Low T Issues, High SHBG Trying to Figure It All Out

Pharma / TRT Testosterone Replacement
1

In your case/thread opening post:
33
5’6”
31”
145
Full beard, all body hair except lower legs, outside and back. Inside of lower legs has full hair. Hair on chest and arms.
Carry some fat around the midsection, love handles, but not too much. Have recently lost 7lbs on whole30 diet and exercise. Cut out all sugar, dairy, grains. Have been using coffee to keep energy levels going, about 4 cups per day, or 20oz in the morning. Have recently cut that back to about 1 cup, or none at all on certain days.
I do not have a gallbladder or an appendix, have had GI issues ever since having my appendix taken out, gallbladder surgery was supposed to help. But it has not, has actually made things worse.
Was told I had lower normal Testosterone in 2015, but did not make too many changes. Naturopathic doctor put me on some supplements to help my digestion and had me do an elimination diet. It helped, but I fell off the wagon after about 3 months of feeling great going back to my old ways.
Have recently cut out all Alc as well, since I had been using weekly, probably about 15-16 per week.
Had elevated Estrogen in the fall, and developed Gynecomastia. Which is the reason why I am trying to change everything now. Estrogen magically fell through the floor on my last blood test and my gynecomastia has since shrunk, but is still there about the size of a marble now, as opposed to a walnut. Was taking a supplement that had Soy since my normal digestive enzyme was out when I went to buy it, took it for 2 months before I realized this. 30 days after stopping the enzymes my E is normal. Not sure if that was the cause or not.
Started taking Sam-e, Vitamin D, Digestive Enzymes since I don’t have a GB and a probiotic.
Recently had an ultrasound of the Testes and it came back all clear, normal blood flow and all.
Abdominal ultrasound also came back clear
Train about 4 days a week now, mostly lifting – a few miles on the treadmill just to keep my legs in shape.
Over the summer I was running 10-15 miles per week, spread over 4 days so about 3-5 miles per run. No lifting though.

Libido has been low, Nocturnal usually seems pretty good, morning isn’t there – doc said if I was away on vacation without stress of life this wouldn’t be an issue.
Last note, I have major stress and anxiety which has gotten worse of the last 5 years or so. Recently had our first child, who is now 9 months old. Work full time and was doing an internship for my Leadership Certification which added extra stress. Sleep is hard to come by as our child is not a good sleeper. Probably average about 6 and a half hours per night. Usually wake up 3 times or so, sometimes due to the baby crying.

Endocrinology Blood Tests 1/10/2018
Testosterone, Total: 487 Range 264-916
Free Testosterone: 1.0 Range 1.5-3.2
Testosterone, Serum: 49 Range 52-280
SHBG: 69.9 Range 16.5-55.9
TSH: 2.550 Range 0.450-4.500
Thyroxine (T4): 1.57 Range 0.82-1.77
Triiodothyronine, Free: 3.4 Range 2.0-4.4
HCG, Beta Subunit, QN: < 1 Range 0-3
LH: 3.8 Range 1.7-8.6
FSH: 9.5 Range 1.5-12.4
Prolactin: 11.1 Range 4.0 -15.2
Estradiol: 14.8 Range 7.6-42.6
Estrogen, Total : 41 Range 40 – 115 (was 158 in November)
Vitamin B-12: 473 Range 232-1245
Vitamin D: 29.5 Range 30-100
Folate: 13.0 Range >3.0
Iron, Serum: 123 Range 38-169
Ferritin: 153 Range 30-400
Iron Binding Capacity: 258 Range 250-450
Iron Saturation: 48% Range 15-55%
Other Blood Work:
Albumin: 4.8 Range 3.5-5.5
Globulins: 2.8 Range 2.0-3.5
AST: 22 Range 0-40
ALT: 22 Range 0-44
GGT: 15 Range 0-44
LDH: 167 Range 121-244
ALP: 87 Range 39-117
Cholesterol
HDL: 56 Range >40
LDL: 136 Range 0-100
VLDL: 11 Range 5-40
Triglycerides: 53 Range 0-150

Thanks for any advice!

2

SHBG is definitely high. List medications, past and present, all.

3

I used to take Dexilant which is a Proton Pump Inhibitor. Did take OTC acid reducers off and on whenever I had heartburn, but again I have not really taken any in the last year. Have not really taken any other medications. Have only taken different vitamins at times, and of course digestive enzymes because of not having a gallbladder.

My wife uses essential oils and a diffuser but have had her stop using the lavender because read it could be estrogenic.

4

SHBG is definitely binding up most of your T, which would mean your TT is inflated do to the lack of FT. If your SHBG was midrange your TT would be even lower likely below the threshold where TRT would be prescribed. Plant based diets will also increase SHBG, something to consider. Most progressive doctors begin treating thyroids once you get above 2.5 instead of waiting for things to reach what is disease status or when things can get no worse.

Your digestive issues are most likely related to low T, I had digestive issues when I scored 225 ng/dL. You need to not take doctors at their word that you fall into the normal range, these ranges are made up and have no worth because everyone has their own genetic set point for hormone levels that is optimal for them and these ranges are a piss poor attempt at determining whether someone is experiencing low T symptoms.

I’m certain given time doctors will be able to run tests that will clearly show if someone is truly low T. Until then doctors will continue to deny TRT for fear of giving it to someone who doesn’t really need it, that’s how inexperienced doctors get in trouble so it’s easier from them to deny TRT to you and say you are fine.

5

Thanks for the reply Systemlord.

I am not sure what exactly is going to happen, the next available appointment is not until March 9th. I was hoping that if my SHBG dropped into normal ranges that I would be okay or that my body would then produce more Testosterone because it realized that my numbers were low.

Is that something that is possible? I think my SHBG is dropping considering my total globulins have fallen since my earlier blood test and my Testosterone has dropped 30 points. I have read it can take up to 3 months for SHBG to normalize once you give up alc. Not sure if that will make a difference or if I am just screwed.

How do my FSH and LH levels look? Does it appear possible I can make more T?

6

Your welcome,

As SHBG rises your pituitary gland should attempt to increase T production to compensate for a lack of FT. We see guys in here all the time with high SHBG with high TT (1200+ ng/dL) to match, when we see this we know their pituitary gland is functioning overtime but it will never be enough to overcome high SHBG.

The problem is the pituitary can’t compete enough with the high SHBG, it’s a losing battle. Your pituitary gland isn’t doing that which probably means your pituitary isn’t respond the way it should, in other words it’s sluggish. Low thyroid hormones can also lower T production which can affect LH, you need a full thyroid panel as most guys that end up here also have thyroid disorders limiting TRT’s effectiveness.

You are going to need a good progressive doctor, most are clueless and don’t even order the proper labs needed for diagnosing your situation because doctor learn nothing about TRT in medical school. It’s simple really, if pharma can’t patient it (testosterone) there’s little money to be made. This is why doctors will throw SSRI’s (Viagra) at you instead of giving you TRT when in fact you are deficient, there’s no money in testosterone treatment but prescribing drugs that come with nasty sides effects is profitable because the drugs are patented.

7

Thanks again.

I am not even sure where to begin. Is there a list of doctors that are progressive in this manner somewhere?

I absolutely want to fix the issues that I am having and find a way to regain my old self. Of course I am hoping that I can fix these issues without having to go on TRT as I am only 33 and I would like to have more children in the future.

How old are you systemlord? Is your story similar to mine?

8

I’m turning 46 in March, I know exactly why my natural T production tanked. I was put on Klonopin at age 14 (14-44 years old) and started tapering off 2.5 years ago and T dropped to 225 ng/dL is a short amount of time, two months later it was 119 ng/dL. I spent a 1.5 years in a low T state hoping my body would hear itself, it never happened. I resisted TRT for awhile because after what happened during that horrible withdraw I told myself no more medications.

There are lots of guys who are on TRT having babies, for those having trouble getting the wife pregnant HCG will improve fertility chances. Measuring LH on TRT is pointless as it’s expected to zero out which is alright. LH would have to increase since it signals the testicles to produce T, HCG might increase it but then you still have a problem with high SHBG binding up all your T. FSH is great.

TRT is really your only hope, there’s just only so much you can do to lower that high SHBG, not by natural means anyway. SHBG increases with age so it will only increase later in life.

9

So my LH level is too low to make Testosterone? And even if my SHBG drops over time it won’t matter? That’s pretty depressing. I know there are guys younger than me here but 33 feels so young for this.

10

Total test is usually inflated by a high shbg. With your high SHBG, your total test was in the 400’s. Even if your SHBG drops, your test level will be very low.

Watch your thyroid.

Heavy drinking can lower testosterone also, so you may recover now that you are done drinking.

11

That’s sort of what I am hoping. I wonder what the correlation is. Like of my SHBG drops 20 points will my T drop 100 points.
This all happened to me over the past year really. I went from trying to have sex all the time to not even caring about it.

Is that LH low? I think FSH is good but to be fair I’m not sure what FSH does. LH is responsible for T, I think?

I ordered some iodine and will try that. I have tested my temps before. Im usually in the 97’s.

Should I retest the levels in a month? Ask the doc to do something other than TRT to start?

12

Lets say your SHBG dropped to 30 points, well your TT would become even lower than it is now. Once you start freeing up more FT, TT will shrink. You are already low T and no matter where your LH is, your T will be tightly bound to SHBG, ie. useless. We see guys in here with perfect numbers ruined by high SHBG.

There is nothing else, you can’t do clomid as it will significantly increase SHBG even further. TRT is it for you. TRT or misery. I chose TRT because I felt like death.

13

Thanks systemlord.

I have to questions maybe you could answer. What does it look like the major issue is? My pituitary gland or my testes?

And is there a good hormone doctor in SE Pennsylvania anyone a recommend? One that will worj with me. This literally has all hit me in the last 3 months so I am stillsort of in shock and don’t want to rush into the wrong protocol.

14

Your liver is ruining your day producing an over abundance of SHBG that your HPTA isn’t fighting back the way it should. I’ve seen guys where their SHBG is high and their HPTA is kicking into overdrive with T levels well above 1200+ ng/dL in an attempt to compensate.

In this case the HPTA will never get over top of the SHBG. In other words your HPTA is on the weak side. You need to detox that liver and stay away from plant based diets as these increase SHBG, heavy drinking will also raise SHBG. Guys should never come within 10 feet of soy products.

Your thyroid is starting to become a mess, most progressive doctors start thyroid treatment when a guy has a TSH of 2.5, you are already there. You are missing complete thyroid labs, reverse T3 can block free T3 hormone causing TSH to rise. Most doctors don’t bother checking when these free hormones have more value.

You need TSH, Free T4, Free T3 and Total T3, Thyroid Antibodies, Calcitonin, Thyroglobulin for a more complete picture. Also track your body temps using a mercury thermometer before you get out of bed and at 12 noon, you should be at 97.7 upon waking and 98.6 12 noon. If not you are iodine deficient.

So there’s a combination of issue, weak HPTA, liver and thyroid are all suboptimal. Also check out our thyroid sticky as you could be iodine deficient which can harm your thyroid over time, iodine could improve your TSH be increasing thyroid free hormones, give iodine/selenium supplements a try.

You are a candidate for TRT based solely off your SHBG numbers, TRT will kill two birds with one stone by forcing down SHBG and greatly increasing TT and FT. You will require larger weekly injections since you hold on to your T so well.

When my TT was 225 ng/dL I had horrible anxiety and was always stressed, now I’m as calm as a turtle. Low T can be causing all your problems. TRT brings calmness to most guys, just be sure your doctor monitors your cortisol levels. Checkout your cortisol levels, high cortisol levels will cause a guy to stress out easily and drain you of all your energy. Symptoms of high cortisol levels include weight gain, a puffy, flushed face, mood swings and increased anxiety, fatigue, trouble sleeping.

https://t-nation.com/t/about-the-t-replacement-category/38/8

15

Thanks for the reply again.

I did order iodine caps. The really strong ones. I also checked my temp this moring when I woke up but it was a digital thermometer. Was 97.6. I will check again later but am not home right now.

I stilp need to find a good doc near me since my endocrinologist didn’t even want to run the SHBG in the first place.

Is there any links for good progressive docs on this site?

Again, thank you for your time. I really appreciate it!

16

Other than the Finding a TRT Doctor is the sticky threads, no lists here. Lots of guys find it difficult to find a doctor skilled enough to manage male hormones, doctors learn nothing about TRT in medical school. Those that do know what their doing are either private practice or cash pay only since to be able to do their job properly doctors need to run the correct tests and insurance companies bulk at what they consider unnecessary tests.

That’s why your doctor won’t run SHBG, insurance companies don’t like it. Most HMO doctors are useless as all they do all day is triage people, get em in get out. They don’t have the time to balance your hormones. I was shocked at how uninterested my endo is towards balancing my hormones, but in reality she just doesn’t have a clue what she’s doing.

Every time I complain about feeling weird she only runs one test, Total Testosterone. She doesn’t even understand that guys on TRT converts more estrogen than they would naturally and that an AI is required to suppress excess estrogen. I’ve never had thyroid hormone labs or cortisol checked, this is standard tests that need to be run, only doctors don’t know.

Any doctor who doesn’t believe SHBG is important is stupid, SHBG is the foundation for activating and regulating sex hormones. It determines what your protocol will be, how often much and how often you inject, otherwise you’ll wonder why TRT isn’t working.

Those that grow tired of clueless doctors scramble for Defy Medical, an good alternative and a guarantee your getting a doctor who knows what their doing. They don’t take insurance and with good reason. They wouldn’t be able to do their job if they did.

17

Hey Guys,

I am in the process of researching for a good HRT doc.

After I found out that I had Gynecomastia and elevated Estrogen I started taking SAM-e and my Estrogen levels dropped from my first test when my numbers were elevated. I also know this is true because my Gynecomastia shrunk severely. I recently stopped the SAM-e for two weeks and my Gynecomastia has grown back almost to the size it was before I started the SAM-e. I guess this is because SAM-e is a methyl and helps with phase 2 detoxification. So it was allowing my body to process and remove the excess estrogen.

I do have some concerns, I am afraid that if I go on TRT my body will just convert the T to E and it won’t matter. I am also concerned that if I got on TRT and have to take an aromatase inhibitor it will damage my liver. Seeing as which I have not taken the best care of it so far in my life.

Can anyone help me with this?

Also, oddly enough I think that I am feeling slightly better since the Estrogen is rising again only because it might be using some of the SHBG allowing for a slightly higher amount of T to be available to me. Not sure if that is just my hope.

Thanks for all the words of wisdom. I appreciate it immensely as I navigate what is best for me.

18

Why dont you stick with the Sam-e for a few more weeks and get labs?

Sounds like you possibly found a fix for your high SHBG and or estrogen issues. Like you said, maybe that’s what your liver needed to get rid of the excess E and SHBG.

I had good success lowering my SHBG with Calcium D Glucarate. Its interesting to know that Sam-E helped you. It would be great to see what your numbers are on the Sam-E.

19

Thanks Alpha.

My total Estrogen was 158 before I started taking the Sam-e.

1 month later the number was 41.

So it dropped 110 points.

I wanted to drop my SHBG, but am afraid that doing so will drop my T levels crazy low. Considering I have only 5.8ng/dl available right now.

I keep having hopes that my SHBG will drop and my body will figure my T is dropping and will make more T. Not sure if that will happen though. Seems like every post I have read it doesn’t happen.

20

Are you sure those e2 tests had the same reference ranges? Because that doesn’t sound right. I would double check that to see if they were the same test. But it would make sense, with what you were saying about the gyno.

Trust me, lowering your SHBG isn’t going to “lower” your test. It will make it more available, but it wont “Lower” it. You will probably have to do TRT eventually if your TT doesn’t come up though. But don’t worry about it dropping because you lowered SHBG. That’s what you want.