I’ve had high SHBG levels for years but they were never >90. My total T has always been very high and free/bioavail.T in the low normal range. I’ve been extremely ‘cold intolerant’ all my adult life and my RBC count is always just below normal . I’m lean and exercise fairly aggressively daily.
Endocrinologist checked thyroid… it’s o.k… So, we started T injections to see if that would improve cold intolerance. Was on 50mg cypionate/week for @14 months. Weaned off and stopped in Sept. 2021 as did not want to lose permanent function of testes (this doc never mentioned HCG). Since then, labs repeatedly show free T, bioavailable T, FSH, LH and SHBG levels ridiculously out of normal range. Just had labs done:
Total T…1037 ng/dL
Free T…35.4 pg/mL
Bioavail T…65.2 ng/dL
SHBG…154 nmo/L
FSH…33.4 mlU/mL
LH…16.1 mlU/mL
RBC…3.77 Million/uL (note: I’m always on low end but never this low)
Hemoglobin…12.8 g/dL (usually on low side but never this low)
I was told that the FSH and LH levels will continue to be abnormal as long as my ‘free T’ levels remain low. It seems that I have no problem producing T but it must be getting bound up by the SHBG (154nmo/L seems crazy high). I need to get a handle on this. Does anyone have input or maybe recommendation for how I can find a well informed and progressive doc in Palm Beach County, FL?
By the way, the endocrinologist suggested I get my liver checked out to see if there might be a hepatic issue causing the high levels of SHBG. However, I did try injectable T once before and had a similar spike in SHBG while on T shots. However, most labs came back to normal range after stopping. Seems to be taking long time now with no change toward normal. Note: testicular atrophy (size) reversed shortly after stopping this most recent course of T.
Thanks in advance for your help!
You pituitary is working like a champ, but your liver is ruining your day pumping out crazy amount of SHBG. These extremely high FSH levels are indicating infertility regardless of where your SHBG levels sit.
This can lead to high cortisol, increasing SHBG, but if you are not eating enough, this will increase SHBG substantially (double whammy) and you are left with sky high SHBG.
This excessive exercise isn’t sustainable and you risk destroying your body and your health.
The only doctor I know of in FL, Tampa Bay area is Dr. Saya who is the medical director of Defy Medical. Dr. Saya is an endocrinologist and can run circles around most sick care doctors.
I’ve even seen Dr. Saya mention some people are more cold intolerant when compared to others.
If you really want the best and are willing to travel, look no further than Dr. Rob Kominiarek.
This guy is amazing!
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Thank you systemlord, for your quick and insightful response to my post. You make several points that have never been mentioned to me previously and I’m wondering if, without offending you, I might ask you about your background… where/how did you manage to learn about all of this?
Do not take your physicians word that your thyroid is ok. I would first make 100% thyroid is actually optimal before digging into other areas , which might make you chase your tail.
At your age why are you worried about the testes? Just curious.
You can get a free consult with my provider Dr. Nichols. He is very very educated on hormones. Dr. Rouzier and Nichols are close friends, and his mentor. Rouzier is the top hormone educator in the world. Dr. go to his courses just to put a plaque on their wall, or mention his name on their webdiste to get more patients. Doesnt mean they actually use his methods. You want someone who actually uses his methods. the guy knows what hes doing for men and women.
Another doctor i know is pretty good is Dr. Rutherbusch . i think hes in florida and he is a caring and insightful expert. I cant think of anyone else.
You will realize the difference in care when you speak to multiple providers. dont pick the first one you talk to.
Good luck and spend allot of time reseraching this stuff. You can google dr rouzier, jay cambell, keith nichols on YT. They have allot of videos out there, and you can learn allot on your own, and then you can qualify a doctor for help.
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Try fixing your diet. Low Carb diets i hear can cause high SHBG. Also, other medications and supplments do the same. you can lower it pretty quick and if you get more Free t converted, you will probably notice a difference before you even do a lab test.
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Thank you for your response. I will check out the doctors you mentioned.
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At the top of the TRT section of the forum, there is a “TRT Credentials Thread” with most of the regulars complete background.
You can learn a lot on these forums, but it’s a balancing act to assimilate correct information. So when someone tells you something, fact check what you’re being told.
There are some forums run by information geeks like Nelson Vergel over at Excelmale who have all the newest studies on men’s and women’s health.
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Fair question… I’m actually a licensed chiropractor here in Florida. However, my clinical focus has not been in the area of endocrinology/TRT. I’ve known about T-Nation and have tried several of their supplements (for variety of things) over past several years. I just learned about the forums from a friend and business associate who used to be very active in these forums. He went by the name of Dr. Destructo.
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This is a good idea for SHBG that high. If you do keto/low carb, that will raise it over time.
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I forgot to ask just out of curiosity, what were your Total T and Free T levels on the 50 mg weekly?
The reason I ask is because this dosage is unusually low for a weekly dose. The only way I’ve seen a protocol like this work out is breaking it up into daily injections, but only for a minority of men.
total T was over 1500 ng/dL
free T was 13.8 pg/mL (reference range is 6.6 - 18.1)
Lemme get this straight:
You had low T. You went on TRT for a time, then off.
NOW, your T levels are super super high?
No… that is NOT correct. I’ve always had high levels of TOTAL T. However, I had fairly low Free T and have also be plagued with cold intolerance for years. That is why my endocrinologist put me on T. Putting on 10 lbs of muscle and raising my metabolism is a good way to stay warm.
My issue seems to be a crazy high SHBG level, so even though my total T is great (even without TRT), too much of it is bound to the SHBG and is not free.
Wow. So you had normally super high TT, and your doc STILL gave you more?
I cannot say as though i follow his thought process. Seems like increasing TT will do more harm than good.
Did he even BOTHER to test E2?
E2 was normal… T shots started in attempt to raise ‘free T’, which was low due to high SHBG
Also wanted to reduce symptoms of cold intolerance and all else (including thyroid) had been tried first.
A bit late to this. As a Chiro, you have the experience and education to make the right decisions in choosing a medical provider when you have the proper information presented to you.
Put an email in your bio (or email me with my email in my bio) and i will get you pointed in the right direction.
Where are you in Florida? I’ll presume you found a doctor to work with you. My urologist in New Smyrna Beach has three decades of experience in hormone replacement. Been my doctor for 10 years.
Thanks for your reply to my post. I’m in Western Palm Beach County and my T levels have normalized naturally. Still have ‘sky high’ SHBG levels. Losing muscle and cold intolerant.
That was a very low dose for TRT. Your total test will always show high, when you have higher SHBG… After years on testosterone, the injections should lower the SHBG. There are some oral steroids that also lower SHBG to free up some test. Was your free test in range when you were on 50mg a week?
I would just bite the bullet, and stay on TRT, at a reasonable dose, say 200mg, and see if it lower the SHBG. Mine was always high, which is why i got on TRT. It was in the 60s when i started, its now around 24-30
Total T is a function of SHBG, the higher the SHBG, the higher the Total T. Total T doesn’t define testosterone deficiency. The Free T does.
Contrary to popular belief, decreasing SHBG doesn’t increase Free T with isolated changes in SHBG. The only mechanism for increase Free T is increasing LH and therefore testosterone production.
Lowering SHBG doesn’t increase LH secretion in the pituitary gland, because there’s no mechanism for that.
Androgens suppress SHBG, so it’s possible that declining testosterone results high SHBG. It’s a fact, Free T declines 50% between ages 40-80 while Total T remains constant.