I’m hoping you can help with some interpretation of my blood results. Any guidance would be helpful.
About me
Male
37 years old
6" 2
195lbs
20% body fat
Cycle: Haven’t touched steroids in 10 years, even then it was a one time anavar only cycle (I know, idiot!)
Activity: Lift twice sometimes 3 times a week if I can. No cardio at the moment.
Diet: Reasonably healthy, very limited junk food, mostly whole foods. Not following a diet a the moment. I don’t drink (haven’t seen I was about 21) and I don’t smoke.
Symptoms: Low libido, irritability, lack of enjoyment from things, weak erections, no morning wood.
I’ve suffered from the above for a number of years, I actually can’t remember ever not having these issues. Over the years I’ve gone to GPs complaining of my symptoms, only to have me do the standard testosterone test which would always come back high, exceeding the range each time. I’d get dismissed and be told it’s depression or psychological.
In 2016 I did a little research and ended up going to see private health clinic that specialised in hormonal conditions. I had bloods taken which showed again high levels of total testosterone, but also super high estrogen and SHBG. The doctor put me on aromasin to reduce the estrogen which eventually brought my levels within normal range. My testosterone dropped a little too as did SHBG. She mentioned I could have ‘testosterone resistance(??)’ and suggested I take HGH (genotropin) to improve my IGF-1 number which was also in the gutter. At the time I believed my low IGF-1 was due to the fact I intermittent fasted but she dismissed this. After sinking a huge amount of cash for 4 months on HGH I decided to cut ties with the clinic as I felt they were just trying to sell me medication. HGH just left me with good skin and made me tired most of the time!
Not being happy with the diagnosis I had, I went to an endocrinologist with my bloods. He didn’t seem to know an awful lot about IGF-1 but suggested we do scans on my liver and testicles to check for tumours. He also repeated the blood tests. No issues with my liver or testicles and the blood results showed elevated test, SHBG but estrogen had come down. Even though the test and SHBG was elevated, they had come down a little bit to just above normal range. The endo’s conclusion was that some people are just made this way and didn’t think I had a problem.
Fast forward to present day and I thought I’d see where my numbers are. Low and behold my SHBG is at a all time high, test is also high and estrogen is back up again! I noticed my prolactin level is also a little bit on the high side, although in normal range.
I’ve booked to see Dr Doug Savage and see what his interpretation is and next steps. I’d love to get some kind of idea from you folks on here what you also think it could be. You can see that actually my bio-available T seems to be okay. I’m so confused. I have symptoms of low T and numbers look bad but then bio-available looks good?!
Testosterone resistance isn’t your problem, the problem is your liver is producing too much SHBG. The causes are many, some believe it may be a chemical in the environment, sometimes it’s just genetic. SHBG scavenges sex hormones and when elevated will choke your free testosterone into oblivion, your only hope is large weekly injections of T, you’ll likely need supraphysiological doses of T to push SHBG down to a lower level.
There lies the problem, insurance doctors typically don’t allow supraphysiological doses, insurance companies have set a limit at 800 ng/dL and for this reason you may need to go private. I don’t understand how your doctor arrived at testosterone resistance, you barely have any bioavailable or free testosterone circulating in your body. The bound hormone (Total T) is useless to the body.
When your pituitary gland detects low levels of free testosterone do to the SHBG binding it all up, so the pituitary gland starts pumping LH hormone in an attempt to get the testicles to increase testosterone production in order to increase free testosterone.
Sadly your pituitary gland will never be able to force your testicles to produce enough testosterone to compete with your very high SHBG.
TSH and Free T4 really doesn’t show a complete picture, Free T3 is the active free hormone and it’s not tested. Reverse T3 can block Free T3 at the receptors if elevated. It seems this doctor isn’t testing Free T or Free T3 hormones, these are the more important tests as a bound up hormones are unavailable to your bodies tissues.
A lot of doctors will struggle in understanding of male hormones. I was forced to go private as insurance based healthcare is in short supply of hormone specialists. None of my endo’s knew what to do or how to manage my symptoms and seem disinterested in treating me.
I thought in my latest bloods the free/bioavailable test (calculated) looked good? Seems like it’s in the middle of the range? Am I reading this wrong?
These ranges are the population at large, not you specifically. I can tell you with my free testosterone midrange I fell like death, only after increasing free testosterone to high normal do I feel good.
GPs aren’t normally trained in hormone therapies let alone being able to properly diagnose them and this is why you were brushed off as suffering from depression without realizing the cause could be from a low hormone state.
We all know low thyroid function and low testosterone can cause depression, instead men, women are scripted SSRI’s instead of thyroid hormones. In this case an SSRI is like slapping a bandaid on a bleeding wound, it may slow the bleeding but you are still bleeding.
Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.
KSman is simply a regular member on this site. Nothing more other than highly active.
I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.
The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.
I’m low SHBG so I must inject smaller doses (20mg) EOD, you on the other hand are going to need more androgens to decrease SHBG. I’m for stability so I would recommend T-cyp 70mg twice weekly retest in 6 weeks.
[6 weeks retest]
Total T
Free T
SHBG
E2 Sensitive LC/MS/MS method
I’ve edited my first post and they now have ranges. I also got further blood work done today and spent an absolute fortune doing it. I’m now waiting on:-
FBC
DHT
LH/FSH
free T3
free t4
Iodine
Iron
Pregnenolone
Vit-D
Magnesium
Zinc
Selenium
Thanks again for everyone’s help. Even though TRT might be the solution, I’m just worried there’s not something more sinister going on. My LH and FSH seem on the high end yet which I’m guessing you wouldn’t expect if I was producing the kind of test results that I am - it’s like they’re constantly producing more??
I have some interim bloods back. These were taken around midday, not sure if that makes any difference. LH is standing out again.
I was wondering if my ADD medication is having an effect on my LH? It’s called Elvanse (Vyvanse in US) and is Lisdexamfetamine.
I haven’t tested my temp as yet because I wanted to do 3 days in the row and I’m flying to the US today so figured I’d be jet lagged and wouldn’t give an accurate reading.
Final set of labs in…
From my basic view, these all look within range. Any advice given all these labs are now done - only thing left is to do my temp which I can do now that I’m back in the UK
@KSman - I’ve got most of the bloods you mention in your sticky. I would really value your opinion.
Your pituitary gland senses low free testosterone and is cranking out LH to make more testosterone in the testicles to get free testosterone to increase. So your pituitary gland is strong and responding accordingly, your liver is ruining everything by pumping out too much SHBG.
Your negative feedback is working well, it will never be enough to compete with the livers output of SHBG. It’s out of control.
Ah got it. Thank you. So the idea that I’ve got some pituitary tumor is pretty low. I had an ultrasound on my liver in 2016 and couldn’t find anything suspicious.
An AI would help to bring down the estrogen which in turn would bring down SHBG but likely not down by much?