Mid-Range TT, High SHBG, Low Free T

Pharma TRT
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Love this forum guys, full of helpful information.

Quick summary:

Just turned 33 and the last 2 years have been hell for my libido, focus, and bodyfat. Need advice on TRT or not.

Libido:
Have a girlfriend of 4 years who wonders what’s going on as we used to have sex 3-5 times a week and now we’re down to once every 2 weeks…sometimes longer. I can still get it up but just have zero motivation to - it just seems like a chore. Have a few cialis around the house for when it needs to be done. Even subtracting my girlfriend from the equation it’s just harder to get hard and completely lost the animal savageness I had.

Focus and Drive:
Went from being completely motivated to grab new clients and expand my company to being complacent and ok with the status quo.

Bodyfat:
I lift weights 3-5 times a week and I’m a big guy. 6’ 250lbs at 27% bf. 2 years ago I was at 18% bodyfat and my diet hasn’t changed at all. I’m the strongest I’ve ever been but it seems impossible to cut my belly fat.

I’ve got the basics in hormones as I’ve been browsing this forum for the last couple weeks. Got my bloodwork done and narrowed down the culprit to high SHBG and maybe high prolactin? I do have gyno and nipples can get itchy at night even though my E2 isn’t elevated. Doing another blood test next week for entire thyroid: including free t4, free t3, reverse t3, etc and throwing in TT, FT, SHBG, E2, and Prolactin.

My main concerns:
-Free T at 13 obviously isn’t working for me. What’re your opinions on that number?

-Is there a natural way keep my SHBG low? I’ve researched online and have been taking boron, magnesium, and zinc for the last week but hasn’t done a damn thing for libido or focus.

Goals:
A) Have the drive to bang my girl 3 times a week
B) Raise focus at work and life
C) Lose that insanely stubborn bodyfat around my stomach

PS Don’t have a doctor so all blood work was done directly through labs. I don’t even know what path to take if I want or need to get TRT. Live in SoCal and looked on Google and there are a couple hormone specialists in the area.

Got my blood taken twice over two weeks. CBC and Comp Panel were great.

My first test had total T at 505 ng/dl and Free T at 11.

SHBG isn’t on this test but on the other it was:

SHBG: 53nmol/L; Range 16 - 55 nmol/L

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I don’t see a problem with your bloods they look fine. You and your girlfriend need to figure out how to spice things up a bit.

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Your free T is pretty low. You would benefit from TRT assuming everything else is in check (sleep, diet, excercise)

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No there is no natural way to lower SHBG, the most effective way is TRT, excess androgens lowers SHBG. Rarely have I seen boron work to lower SHBG. Your problem is you will need very high Total T levels to get optimal Free T levels, you will more than likely need Total T levels 1000> which pretty much eliminates any insurance based doctors.

The insurance guidelines are strict and were written at a time of great ignorance and TRT will be stopped or dosages reduced if levels are 800> leaving you with only one option, to seek private care for your TRT which is what you should be doing anyways.

Those Free T levels aren’t even those of healthy 50 year old men, those are geriatric levels. Your thyroid panels looks fine, but no active thyroid hormones were tested like Free T3 or Reverse T3.

Your pituitary is not behaving appropriately, normally we see men with high SHBG also with high Total T and very high LH, yours is barely midrange which hints at a sluggish pituitary gland. Even if you decreased SHBG 50%, you would still have suboptimal Free T.

In your case LH is a better indicator is T status, so midrange levels. T-Nation gets men all the time with midrange testosterone and needing TRT do to symptomatology. It was Dr. Abraham Morgentaler, an expert in TRT at Harvard who said men at or below 15 pg/mL would show benefit on TRT.

It was Dr. Abraham Morgentaler who has proven TRT doesn’t cause prostate cancer, in fact he has had men with prostate cancer on TRT for about 20 years now with no signs of progression of the disease.

You’ll need to be a little more clear, great CBC numbers with low testosterone can present problems while on TRT because it will increase RBC and hematocrit. Frequent dosing can help in most cases, my daily protocol produced the lowest (HCT -4%) CBC labs of any protocol before it within 50 ng/dL of previous levels.

This entire process will be easier avoiding managed healthcare doctors, plus you would have to fight for TRT with “in range” numbers with doctors who have no clue about normal status blindly following guidelines.

You will need frequent injections in order to control estrogen, once Free T increases so to will estrogen and frequent dosing is how you deal with estrogen.

AI are to be avoided if you can help it, some are AI over-responders needing a fraction of 1mg tablet. If you find yourself sensitive to medications, you will likely over-respond to AI’s.

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Thanks for the reply, systemlord. I’ve read a lot of your posts lurking through the forums. Looks like a lot of people needing TRT don’t have high SHBG and are in the opposite position I am.

Side note: have you ever seen people get gyno from high prolactin?

Friday I’m going to re-do bloods with all the thyroid information I need and re-do TT, Free T, SHBG, E2, and Prolactin just for shits n giggles.

If you were in my position, what would be your next step?

PS. Here are my bloods for RBC, Hematocrit, and PSA. Used QuestDirect for these and don’t have the convenient layout.

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I had mid To low TT, super high shbg, low low free T and low estradiol. TRT has helped me but my numbers were worse than yours.

People supposedly feel better with free T on the high end of “normal” but since you aren’t super low you’re in a bit of a gray area to me

Is fertility a concern?

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I have similar bloods, just my free T is a little bit lower.

Your testosterone and free t are not low, but they are SUBOPTIMAL. Most likely you will benefit from TRT.

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That’s the part that bugs me…since TT is average, and my SHBG is high, I’ll be stuck at suboptimal Free T until my ranges go down even more. Do I jump on the TRT train now and live life to the fullest or do I continue on and maybe regret not being the best I can be in my 30s when I eventually have to get on anyways in my 40s.

Fertility is important, as I’ll try to conceive in the next 1-4 years. Right now my sperm count is good since I got it tested. If I jumped on the TRT train with HCG would I still be fertile?

God damn this issue sucks.

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What is your free T at? You haven’t jumped on the TRT train yet?

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Im in the same situation like you.

I also want to be fertile, but I dont wanna continue feel like shit.

I havent yes. But I will in 5 months. Im working on freezing sperm now. I have some small bacterial infection that needs to be cleared first. Also I will try HCG monotherapy before TRT.

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Gotcha. Respect you trying it all before taking the plunge.

For HCG mono, you’re going to have to skyrocket that TT to beat that high SHBG for free T. Have you read about any successes for those in our situation?

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I hope the SHBG will not rise but I think I will feel shitty from HCG mono.

Successes with it are rare, most people do not feel well on HCG.

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How old are you?

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30 and I dont have kids yet. Fertility is the only reason I’ve not started TRT yet but I plan to resolve this issue as well.

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When testosterone, estrogen, DHT and prolactin are out of balance, gyno will occur in those susceptible. The protocols with frequent dosing will push Total T and Free T high initially and keep it there while keeping estrogen lower which is what frequent daily dosing is all about.

I wouldn’t waste money on thyroid labs right now, TRT will demand more from the thyroid and you should test it a couple of months after starting TRT. I don’t expect you’ll find problems, but you never know. TSH almost always increase when you start TRT because demand is higher.

My TSH went from .6–>.9 on TRT.

As for your RBC, it isn’t higher than mine was, but HCT is a little higher which means frequent dosing is going to be more beneficial to you in keeping it from getting out of control. Careful about donating too often as you can crash ferritin creating iron deficiency.

Some will say HCT is unimportant and let it go where it wants, but I’m in the belief more pressure in the pipes the harder the heart has to work, most doctors will take action with HCT 54%>, but there are people at high altitude with very high HCT and live long lives.

We are all different is what I’m trying to say, I’ve seen men with HCT at 58% and no symptoms and others at 52% with symptoms.