T Nation

2.5 Years on TRT and Never Got Better

Any ai? You need to stop taking that. Control e2 with lowering dose. If you free t is good you can lower dose

No AI

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Get thorough labs as described above.

Add vit B12 and folate.

Being deficienct in these 2 vitamins means something else can be wrong as well

The OP is not a competitive athlete, it is the experienced of the OP that TRT isn’t working and the reason is probably as I stated. We see low SHBG men all the time with similar problems and those majority start seeing results when inject smaller frequent doses.

More complete testing is needed though, there could be thyroid or mineral deficiencies which could explain these problems, but I still think the protocol isn’t appropriate. I think daily dosing should be attempted before spending big bucks on lab testing, it just might resolve a lot of these issues.

OK, my guess is that your free test level is pretty good, given SHBG of 17. Did you have albumin checked?

As systemlord stated, I think you really want to have your thyroid evaluated. Assuming it is fine, I think I would increase my dosage if I am you. You doctor does not sound like he will help. Some guys need higher doses to feel right and like we shouldn’t fixate on a number when it is 500, the same goes for 1500. I’m not sold on the necessity of daily injections either, though I see no harm.

My SHBG is 19, and 200mg once a week put me a 900 and 278 last time.

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Who is “we”? Where are these low SHBG men?

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Please excuse me, “I see”. I probably spend more time on T-Nation than most do.

I only ordered the female panel on privatemdlabs. Doesn’t do freeT or really anything else. I don’t want to drop a ton on blood testing if I don’t have to.

Understood, will your doctor order thyroid for you?

He likely would. I had it test a while back but don’t have the results and the doc said it was “normal”

Probably more than everyone. I’m talking about people I know personally, with and without supervision. Most are taking 150-200mg once a week and doing great. They are not on the internet. Many have low SHBG levels and inject once a week.

I believe there are outliers here, guys struggling on TRT resorting to the internet for help and answers.

Most doctors still believe TSH reference ranges are normal, they are not normal. Doctors still use the old ranges. The TSH reference ranges were compiled from second generation TSH testing, when third generation testing came about, they discovered the population that increase the mean TSH level was contaminated with people who had thyroid dysfunction invalidating the references ranges.

The question is when are the doctors going to pull their head out of their… Doctors are not overly concerned with low normal levels even though symptoms may be present, doctors are taught that in range is normal and the ranges they use to determine normal status are not normal.

Reference ranges for TSH and thyroid hormones

Though TSH remains the most commonly used endocrine test in clinical practice, the issue of an appropriate TSH, and to a lesser extent, free T4 and free T3 reference ranges is still under debate. 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.

The evidence for a narrower thyrotropin reference range

Intimately related to the controversy is the definition of the normal reference range for TSH. 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.

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See if you can get those results. Better than nothing.

Maybe look into depression. Sometimes TRT fixes depression and low energy, sometimes it doesn’t.

Everybody has different experiences with TRT. Some people find that they have better drive in life, some don’t. I would not expect it to fix all your problems.

I agree with systemlord here, Ive seen so many guys struggle with TRT when they have low shbg. They switch to daily injections and soon enough things start working.

Im low SHBG and my penis just dont get hard on 1-2 weekly injections.

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@systemlord does SHGB ever change with T dosage while on TRT? I’ve never been tested for SHGB and am curious if my current protocol will alter my SHGB

I’m gonna have to sit down and read that a couple more times. After reading once I have no idea what any of that means. Thank you for posting!

It’s not exactly what you’re asking, not sure various protocols have been studied, but it’s commonly accepted that SHBG decreases with TRT.

My SHBG increased on TRT, pre-TRT SHBG was 14 and on TRT it was 22. The reason is insulin resistance is suppressing SHBG.