Curious why my lipids seem out of whack - I haven’t changed anything and my diet has been mostly the same since last bloodwork… I’ve also lost a few lbs since then.
Also curious if SHBG well below range is a good or bad thing. Free T is pretty well up there on the charts as a result, but maybe I’m missing the forest for the trees.
Imo, it’s kinda a gray area where you are. It’s kinda a decision similar if you want to go on gear, but legally and with lower dosages (although what some trt clinics prescribe would have Hippocrates rolling in his grave, it’s still less than most who who blast, and by a lot less in most cases). You know your risks at this point.
I’ll say for me, it’s been worth it. Not what I expected, but still worth it. My levels were slightly higher than your’s.
Imo, it’s okay to do something not medically necessary if the trade offs are worth it. Imo, if you keep things reasonable, it won’t impact long term health. The science isn’t complete, but what we have doesn’t suggest long term health is impacted significantly.
It is a pita though. Another responsibility. I do question if I need it sometimes. But even if I didn’t need it, the benefits have been worth it. My balls are smaller, and starting finasteride at the first sign of thinning have been my main negatives. I don’t know about fertility? I’m pretty sure I could get that back though.
It seems like the gym life style is a big part of you. That was a big part for me.
The low SHBG isn’t good per say, it can be low due to genetics, or low due to metabolic syndrome, diabetes and thyroid problems. You can have metabolic syndrome without diabetes and the vast majority of men with secondary hypogonadism have metabolic syndrome that is lowering the testosterone and LH.
The direct testing method is trash, even the endocrine society says not to use it. The Equilibrium Dialysis or Ultrafiltration methods are the gold standards for Free T testing.
My SHBG has gone up on TRT (11->19) and is due to improving my health. I see it higher every time I test it. My triglycerides was also in the high 300’s and is most likely normal as my testing done 8 months ago was very close to being in range. This was before I started losing weight.
For the fact that your SHBG is low and unless you have metabolic syndrome that’s lowering the SHBG, I would recommended a topical which has little or no impact on SHBG. The last thing you want is for injections to lower your SHBG even further.
My lipids are also slightly over/under the range every time I do bloods. My triglycerides are good though. I’m wondering how the high TG amid high cholesterol come.
I can’t risk transference as I’ve got a young one in the house. My SHBG wasn’t below range on my previous blood test so IDK why it would have changed.
I’ve been in a mix between maintenance and dieting since last bloods. BF% is higher than i want it to be but better than it was when last bloods were taken. Estimate 20%
No new medications but I’m on adderall (prescribed), otherwise i rarely take any meds.
My lipids were fine on my last test and they got worse as I’ve been dieting somehow.
Could be transient when you are changing dietary regiments to low carb and high fat. Could also be fat mobilization though I’m not aware of studies on that.
With 20% BF I’m not surprised that they are slightly over the range. In winter, when I’m 18-20% I’m not even taking bloods as I expect them to be much higher at the peak of my bulk. When I’m lean mine are slightly over the range like your LDL is right now.
Injecting Test will be problematic for you twofold. First, it can lower HDL further which yours isn’t great. Although an AI will do it far worse. Second, as @systemlord stated it can decrease SHBG too.
If FT is accurate, I wouldn’t jump on TRT. You are not likely to see significant results unless you are looking for extremely high doses. Your FT is already higher than mine is on TRT.
What doesn’t make sense to me is why my fT more than doubled in 6 months. My SHBG lowered a lot and TT was more or less constant, so any clues why SHBG would drop?
Is it normal for calculated vs tested fT to be this far off? Calculated shows I’d be at 7.94, which would be below range - but tested shows 21.2.
From what @systemlord is saying, it sounds like direct fT testing doesn’t work well and obviously the calculated method doesn’t either. So it leaves me either below range, or at the high end of the range… doesn’t make for easy diagnosing.
I only have what’s above… I guess I thought they’d tested for lipids then - I was wrong.
Learn this stuff (below) if you are going on TRT/TOT and don’t want to be perpetually in the dark. You may learn it and then not decide to go on. Either way you should understand the fT situation and be able to convert and compare the various fT assay results. Think of this as free Testosterone 101. Not many understand it properly. Also I recommend never throwing out a number without a unit(s) behind it and understanding what type of assay the number and unit(s) come from.
Go through this exercise for your numbers so you can transfer between direct RIA fT (measuring a proxy for fT), calculated fT (cfTV and cfTZ based on TT, SHBG, HSA), fT by equilibrium dialysis (measuring direct or indirect fT). After doing this you should be able to compare and rationalize your numbers and put them all on the same unit basis.
Current methods for measuring free testosterone (fT) are technically challenging and not accurate. The widely used direct immunoassay and tracer analog techniques for measuring fT have been shown to be inaccurate. Equilibrium dialysis, the reference method against which other methods are compared, is labor-intensive and cumbersome, and therefore has had limited clinical adoption. Recently, Endocrine Society’s Expert Panel acknowledged the experimental problems in fT measurements and concluded that “…the calculation of free testosterone is the most useful estimate of free testosterone in plasma…” For this reason they advocate for indirect “calculator” based methods, where free testosterone can be computed from the total testosterone, SHBG, and albumin concentrations.
However, we have demonstrated that even the calculated fT values derived from the prevailing equations, based on linear law-of-mass action models or empiric equations, differ systematically from free testosterone measured by equilibrium dialysis by as much as 40%.
Update:
Spoke with Dr. Mike today and he put me on a 26mg ED dose (182mg/wk) because my low SHBG numbers. Also prescribed Vitamin D 50k iu injection and L-Carnitine (unsure dose atm) to help with skin and weight loss, respectively.
