High SHBG, Prolactin, and TSH, Low FT

You really have a good grasp of things and have done most of my work for me. I do not need to ask for much or nag for thyroid items! :+1:

Your labs suggest dehydration. Please drink water in your lab fasting.

Over training and/or lack of recovery is a stress that can push up rT3, and this gets more severe when thyroid function and/or T is low as adrenalin is compensating for a loss of natural energy.

LH:FSH ratio is odd, should be nearer to 1:1.
When FSH is really dominant, we need to consider that a FSH secreting testicular cancer might be responsible. Anything feels odd with your testes? When on TRT, we expect LH&FSH–>zero and testing then can rule in/out a cancer. So some screening is advisable. But we so see some odd FSH:LH at times and while FSH levels are steadier with a longer half-life, LH is quite the opposite and you may have caught a trough. Repeat LH/FSH might be useful later.

SHBG is quite high and your low E2 is obviously not a cause. SHBG is made in the liver and liver pathologies can increase SHBG, but we see no issues with AST/ALT/GGT and your consumption of alcohol seems low-moderate.

SHBG levels increase with estrogenic states (oral contraceptives), pregnancy, hyperthyroidism, cirrhosis, anorexia nervosa, and certain drugs. Long-term calorie restriction of more than 50 percent increases SHBG, while lowering free and total testosterone and estradiol. Sex hormone-binding globulin - Wikipedia

High SHBG means that there is lots of non-bioavailable SHBG+T that inflates your TT and TT thus overstates your T status. Also reduces FT. Your FT:TT thus is low. But FT is pulsatile with a short half-life, even shorter with your high SHBG and we are faced with a a bad signal:noise ratio. A calculated FT might be useful and cut through the noise as TT and SHBG levels are quite steady.

Hemoglobin, RBC and hematocrit also speak to lower T status than TT implies.

TSH sucks. T4 is well below mid-range, fT4 is good, fT3 is good, low body temperatures suggest that rT3 is blocking fT3 at T3 receptors. Thyroid binding globulin may be lowish, that that is neither here nor there.

Prolactin can be elevated by some meds, orgasms, hugging {babies | puppies | kittens} so avoid for 3 days before labs. You seem a bit old for presentation of a prolactin secreting pituitary adinoma.

Your thyroid antibodies suggest that you may have issues from high TSH and a lack of selenium. So you need to eat one or two Brazil nuts per day or get 150-200mcg in a supplement. With your anti-bodies, I would like to see you taking selenium for 3 weeks before an major iodine supplements.

A good multi-vit, no iron for men, with iodine and selenium would be good as well as a spectrum of other trace elements that are mission critical for many enzymes.

Most are magnesium deficient. A lack can show up as increased BP or leg/foot cramps. See ZMA sold here in the biotest store.

DHEA-S is suboptimal. Take 25mg DHEA with a meal that has fats and avoiding high fiber foods. Ditto for EFAs [fish oil, nuts, flax seed oil/meal] and Vit-D3.

So what to do. Your FT says you need TRT, most docs will shutdown on TT. SHBG is a problem. E2 liver clearance appears good. A1C wants diet change, but we can be quite confident that low T and low thyroid function are lowering insulin sensitivity and these can be fixed. Your apparently low T production [FT] and strong LH/FSH suggest that testes are not working well, but no orga system in your body can function properly with your low thyroid function. Get on selenium and other trace elements for 3 weeks, then start IR and monitor body temperatures and mental clarity that must be suffering now.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.