly? How old is she? Is she post menopausal? If not, when were these labs taken in respect to her menstrual cycle?

What is her body fat %?

Estradiol is low. She's right in that change of life, at 46. Last two labs, 6 weeks apart, e2 was in lowest of ranges. 8-9 weeks since last period. Prior to that very sporadic, so we've been watching.

Albumin is middle of range.

It's kinda perplexing. Total T is super high, as you see. SHBG on low side, albumin low, yet free T low. So what's all that T bound to?

And we can tell that her free T is low. She's not feeling the T the way she was a year ago. Back then her free T was 3.5-3.7 and she felt fantastic.

Oh, and she's on pellets but it works out to about 20mg a week of actual T, comparable to 25-27 mg a week of test Cypionate.