On the fence about starting TRT: Healthy Total T, High SHBG, Low Free T, High FSH

Hello T Nation folks!

Hoping for guidance as I’m considering starting TRT after a few years of gradually worsening Low-T symptoms with blood work over the past 3-4 months that confirming it. Typical Symptoms: Low energy, easily fatigued, no libido, ED, building/maintaining muscle despite same training/nutrition, poor recovery, mood/anxiety/depression, poor sleep.

After seeing the first tests horrendous results I ready through this forum and the other TRT forums to learn all I could. I’ve seen many of the High SHBG/Low Free T posts/new user cases, and consensus seems to be split. Is High SHBG the egg causing the low Free T chicken or vice versa? So I almost hesitated in posting this but everyone’s case/profile is different so went ahead. During the past 3 months, to avoid TRT as a last result, I’ve tried to attack this problem naturally by optimizing diet, sleep, training, and lifestyle but up until yesterday the monthly bloodwork showed virtually no progress.

Last week I met with an Endo and now have a script for 100mg/week of Test C on a 2x/week protocol but paused yesterday when my last blood results came in and I finally saw progress in the critical areas: SHBG, Free T, unbound androgens (although FSH is still sky high.)

At this point I’m weighing hitting the TRT easy button to hopefully start being able to live life again and not feel like everything is wading through a swimming pool versus giving this natural experiment more time for symptoms improvement and some objective numbers ultimately reaching at least the mid- to upper mid range numbers (Free T 15<, SHBG down to 30ish etc.)

Understanding TRT is not actually an easy button but a lifelong commitment and diligence I’m cautious to jump in until I’ve ruled all causes out so went all in on the Marek labs, posted below. Here’s other info:

Quick bits:
• 43 yo. 5’8”, 160lbs, 15% BF.
• Diet: Pretty dialed-in Protein 20%, Carb 45%, Fat 35%. Intermittent Fast 16 hours avg.
• Sleep: Decent 6-7 hours/night. No Sleep apnea (AHI only 2)
• Exercise: Lift 2x/week. DL’s, Squats, compound etc. for 45-60mins. Walk 3-4miles or Zone 2 cardio 2-3x/week. Was doing lifts at 0-1 RIR level intensity but eased up recently to rule out overtraining.

10/30 Blood Test (Free T via Equilibrium Dialysis)
• TT: 680 ng/dl (ref range 264-916)
• FT: 5.4 ng/dl (ref 52-280)
• FT%: .8% (ref 1.5-3.2%)
• DHT: 53 ng/dl (ref 30 - 85)
• Free DHT: 1.8 pg/ml (2.3-11.6)
• Notes: 11/10: Cut daily fluticasone nasal spray (apparently raises SHBG)

11/25: (learned about SHBG’s role binding Free T, Free DHT, and E2, included)
• TT: 673 ng/dl (ref range 264-916)
• FT: 4.7 ng/dl (ref 52-280)
• E2: 13.3 pg/ml (ref 8 – 35)
• DHT: 40 ng/dl (ref 30 - 85)
• FDHT: 1.44 pg/ml (2.3-11.6)
• SHBG: 87 nmol/L (ref 16.5 – 55.9)
• Cortisol: 13.3 ug/dl (ref 6.2-19.4)
• LH: 6.2 miU/ml (ref 1.7-8.6)
• FSH: 14.3 miU/ml (ref 1.5-12.4)
• Prolactin: 6.2 ng/mL (ref 3.9 – 22.7)
• Progesterone: 0.3 ng/ml (ref 0-0.5)
• Notes: 11/25 started Boron 6mg/day, Tongkat Ali 100mg/day to knock down SHBG.

11/30: Full metabolic panel, liver (SHBG cause?), thyroid…
• TT: 653 (ref 264-916)
• FT: 6.5 (ref 52-280)
• E2: 15.7 (ref 8 – 35)
• DHT: 46 (ref 30 - 85)
• FDHT: 2 (ref 2.3-11.6)
• SHBG: 84.5 (ref 16.5 – 55.9)
• Cortisol: 10.4 (ref 6.2-19.4)
• LH 4.8 (ref 1.7-8.6)
• FSH 11.6 (ref 1.5-12.4)
• Prolactin: 5.4 (ref 3.9 – 22.7)
• Progesterone: 0.3 ng/ml (ref 0-0.5)
• TSH 2.6 uiu/mL (ref .450-4.5)
• FT3: 3 pg/ml (2 - 4.4)
• FT4: 1.39 ng/dl (ref .82-1.77)
• DHEA Sulfate: 346 ug/dl (ref 103-416)
• IGF-1: 164 ng/ml (84-270)
• Insulin: 3.2 uiu/ml (2.6 – 24.9)
• Ferritin: 111 (30-400)
• Vitamin D: 82 ng/ml (30-100)
• AST: 33 (0-40)
• ALT: 28 (0-44)

12/30
• TT: 601 (ref 264-916)
• FT 6 (ref 52-280)
• E2 10.7 (ref 8 – 35)
• DHT 36 (ref 30 - 85)
• FDHT: 1.84 (ref 2.3-11.6)
• SHBG: 88 (ref 16.5 – 55.9)
• Notes: starting 1/1 Boron upped to 12mg/day. Cut all lifting and only exercise was walking daily for 3-4 miles) to rule out overtraining.
Sleep improved to about 9 hours/night during this time over the previous ~7/night.
o Cut out Alcohol (was previously only 1-2x month around 3-4 drinks)

1/22: added more Thyroid to rule out as that as cause
• TT: 609 (ref 264-916)
• FT: 7.9 (ref 52-280)
• E2 9.9 (ref 8 – 35)
• DHT 38 (ref 30 - 85)
• FDHT: 2.17 (2.3-11.6)
• SHBG 67 (ref 16.5 – 55.9)
• Cortisol: 13.6 (ref 6.2-19.4)
• LH 4.9 (ref 1.7-8.6)
• FSH 11.4 (ref 1.5-12.4)
• TSH 3.1 (ref .450-4.5)
• FT3 3.1 (2 - 4.4)
• FT4: 1.53 (ref .82-1.77)
• Thyroid Peroxidase (TPO) Ab01: 31 (ref 0-34)
• Reverse T3: 21.7 ng/dl (ref 9.2-24.1)

So my levels are still really poor, but I’m encouraged that SHBG dropped, Free T jumped while Total T remained the same, and free androgens all increased but still looking at that high FSH number.

Should I give the natural attempt a few more months or start the TRT?

I realize this is a lot of info and appreciate any insight into the data and advice from the community.

These results are just snapshots in time. You are going to see fluctuations caused by many variables. But the commonality is the results are not great.
Personally I would start TRT. Your not getting any younger. If you were very overweight your levels could improve with weight loss but at your weight dropping a couple percent is not gonna be a game changer.

On a side note you say your diet is dialed in but and you may be eating great but not a fan of your macro distribution.
What are your daily cals?

Thanks for taking the time and thoughts. My thoughts are, if there’s this benchmark of “Feeling Good” at around Free T of 15, T:E Ratio is x, etc. then maybe I just need 3-5 more good months to get back to that level but as you said I’m definitely not getting younger. So even reaching that objective benchmark might still be on the borderline of good/crappy and at some point the age might just be too much to sustain. However, I still have the urge to see if I can push hard enough to reach it on natural terms and have the TRT as insurance policy. I’m just wondering if others have been in similar situations and how that worked out.

I’m at about maintenance, 2300-2400 calories roughly. What are your thoughts around that?

There really is no benchmark. Achieving certain numbers/ratios really means nothing in the real world. Once you start you just need go off how you feel and balance(if needed) with your bloodwork. Some guys struggle to find a protocol as they are chasing numbers instead of what feels best to them.
Advice if begin, start low you can always raise your dose. It’s a mindfuck if you start at 200 and you feel great but need to lower.

As far as you diet goes you really need to get more protien in.
Your only getting about 110g protien at 20% of your caloric intake.
At bare minimum you need 1g per 1lb of lean body mass. For you at 160lbs and 15%bf that puts your lbm at 136lbs. That is the bare minimum protien you should be consuming. 136g.
I always recommend 1.25xLBM for anyone that wants to build muscle and have a lean physique. For you that would be 170g(680cals) protien per day.
I also like to set fats at .3 to .35g per lb of LBM. That puts your fats at 41-48 or 369/432 cals coming from fats. Once you have those numbers nailed down you would fill up the rest of your caloric ration with carbs.
So for you it would look like this
136lb lbs x 1.25= 170g protien/680casl
136lb x .35= 48g fats/432cals
1112cals so far now carbs.
2400-1112=1288carbs(322cals)
This would be a baseline diet for me. I would adjust macros per my goals.

Your numbers are nearly identical to mine. I started TRT 15 months ago and feel incredible now. I started at 140, but that put me lower then natural so we bumped up to 160mg/week

Good advice. That was my thought as well. Easing up dosing.

I’m going to try to raising protein and carbs a bit closer to your suggestions although seems like when I bring fat lower than 30% of daily I start to feel off. Probably worth a change as reading higher protein lowers SHBG as well. Thanks man

If you like higher fats I would adjust protien way up and carbs down then.
Whatever works best for you. My main point is your protien needs to come up. Play with the other macros to hit your goals/lifestyle.

Which pieces of the numbers were similar to yours? Do you mean the High SBHG, High FSH or the Total T/Free T ratios?

It’s great to hear people have life changing experiences. Another thing I’d like to do if possible is if I do start the TRT shorten the time it takes to dial it in.

The other issue that is keeping me guessing is the persistently high FSH levels. LH seems to be mid range (healthy?) while FSH not moving much leading me to think primary hypogonadism culprit where TRT is only solution. If it’s a case of brain recognizing the need for more T production but the nuts just not producing. But why wouldn’t LH also be high?

Will plan to do that whether start TRT or delay that for a bit longer.