Low T Symptoms with Above Range T Numbers? High SHBG and rT3

[Sean0987]

Recently decided to finally look into hormone replacement due to long standing:
-Depression
-Anxiety
-Mental Fog (ADD-PI?)
-Chronic Fatigue
-Erectile dysfunction
-Gyno

In case this is relavant, for me puberty was delayed and didn’t start till I was 15-16, it was around that age I started to develop gyno and gained a lot of weight on the chest, waist, ass and thighs. around that time, all the other symptoms I listed came into play.

Reason docs turned me away when I asked about test was due to high test features like full beard, low voice, body hair, decent muscle mass.

So before coming here I had contacted Dr. Rand McClain http://psrmed.com/ after coming across his youtube series (anyone here know of him?), this was the bloodwork he said I should get, and is what I asked my GP to order:

Tests with CPT Codes:
Magnesium, RBC (83735)
DHEA- Sulfate (82627)
DHEA- Serum (82626)
Estradiol, Sensitive (82670)
CBC with Differential/Platelet (85025)
Comp. Metabolic Comprehensive (80053)
Triiodothyronine, Free Serum (84480)
T4 Free(Direct) (84443)
TSH (84443)
Vitamin D, 25-Hydroxy (82306)
Testosterone, Free & Total (84402; 84403)
Dihydrotestosterone (80327)
IGF-1 (84305)
Glutamyl Transferase (GGT- 82977)
Lipid panel (80061)
Prolactin (84146 )

Took that list to my GP and had him order those tests, I believe either my doc, or labcorp mixed a couple things up:

These are items not requested by the doc, which I found in the lab work sticky:

Cortisol
Pregnenolone
fT3
fT4
rT3
THS 3 rd generation
tpo,
tgab
ferritin
SHBG
bio-T
cortisol am and free
progesterone
CMP
B-12/folate serum

I am going back to my GP to have him redo my bloodwork, is there anything else I should have done that I am missing here?

Also, thank you so much for the help, because of this forum I feel I am starting to grasp the processes of HRT. I read through all the stickies and have been reading other’s cases all week. You guys are awesome.

[highpull]

You need more lab work, free test, E2, SHBG, LH, FSH, reverse T3, free T3.

[systemlord]

You need more complete thyroid labs already suggested, I suspect either thyroid issues or elevated SHBG which can shrink FT if high enough.

Make sure it’s E2 sensitive labs = LC/MS/MS method, otherwise you are using female E2 labs.

[Sean0987]

I had a feeling. Ok I will do a little more research and come back here to post what else I am going to have tested to be sure I don’t miss anything.

[Sean0987]

Somehow missed in my post: Estradiol (Roche ECLIA) 29.1 pg/mL 7.6-42.6

[systemlord]

Wrong test.

[phil65]

What is the proper terminology when asking for a sensitive test?

[systemlord]

@phil65

What is the proper terminology when asking for a sensitive test?

E2 sensitive or E2 ultra sensitive.

[Sean0987]

So before coming here I had contacted Dr. Rand McClain after coming across his youtube series (anyone here know of him?), this was the bloodwork he said I should get, and is what I asked my GP to order:

Tests with CPT Codes:
Magnesium, RBC (83735)
DHEA- Sulfate (82627)
DHEA- Serum (82626)
Estradiol, Sensitive (82670)
CBC with Differential/Platelet (85025)
Comp. Metabolic Comprehensive (80053)
Triiodothyronine, Free Serum (84480)
T4 Free(Direct) (84443)
TSH (84443)
Vitamin D, 25-Hydroxy (82306)
Testosterone, Free & Total (84402; 84403)
Dihydrotestosterone (80327)
IGF-1 (84305)
Glutamyl Transferase (GGT- 82977)
Lipid panel (80061)
Prolactin (84146 )

Took that list to my GP and had him order those tests, I believe either my doc, or labcorp mixed a couple things up:

These are items not requested by the doc, which I found in the lab work sticky:

Cortisol
Pregnenolone
fT3
fT4
rT3
THS 3 rd generation
tpo,
tgab
ferritin
SHBG
bio-T
cortisol am and free
progesterone
CMP
B-12/folate serum

I am going back to my GP to have him redo my bloodwork, is there anything else I should have done that I am missing here?

Also, thank you so much for the help, because of this forum I feel I am starting to grasp the processes of HRT. I read through all the stickies and have been reading other’s cases all week. You guys are awesome.

[Sean0987]

Updated OP to keep updates consolidated to that post

[Sean0987]

I have now gone to Labcorp 3 times to get blood drawn, and so far they have managed to fuck something up each time. I am short a E2 test, and will hopefully be able to get it before my TRT appointment. Anyway, I figure it’s worth posting what I have, since there are a couple issues that stand out… High SHBG and high rT3:

@systemlord @highpull @KSman What do you think? I have symptoms of high E2 for what it’s worth…

[highpull]

Given your fT3 numbers, rT3 should be about half of what it is. It is blocking your fT3.

You’re low T due to high SHBG. Given those numbers, your symptoms are very understandable.

[mnben87]

Seems like TRT would not do much here. Already high natural levels, but the SHBG is high, so that seems to be lowering your free T. I am not the expert on TRT here though.

[systemlord]

This just goes to show you TSH doesn’t really tell you much about the thyroid, it should be elevated but isn’t, it can’t be trusted. TRT might be the only thing to bring down SHBG, TRT has a damping effect on SHBG levels and most who start TRT see their SHBG drop. How much depends on the individual. Eating veggies can increase SHBG.

Your testosterone is actually quite a bit lower than stated, SHBG is inflating T status. If SHBG dropped testosterone would drop along with it.

[Sean0987]

So I am guessing TRT is around the corner for me (appointment with Dr. McClain is tomorrow), but what can be done to bring down rT3? I’m taking iodine and selenium… I don’t like the idea of also starting thyroid medication, so if the doc suggests it I already know I am going to be torn on what to do. As far as I understand, when you start thyroid meds, you’re on em for life. HcG is the reason I am willing to go for TRT. I’m 30 and might want kids…

In the end, I’ll do what it takes to not feel like shit anymore.

Thanks for the input guys.

[highpull]

How is your diet? Low calorie diets can drive rT3 up. Any chronic inflammation, or illness, recent infections?

Emotional stress? Some meds can increase rT3, anti-depressants, BP drugs, narcotics.

[Sean0987]

Short version:

Diet is decent. I was into bodybuilding a bit when I was in my early 20s, so I try to keep it clean and have decent macros. I get lazy when it comes to eating veggies though.

I try to work out often, but its a struggle, and often times I am shakey and my lifts arent even close to what they used to be, even though my workouts are the same and almost as consistent as before.

No illness in recent past. For a while I was convinced that I had Chronic Fatigue Syndrome, because one year I got sick 10 times in one season, and struggled with more intense fatigue for a while after that.

-Severe Insomnia as a teen, prescribed trazodone 100mg
-Adhd-pi diagnosis at 20, prescribed adderall (have trialed all the meds by now, including desoxyn, and have settled with dexedrine for the last few years)
-Have always struggled with anxiety and depression, especially as a teen being a very late bloomer. Tried SSRI’s but they only made anxiety worse
-Was prescribed Klonopin as needed in my 20s for anxiety. Never used continuously… until recently. I’ve used 5x a week for a few months now. It’s a problem, and it’s the reason I am ready to take more drastic steps to turn this shit around.
-For years I have used cannabis as a way to manage anxiety without being too reliant on benzos, and to augment trazodone’s effect on my ability to sleep

Abbreviated sob story: I tore my right hamstring tendon a year ago, went on unemployment. Was a fine dining waiter, and couldn’t be on my feet. Was a high stress envoronment, couldn’t do the job without amphetamines, did it for a decade. Took the injury as a sign that I needed to make a change, have been wanting to start a software dev bootcamp, but currently feel too shitty to be confident in my ability to manage the stress. Unemployed for a year now, supported by family (I’m lucky). Untill recently, I was still working under the presumption that what I was experiencing was deep depression, and that therapy and more meds was the solution.

I went into this expecting to find that all the meds were fucking with my endocrine system. As the pieces of this come together, my hope is that once I get myself dialed in, I can get off the meds for good.

[systemlord]

I took Klonopin for 30 years and is the reason I’m on TRT, didn’t have any problems on it, problems started when I began tapering off. Testosterone tanked as a result and never recovered.

I imagine in the next 10 years we know more about how these SSRIs damage our endocrine systems, I think doctors should only be using these SSRIs in emergency situations for short term with the intent of getting you off once the crisis is averted.

The real kicker for myself is I started taking Klonopin at age 14 for Tourette Syndrome and symptoms vanished and probably could have tapered off in high school and avert the damaged caused. Too little too late.

Klonopin is excellent at reducing depression and anxiety, but is tricky to come off safely.

Your thyroid and high SHBG are likely causing you depression and anxiety, you have a double dose of testosterone and thyroid issues. People with hypothyroid issues are often prescribe SSRIs and told it’s all in their head when low hormones is the cause.

[Sean0987]

How long did you taper for to get off for good? I think I am at a point where I am going to need to taper off. I went 5 days without last week and it wasn’t pleasant by day 5. Clearly my physical dependence isn’t anything like yours was, but I could tell that I was feeling very fatigued weak as I entered withdrawal.

I can already sense in myself that if this ends up being a game changer for me, I am going to want to track down the doc told me TRT was for old men and that it was all in my head and tear him a new one.

[systemlord]

Ten grueling painful months, I emerged with wasting muscles, anemia from low red blood cell count and could not climb a flight of stairs without severe exhaustion. We see guys in their early 20’s who haven’t completed puberty and penis are undersized, your doctor sounds like a moron.

His head is buried in the sand, I have a low tolerance for ignorance. I carry a cold wet fish in my pocket for such occasions and use it to slap doctors across the face.

It only takes a few months on continuous Klonopin dosage to get hooked, now imagine being on it for 30 years and stopping it. You can forget about sleep for along time, my brain never rewired itself back to normal.

If you must cycle Klonopin to prevent getting addicted, only take it when needed.