Depression, High Ferritin, High E2, High SHBG, Low Free T

Pharma / TRT Testosterone Replacement
1

Hey guys, i’ve been perusing these forums for a little while, trying to gain an understanding of what’s going on with my body and if HRT is worthwhile endeavor. I seem to be having terrible brain fog as of late, trouble concentrating, shitty mood, frequent urination, low patience, low confidence and i’ve had depression and anxiety for many years. I’m 32 now and have been a heavy drinker (8 years) and smoker (12 years) in the past and only started weight training 2.5 years ago. I have a fair knowledge of strength training now and *try to train the olympic lifts, but my strength & muscle gains are very average. As i’m training for numbers, it’s come to the point where I feel a bit embarrassed about my strength level.

One thing that I almost have always had is my my sex drive, although, i’m not sure if perversion plays into that. My recent testosterone numbers don’t look too horrible, but i’m concerned about E2 & ferritin levels. Mild gynecomastia appeared a year or so ago and is here to stay. I have used a couple of peptides, short term, (2 months) and they include GHRP-2 w/MOD-GRF & at later date PEG-MGF. I’m not sure if they caused the gyno or not. Ferritin levels have been elevated for as long as I have results for- 3.5 years. I will be having having haemochromatosis gene testing done shortly. My digestion ranges from excellent to terrible. Some weeks i’m very gassy and bloated, borderline constipated, other weeks i’m having 3-4 BMs a day with very little gas. I have a feeling this may have something to do with work and sleep, as my digestion seems to get better on weekends.

I eat quite a clean diet. Vegetarian- so a lot of legumes/tofu, rice, greens, fruits, seeds & nuts. Plain cow’s milk yogurt often, eggs and butter a couple of times a week. Goats milk occasionally.

Supplements I use include a fish oil, multi vitamin (have cut this out for the time being due to high iron), B12, vit D in winter, whey protein & creatine occasionally.

32 years old
6’1", 185 lbs (84kg)
15-16% BF (32-34 waist)

Tests done in JAN 2016

ANDROGENS
Total T- 459 ng/dl [231-865] (391 ng/dl in Jan 2015)
SHBG - 61 nmol/L [17-66]
Free T- 216 pmol/L [170-500]

HORMONES
FSH- 4 IU/L [1-8]
LH- 4 IU/L [2-8]
Prolactin- 5.4 ug/L [<20.0]
Estradiol- 161 pmol/L [<150]

LIPIDS
HDL Chol- 1.1 nmol/l [>1.0]
LDL Chol- 2.7 nmol/l [<2.5]
Triglyceride 1.2 nmol/l [<2.0]

IRON
Iron- 43.5 umol/L [10.0-30.0]
Transferrin- 1.96 g/L [2.10-3.80]
Saturation- 89 % [15-50]
Ferritin- 398 ug/L [20-250] (01/15- 545 ug/L)

THYROID
TSH- 1.86 mIU/L [0.50-5.00]

B12
B12- 807 pmol/L [>180]

I have only seen my endo a couple of times and she seems to think the fatigue could stem from the high iron levels. I raised the issue of E2 and she said it is normal and has not arranged for another follow up appointment.

Thoughts?

2

I am sure the more experienced vets will reply soon. However, what method did you get your Test and FT tested? FT doesn’t seem accurate, especially if your albumin is not abnormally low. Do you have your Albumin labs? Your SHBG like mine, is very high, Although the lab ranges are different. You might be having low FT with that high SHBG, which is a more accurate value to diagnose hypogonadism rather than just TT values.

Please read the stickies and post more labs if you have. Thyroid values would also be helpful to the forum members to guide you.

Best of luck.

3

Do you have hematocrit?

Your E2 would be better near 80pmol/L. Your high E2 could be from body weight and alcohol. Higher E2 is increasing SHBG, but there might also be other influences.

Prolactin is quite low, not a factor in gyno, so its all about the estrogen.

Please follow these links in the 2nd post of the 1st forum topic:

  • advice for new guys - provide more info about you
  • things that damage your hormones

Have you always used iodized salt?
Concern is iodine deficiency and low thyroid function.
Are your outer eyebrows sparse?
Get cold easily now?

Iron:
Avoid iron fortified foods. This may also include bread and cereals.

4

Thanks for the replies.
gunner, 8:30am fasted blood test. Why do you say the FT does not seem accurate? My Albumin was 42 g/L [35-50].

K Sman, I have some haematology labs from the start of the year- hematocrit, i’m not sure?
I haven’t been a heavy drinker for years and I wouldn’t say i’m overweight.
I do not used iodized salt. Although, eggs, yogurt, bananas, potatoes are all staples of my diet. Also, my multi contains iodine.
Last year I had quite a few colds (3, if memory serves me right), but, I drive a bus for a living, and encounter literally hundreds of children in a day. I think the heavy strength training may also impair the immune system to some degree.

*Added thyroid value to first post

5

Your SHBG, like mine is very high. TT= T bound to SHBG + T loosely bound to albumin + Free T. Free T is what actually matters and leads to symptomatic hypogonadism. TT can be elevated and does not show true reflection of T levels due to high SHBG who apparently increases the half life of TT in your blood. Your FT is very low and that could be the main reason for your problems. Thyroid and other reasons that can lead to symptoms can be better looked at by forum vets. You can use Nebido (https://www.nebido.com/tools/index.php/en/default/index/free-calculator) to calculate FT. It shows that you’re below range.

Also since you have had drinking issues in the past, you should look at your LFT numbers. Liver function disorders and diseases can lead to high SHBG and Estradiol both of which result in high SHBG and low FT.

6

Thanks for the info gunner. I did have some slight liver damage in the past, (2013), but my liver function numbers are now within normal limits my GP has advised.

Just out of interest, what is your current treatment protocol?

7

As Gunner said, low free T levels can lead to hypogonadism. The cut-off is a bit of a grey area, but somewhere around 6.5 ng/dL or 230 pmol/L has been proposed, and you sit just under that.

There is a correlation between low free T and depression, and also the loss of libido if you’re running an SSRI.

KSman has said in the past that high levels of SHBG can boost the TT measurement. I haven’t found any resources indicating that, but it’s worth bearing in mind.

High SHBG levels are associated with gynecomastia. It throws off the T to E2 balance. You’re not having much luck here, are you?

Also, I’ve heard SHBG can fluctuate quite a lot. Mine has been measured at 61, 37, and 35 nmol/L. It’s going to get checked at the end of the month.

8

How do your other values fluctuate with fluctuations in SHBG? I didn’t know if fluctuated a lot. Mine has been similar in 3 labs the past month or so. How does your TT and FT values respond when SHBG drops?

9

My three draws to date were:

19th August

T: 18.5 nmol/L (= 534 ng/dL) (9.7 - 27.8)
SHBG: 67 nmol/L HIGH (17 - 56)
Free T (calculated): 231 pmol/L (= 6.7 ng/dL) (170 - 670)

7th December

T: 12.8 nmol/L (= 368 ng/dL) (9.9 - 27.8)
SHBG: 37 nmol/L (17 - 56)
Free T (calculated): 243 pmol/L (= 7.0 ng/dL) (170 - 670)

10th December

T: 16.1 nmol/L (= 464 ng/dL) (9.9 - 27.8)
SHBG: 35 nmol/L (17 - 56)
Free T (calculated): 339 pmol/L (= 9.8 ng/dL) (170 - 670)

Between August and December I stopped taking an SSRI, which might have driven up SHBG, and I was on a course of antibiotics in early November, which might have had an effect.

10

So that proves that SHBG really inflates actual TT labs. It’s interesting how your SHBG fluctuates to this extent? How are you getting on to find a doc who can treat you?

11

My suspicion is that cortisol was elevated, due to having a bad bout of depression, and that’s driven down SHBG and TT.

I’m not on any TRT programme. I’m not seriously looking at present.

Sorry for the thread hijack @break, and @gunner223 if you’ve got any other questions then please post them over here.

12

Given my E2 level, is there any reason why I shouldn’t experiment with an anastrozole only treatment? I’ll be getting my test/E2 levels checked again in 3 months time. Although my testosterone is on the lower side, I live in Australia and getting a doc to even consider TRT, with my TT level at 459 ng/dl, would be very difficult. Especially my current doc, as he seems to be an asshole. I queried him in regards to the high E2 and he just changed the subject to my iron issues. In any case, I don’t really want to use TRT unless absolutely necessary.

13

ABC re-ran the Head First episode “Tailor Made Bodies”, which is about bodybuilding and TRT last week. You can find it on iView until 28th May.

That featured an integrative doctor in Melbourne who was willing offer TRT to the presenter, despite his TT being around 16.7 nmol/L. So there are options there, but it’s likely to cost you.

I’m in a similar position to you (low free T, low-normal TT, depression, gyno), and trying to find a cause to some or all of the issues. I’m not looking at jumping on TRT, as it’s a lifetime commitment, and I’m not sure if it’s justified in my case.

14

Hah thanks. I actually remember seeing that show when it first aired. I don’t know, I don’t really fancy dealing with an anti-aging doctor unless I become very desperate. How are your E2 levels? Just out of interest, do you consume dairy?

15

Urologists seem to be big on TRT in Oz, so that might be investigating that angle. There’s a Men’s Health Clinic in East Melbourne (if you’re in that neck of the woods) that offers treatment.

There’s a gym / PT company in Melbourne’s CBD that runs TRT programmes too, but they don’t seem to pay attention to free T. Plus I would prefer to see someone who knows what they’re doing.

My E2 levels are fairly low:

E2: 46 pmol/L (= 12.5 pg/mL) (< 160 pmol/L)

I consume dairy, so I don’t think that there’s a correlation there.

16

I’m in Melbourne SE suburbs. Cool, thanks for the tips.

17

Just an update, I have in fact tested positive to carrying the hemochromatosis gene. I’m yet to be referred on to a hematologist, but i’ll report back after I have had a few phlebotomies to lower iron stores.

18

Unfortunately since having multiple therapeutic venesections (5 or 6) my brain fog, low energy and low motivation are still very much with me. I saw my hematologist today and he has given me the go ahead to keep going with the monthly venesections even though my ferritin has dropped considerably. Another thing i’m noticing is that I get quite dizzy when I bend down for a moment, very apparent when gardening.

I had gynecomastia correction surgery in October and the bloods from that surgery revealed I have had exposure to HSV-1 (Herpes simplex virus).

I have been taking a probiotic and resveratrol consistently for a few months now and last week started taking DIM, 80-90mg zinc daily and kelp tablets (equiv. 1mg iodine daily).

Still exercising and lifting, but finding the motivation is murder. Diet is still very stable, high quality vegetarian/pescatarian. I have been cutting back on mental distractions and doing some pretty hard inner work (seeing a psychologist, meditating daily, psychedelic therapy) giving me some relief from my depression. Body fat is still around 15%, waist 32-34 and dropped to 81.5kg.

Last androgen labs from July showed a negligible improvement in Free T, SHBG basically the same and slight increase in Total T.

As of JULY 2016

ANDROGENS
Total T- 16.4 nmol/L (473ng/dl) [8.0-30.0]
SHBG- 62 nmol/L [17-66]
Free T- 221 pmol/L [170-500] (previously 216 pmol/L)

19

As of NOVEMBER 2016

IRON
Iron- 52.8 umol/L [10-30]
Transferrin- 2.32 g/L [2.10-3.80]
Saturation- 91% [15-50]
Ferritin- 59 ug/L [20-250]

HAEMATOLOGY
Haemoglobin- 162 g/L [130-180]
RBC- 5.16 x10 ^12/L [4.5-6.5]
PVC- 0.47 [0.40-0.55]
MCV- 91 fL [80-99]
MCH- 31.4 pg [27-32]
MCHC- 345 g/L [310-360]
RDW- 11.6% [11-15]
WCC- 5.8 x10 ^9/L [4-11]
Neutrophilis- 3.2 x10 ^9/L [2-8]
Lymphocytes- 1.9 x10 ^9/L [1-4]
Monocytes- 0.5 x10 ^9/L [<1.1]
Eosinophilis- 0.2 x10 ^9/L [<0.6]
Platelets- 233 x10 ^9/L [150-450]

LFT
T. Protein- 70 g/L [60-82]
Albumin- 47 g/L [35-50]
ALP- 75 U/L [30-120]
Bilirubin- 14 umol/L [<25]
AST- 27 U/L [<41]
ALT- 24 U/L [<51]

I will update with body temps, Free T and E2 values shortly.

20

Keen to see what your E2 levels are now. It seems like your SHBG came back under control and is at a good level now. I am on anastrozole monotherapy for high E2, and it will lower your SHBG even further. With that I saw increases in free testosterone.

Your test is not at the best level, however it is more about how you feel than numbers. LH and FSH are midrange so it does not exactly point to primary or secondary hypogonadism. Arimidex will increase your testosterone levels also.

Have you had your balls ultrasounded? No testicle pain? Definitely no hydrocele or varicocele? There was a study I read of varicocele showing increased E2 levels in men.