Lab Feedback: 32Y/O, Low Free T, Very High SHBG, High TSH, High E2

[deficientman]

After going through the stickies and various other sources, it seems I have a whole host of issues. But what spurred me to bloodwork is because I knew I felt like dogshit all the damn time. Any feedback would be much appreciated!

Brief history:

In 2013 I did a cycle of Test E for around 6-8 months kept to around 500mg/wk. Was also throwing in random exemstane and various AI’s because still felt like hot garbage. No bloods from the time, and obviously moronic behavior. It gets worse: I also did some Halo for the last month of so of those 6 months and did no PCT.

About 4-5 months after that, I began to experiment with clomid and more AI’s. Also threw in some T3 for a while on the way (hated it, cardio was terrible, and hair began falling out so it spooked me and I quit).

I’ve now not taken anything for about 1.5 years.

Symptoms (predictably):
Low lobido
Cold intolerance
No motivation (i’m almost a total shut-in recluse now)
No energy/drive
Depression
etc
etc

CBC With Differential/Platelet
WBC 4.4 3.4-10.8 x10E3/uL
RBC 5.40 4.14-5.80 x10E6/uL
Hemoglobin 16.0 12.6-17.7 g/dL
Hematocrit 47.7 37.5-51.0 %
MCV 88 79-97 fL
MCH 29.6 26.6-33.0 pg
MCHC 33.5 31.5-35.7 g/dL
RDW 13.9 12.3-15.4 %
Platelets 188 150-379 x10E3/uL
Neutrophils 56 %
Lymphs 35 %
Monocytes 6 %
Eos 2 %
Basos 1 %
Neutrophils (Absolute) 2.5 1.4-7.0 x10E3/uL
Lymphs (Absolute) 1.5 0.7-3.1 x10E3/uL
Monocytes(Absolute) 0.2 0.1-0.9 x10E3/uL
Eos (Absolute) 0.1 0.0-0.4 x10E3/uL
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL
Comp. Metabolic Panel (14)
Glucose, Serum 87 65-99 mg/dL
BUN 7 6-20 mg/dL
Creatinine, Serum 0.96 0.76-1.27 mg/dL
eGFR If NonAfricn Am 104 >59 mL/min/1.73
eGFR If Africn Am 120 >59 mL/min/1.73
BUN/Creatinine Ratio 7 LOW 9-20
Sodium, Serum 143 134-144 mmol/L
Potassium, Serum 4.0 3.5-5.2 mmol/L
Chloride, Serum 102 96-106 mmol/L
Carbon Dioxide, Total 25 18-29 mmol/L
Calcium, Serum 9.5 8.7-10.2 mg/dL
Protein, Total, Serum 6.8 6.0-8.5 g/dL
Albumin, Serum 4.8 3.5-5.5 g/dL
Globulin, Total 2.0 1.5-4.5 g/dL
A/G Ratio 2.4 HIGH 1.2-2.2
Bilirubin, Total 0.8 0.0-1.2 mg/dL
Alkaline Phosphatase, S 59 39-117 IU/L
AST (SGOT) 20 0-40 IU/L
ALT (SGPT) 20 0-44 IU/L
Lipid Panel
Cholesterol, Total 174 100-199 mg/dL
Triglycerides 48 0-149 mg/dL
HDL Cholesterol 98 >39 mg/dL
VLDL Cholesterol Cal 10 5-40 mg/dL
LDL Cholesterol Calc 66 0-99 mg/dL
Thyroid Panel With TSH
TSH 3.000 0.450-4.500 uIU/mL
Thyroxine (T4) 8.2 4.5-12.0 ug/dL
T3 Uptake 29 24-39 %
Free Thyroxine Index 2.4 1.2-4.9
Testosterone,Free and Total
Testosterone, Serum 532 348-1197 ng/dL
Free Testosterone(Direct) 9.6 8.7-25.1 pg/mL
Prostate Specific Ag, Serum 0.7 0.0-4.0 ng/mL
Roche ECLIA methodology.
Insulin-Like Growth Factor I 199 88-246 ng/mL
Estradiol, Sensitive 15.5 8.0-35.0 pg/mL
Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)
Sex Horm Binding Glob, Serum 76.8 HIGH 16.5-55.9 nmol/L

The following testing was a done a week later because I was dumb and forgot to test LH and FSH so just ordered more testing:

Salivary Steroids
Cortisol 7.0 3.7-9.5 ng/mL (morning)
Cortisol 1.9 1.2-3.0 ng/mL (noon)
Cortisol 1.4 0.6-1.9 ng/mL (evening)
Cortisol 0.5 0.4-1.0 ng/mL (night)

Blood Spot Steroids
Estradiol 33 12-56 pg/mL
Progesterone 0.5 <0.1-0.8 ng/mL
Testosterone 330 L 400-1200 ng/dL (Age Dependent)
Ratio: T/SHBG 0.2 L .7 - 1.0
SHBG 52 H 15-50 nmol/L
DHEAS 145 70-325 µg/dL

Blood Spot
LH 1.4 1.0-8.4 U/L (adult male)
FSH 2.0 1.0-10.5 U/L (adult male)
Blood Spot Thyroids
Free T4* 1.4 0.7-2.5 ng/dL
Free T3 3.2 2.4-4.2 pg/mL
TSH 3.2 H 0.5-3.0 µU/mL
TPOab* 18 0-150 IU/mL (70-150 borderline)

Body Temps: past week

AM Avg = 97.22
97.8
97.2
97
97.55
97
96.8

PM Avg = 98.08
97.7
97.8
98.2
97.85
98.6
98.4
98

My plan of action right now is to try a Iodine/selenium protocol now that my antibodies show low likelihood of Hasimoto’s. If more treatment is needed (seems likely), then I plan to self-medicate with copious amounts of testosterone and re-do bloods 8 weeks thereafter. I say self-medicate because I dread wasting another year in this condition searching for a decent doc.

Main apprehension to test treatment is the whole UGL scene, needing it for life (ya I know, too late, that ship looks to have sailed a long time ago), but also fundamental shifts in mental behaviors, distractions chasing women all day (like when I was 25) etc … But with all that being said, get busy livin or get busy dying amirite??

Any feedback would be great and thanks for reading!

[KSman]

You have been reading!

Did you look at the HPTA restart sticky?
Does not work that often.

TSH is high, fT3 look good. So your low body temps do suggest adrenal fatigue. Your morning cortisol would be good if 1 hour after you woke up. AM Cortisol blood work would be good to have. DHEA, another adrenal hormone is low.

Need info:
age
height
weight
waist size
other stuff from advice from new guys sticky

SHBG all over the map. SHBG is made in the liver and some meds might increase SHBG, as well as starvation diets. How did E2 double?

Just have to do this:

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.

[KSman]

Were PM temperatures mid-afternoon?

[deficientman]

KSman,

First, thank you for your insight and lending your experience.

Now to your questions,

age : 32
height :6’1
weight :180
waist size: 31

(I know, I know, … “do you even lift bro?” Well unfortunately life has gotten in the way quite a bit over the last few years but I did have a long history of lifting where I was normally walking around 215-225 LBS, way before trying gear, and was squatting 4 plates a side deadlifting more and had a decent bench.)

@KSman

Did you look at the HPTA restart sticky?
Does not work that often.

I did, and yes, it seems i’m a great example of it failing. Although without blood work to lean on prior to my first run on gear, it may be that my HPTA has always had issues - I don’t know.

In my attempt to restart HPTA I did run the typical bro-science PCT of SERMs including Nolva. (never tried hCG). I was miserable during the Nolva, AIs, and Clomid runs and without bloodwork at the time to dial it in, it could be I didn’t give it a fair shot.

@KSman

TSH is high, fT3 look good. So your low body temps do suggest adrenal fatigue. Your morning cortisol would be good if 1 hour after you woke up. AM Cortisol blood work would be good to have. DHEA, another adrenal hormone is low.

Would you suggest going ahead with the iodine protocol even though my fT3 looks good? And as far as adrenal fatigue, I was living a high stress lifestyle for quite some time, but recently it’s been low stress objectively, but subjectively I still get anxious, moody etc … And in one of your other threads, I did notice you mention that a highly fluctuating temperature might suggest hypothyroid along with high TSH. I don’t know if my fluctuating temps meet that criteria, but hypothyroid seems odd since for most of my life I was always accused of having a great metabolism, was never fat etc. Even now, despite my pitiful bodyweight, i’m not skinny fat, people can tell I did lift once upon a time.

@KSman

SHBG all over the map. SHBG is made in the liver and some meds might increase SHBG, as well as starvation diets.

Very interesting regarding diet! I have been doing intermittent fasting (modified) for a long time now. 5-6 days out of the week I only eat in the evenings and my body weight has plummeted over the last 2-3 years by 20-30lbs.

As far as meds, occasional runs (6-8wks) of oral albuterol 8-16g/day, more specifically levosalbutomal (less cardio effect, same beta2 agonist). Also have done a period of ephedrine use before that and an occasional modafinil. I’m somewhat well read on the these, and don’t recall liver issues but it could be I wasn’t reading close enough.

@KSman

How did E2 double?

Great question. I had not even noticed that! And those tests were done only approx 1-2 weeks apart which is the amazing part. Bizarre. Wild guess would be coming off albuterol.

@KSman

Were PM temperatures mid-afternoon?

They were.

Thanks again for your help.

[deficientman]

I should include what ZRT labs gave as their analysis to my blood spot and saliva tests:

Lab Comments
Cortisol is near expected range throughout most of the day and is following a normal circadian rhythm; however, a significant number of symptoms commonly associated with adrenal stressors are self reported. Under stress situations the adrenal glands normally respond by increasing cortisol output. However, when cortisol levels are within normal range under situations of excessive stress, as reported herein, this suggests they may be overworking to keep up with the demands of the stressors, which could eventually lead to adrenal exhaustion. Adrenal exhaustion is most commonly caused by stressors which include:
psychological stress (emotional), sleep deprivation, poor diet (low protein-particularly problematic in vegetarians), nutrient deficiencies (particularly low vitamins C and B5), physical insults (surgery, injury), diseases (cancer, diabetes), chemical exposure (environmental pollutants, excessive medications), low levels of cortisol precursors (pregnenolone and progesterone) and pathogenic infections (bacteria, viruses and fungi). A normal daily output of cortisol is essential to maintain normal metabolic activity, help regulate steady state glucose levels (important for brain function and energy production), and optimize immune function. Depletion of adrenal cortisol synthesis by a chronic stressor, sleep deprivation, and/or nutrient deficiencies
(particularly vitamins C and B5) often leads to symptoms such as fatigue, allergies (immune dysfunction), chemical sensitivity, cold body temp, and sugar craving. For additional information about strategies for supporting adrenal health and reducing stress(ors), the following books are worth reading: “Adrenal Fatigue”, by James L. Wilson, N.D., D.C., Ph.D.; “The Cortisol Connection”, by Shawn Talbott, Ph.D.; “The End of Stress As We Know It” by Bruce McEwen; “Awakening Athena” by Kenna Stephenson, MD.

Estradiol (blood spot) is within observed range for a male.

Progesterone is within the expected reference range for a male.

Testosterone is low and SHBG is high, resulting in a very low bioavailable fraction of testosterone determined by the Free Testosterone Index (FTI = T/SHBG). Low testosterone in men is commonly seen beginning in the fourth decade of life, and is associated with symptoms of aging referred to as andropause. The expected blood (blood spot, serum, or plasma) levels for testosterone in a male range from 250 to 1200 ng/dL; however, when values drop below about 350-400 ng/dL symptoms of andropause are more frequent. Testosterone is an important anabolic hormone that helps to maintain both physical and mental
health: it prevents fatigue, helps to maintain a normal sex drive, increases the strength of all structural tissues (skin, bone, muscles, heart) and prevents depression and mental fatigue. Testosterone deficiency is associated with symptoms such as erectile dysfunction, decreased sex drive, decreased mental and physical ability, apathy, and loss of muscle mass. Low testosterone in men is closely associated with insulin resistance/metabolic syndrome. Stress management, exercise, proper nutrition, dietary supplements (particularly adequate zinc and selenium), and androgen replacement therapy (testosterone) have
all been shown to raise androgen levels in men and help counter andropause symptoms. Testosterone therapy is worthwhile considering if PSA is within normal range. Weight reduction with proper diet and exercise, and stress reduction (lowers cortisol) are important components to androgen replacement therapy.

SHBG (Sex Hormone Binding Globulin) is high, strongly suggesting exposure to a high level of estrogens. SHBG is a protein synthesized by the liver in response to estrogen exposure. All forms of estrogens (endogenous, phytoestrogens, and xenoestrogens) will increase liver production of SHBG. Hepatic induction of SHBG by estrogens is inhibited by testosterone, high insulin from insulin resistance, and low thyroid (hypothyroidism). Phytoestrogens found in many foods, spices, and herbs as well as xenoestrogens derived from petrochemical pollutants induce hepatic production of SHBG but are not detected with the
immunoassays for the endogenous estrogens (estradiol, estrone, or estriol); therefore, a high SHBG in the absence of a high level of endogenous estrogens suggests exposure to other exogenous estrogens. Testing for estradiol and estrone in saliva is recommended.

DHEAS (blood spot) is within mid-normal range.

LH is within expected range.

FSH is within expected range.

Free T4 is within normal range but reported symptoms indicate thyroid deficiency. This might suggest that hepatic conversion of T4 to T3 is impaired or T4 is being converted to reverse T3 (both conditions increased under conditions of high stress/cortisol). It would be worthwhile to evaluate steroid hormones by saliva and correct any hormonal imbalances (eg. high estradiol, low progesterone, low testosterone, high or low cortisol) that might impede optimal thyroid function.

Free T3 is within normal range but symptoms indicate thyroid deficiency. A normal T3 does not exclude the possibility of a
“functional” thyroid deficiency caused by other hormonal imbalances such as excess estrogen, low progesterone, low
testosterone, low or high cortisol, and low growth hormone (IGF-1). Testing for these hormones is recommended.

TSH is high. Although most laboratories have a TSH range of 0.35-5.50, new studies are finding that the mean and median values are 1.0-1.5mU/l . TSH levels >3.0 are now considered abnormal due to changes by the endocrinology association - see www.aace.com for more information. Some experts believe that TSH should be kept below 2.0 for optimal health. Elevated TSH is often associated with symptoms of hypothyrodism, which include fatigue, decreased stamina, depression, rheumatic pain,
sleep disturbances, cold extremities or feeling cold, reduced body temperature, brittle nails, dry course hair, hair loss, infertility, low libido, puffy eyes and face, decreased sweating, menorrhagia, and/or constipation. Periodic TSH monitoring is recommended if clinical symptoms of thyroid deficiency persist. Thyroid therapy may be worthwhile considering if T4 and/or T3 are low and symptoms of thyroid deficiency are problematic.
Thyroid peroxidase (TPO) antibodies are low indicating that Hashimoto’s autoimmune thyroiditis is unlikely.

[KSman]

@deficientman

Testing for estradiol and estrone in saliva is recommended.

Good to do this as part of investigation of high SHBG.
Those are good lab notes.

Also see references in the thyroid basics sticky to:
adrenal fatigue
stress
starvation diets
Wilson’s book

[deficientman]

I will be beginning the IR protocol discussed in the thyroid sticky by taking Iodine (from potassium iodide) 12.5mg and selenium 50mcg.

My target will be an average 98.6f body temperature in the afternoons.

I plan to update this thread with the outcome. Afterwards I will most likely move on to self-treatment of low-T. After investigating SHBG more, it seems there isn’t much to be done about it and it may be that I will simply need a larger dose of testosterone to compensate (resulting in more free-T).

[dabah2014]

Your situation is almost identical to mine.

Low thyroid(aka high TSH), low free test, extremely high SHBG.

I started naturethroid and saw some improvement in my thyroid symptoms, but my SHBG skyrocketed and my testosterone didn’t improve at all and got slightly lower from the high SHBG.

I’ve spent the last year and a half trying to naturally raise my free test and lower my SHBG and have come to the same conclusion as you: I’ll probably need a high dose of testosterone.

I’m waiting until I see a natural specialist in Arizona at the end of June to see if there’s any possible way to avoid TRT. I’d like to avoid drugs if at all possible, but after 2 years of zero sex drive, muscle loss, and rock-bottom energy I’m running out of options. Hopefully this natural doctor who I’m paying $500/hr for will help me. If not, I’m taking the drug route and with a clear conscience.

Good luck to you, keep us updated.

[deficientman]

Thanks for your feedback and sorry for your struggles. You have more patience than I do. Life is too short to waste and this is no way to live. I’ve lost confidence in any natural remedies; and not necessarily homeopathic treatments, but also fixing things by eating right, sleeping and diet and lifting.

It sounds like you haven’t crossed the bridge to the drug route yet and so I understand your hesitancy, but I have already have.

Good luck in Arizona, I hope you find valuable guidance and I would be curious to hear his recommendations.

[KSman]

50mcg selenium is not considered adequate. I am not going to dig up references.

[deficientman]

Thanks for the heads up. I will have to grab some more to supplement and throw in some Vit D while im there.

The product I went with skimped on it I guess:

Zen Haus High Potency 12.5 mg Iodine Supplement plus Selenium and Chromium - Thyroid Support and Weight Loss Support - 200 Tablets with Potassium Iodide