I’m a 45 YO high-SHBG guy that had normal range T production but tanked free T due to very high SHBG (60’s and 70’s). Good overall health, frequent exercise, healthy weight, try to get good sleep so most of the external controllables are under OK control.
Pre-treatment was experiencing the range of typical low-T symptoms (low energy, interrupted sleep, body composition changes, low libido, ED/loss of penile sensitivity)
I’m now 4.5 months in with encouraging but a little mixed results.
100 mg/once weekly dosage throughout has yielded significantly improved sleep and improved (still not great but better) libido and body composition.
My most notable lingering symptom is the ED/lack of sensitivity piece. I know this symptom can sometimes take the longest to resolve (many places say 6 months).
My question for the group is whether any guys (especially high SHBG) have turned the corner 5+ months in and regained their sensitivity/improved ED with or without a change in dosage.
I asked my endo to bump up dosage from 100/week but he was reluctant since my hematocrit is marginally high (~52) even though it was 51 before starting TRT. My trough bloods 3 months in were unremarkable - free T low-middle range and total T around 850. My GP was unbothered by the hematocrit and said GP’s tend to focus more on hemoglobin (which is in-range) than hematocrit.
I’m trying to gauge how likely it is that I’ll turn the corner on the sensitivity/ED piece 5+ months out, without an increase in dosage. I picked up a daily Cialis prescription to help in the interim and this helps with the erection piece but not the sensitivity, and it’s not a permanent solution.
Things will not get better at this dosage as your Free T levels are suboptimal. I have seen guys go on TRT due to having low-midrange Free T levels.
You are being kept in a disease state and it’s unacceptable. ED is marker for heart health and ED is an alarm bell ringing for future cardiovascular problems, full blown heart attacks and premature death from any cause and your doctor is putting you at risk!
Find a new doctor because your endo is out to lunch.
Maybe your GP can take over treatment.
You probably need 150mg weekly.
This is true, my endo cares more about hemoglobin and I get phlebotomized monthly (hemoglobin ->18.8) so I can benefit from therapy.
The guidelines for TRT say 55%> hematocrit, action is taken.
Your either lower the dosage or get reoccurring phlebotomies.
Can therapeutic phlebotomies be done in perpetuity?
Is it known what specific physiological process involved in erections/sensitivity is impeded by low free T?
I doubt my GP is game for taking it over, he’s a good generalist but quick to say hormones aren’t his specialty. My endo has suggested taking another six months and seeing how I feel at that time before making a call on bumping dosage (that will be 9 months into treatment) but that seems unnecessarily passive. I’d prefer to bump to 125 or 150 for the next 90 days, get more bloods, and compare how I feel then and now so we can make an informed decision.
Testosterone increases blood flow to the penis, it’s one reason why ED meds can’t work when testosterone is low. Testosterone also converts → DHT, DHT is crucial for sexual health, libido, and erections in men.
I’ll bet your DHT levels mirror your Free T levels.
Your doctor can write a prescription, reoccuring if necessary.
Damn so my only hope is to stick at one shot a week but increase the amount. Today is my shot day and yesterday I was awful . Moody emotional and felt shit . May be the trough before today’s injection
If you dont feel good before your next injection, your dose probably sucks. You need to leave your doctor if he or she is not raising your dose. You need a DR who is willing to increase dosage quickly until you feel better within months time. Not many several months.
Not sure if your sensitivty got better. HCG helps, but i stopped it and after about 1.5 YRS My sensitivty improved substantially. I also abstain from everything but actual sex. Sometimes 2-3 days at a time… the longer i wait, the better it feels.
To recap, started TRT with normal total T levels but low free-T (and low T symptoms) due to high SHBG (~70), likely from fairly extended low carb and intermittent fasting.
Dose first 6 months was 100 mg e7d.
At 6 months, sleep, workout energy, body composition improved somewhat. Libido a little better. Erections and sensitivity maybe improved a tiny bit but not much at all.
6 month bloods indicated trough TT of 770 (264-916 rr) and free-T of 11 (6.8-21.5). Imputed SHBG somewhere around 62 based on TT, Albumin, and resultant free-T. These trough TT and FT levels are roughly the same as pre-TRT.
Bumped dosage 2.5 weeks ago to 140 mg a week. Also went to e3.5d to reduce peaks since my hematocrit is nominally high (52.1; was 50.9 before TT so not much higher than before but still just out of range).
No changes in way I feel (not that I would expect any 2.5 weeks in). Will update as I get closer to steady state.
You need to get your FREE T Into the 20s. You are wasting your time. I would simply take 200mg and sit at that level for a few months. You can then lower it until you find the sweet spot.
Dont listen to the nonsense around here about 100 or 150mg being a high dose. Its utter bullshit. Every person is different. Some are genetically prone to need higher levels. Some have other isseus like high shbg, others have unknown issues that do not allow them to feel the benefits until they are on a higher dose.
Forget what people think around here or suggest. Use logic and increase that dose to a higher dose and get this resolved. Later lower the dose if you want.
I would take EOD / 200mg per week.
F out of range. When i started TRT high total T was 1200/1300. 23/24 I think was high range of free t. Now its lower. Years before it was even higher.
Ranges are bullshit. You dose until symptoms resolve. Ranges are based on todays unhealthy men. Its proven we have lower hormone levels than years past. our forefathers had higher levels of T. Plenty of info out there. EVen a study was done by the same idiot who lowered the ranges with his analysis. Instead of questioning it, he went ahead and gave new ranges to follow, while having a report showing men have lower T levels today than past.
Once you go on TRT though, lowering SHBG becomes virtually irrelevant.
Knowing what it is is important to contextualize TRT treatment strategy and dosage but lowering it isn’t.
Frankly in a vacuum, higher SHBG can signal metabolic health since it correlates strongly with insulin sensitivity. It just becomes a problem if the high SHBG starts causing low-T symptoms.
My dose is now up to 160 mg/wk (after 6 months at 100/wk and 2 months at 140/wk). Been at this dose for just under 4 weeks.
Biggest change the last couple of weeks is I feel like I’m experiencing SSRI-like effects including side effects (very low sensitivity/arousal and ED). I’ve never tried an SSRI but it feels exactly like my wife described one when she was on one for a few months to head off post-partum depression.
My mood is also very calm, almost undeter-able.
In reading about it some, it sounds like TRT can increase serotonin levels in the brain. Some of this I imagine is good especially in those prone to anxiety (I’m not historically).
Has anyone else experienced anything similar?
Did it abate at your then-current dose as your body adjusted to higher Free T (and perhaps higher serotonin) or did you have to adjust dosage to get it to go away?
Is there a blood test for serotonin? If so is it helpful for men on TRT?
As a recap, I’m high SHGB so pushing my dosage up to 160 from 100/wk was an effort to free up enough T. Sex side effects have been noticeable since ever since my low T started, and haven’t yet gotten much better on TRT. The last couple of weeks they’ve probably been the worst they’ve been since starting TRT though.
My last bloods (at 140/wk) had Free T in the low 20’s, just FYI.