Hi,
I have a problem for which seemingly no solution and not even an explanation exists: normal total testosterone, but low free & bioavailable testosterone due to high SHBG and Albumin.
My blood levels in short:
- Low normal total testosterone, high SHBG & Albumin , therefore low free & bioavailable testosterone, low free androgen index
- TSH sometimes high , sometimes normal. fT3 normal, but not optimal. fT4 low . No thyroid antibodies. Thyroid volume is low (right 7ml + left 3ml = 10ml), “harmless cysts”, sonography shows no signs of autoimmune thyroiditis.
- High progesterone (depending on the used reference range; mine seems too narrow)
- Low estradiol
- LH seems fine, FSH rather low
- Cortisol seems fine, only slightly high once
- Lipids are fine
- GPT slightly high only once
- Prolactin, IGF-1, STH seem fine
- Some values seem to correlate: especially SHBG and total testosterone. I had relatively high total testosterone once, but SHBG also climbed to about 140% . This was also the only time where my estradiol fell in the optimal range - it was twice as high as my usual levels. Also my fT3 was almost in the optimal range (upper third).
Free testosterone
- Afaik it’s not 100% certain that the “free hormone hypothesis” (only free testosterone can be used) is true
- For example, I also read that SHBG protects testosterone from being metabolized too early and that a slightly high SHBG is good. Or that the effects of total and free testosterone differ : total testosterone affects libido, drive, mood etc, but free testosterone is necessary for gaining muscle.
- But there are also at least 2 studies* that show exactly that : androgen deficiency symptoms are possible when somebody has normal total testosterone, but low free testosterone
- therefore I also think that free testosterone matters (even if SHBG protects testosterone etc)
Reference ranges:
- Free testosterone : 0.174-0.672 nmol/l or: >0,25 nmol/l or: >0,2 nmol/l
- Bioavailable testosterone : 3.68-15.3 nmol/l or: >4,37 nmol/l or: > 4,54 nmol/l
- Free Androgen Index : 35-150
Date | Total T | SHBG | free T | bioavailable T | free androgen index |
---|---|---|---|---|---|
04/2016 | 15,97 nmol/l | 41,8 nmol/l | 0,23 nmol/l | 6,31 nmol/l | / |
06/2017 | 20,2 nmol/l | 49,6 nmol/l | 0,26 nmol/l | 7,18 nmol/l | 40 |
05/2018 | 20,9 nmol/l | 48,4 nmol/l | 0,27 nmol/l | 7,55 nmol/l | 43 |
01/2019 | 26,5 nmol/l | 65,0 nmol/l | 0,29 nmol/l | 7,85 nmol/l | 40 |
01/2019 | 16,3 nmol/l | 51,3 nmol/l | 0,20 nmol/l | 5,66 nmol/l | 31 |
Estradiol
Reference range : 11-43 pg/ml
My values :
-
2017: 18,5 pg/ml
-
2018: 14,8 pg/ml
-
2019: 28,7 pg/ml
-
2019: 11,70 pg/ml
-
Afaik E2 should be between 20-30 pg/ml -> I only fell in this range once , when my total testosterone and SHBG were also high
-
My other values are rather low and the last one is at the lower limit
-
Average E2 for <29 yrs is about 25 pg/ml . Levels below 20 pg/ml have negative consequences for bones, levels below 12 pg/ml cause a 3 times higher death rate.
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I think, my E2 was measured with the wrong method (not sensitive test), so my “true” E2 values could be even lower .
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I think, these levels are low enough to cause their own symptoms (independent of low testosterone). Some of my symptoms that could be due to low E2: very dry skin, eyes, lips . Hot flashes. Cracking joints. Low libido.
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In one study people who had normal total testosterone but low free testosterone also had low E2
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Testosterone has a higher binding affinity to SHBG than E2 does. But could it be, that due to my high SHBG my free E2 is below the reference range?
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The only way to raise E2 seems to be raising testosterone
Questions
- Do you think my levels of free & bioavailable testosterone and estradiol are a problem? I have some testosterone and estrogen deficiency symptoms (some are more intensive, some less).
- Assuming diet, sleep, exercise etc are good, is there even anything I could do about it, aside from proviron, TRT, ostarine or clomid?
*References: