ALT is high. From recent training or sore muscles - or a liver problem.
SHBG is made in the liver, E2 increases, FT lowers.
SHBG lowers FT, SHBG+T is not bio-available.
SHBG+T inflates TT
So your labs make sense.
Free T, FT should be tested, but it should be low.
TRT will lower SHBG if E2 is actively managed with E2 to be near E2=22pg/ml and FT is high.
E2 is already there with low FT, so TRT will increase it and E2 management with anastrozole needs to be started with first dose of T, not after weeks to see how bad the labs are.
TSH should be closer to 1.0, the ranges are stupid.
See the last paragraph in this post to eval overall thyroid function.
If you have not been using iodized salt, that is probably cause of thyroid issues.
200mg T per week is wrong
TRT:
- self inject T cyp SC/SQ, not IM, with #29, 1/2", 0.5ml insulin syringes
- 0.5mg anastrozole at time of T injections - see stickies re over-responders
- 250iu hCG SC EOD to preserve testes/fertility
At age 44, with your high SHBG, TRT makes sense, only if done as I suggest.
You need to look at liver to see if SHBG is driven by disease.
Please read the stickies found here: About the T Replacement Category - #2 by KSman
- advice for new guys
- 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.