T Nation

1.5 Years Chronic Pain, Low T, High SHBG, Low E After Minor Car Accident


#1

I appreciate everyone taking the time to weigh in here. Around a year ago I was in a light whiplash accident - from two weeks on after that, everything seemed to start going ‘downhill.’ I developed chronic nerve type pain in my lower right leg and left shoulder blade. Without fail it has come on every day. I’ve had the whole run of MRIs, EMGs, etc. yet none of the results really pinpoint what’s going on. I got on Gabapentin 300mg 2x/ day for about 3 months but felt like an utter zombie.

Symptoms related to Low T for me: extremely low libido, no morning erectors, chronic inflammation (high d-dimer blood tests yet not blood clots), loss of ‘spunk’ for most things in life, weight loss despite working out.

Finally, my GP decided to run some serious blood tests on me - turns on my T was very low. He sent me to a male hormone specialist who spent a ton of time with me, re-ran my numbers and these came back:

Testosterone: 364 (old blood tests of mine show levels around 510-650, those were taken about 18 months ago)
Free Testosterone (Direct): 5.0
LH: 2.2
FSH: 2.7
Prolactin: 5.2

My testosterone level dropped (I think due to a concussion from my head hitting the seat). I’ve lost major libido and find myself getting injured frequently. To put this in perspective, prior to the accident I was playing competitive ice hockey 5x/ a week.

I’m on 100mg Test cyp but my libido has yet to return. Any thoughts?

My most recent labs were:

TSH 1.77 mIU/L 0.40-4.50

T4(THYROXINE),TOTAL 5.9 mcg/dL 4.5-12.0

ESTRADIOL 33 pg/mL < OR = 39

C-REACTIVE PROTEIN <0.2 mg/L <8.0

TESTOSTERONE FREE 65.2 pg/mL 46.0-224.0

TESTOSTERONE BIOAVAILABLE 153.8 ng/dL 110.0-575.0

SHBG 48 nmol/L 10-50

Please let me know what other numbers would help!


#2

Your FT is low because SHBG is high, you need large weekly injections in order to suppress SHBG down to where you can increase your FT. TSH isn’t optimal and anything past 2.0 starts becoming a problem, you want to be closer to 1.0. Where’s your Total Test scores?

You will require an AI to suppress excess E2 conversion as you are already at the limit, if E2 gets high it will feel as if you are not on TRT at all. Be aware it can take up to a year for libido/erection to be fully restored, I’m 8.5 month into TRT and my progress has been slower than most. You need more thyroid hormone tests checking fT3, rT3 as fT3 is the active thyroid hormone, high rT3 will block fT3 hormones and TSH is expected to rise.

Please include lab ranges, in any case LH is low so T is expected to be low. You might want to freeze some sperm before TRT, it will greatly lower LH and FSH to near zero. Injecting HCG will improve fertility chances while on TRT allow keep testicles from atrophying. You need to have doctor increase you T dosage. You might be able to get away with two large injections twice weekly, but some High SHBG guys feel fine on large weekly injections.

We normally get our reliable FT scores by calculating our TT, SHBG and Albumin using an SHBG calculator. You need to detail your protocol, do you inject 100 mg once weekly? When did you start TRT?



#3

Thank you for the quick reply. I hope some of this helps:

I began Testosterone treatment at 100mg/ weekly in September 2017.

More labs, with included ranges:
Testosterone, Serum 731 ng/dL 264-916 01
WBC 7.3 Thous/mcL 3.8-10.8 TBR
RBC 4.26 Mill/mcL 4.20-5.80 TBR
HEMOGLOBIN 13.7 g/dL 13.2-17.1 TBR
HEMATOCRIT 41.5 % 38.5-50.0 TBR
MCV 97.5 fL 80.0-100.0 TBR
MCH 32.2 pg 27.0-33.0 TBR
MCHC 33.1 g/dL 32.0-36.0 TBR
RDW 13.5 % 11.0-15.0 TBR
PLATELET
COUNT
217 Thous/mcL 140-400 TBR
MPV 9.5 fL 7.5-12.5 TBR

Estradiol 9.7 pg/mL 7.6-42.6 01


#4

All your numbers look excellent with the exception of E2, your E2 is way too low. Low E2 is dangerous for bones, organs and your health, E2 needs to be in a tight range between 20-30 pg/mL. If it falls out of these range libido and erections will suffer, most doctors completely ignore E2 testing and this is the reason why you hear about guys who are on TRT and don’t feel the full effects of TRT. I don’t understand how you TT can be towards the high range and still have low E2…?

Your E2 problem is why you are here seeking help, no libido/erection will happen as long as your E2 is low. The only way to increase E2 is more testosterone, are you on an AI? If so decrease AI dosage a little bit. Make sure your doctor orders the correct E2 labs Sensitive LC-MS/MS which is for males, most doctors order female E2 tests on guys. This is a mistake.


#5

My most recent Estradiol test showed this was not the sensitive one):

ESTRADIOL 33 pg/mL < OR = 39 TBR

The only marker that was “out-of-range” was:
ALBUMIN,SERUM 5.2 High g/dL (3.6-5.1)


#6

Forget about E2 until you get the correct one, it’s pointless to go by a female E2 test. Based off your numbers your FT is below. Normally you want 2-3 percent for FT, your FT is low. If your sensitive E2 labs show anything below 20 pg/mL you need to increase your T dosage.

Free Testosterone 11.8 ng/dL = 1.62 %
Bioavailable Testosterone 332 ng/dL = 45.5 %


#7

I wanted to post the results from my December physical (keep in mind I’m going to get more bloodwork next week) just to see if any of this helps
As a FYI - I take a once monthly Cyanocobalamin shot (1000)


#8

Sorry to double post but heading to the doctor today and wanted to offer any feedback you all had on my labs, to him.


#9

You said they did an MRI and it came back clean. But is there any chance that your accident did some minor, barely-detectable damage to your pituitary? If so that could be a source of the problem. There seems to be a connection between your accident (head trauma) and your symptoms, no?


#10

You only have half the thyroid labs needed for proper diagnoses, T4 is low, FT low and SHBG high. You need at a bare minimum fT3, rT3, T4. Don’t pay any attention to directly measured FT, calculate TT and SHBG = 13 ng/dL = 1.78 %, 2-3% is normal and you’re under it. LH is low TT is expected to be as well.


#11

@iron_yuppie and @systemlord

I had a brain MRI but NOT a pituitary one. Next week I get the pituitary one but it was ordered without contrast (from what I’ve read it seems that maybe I need one with contrast?)

I have asked my doctor to subscribe more of those labs - quick question for you and I’m sure there is a sticky on it - can I ever order those on my own?

Beyond the ‘bare’ minimum - what else would you add there?

Thanks again .


#12

The most important is fT3 and reverse T3, these would make a guy hypothyroid if either or both were out of range even if T4 is optimal. You can have low T4 and high fT3 in the same way you can have low TT and high FT. Free hormones are always telling you what is going on.

Low T4 and high fT3 means you convert T4–>fT3 efficiently, some simply don’t and are hypothyroid. Most are unaware and large percentage in USA have subclinical hypothyroidism.

I have midrange T4, low fT4, midrange-high fT3 and TSH .580. I’m 97.8 upon waking and 98.7 mid afternoon, I fall asleep 11-11:30 every night and wake consistently every morning 7-8:00am every morning without any alarm. This is a hallmark of a good functioning thyroid.


#13

I’ve had only one MRI with contrast and that stuff made me feel like I’d been hit by a bus made of smaller, pointier buses. I would say that between the MRI and new blood panels you’re going to find an answer. Best of luck to you.


#14

@systemlord @KSman

Sorry to tag you two but just got a big load of test results back with some things that are concerning to me. As a reminder - low libido, 100mg test cypionate done once weekly. Pain (left shoulder blade, foot) following a minor car accident where I did hit my head hard

My number, followed by range in ( )
CRP .44 (0-3)
Vitamin B12 900 (232-1245)
Creatine Kinase 378 HIGH (24-204)
Amylase, Serum. 78 (31-124)
Hemoglobin A1c 4.7 LOW (4.8-5.6%)
T4, Free Direct .96 (.82-1.77)
DHEA 406 (31-701)
Growth Hormone .8ng/ml (0-10)
Progesterone .3 (0-.5)
Prolactin 12.1 (4-15.2)
Estradiol 17.4 (7.6-42.6 pg/ml)
Estrone 65 (12-72)
Ferritin 104 (30-400)
TPO Ab 18 (0-34)
IGF-1 111 (88-246)
Apolipoprotein A-1 187 HIGH (101-178)

Thyroid Profile
TSH 4.6 HIGH (.45-4.5)
T4 4.6 (4.5-12)
T3 Uptake 29 (24-39)
Free Thyroxine Index 1.3 (1.2-4.9)
T3 54 L LOW (71-180)

LH .1 LOW (1.7-8.6)
FSH LOW <0.2 (1.5-12.4)
SHBG 42.7 (16.5-55.9)
Test, Serum 1251 (264-916)
Free T (Direct) 31.4 (8.7-25.1)

Reverse T3, Serum 26.9 HIGH (9.2-24.1)

Vitamin D 56.1 (30-100)
Dihydrotestosterone 51ng/dl

Free Insulin 1.3
Total Insulin 1.3


#15

Just making sure this posted - any thoughts?

Sorry to tag you two but just got a big load of test results back with some things that are concerning to me. As a reminder - low libido, 100mg test cypionate done once weekly. Pain (left shoulder blade, foot) following a minor car accident where I did hit my head hard

My number, followed by range in ( )
CRP .44 (0-3)
Vitamin B12 900 (232-1245)
Creatine Kinase 378 HIGH (24-204)
Amylase, Serum. 78 (31-124)
Hemoglobin A1c 4.7 LOW (4.8-5.6%)
T4, Free Direct .96 (.82-1.77)
DHEA 406 (31-701)
Growth Hormone .8ng/ml (0-10)
Progesterone .3 (0-.5)
Prolactin 12.1 (4-15.2)
Estradiol 17.4 (7.6-42.6 pg/ml)
Estrone 65 (12-72)
Ferritin 104 (30-400)
TPO Ab 18 (0-34)
IGF-1 111 (88-246)
Apolipoprotein A-1 187 HIGH (101-178)

Thyroid Profile
TSH 4.6 HIGH (.45-4.5)
T4 4.6 (4.5-12)
T3 Uptake 29 (24-39)
Free Thyroxine Index 1.3 (1.2-4.9)
T3 54 L LOW (71-180)

LH .1 LOW (1.7-8.6)
FSH LOW <0.2 (1.5-12.4)
SHBG 42.7 (16.5-55.9)
Test, Serum 1251 (264-916)
Free T (Direct) 31.4 (8.7-25.1)

Reverse T3, Serum 26.9 HIGH (9.2-24.1)

Vitamin D 56.1 (30-100)
Dihydrotestosterone 51ng/dl

Free Insulin 1.3
Total Insulin 1.3


#16

I’m pretty impressed with those Test numbers considering your SHBG is so high and you Cypionate dosage at 100mg weekly. Nice numbers. Your estradiol is to low and they are giving you the wrong Estradiol test. Could certainly be causing low libido issues. Are you using arimidex? If so you should probably back off a little. You GH is low and you would surely benefit from increasing that. When was this test performed in relation to your injection?


#17

This test was performed on the last day before my injection (5 days after)

I am not on armidex. I am definitely concerned by my high Reverse T3 numbers (which could explain my chronic pain)

Perhaps my issue was never low T but a thyroid issue causing low T?

Any suggestions for increasing my GH level


#18

https://www.empowerpharmacy.com/sermorelin.html


#19

Any thoughts on the T3, etc?


#20

Kindly checking in again on these labs …

@systemlord