Normal Test but High SHBG - Any Advice Appreciated

Pharma / TRT Testosterone Replacement
1

Hi All

Firstly can I say how good it is to find a forum like this. Only came across it last week but have spent some time here reading up.

Looking for some feedback. I noticed over the last few years, even though I really try to pay attention to my health and keeping fit…everything started to gradually go south! I am 49 years old.

Had a blood test last year & it came back with my SHBG high. So thought to study and try things, including my diet, to change this and test again in 3 to 6 months.

Just got my second test back and it confirms everything is pretty much the same and still have high SHBG putting my free test at the bottom level.

So I have read and read an think I have concluded that taking exogenous testosterone is probably the best and most elegant way of someone of my age to lower SHBG ( bearing in mind I have already had the snip and not looking to father any more children)

Does a simple protocol of 0.6ml (150mg testosterone) enanthate, split into twice weekly ( 2 x 75mgl) (1 x injection Monday - 1 x injection Friday) …look good ??

I have read so much about Clomiphene, HcG, AI…but at my age of nearly 50 I am wondering if the best and simplest treatment would be a simple weekly dose of Test Enanthate?

Any, and I mean any input would be greatly appreciated

Please see my results below:

The test results were taken about 6 months apart:

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Test%20result%201651×518 36 KB

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Thanks in advance and kind regards

2

This is a sensible approach guaranteed to keep levels from swinging. Your thyroid function is terrible, Free T4 is high and may hint at a conversion problem, Free T3 (not TSH or Free T4) speeds up every cell in your body soaking into your cells providing energy and if it’s low TRT will not work very well.

TSH increases when the pituitary gland detects less than optimal Free T3 in circulation, so when I see TSH above the median value, there can only be problems brewing. Reverse T3 is if high can block Free T3 in those with conversion problems. I do not expect TRT to show good results with your TSH above 3.0. and for the record your thyroid is not normal. Normal TSH is under 1.5 in 95% of the population for which most doctors are unaware and still using the old outdated TSH reference ranges.

TRT may in fact increase TSH as the demand is greater when stepping up the metabolic rates on TRT that will take borderline low thyroid function to the brink. I do not believe your doctor has the knowledge to treat your thyroid problem or TRT for that matter.

So if in fact you are having thyroid problems which I believe you are, thyroid medicine increases SHBG further complicating things requiring more T to suppress SHBG…

First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L [1-3]. On the other hand, upper TSH reference limit is (assay-dependent) usually around 4.2-4.5 mU/L. There is also an argument that significant number of patients (up to 30%) with TSH above 3.0 mU/L have an occult autoimmune thyroid disease

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group. Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter.

3

Hi Systemlord,

Thank you so much for your comprehensive reply. I did not know this, thank you. Some of your reply has gone over my head…so any advice you can give on how I can look to remedy this would be greatly appreciated.

I took the first set of results to the Doctor last week…he never even raised the point about the Thyroid levels. Could a poor acting thyroid also be causing my SHBG to be high?

So in summery are you suggesting I should look to address the thyroid before TRT? & if so do you have any recommendations?

Thank you again for your reply. It seems so hard to find any real constructive help. My GP hasn’t been any real help so far.

Just for info: I don’t smoke or drink alcohol, I try to eat very healthily, walk often, and get to the gym 4 times a week.

Kind regards
Jason

4

This is because most doctors even those who are so called thyroid doctors do not understand things very well. They were taught a certain way in medical school, doctors were taught TSH and Free T4 can tell you most of what you want to know about thyroid status.

Sadly I see men on T-nation with perfect TSH and Free T4 and abnormally low Free T3 and/or very high Reverse T3 that should see TSH elevated, but is not as it should be. Today we are dealing with endocrine disrupting chemicals in the environment and is more polluted than ever.

I am also seeing men with good thyroid labs, but every symptoms in the book, medical literature is showing people with normal thyroid labs showing improvement on thyroid medicine. Lab testing is still in the stone age as far as I’m concerned, it’s not good enough.

If anything thyroid problems lower SHBG, Free T3 speeds up every organ including the liver production of SHBG. You need further investigation of your thyroid, a thyroid panel is recommended checking TSH, Free T4, Free T3 (not T3), Reverse T3 and antibodies.

These days in managed healthcare it is challenging to find a good thyroid doctor that doesn’t fixate on lab ranges, but also considers symptoms when assessing the labs values. A lot of doctors are no good at spotting iron deficiencies which can cause thyroid problems, iron deficiencies can decrease the metabolism boosting properties of thyroid hormone.

It is for this reason I would also recommend an iron panel, ferritin, CBC and cortisol. The first three three are needed for determining iron status, the latter is needed for thyroid function as well.

Today doctors are under pressure to reduce healthcare costs often cutting corners and triaging people who are not dying, but are suffering being told we are normal by our doctors.

I had to go private and pay out of pocket to get the care that was not getting in a system not designed to prevent disease, but to sit around waiting for it, you just cannot get proper care under insurance HMO’s anymore unless you are dying.

If I knew you location, I know of a few private doctors, your other recourse is to Google anti-aging or sports medicine clinics in your area or even contact Empower and get a list of competent anti-aging doctors in your area. There are a lot of fantastic doctors who use Empower Pharmacy.

5

Systemlord,

Thank you again for this. I have done some reading since you posting about the Thyroid, and as you say there seems to be some disagreement and controversy about what levels are ‘normal’, as you suggest.

Okay, I will look to get these tested and put some focus on the thyroid issue.

I am in the UK. I have just found a Doctor about an hour away from me who seems to specialise in this kind of thing, so I am going to contact him and see if he can help.

If everything else is okay…am I right in thinking my suggested protocol would be the best long term solution if I have a naturally high SHBG?

I have read several studies that suggest the latest take is that strong androgens like testosterone lower SHBG, by lowering a hormone called adiponectin.

Am I about right in my thinking there Systemlord.??

Again, thank you for your help on this, you seem very knowledgeable on this matter.

Kind regards
Jason

6

Sure you’re welcome.

There is always Balance My Hormones in Dorset if this doctor doesn’t workout.

The correct treatment for high SHBG, high testosterone usually does the trick. As far as protocols some high SHBG men do very well on more frequent dosing because some men are hyper T metabolizers and works great to lower estrogen.

On average once or twice weekly dosing works great for high SHBG men, twice weekly eliminates any chance of the hormonal roller coaster from occurring. It can take months for SHBG to finely find a new lower level, often you’ll see an almost immediately decrease.

7

Thank you again for your concise & educated input, this is really helping clarify things for me. Testosterone does seem to be the clear long term answer.

Can I ask systemlord, in your experience, are there many medical benefits to also taking HcG with testosterone? I am 50 next birthday, have had the snip, and not looking to father any more children…so in my circumstances I am wondering if HcG has any clear medical benefit for me. I am just trying to get as clear an understanding as I can on all aspects.

I understand the mechanism of HcG and why people take it, but I have heard there can be downsides too?

I understand it is probably hard to comment on it, but I would certainly be interested in your opinion on it?

Kind regards

8

HCG does have medical benefit, HCG can support adrenal function, but in some men can negatively affect the adrenals causing symptoms. HCG can allow you to regain full testicular size, most see a 20-30% reduction in testicle size on TRT in isolation, others more.

Some men notice libido and mood benefits on top of increased testicle size on HCG, some notice the opposite, loss of libido and mood. I recommend starting TRT in isolation, dial-in and add HCG laster if you want, but adding two different compounds at once can make dialing in TRT difficult.

Your Free T being in the basement and Total T slightly above mid-range, it would be prudent to start out Sustanon 180mg once weekly and then retest after 6 weeks. I forgot you’re in the UK, Sustanon is more than fine to inject once weekly, unless if using enanthate, then twice weekly is fine if wanting to lower estrogen.

Do yourself a favor, use 1ml 27-29 gauge insulin syringes or if having difficulty getting all the Test into one syringe, 3ml 25 gauge syringes, anything larger is self torture.

9

Sytemlord…you are a star and a godsend in this complicated world, thank you so much for your advice!

Men get little to no help with this on the NHS in the UK…even though women have been having HRT for decades, you would think they would be on top of this tome some degree now, I guess they are just not interested and want to avoid the cost too. It is a great thing that chaps can come together and help each other on forums like this.

Thank you again, your advice makes so much rational sense.

10

your situation very similar to mine
i hope you find what you are looking for friend
there is a place called mans health clinic in the UK worth to contact

11

Thank you for that bikerg, will take a look.

I think after studying all the data, and advice on here from systemlord, a weekly injection of testosterone is the way to go to lower SHBG & free up some testosterone. At present I have the free test of a 65 to 75 year old…which is not what you want at 49.

I am finding this forum a great resource for guys in our situation.

more power to you too bikerg
Kind regards
J

12

i find the issue is we present symptams of low testosterone but on paper our numbers are OK for example my total is 500 whic is actually good my doctor said i was ok although my FREE t is identical to yours, at 0.2 and recently 0.24

i am right now seeing if my thyroid is improving things like now with selenium and iodine…

you are 49 i am in my thirties, still it is very bad for either of us, why live with free testosterone that is of an old man?? is that how we want to spent our lies? from 30 onwards our testosterone drops year by year so things will not improve… only get worse ! ! we only get one life ! but still i am very very hesistanting of starting trt i wish there was a natural solution i pray to god there was to not inject for life… but as i look more and more i feel there is only one answer to this issue.

did you try Boron, Nettle root (not leaf) and vitamin D supplementation, Zinc, Magnesium? this is what t nation recommends i see it alot…

i live in europe if you are in england i would go to see mens health clinic in dorset as systemlord says and let me know what happens … i am interested because we are similar please let me know what you do and what happens…

13

Hi bikerg

Yep it is not good at all, and as you say why live like an old man!

I know what you mean, I have been very hesitant, and still am to some degree, but testosterone is natural really and seems the way to go.

I eat well & look after myself. Yes I take Vit D, Zinc & Magnesium…I have also tried Boron. I have just ordered some more Boron as that seemed to have some mild effect, but I have heard it is not sustaining.

I am 50 next birthday and the idea of clinging to my natural state, at these levels, seems to make no sense. have been watching a series of videos by a US Doctor - Dr Rand McClain, he makes a lot of sense. As he said in one of is videos…this idea of ‘clinging on’ or trying to keep your natural production, if it is low and not making you feel good, and you are only going to get older, then what is the point of trying to cling on to it.

Different for us all I know, and you are younger than I.

I feel the same way as you bikerg. I wish I didn’t have to start injecting myself, but think this is the only way to go now…and the benefits are many I believe.

Best
J

14

did you decide on trt do you have update

16

Hello friend
I am considering trt still
Are you feeling any less tired or better mentally?
Does your libido improve at all?
My worry is that I feel the same on TRT as now because my total T is decent And replacing something ok with hassle

Did you get any blood work yet?

17

Hi bikerg

Yes feeling much better to be honest. The core problem of HIGH SHBG is the thing to tackle. I have been to see a Dr Savage (ace name)…such a nice guy & will be working with him.

I have tried Proviron (2 x 25mg per day) this binds to SHBG & seems to work well, it does work and increases the libido quite well.

Dr Savage has prescribed me Danazol - 100mg every other day. I will be trying that next after I have finished this run or Proviron.

bikerg…go read this study/Patent on Danazol and TRT therapies, it is very in depth and comprehensive. It is well worth a read and gives very good and positive results in lowering SHBG:

https://patents.google.com/patent/EP1079836B1