Bloodwork: High Free T, High SHBG

I am new here and have a question about my blood work. I am 35 I am 5’9" 195 pounds. I lift weights 2-3 times a week and do brazilian jiu jitsu 3 times a week. I eat very clean and do not drink. I also work a very stressful job. I have had some symptoms of low t such as no morning wood, low libido, erections not as hard and sensitivity is way down. I decided to get a blood test to check my testosterone and my results were:

total t 639 ng/dl range 264-916
free t 25.9 pg/ml range 8.7-25.1
shbg 45.2 nmol/l range 16.5-55.9

I am confused because my free t came back high but my shbg seems high. I take Boron and it seems to help with my symptoms for a couple days then it stops working. So is it my SHBG causing my problems and if so why would my free t be high? Would TRT help with symptoms?

Testosterone does not appear to be your problem. Do a full panel looking at Thyroid. You should have also included estrogen numbers in your hormone profile. Look at the entire picture instead of starting with an answer(like low T). Let the evidence guide you. You are in your mid 30’s and training 6 days/week and have a stressful job. How do you sleep? Do you feel energized after you workout, or depleted?

Thanks for the reply. I am asleep by 10 pm and up at 5am everyday. After I work out with weights I feel great. The jiu jitsu beats me up. My estradiol was 23.9 pg/ml. I plan on getting a full hormone profile but just wanted to check Testosterone first.

Your numbers look good. A lot of people on this forum would LOVE to be 639T / 24E natural. Tho Something doesnt quite add up because your SHBG is upper range…and so is your Free T. Something to note when you do follow up bloodwork. I noticed in my mid 30’s that I just couldnt handle the same volume of exercise. Even on TRT now, I have to watch the intensity and volume. I had a point when I was about 36-37 where I went pretty deep into an overtrained state and it took me about a year to pull myself out. I had to drop the mentality of trying harder and pushing harder. Mind you, im 42 and can still squat 400 but i now dedicate at least 2 days/week to just walking and stretching. And I feel much better now than when I was going 100% all the time. Only you can know where you are but stress, be it mental or physical, is a major contributor to the symptoms you describe. So until you get all of the bloodwork figured out, you could start with some lifestyle modifications.

If you wanted to start with some supplements aimed at thyroid support and improving penile sensitivity…

iodine 500-1000mcg(morning)
selenium 200mcg(morning)
carnitine 5-10g/day(split doses)

And cut out the porn.

Your Testosterone/Estrogen are not your problem. High SHBG is an indication that something is going on. You need to check Free T3/Free T4 and 24-Hour Cortisol Saliva panel. Have you taken antibiotics? Have you done a CBC? You should make sure your WBC/RBC level is normal. Active infections/viruses will effect the adrenal gland function.

I do not have an infection or virus. I try to not take antibiotics. I took them as a kid for acne though. I do drink coffee in the am. Was going to cut it out and see how I feel. I will check out my thyroid next.

These results are unusual, I would retest. Directly measured FT is often unreliable which is why doctors tend to fixate on TT. The FT calculator has your FT at 20 ng/dL (16-31 ng/dL). Laboratory testing for testosterone has a long way to go, no standards and some labs are using outdated testing methods.

You should be using the Equilibrium Dialysis or Ultrafiltration and not the Direct Immunoassay which tends to overestimate directly measured FT. There’s no way your SHBG isn’t negatively affecting your FT levels, usually FT starts to become affected negatively when in the 40’s.

If you test one thing at a time, you could miss other potential problems, better to go big on testing or go home because it only takes one biomarker to be out of range and you are going to spends years wondering why you are feeling the way you do.

These should be on your short list for lab testing:

  • Total T
  • Free T
  • SHBG
  • Estradiol Sensitive (E2)
  • LH-Luteinizing Hormone
  • FSH-Follicle stimulating hormone
  • Prolactin
  • Cortisol
  • Ferritin
  • Thyroid Panel
  • CBC-complete blood count
  • Comprehensive Metabolic Panel
  • Lipid profile/panel

Yea because of my symptoms I was looking into TRT. I wanted to test my levels first before spending $600 for bloods and consultation with Defy. I suspected I had high SHBG before the test and was surprised that free T was high also on the test. So with the calculations that you made that would make my free t low? I have been doing research and read articles about SHBG and tried Boron which helps for a few days then seems to stop working.

No one can answer this question with absolute certainty because I have no clue about your T receptor density and/or sensitivity to hormones. Someone like myself needs very little testosterone to feel optimal. I have one of the lowest T dosage around when I’m on TRT.

This is as they say the smoking gun. The body has the ability to circumvent attempts to alter the direction the body has chosen to go. In your case your liver seems hellbent on increasing SHBG and it very well could be genetics and if so there’s little you can do about it.

Also the body sometimes when experiencing low T will increase SHBG in order to hold on to what is on the decline. I see it all the time on T-Nation. Restricting food intake, starving yourself (keto diets) will also increase SHBG.

I was doing Keto and IF in the summer and lost around 25 pounds. Was also very active. I felt great but had no sex drive. Wife started to get mad. I started to add certain carbs back in and it helped but not as much as I would have liked. So in your opinion should I still try to fix SHBG naturally or is TRT the only thing that would help it?

It’s a waste of time because in time SHBG will increase as you age anyway, your keto diet has sped up this process. TRT suppresses SHBG like nothing else because of the long unnatural peak in hormones.

I’ve seen some men pre-TRT have their SHBG in the 40’s and now after months on TRT SHBG is closer to 20.

Thanks for your input.

I would not get on TRT with numbers like that.

If you stick around here long enough, you will see that Systemlord recommends everyone jump on TRT. It’s reckless.

You should look elsewhere before committing to lifelong TRT (which is by no means a guarantee to feel better and may even worsen symptoms).

You think I should test thyroid and try to lower SHBG naturally?

I think you should get a better picture with a blood test looking at everything that was mentioned above. Definitely check out thyroid if you haven’t already - you may have mentioned this but I missed it.

TRT is expensive, a lifelong commitment, and may require a long period of adjusting dosage and dealing with side effects that aren’t guaranteed to go away. It may seem like the best idea right now, especially when looking at a forum where many encourage “get on TRT bro you’ll feel like a million bucks with never ending rock hard boners.” That’s not the reality - 75% of the people posting are trying to find ways to change their protocol because of unwanted side effects.

If it was me, I would explore all avenues of optimizing my health before going down the TRT road. This is coming from someone who was on injections for 5 years and didn’t explore all avenues prior to getting on trt.

If you see no other issues with your health via blood tests, diet, sleep, exercise routine, etc. yet still feel like balls, maybe look at going on TRT

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Thanks for input.

Show me where I recommended TRT, I didn’t even recommended a TRT protocol. I recommended more testing and gave him some info to soak up. We are in the midst of a low testosterone crisis worldwide and it’s getting worse with each generation, if I see someone with lower than normal levels when accounting for age, you bet I’ll recommended TRT.

You can’t determine anything by only one set of labs, most of all directly measured FT when it’s uncertain the method of testing especially if direct immunoassay. You don’t want to hang your hat on inaccurate testing.

Most of the men that end up on forums tend to be having problems, there are men doing well on TRT and you most likely won’t ever hear from because they have no need to seek assistance on TRT boards.

TRT is dirt cheap and is the biggest bang for your buck in western medicine, TRT treats and prevents metabolic syndrome, diabetes, cardiovascular disease and heart disease and that’s only off the top of my head.

Maybe TRT is expensive for you, but I don’t think you speak for everyone.

Maybe not in this instance but I’ve seen you state “TRT is your only option” to countless individuals despite being under the age of 30. Maybe it is their only option, neither you nor I know that for fact, but not encouraging someone (especially on the younger end) to seek out other options before committing to TRT is ridiculous.

Not to mention these ideas you have clearly aren’t working out for your own health but that’s a different subject. Why would you not encourage someone to cover all their bases in relation to hormone health before going down the TRT road? You’ve had your own difficulties with TRT in relation to your chronic health issues so I would think you would consider that when making suggestions.

Repeat lab tests with trying new things. Take some time to change up lifestyle as much as possible before committing to a lifetime of TRT. I don’t get why that’s so hard for people to consider.

He will likely be going with a private doc because insurance is not likely to cover someone with numbers like his. That’s easily ~$1500 out of pocket a year and that’s a low estimate with one of the more affordable private clinics. That’s on top of other insurance costs. That’s not cheap by any means in my opinion.

Age has nothing to do with my recommendations, whether the guy is young or middle aged, the symptoms are not any different, expect for the younger guy will experience the symptoms to a greater degree than the middle aged man.

If a guy has high SHBG, the treatment is the same regardless of age, so being younger makes no difference. A lot of these guys that I recommend TRT have actually tried to correct things the best they can. It’s like a broken record, they go on about how they are exhausted and have tried going to the gym and just are unable to make any progress at all.

The OP might not even have low T, but he might have other biomarkers out of range, it could be as simple as iron deficiency or a thyroid problem which is why I recommended no TRT protocol let alone TRT. I recommended more testing.

The guys even said how boron helps but only temporary, that’s why I have a hard time believing hid FT labs.