I’m a 40 years old male with hypogonadism symptoms (from Spain, excuse me from my english). I have recenty received my blood lab results and I still can’t understand them. Specially with the first 3 values:
How is it possible to have that really high free testosterone??. So my total testosterone is lets say not terrible but my shbg is awful. It was my understanding that a good amount of my total would be captured by that high shbg number. I dont get the arithmethics. With that total t and shbg I do have a brilliant free t??.
Please can anyone help me understand this.
Lab report was requested by my medical private insurance.
I am decided to start trt - at least for a couple of months with hcg to keep everything running just in case - and see what happens. If it works I will probably ditch the hcg and keep the trt forever.
For the numbers above I was planning 250 mg of testosterone enanthate per week in 1 dose (I understand that high shbg have higher inertia and requires higher dosis per shot). Does this make sense to you?. I’m a newbie here.
Im also a newbie and I started TRT recently, however I see 3 big problems in the way you wanna start TRT:
Many men do not feel optimal on once per week injection. This causes them hormone swings. The more frequent you inject the less chance of swings in well being on TRt. Thats why I started daily injections and never considered anything else. No matter of the half life not all men metabolize testosterone at the same rate. For me the logic is simple: frequent small dosages of everything is better than loading your body with a bunch of stuff at once. Some people even get anxiety and panic attacks from so much testosterone in one shot.
HCG makes many men feel crappy. Starting it together with TRT is a bad idea. I also wanna take HCG but have not started it yet. It is recommended to start it 6 weeks after initiation of testosterone if you feel optimized on t alone
250mg can be high for many people. Most people find their right dosage to be between 100 and 200mg weekly. There are guys on 250 but they are not the common case
Thanks Vonko. I just presumed that the “standard” TRT dosage was not enough for a man with such high shbg numbers. What I do not want is to end having lower numbers than now. I will start with those numbers and take a blood draw after a month, and I will try to adjust it.
Regarding HCG; I will follow your reccomendation and let it be at least until that first month, just to avoid “testing” with too many chemicals. And I didn’t know about that feeling, so thanks.
I will try then twice a week instead once a week. Again I need to saturate all this SHBG and low dosages might not be that good in my case.
Anyway, please correct me in anything I say guys. I’m an engineer and I just try to do my best here. Survival.
The SHBG moment is very tricky, yes. However in most guys TRT will decrease it even in “normal” doses but Im not sure about that.
Two times per week definitely sounds better than once per week.
Higher level of t weekly will definitely help you overcompensate SHBG but increases the risk of side effects so it is a tricky balance. Most doctors that know how to make properly TRT tend to start on lower dose and adjust higher if necessary, but others tend to more aggressive approach
As mentioned, the lab results are suspect, but you have hypogonadism symptoms.
If you decide to start TRT, do you have access to a TRT doctor? Or, one with some experience treating guys like you? That would be ideal.
If not, I can tell you this: Most guys on TRT take 150-200mg injections once weekly. Some use scrotal creams, or pellets, don’t know if those are options, but personal preferences aside, injections are the easiest and cheapest. Some guys use different protocols with regard to dosing and frequency. I would start out as simple as possible. You can always adjust form there.
As for hCG, I would not use it unless you are currently trying to conceive. The only other reason is to prevent testicular atrophy, if that would bother you. Good luck. This is usually life changing and many guys, after starting TRT, wish they would have started it sooner.
No lab ranges, no clue. It’s may not your insurance cheating you in this instance, it’s the doctors who are uneducated on sex hormones that is the problem. Your LH is a better indicator of T status, it is on the lower end and SHBG is goddamn high and there is no way FT is healthy because the testicles aren’t receiving much stimulation at these LH levels.
A lot of uneducated people will see TT above midrange and believe everything is fine. Too many doctors get sex hormones wrong because there’s very few places that teach hormones to doctors. Your testing in Spain is more than likely not worth the paper it’s printed on, probably direct immunoassay.
I see some doctors don’t know what SHBG is or what it does or implications of high levels because they have no education in sex hormones, hormones aren’t taught in residency or mainstream medical schools. So asking these doctors to diagnose you is absurd.
You need to find a doctor that has the proper education in sex hormones, someone who prescribes TRT on a frequent basis.
I requested a new blood analysis in a different lab. This last one has more than 4 months of difference from the previous. The only change I made between both analysis is the use of 25 mg zinc, 240 Mb of magnesium, and 200 mg pregnenolone daily. Results from this last analysis are:
Total testosterone 8,91 ng/mL (last value 5,72) - lab ranges (2,6 - 10)
Free testosterone 20,27 pg/mL (last value 25,1 ) - lab ranges (1 - 28)
SHBG 91 * nmol/L (last value 79) - lab ranges (10-50)
E2 18 pg/mL —> no last value - lab ranges (<56)
So here is what I guess (please correct me if wrong):
I raised total testosterone with those supplements including the sky high pregnenolone dosis. But my SHBG raised in 20 points to a also sky high value of 91. So in the end I am more or less in the same place as before. In fact, I feel the same - of bad-
I don’t tend to aromatize as my estradiol is not too high
To have a clear idea of whether I improved or not with the supplements, I calculated the Free Androgenic Index (FAI) using the following arithmetic:
(test total nmol/l)/(SHBG nmol/l) * 100 = ( test total ng/mL * 3,467) / SHBG nmolL)*100
In my first blood analysis without supps, this index was 25
In my last analysis, the index was 33
According to the standard, the normal ranges are between 30 and 150. So I was clearly hypogonad in my first analysis, and I am currently quite near the lower limit. My supplements improved my situation a little bit, but not enough to reach an optimum level.
So I intend to go ahead with TRT and try to raise this FAI to the middle of the “normal” range, which is 60. And see what happens.
What are your thoughts?
Regards
PD (excuse my english again)
There is definitely something wrong with these laboratory testing, you would expect to see these FT levels in someone with low SHBG, either your SHBG has the weakest binding force I’ve ever seen or these test results are no good.
These levels with an LH of 2.4, seems impossible even if you were 21 year old. Most men need FT above midrange, this is where symptoms cease to exist and is where other biomarkers seem to improve.
Remember my free test was 20,27 pg/mL ?. Well, I’ve just notice that the LAB ranges are 4,5 to 42. But checking other lab ranges ( Testosterone, Free and Total, Adult ) I do see that those are quite different for the same units :
Free testosterone
Males
0-9 years Less than 1 pg/mL
10-11 years Less than 4 pg/mL
12-13 years Less than 68 pg/mL
14-15 years 2-95 pg/mL
16-17 years 26-119 pg/mL
18 years and older 32-168 pg/mL ----------------------------
How can this be??. If we are using the same units, “normal” ranges should be the same between labs right? We are all human beings here. The value of 20 I got is quite under the minimum with this Iowa University lab.
I am really puzzled.
Do you have any ideas?.
What do you think?
Regards
You cannot compare other lab companies lab ranges, Labcorp ranges for FT is 10.8-26.5 pg/mL for men in their 20’s. There are no standards and only a few are getting things right.
No. It depends on the equipment and method of assay at the individual lab. It is not standardized across labs right now. The zinc is keeping your E2 low.
Do you reccomend zinc while on TRT?. I’m not going to use the arimidex (though I already have it just in case it is needed), but maybe zinc is a “soft” approach for estrogen control while on trt?. Just wondering, don’t have info with this.