High SHBG (etc.) Conundrum

Pharma / TRT Testosterone Replacement
1

Over the past handful of years or so I’ve had this conundrum of having sky-high SHBG (and typically the low Free T that accompanies that). Libido hasn’t been what it should be (though it comes and goes), and no one, from endocrinologists to general practitioners to anyone else seems to have a solution, other than possibly going on TRT, which I’m hesitant to do if I can avoid it.

Historically (going by blood work I’ve had done a few times over recent years), my Total T has been toward the high (or at least mid-high) end of the normal range, with SHBG sky-high (out of normal range) and Free T low-ish (near the bottom end of normal range). E2 has at times been spot-on and at times been high.

But I haven’t had blood work done in a while, so I just did again, and the mystery continues. As background, I am 40 years old, 5’11", 205, muscular (but always had trouble getting “better than ok” ab definition and always have that tiny bit of extra fat on the umbilicus I can’t fully get rid of). Nowadays I lift twice a week (mostly full or almost-full body workouts, leaning toward compound and functional stuff) and do muay thai training (which is like HIIT cardio, in a sense) 3-4 times per week. Diet lately is loosely Paleo-ish 5-6 days per week, with cheating 1-2 days/week.

The doctor just now, frustratingly, didn’t do all of the hormonal tests I requested, only very few basic ones. But in the past, thyroid hormones, DHT, FSH, LH, etc. have all been normal, with DHEA being toward the low end of the range. Also, this recent round of blood work was taken at 3:00 in the afternoon (not ideal), but anyway, as of 3/20/15:

  • Testosterone, Total: 377.95 ng/dl (175 - 781)

  • Free Testosterone: 22.01 PG/ML (4.25 - 30.37)

  • Estradiol: 14.8 pg/ml (10 - 42)

  • Estradiol Non-Preg, Serum: 1.0 pg/ml (0 - 47)

  • SHBG: 78.9 nmol/L (13.3 - 89.5)

  • PSA, total: 0.6 NG/ML (0 - 4)

  • HDL cholesterol: 110.0 MG/DL (>40)

  • LDL cholesterol: 107.8 MG/DL (<100)

  • Triglycerides: 61 MG/DL (<150)

  • Total cholesterol: 230 MG/DL (<200)

  • Vitamin D, 25-OH: 46.9 ng/ml (30 - 100)

All of the other CBC stuff was just fine. (BUN and creatinine were a tiny bit high, but that’s probably just from heavy lifting.) UNFORTUNATELY the doc didn’t order the tests for Thyroid stuff or other related male hormonal stuff, so this is what I have at the moment. I’m trying to get more testing done shortly.

But, question:

How the hell can SHBG be so damn high (although at least it’s not officially out of range this time, whereas it’s been even worse in the past) and Total T be so low, with Estradiol being on the low-ish side of ideal (I understand that 22-ish is ideal), and yet FREE T be so apparently good? Does any of this make any sense?

Still experiencing typical “low T” symptoms, which is frustrating. Does anyone have any input, or thoughts on how to right this ship?

Thanks.

2

Your case is unique. Your numbers don’t make much sense. High SHBG often comes with high E2 and low fT. Yours is opposite.

Your liver values will be of interest since that is where SHBG is produced. Have you had any history of substance abuse?

3

AST (SGOT): 34 U/L (15 - 41)
ALT (SGPT): 51 U/L (17 - 63)
Albumin: 4.4 G/DL (3.5 - 4.8)
Bilirubin, Total: 0.5 MG/DL (0.3 - 1.2)

Nope, never been a drug user, I drink very infrequently (1 or 2 drinks per weekend, sometimes none at all), and have never done AAS, etc. I’m not on any medication and haven’t been for ages. (Years ago I did three different cycles of Accutane, but the last one was 10 years ago.)

4

Looks normal there. I wanna say do another test. Could be lab error. Very odd…

5

Yeah, I’m not sure what to make of it all, and I will get a re-test soon.

But the high SHBG / low Free T conundrum (even though Free T doesn’t look low this time) has been an ongoing problem for a handful of years, at least. Very frustrating.

6

Have you had your thyroid tested or taken your morning temps?

Hyperthyroidism causes high shbg might be worth exploring that possibility, just a thought. A lot of great info in the stickies, make sure you read them.

7

He didn’t have the lab do the thryoid tests (annoyingly) this time around, but I’m hoping to do so shortly when I have another round of blood work done.

Haven’t tried the morning temp thing, but will give it a shot.

Thanks.

8

KSman, if you’re around, any guesses as to what’s going on here…?

Thanks.

9

Something looks wrong with the lab results. With total T at 378 and SHBG at 79, your free T should be at 4 if your Albumin is average. Even if your Albumin was as low as 0.1, your free T would only be at 5.61. To get a free T number of 22, your total T would need to be close to 1500 if your Albumin is average.

https://www.nebido.com/tools/index.php/en/default/index/free-calculator

378 is at the lower end of the normal range. The 3pm blood draw can reduce total T by about 20 to 25% for a 40 year old guy.

It looks like you need to retest at 8 AM and by the looks of the numbers, maybe the lab should do it for free.

10

That’s what I thought! How can Total T be so low and SHBG so damn high, and yet Free T still be so high?!

Thanks for the info.

11

I just looked at the lab results and Albumin is 4.4 G/DL. (Range is 3.5 - 4.8.)

So yes, by that calculation, Free T is 4.07 ng/dl (1.08%). (!)

This whole thing is getting frustrating/mystifying as all hell. I’m seeing a highly recommended (by others on the forum) urologist / andrology doctor on Thursday of next week. Hopefully he can sort this craziness out. My primary care doctor literally didn’t even know what SHBG was. When I requested he test for it I had to slowly sound out “sex hormone-binding globulin” to him a few times. (Sigh.)

12

Just bumping in case KSman is able to take a look. Thanks in advance.

13

I saw a doctor today who specializes in Andrology, who was recommended in one of the threads here. He looked over my recent lab work as well as a few earlier bouts of lab work I’ve had over the past few years. He’s going to have me do some new blood work to check all the thyroid and liver readings, and he’s going to re-test Total and Free T while I’m at it.

But his take is that nothing is abnormal, and there doesn’t appear to be any reason to go on TRT. I pointed out the nonsensical Free T reading on my latest labs, and how the calculation should show that Free T is actually 4 and not 22, but he brushed that off and said something like, “You can’t really calculate these things consistently. They might be using a different method,” or something like that. This mystified me. But I’m having blood drawn tomorrow morning, so maybe that will clear up what my Free T level is either way.

Regardless, clearly nothing is at “optimal” level, but because everything is (that questionable Free T reading aside) technically in “normal range,” he’s reluctant to put me on anything. I’m not exactly dying to get on TRT, as its quite the ongoing undertaking and commitment, but on the other hand a part of me sees no other solution at this point.

Sigh. At a bit of a loss.

14

Just took my waking temperature. 97.2.

EDIT: Been reading the Thyroid sticky in this forum. Just got me some Iodoral, and am starting that protocol. Still curious to see what the lab results from this morning’s blood draw show, of course.

15

Free T tests often give nonsensical answers. The equipment is often unreliable.

In any case, free T is unimportant. What is important is bioavailable T (free and weakly bound). Free T is only a small fraction of bioavailable T. Bio-T can be caculated from TT, SHBG, and albumin.

16

I do not have an answer.

Can you get to 98.6 during the afternoon?

No help here:

17

It’s the weirdest thing. No one, no doctor, no info online, no one seems to be able to figure this one out.

No, I’m not getting to 98.6 in the afternoon. Only up to 97.6. Today is my fifth day of the Iodoral regimen (4 tablets per day), so we’ll see if that helps.

My lab results (blood taken 3 days ago) came back and I only got the very quick scoop over the phone from the doc, but don’t have access to the full report yet. (I should have the full thing tomorrow.) But in short, my total T is nice and high (around 1,020), my Free T was within range but toward the low end of the range, same with Bioavailable T, and he said my thyroid readings were “normal,” but again, I don’t know what that means in detail. Will post full numbers and ranges as soon as I have them.

18

Lab results from 4/10/15:

Abumin Serum: 4.6 (3.6-5.1 g/dL)
SHBG: 69 (10-50 nmol/L) (*High)
Test, Bioavailable: 167.2 (110.0-575.0 ng/dL)
Test, Total: 1028 (250-1100 ng/dL)
Test, Free: 79.6 (46.0-224.0 pg/mL)

Thyroxine: 8.0 (5.3-10.5 ug/dL)
Triiodothyronine: 84.3 (60-181 ng/dL)
Free T3: 3.1 (2.3-4.2 pg/mL)
Thyroxine, Free: 1.39 (0.80-1.76 ng/dL)
TSH: 2.132 (0.55-4.78 uIU/mL)

Anion Gap: 9 (7-16 mmoL/L)
A/G Ratio: 1.7 (no range given)
Albumin: 4.3 (3.5-5.0 g/dL)
Bilit, Tot: 0.9 (0.2-1.3 mg/dL)
BUN: 30 (8-24 mg/dL) (*High)
CA: 9.7 (8.4-10.3 mg/dL)
CL: 104 (98-107 mmol/L)
CO2: 27 (22-30 mmol/L)
Creatinine: 1.35 (0.66-1.25 mg/dL) (*High)
GLUC, RND: 82 (74-106 mg/dL)
K: 4.5 (3.5-5.1 mmol/L)
NA: 140 (136-146 mmol/L)
ALK PHOS: 50 (38-126 U/L)
AST: 38 (15-46 U/L)
TP: 6.9 (6.3-8.2 g/dL)
ALT: 51 (13-69 U/L)
EST GFR: 59 (no range given)

(Why do I feel like there are more thyroid markers he should have tested for?)

Any ideas as to what’s going on?

19

By the way, today is my sixth day on the Iodoral regimen (50 mg/day). I’ve been experiencing more brain fog than usual, occasional bouts of serious lethargy in the late afternoon (which eventually pass) and occasional heart palpitations. Is it usual to feel this way in the early stages of the regimen? At what point do people normally start feeling better?

My temperatures readings are still low.

20

Thyroxine: 8.0 (5.3-10.5 ug/dL) MR=7.9
Triiodothyronine: 84.3 (60-181 ng/dL) MR=120
Free T3: 3.1 (2.3-4.2 pg/mL) MR=3.25
Thyroxine, Free: 1.39 (0.80-1.76 ng/dL) MR=1.3
TSH: 2.132 (0.55-4.78 uIU/mL)

fT3 should be supporting decent body temperatures. When we see lower temps with decent fT3 we suspect that fT3 is getting blocked by rT3 and not enough fT3 is entering the cells. TSH is up because of low body temps and/or low thyroid hormones.

I marked mid range [MR] above. T3 is low

Your hypothalamus might also not be seeing fT3 as rT3 might be blocking that feedback signal there and then TSH might be up from that.

See references to rT3, stress, adrenal fatigue and Wilson’s book in the thyroid basics sticky.

You are taking a multi-vit that lists selenium with your iodine replenishment???

You could feel off if you have stored bromines on-board that are getting displaced with iodine and excreted. If that happens, one can have a bad odor that some describe as fishy. If the problem is rT3 then iodine might possibly not have been the problem. You have not described your long term use [or not] of iodized salt.

SHBG: If could be elevated if E1 or E3 are elevated. You could test:
E1
E2 - not needed, but may be part of a panel
E3
total estrogens

Yes, its a fishing expedition.

So read up on the stress related and rT3 issues. Get labs to see whats going on with other estrogens.