Low fT, Low DHEA, High SHBG

Pharma / TRT Testosterone Replacement
1

I have been feeling a little off and decided to have bloodwork done to perhaps gain some insight on any potential issues. My symptoms are slow progress with muscle gain, not as much energy as I would like to have, and low libido. I am not and have never been on any hormone supplements.

I have read all of the stickies and many posts here and would appreciate any input on my labs and situation.

-age 34
-height 5’ 11"
waist 32"
-weight 180
-describe body and facial hair: Very hairy over nearly entire body. Thick course fast growing facial hair.
-describe where you carry fat and how changed: evenly distributed, slight gut.
-health conditions, symptoms [history] 2012 small epididymal cyst on right testicle that has not changed since. Frequently have normal bowel movement in morning and then one or more loose stools a few hours later. Libido is not up to par but no sexual dysfunction.
-Rx and OTC drugs: No
-describe diet: Mostly whole foods, low sugar, approx. 50% of calories from fat, approx 200g carb per day, approx 180-200g protein per day. Supplement D3 5000iu, fish oil, creatine, whey, collagen after WO. In the past I have done Ketogenic diet and a lot of intermittent fasting but not with severe calorie restrictions.

-describe training Weights 5 1hr sessions per week. Various cardio approx 1 hr total per week.
-testes ache, ever, with a fever? - No
-how have morning wood and nocturnal erections changed. Intermittently I do get morning wood. Has not been consistent for a long time.

Body temp: Varies. For a few days I was waking up at 97.3 and not getting to 98.6 however for the past week I have been waking at 97.9 and getting to around 98.6 or better.

Labs:
Testosterone,Free and Total 274-535-0094-0
Testosterone, Serum 476 ng/dL 348-1197 SE
Comment: Comment SE Adult male reference interval is based on a population of lean males up to 40 years old.
Free Testosterone(Direct) 7.8 Low pg/mL 8.7-25.1 BN
Vitamin B12 and Folate 274-535-0094-0
Vitamin B12 439 pg/mL 211-946 SE
Folate (Folic Acid), Serum 14.9 ng/mL >3.0 SE
A serum folate concentration of less than 3.1 ng/mL is
considered to represent clinical deficiency.
Pregnenolone, MS 274-535-0094-0
Pregnenolone, MS 71 ng/dL ES Reference Range:Adults: <151
Dihydrotestosterone 274-535-0094-0
Dihydrotestosterone 29 Low ng/dL ES
Reference Range:
Adult Male: 30 - 85
Thyroxine (T4) Free, Direct, S 274-535-0094-0
T4,Free(Direct) 1.28 ng/dL 0.82-1.77 SE
DHEA-Sulfate 274-535-0094-0
DHEA-Sulfate 136.1 Low ug/dL 138.5-475.2 SE
Cortisol 274-535-0094-0
Cortisol 16.2 ug/dL 2.3-19.4 SE
Cortisol AM 6.2 - 19.4
Cortisol PM 2.3 - 11.9
TSH 274-535-0094-0
TSH 2.840 uIU/mL 0.450-4.500 SE
Estradiol 274-535-0094-0
Estradiol 9.9 pg/mL 7.6-42.6 SE
Prostate-Specific Ag, Serum 274-535-0094-0
Prostate Specific Ag, Serum 0.2 ng/mL 0.0-4.0 SE
Vitamin D, 25-Hydroxy 274-535-0094-0
Vitamin D, 25-Hydroxy 49.8 ng/mL 30.0-100.0 SE
Coenzyme Q10, Total 274-535-0094-0
Coenzyme Q10, Total 1.14 ug/mL 0.37-2.20 BN
Vitamin C 274-535-0094-0
Vitamin C 1.0 mg/dL 0.2-2.0 BN
Zinc, Plasma or Serum 274-535-0094-0
Zinc, Plasma or Serum 133 ug/dL 56-134 BN
Detection Limit = 5
Triiodothyronine,Free,Serum 274-535-0094-0
Triiodothyronine,Free,Serum 2.9 pg/mL 2.0-4.4 SE
Vitamin A, Serum 274-535-0094-0
Vitamin A, Serum 58 ug/dL 18-77 BN
Magnesium, RBC 274-535-0094-0
Magnesium, RBC 5.8 mg/dL 4.2-6.8 BN
Sex Horm Binding Glob, Serum 274-535-0094-0
Sex Horm Binding Glob, Serum 63.8 High nmol/L 16.5-55.9 SE
Selenium, Serum/Plasma 274-535-0094-0
Selenium, Serum/Plasma 195 ug/L 79-326 BN

CMP14+LP+4AC+CBC/D/Plt 274-535-0094-0
Glucose, Serum 90 mg/dL 65-99 SE
Uric Acid, Serum 4.9 mg/dL 3.7-8.6 SE
BUN 17 mg/dL 6-20 SE
Creatinine, Serum 0.88 mg/dL 0.76-1.27 SE
eGFR If NonAfricn Am 112 mL/min/1.73 >59 SE
eGFR If Africn Am 130 mL/min/1.73 >59 SE
BUN/Creatinine Ratio 19 8-19 SE
Sodium, Serum 137 mmol/L 134-144 SE
Potassium, Serum 4.3 mmol/L 3.5-5.2 SE
Chloride, Serum 99 mmol/L 97-108 SE
Carbon Dioxide, Total 23 mmol/L 18-29 SE
Calcium, Serum 9.0 mg/dL 8.7-10.2 SE
Phosphorus, Serum 4.3 mg/dL 2.5-4.5 SE
Protein, Total, Serum 6.4 g/dL 6.0-8.5 SE
Albumin, Serum 4.7 g/dL 3.5-5.5 SE
Globulin, Total 1.7 g/dL 1.5-4.5 SE
A/G Ratio 2.8 High 1.1-2.5 SE
Bilirubin, Total 0.8 mg/dL 0.0-1.2 SE
Alkaline Phosphatase, S 97 IU/L 39-117 SE
LDH 157 IU/L 121-224 SE

CMP14+LP+4AC+CBC/D/Plt 274-535-0094-0
AST (SGOT) 32 IU/L 0-40 SE
ALT (SGPT) 23 IU/L 0-44 SE
Iron, Serum 82 ug/dL 40-155 SE
Cholesterol, Total 189 mg/dL 100-199 SE
Triglycerides 79 mg/dL 0-149 SE
HDL Cholesterol 66 mg/dL >39 SE
VLDL Cholesterol Cal 16 mg/dL 5-40 SE
LDL Cholesterol Calc 107 High mg/dL 0-99 SE
Comment: SE
T. Chol/HDL Ratio 2.9 ratio units 0.0-5.0 SE
WBC 6.5 x10E3/uL 3.4-10.8 SE
RBC 4.83 x10E6/uL 4.14-5.80 SE
Hemoglobin 14.7 g/dL 12.6-17.7 SE
Hematocrit 44.4 % 37.5-51.0 SE
MCV 92 fL 79-97 SE
MCH 30.4 pg 26.6-33.0 SE
MCHC 33.1 g/dL 31.5-35.7 SE
RDW 14.2 % 12.3-15.4 SE
Platelets 194 x10E3/uL 150-379 SE
Neutrophils 49 % SE
Lymphs 34 % SE
Monocytes 6 % SE
Eos 11 % SE
Basos 0 % SE
Immature Cells SE
Neutrophils (Absolute) 3.2 x10E3/uL 1.4-7.0 SE
Lymphs (Absolute) 2.2 x10E3/uL 0.7-3.1 SE
Monocytes(Absolute) 0.4 x10E3/uL 0.1-0.9 SE
Eos (Absolute) 0.7 High x10E3/uL 0.0-0.4 SE
Baso (Absolute) 0.0 x10E3/uL 0.0-0.2 SE
Immature Granulocytes 0 % SE
Immature Grans (Abs) 0.0 x10E3/uL 0.0-0.1 SE
NRBC SE
Hematology Comments: SE

2

Your DHT is very low. Are you on any hair-loss medications (even topical liquids/creams/shampoos)?

Look up “causes of elevated SHBG” on reputable sources such as the Mayo clinic to see if anything fits.

My SHBG is also about the same as yours, so far without good explanation for it.

3

DHT is low because T is low. No problem with that.

TSH 2.840
This is bad. TSH should be nearer to 1.0, T3, T4, fT3, fT4 should be near midrange or a bit higher.
fT3 is a bit low.

Suspect that you have not been using iodized salt.

Please read these stickies:

  • advice for new guys
  • things that damage your hormones
  • thyroid basics

Over training and starvation diets can damage your hormones.

Your lab set is exceptional. Now that we know that T is low, you need to test:
LH/FSH
prolactin
IGF-1
rT3

This is strange:
Sex Horm Binding Glob, Serum 63.8 High nmol/L 16.5-55.9 SE
Testosterone, Serum 476 ng/dL 348-1197 SE
Free Testosterone(Direct) 7.8 Low pg/mL 8.7-25.1
Estradiol 9.9 pg/mL 7.6-42.6 SE

With low FT, we expect low E2
With low E2 we expect low SHBG
But we see high SHBG
High SHBG creates a lot more T+SHBG and inflates TT
So the burning questions is why is SHBG high.
We do know that TRT with strong FT numbers normally helps reduce SHBG.

“Long-term calorie restriction of more than 50 percent increases SHBG”
Low protein can increase SHBG. Maybe your training is a factor there.
Total protein [albumin+globulin] seems low too. But that can be part of low T catabolic state.

So you have a lot of reading to do in the stickies.
I feel that your training and diet are significant factors. But need those additional labs first.

You definitely need some changes and TRT is a strong possibility. Lots yet to be understood. Thyroid issues can rob your energy and so can low T. Thyroid function may be poor from rT3 blocking rT3. Low DHEA is another marker for adrenal problems.

Take [more] vit-D3 with meals that are higher in fats and lower fiber. 5000iu total
Take 25mg DHEA per day with meals that are higher in fats and lower fiber then test DHEA-S later to see where you are at.
Low DHEA can in theory limit DHEA–>T inside the tests, but I am expecting to see lower LH/FSH as the major factor.

Keep coming back to this thread, do not spread your case across multiple threads.

You can always ping me at the KSman is here thread and I will get email notification. There are no PMs at this site.

4

Ketogenic diet will mess with your hormones. Weird diets like that, or starvation diets, fasting … those all will mess with your thyroid.
Have you had your cholesterol checked ? If it’s too low, that will mess up your hormones too.
Ketogenic diets and fasting in the name of “Health” … will usually just end up screwing you up. I know you referred to the keto and fasting as “in the past” but stay away from those in the future.
KSMan gives good advice. TRT may well be an option for you. Exogenous testosterone will drive down your SHBG, which in turn will give you more free testosterone … and also in your case… raise your E2, which would be a good thing, because it’s too low.
Ketogenic diets, low testosterone, low E2, are the perfect recipe for osteopenia and osteoporosis. You may want to ask your doctor to send you in for a bone density scan.

5

Here are results from the additional labs:

IGF 1+IL 6 285-535-0077-0
Insulin-Like Growth Factor I 244 ng/mL 88-246 BN
Interleukin-6, Serum <0.7 pg/mL 0.0-15.5 BN
FSH and LH 285-535-0077-0
LH 2.7 mIU/mL 1.7-8.6 SE
FSH 1.7 mIU/mL 1.5-12.4 SE
DHEA-Sulfate 285-535-0077-0
DHEA-Sulfate 124.7 Low ug/dL 138.5-475.2 SE
Cortisol 285-535-0077-0
Cortisol 10.1 ug/dL 2.3-19.4 SE
Prolactin 285-535-0077-0
Prolactin 12.9 ng/mL 4.0-15.2 SE
Reverse T3, Serum 285-535-0077-0
Reverse T3, Serum 13.4 ng/dL 9.2-24.1 BN

[quote]KSman wrote:
Suspect that you have not been using iodized salt.
[/quote]
I do use iodized salt. I normally use lite salt which is 50% potassium. I do this to get more potassium not to avoid sodium.

[quote]KSman wrote:
Over training and starvation diets can damage your hormones.
[/quote]
1+ year go I was doing up to 2 hours of moderate cardio per day. Since then I have capped any workouts at 1hr and done primarily short hiit sessions and 1hr weight training sessions. I have done a couple cuts over the last year but never below 2000 kcal per day and only sustained that level for ~6 weeks. I estimate my maintenance kcal is around 2500. I am currently eating 3100 kcal per day. I have been tracking macros each day for about one year.

[quote]KSman wrote:
Low protein can increase SHBG. Maybe your training is a factor there.
Total protein [albumin+globulin] seems low too. But that can be part of low T catabolic state. [/quote]
I average 180g protein per day. I have maintained that whether cutting or bulking. For several years I have had various amounts of digestive trouble usually manifested as one or more loose stools in the early afternoons. Maybe I am not absorbing all of the protein that I am eating.

[quote]KSman wrote:
Take [more] vit-D3 with meals that are higher in fats and lower fiber. 5000iu total
Take 25mg DHEA per day with meals that are higher in fats and lower fiber then test DHEA-S later to see where you are at. [/quote]
I am taking 5000iu d3 each morning with fish oil and no fiber. I am getting approx. 1000iu additional from multi vitamin. Per your recommendation I have started taking 25mg dhea at the same time.

Thank you. I appreciate your generous help.

6

Your vitamin D level is fine. Low D isn’t the cause of any problems you may have.

7

You might be iodine deficient. Please read the thyroid basics sticky and also check oral body temps as suggested.
If temps are low, that is a major factor in your reduced energy. Iodine deficiency is correctable. If something else, less so.
You also need an identifiable source of selenium in your diet. A lack of iodine can lead to thyroid auto-immune disease.

Get a good probiotic and see if your digestions improves. “Ultimate Flora” is an excellent product. Need to take for a while to shift gut bacterial dominance. Could be that diet favors unfriendly bacterial. You can also first take some Pepto-Bismol which can correct some common conditions. Your gut bacterial affect your body in many ways beyond food absorption.

Cortisol=10.1 at 8AM is not very good.
When was this done?

Lower DHEA, lower cortisol and moderately interesting rT3 all could suggest an adrenal connection

You may be able to promote more cortisol by applying 2% OTC progesterone cream. Look for KAL brand, amazon has it. Also my be beneficial for for GF/wife.

IGF-1 is strong, good GH status!

rT3 is interesting, but not at a level that is black/white
diet/stress may be a factor

8

[quote]KSman wrote:
You might be iodine deficient. Please read the thyroid basics sticky and also check oral body temps as suggested.
[/quote]
Thank you. I reviewed the thyroid sticky before my original post and many times since. In my original post I reported that I had a couple days of low oral temps and then several days of normal temps. I have continued monitoring since that post and have been steadily 97.9 when getting out of bed and I have been achieving 98.6 during the day. Since I am using iodized salt and getting some iodine from my multi vit (I realize these are not IR quantities), my temps are normal, and it seems likely that my rt3 is elevated due to gut issues would you still recommend IR at this point? Would it better to try to treat the gut issues before trying IR? If you do suggest IR immediately should I get thyroid antibody tests?

[quote]KSman wrote:
Cortisol=10.1 at 8AM is not very good.
When was this done? [/quote]
Yes, 8AM. I have to get up at 5:30AM and drive 2+ hours to get the tests done so I don’t know if cortisol would drop during that time. I repeated the cortisol test because the original cortisol test was 16.2 also taken at 8am which seemed on the high end.

[quote]KSman wrote:
Lower DHEA, lower cortisol and moderately interesting rT3 all could suggest an adrenal connection [/quote]
From my reading it looks like this could likely be caused by gut health issues as well. I just did a Doctor’s Data stool analysis with parasitology and I am starting vsl#3 probiotic today.

[quote]KSman wrote:
IGF-1 is strong, good GH status! [/quote]
Would you have any concerns about this level being caused by a pituitary tumor?

9

Your IGF-1 level is a good thing. Many who are older need to take around 1.5iu to get where you are. Level is not excessive.
I was concerned that it might low. Your IGF-1 is not holding down your metabolism or energy.

I think that your cortisol is good given other info that you have provided.

That is a good probiotic!

You are taking DHEA

Your body temps are good, but TSH still shows something is up. But almost all doctors will think that its great.
You could check anti-bodies to know for sure.

Try using ordinary iodized salt for a while. Do you know that you were ever potassium deficient before. Healthy kidneys are good at “sparing” potassium.

We need to see what happens with DHEA and probiotic.

The remaining issues are midrange TT, low FT implying high SHBG which we do see.
We do not see elevated glucose, so a diabetic reason for high SHBG is not expected.
That could be further explored with lab for A1C, but given your weight and waist, seems very very remote.
Your LH/FSH indicate that you have secondary hypogonadism
Prolactin does not seem to be high, but interesting, so prolactin secreting adinoma may exist and be too small to image via MRI.
But there can be other problems with the pituitary that can reduce LH/FSH

So you have two options:

  1. go to TRT, could try hCG mono
  2. try HPTA restart, if that fails, go to (1) https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hpta_restart_for_trt_guys_with_application_to_gear_and_pct

Low energy does not see to be cortisol, thyroid still in doubt.
Low energy can easily be from low FT.