I’m a bit stuck with what to do and also having a tough time finding a doctor who seems engaged to help vs either dismissing it or going straight to TRT injections.
Current condition:
500 total test (mid)
6.4 free test (below reference)
5.3 LH (mid)
100+ SHBG (high, above reference)
Very low libido, low mood/energy. I started taking 12.5mg of Enclomiphene 3 weeks ago and I don’t particularly feel that different.
What else should I test to help figure out what to do to get my shbg down and free up some test or raise total so my free is higher?
Thats because T injections are your best bet. I’m not a TRT pusher at all but you can’t naturally drive down your SHBG. What was your FSH? E2? More or less TRT will likely lower your SHBG a bit but also increase FT depending on dose. How old are you?
That’s not how it works, lowering SHBG does not increase Free T. The high SHBG could be the result of low Free T, because androgens lower SHBG.
There have been guys with high SHBG and above range Free T, killing the idea that high SHBG leads to low Free T.
The only difference between a guy with low Total T and low Free T and a guy with high SHBG and low Free T, is the difference in SHBG levels. Both men have low-T.
A more in-depth explanation on SHBG and Free T. Take a potted plant, the soil represents the SHBG molecule, the water is Free T. Pour water onto the soil, and once the soil has absorbed all the water it can, the rest is spill-over.
The SHBG is the same, once it absorbs all the Free T is can, the rest is spill-over which represents the Free T in circulation.
I know you mentioned you were having trouble getting a doctor to work with you. However, that is very high, particularly for one your age. I’d look into determining, if possible, why it is so high.
Really? How high is high? If high is above range (10-50 in guys under 50), I don’t think I have ever seen any man with SHBG close to 50 present with high free testosterone, not even close.
Google "20 year-old full hormone panel. Thoughts?. This is only one example of many men, some not on thyroid medicine, that have similar lab results → high SHBG and naturally high Free T.
This member is on Synthroid, which might help explain part of the reason why there’s an elevation in SHBG. This however doesn’t explain the naturally high Free T.
Total Testosterone LC/MS: 1,238 H (250-1100) high
Free Testosterone Equilibrium Dialysis: 195.6 H (35-155) high
LH: 5.4 (1.5-9.3)
FSH: 5.3 (1.6-8)
SHBG: 65 H (10-50) high
Estradiol, Ultrasensitive LC/MS: 36 H (<=29) high
Estradiol, Free: 0.72 H (<=0.45) high
If you read my post you’ll note the words, “I don’t think”. I’m not even sure I’ve never seen it, just do not think so. I doubt a guy with those levels would be showing up in my office anyway. Regardless, where ever he is, he’s an outlier. You probably know that.
His free testosterone is high because his total testosterone is high enough to overcome the elevated SHBG. That I do see, on TRT though.
You’re correct, thyroid will increase SHBG, pretty common to see patients (usually women) with low T symptoms, secondary to high SHBG, taking thyroid.
Exactly, because SHBG doesn’t influence the testicles production of testosterone, because there’s no mechanism for that. Sometimes an elevation in SHBG is a direct result of low Free T.
So lowering of SHBG doesn’t increase Free T as many believe.