Very well written and organized!
Where are you located? Affects diagnostic and treatment options.
SHBG is made in the liver to scavenge sex hormones from the blood. Elevated E2 increases, more T decreases. Your E2 is not bad, but with low FT, E2 makes you estrogen dominant which is not good for SHBG
TT=20.2 is overstating your T status as high SHBG creates a lot of SHBG+T that inflates TT and SHBG+T is not bio-available.
Liver problems/conditions/disease can cause high SHBG. Liver labs AST/ALT can be useful, but if muscles are sore or not recovered, results can be high from that. So labs would require planning/preparation.
Starvation diets can increase SHBG.
You have secondary hypogonadism complicated by high SHBG with possible liver complications. Problem is not high -ve feedback from E2 or prolactin.
Suggested treatment:
- Get on SERM to increase LH/FSH and T, using anastrozole to keep E2 near 80 pmol/L. This will recover testes and may shift SHBG down, which may be slow. You will do labs for TT, FT, SHBG, LH/FSH
- Later, proceed from the HPTA restart sticky noting that you have completed the first phase.
I am sure you have seen the following.
Please check oral body temps as per last paragraph to eval overall thyroid function.
Did you ever not use iodized salt?
Any starvation diets?
Please read the stickies found here: About the T Replacement Category - #2 by KSman
- advice for new guys - need more info about you
- things that damage your hormones
- protocol for injections
- finding a TRT doc
Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.