Men,
So late on reply here…
Here is the background. I am now 43 yrs. old. From summer 2014 to summer 2015, I was in a high stress accelerated military grad program. I ate all of my meals (~3600 cal/day on average) and never missed, but my training was much less frequent. Lots of sleep deprivation. Took 10+ days on average to get through my 5-day training split. Problem began ~summer 2015. I’d been tired and not recuperating very well for some months and finally in Nov 2015, I demanded my doc run a full endocrine panel. Even though my SHBG was like 2X the normal limit and ALT was moderately high, since I am quite muscular, he kept saying “look at you” and insisted everything was fine,. Because I beat my chest at him about how I’ve been decreasing in recuperation and energy in the last several months and not linearly w/time, he referred me to an endocrinologist who’s helped me pull tons of blood work to try and nail this down. The endocrinologist has been a godsend and helped me pull 13 comprehensive panels during this time.
Before I get started here, for the guys who feel like 1 million bucks and are natural, but thinking about supplementing exogenous T or anything like that, be sure that you go and get a comprehensive baseline right now. You can see how wide the normal range of most hormones is considered to be. As long as most of your values are somewhere in these intervals, most doctors will not help you. I might be captaining the obvious, but I sure as hell wish I’d done a baseline when I felt great to know what normal looks like for me. Don’t be me.
To the question - I have tried almost every supplement on the list to drive down SHBG and ALT, including calcium D glucarate, to seemingly no result. Tongkat ali, etc…none helped. Used tongkat for 6 weeks. Did before and after panels and gave each supplement at least a good 4 weeks to take effect. I take no prescription or over the counter meds – no NSAIDS, etc. No supplemental T now or ever.
Looking through my medical records, there is a gap in full metabolic panels from 2010-2012. This is unfortunate since it was in 2010 that I began a very high protein whole food diet and competitive bodybuilding; it would have been nice to see if/how my ALT profile ramped up over time in response to very high dietary protein. As of 2009 and before, my ALT and AST were in the normal range. In Dec 2012, there is a high ALT reading, and they have always been high since then. However, I did not start feeling like shit until ~ 2014, summer. Nov 2015 is the first hormone panel I ever had.
Throughout the main interval of focus here, summer 2014-present, my AST has been high only a few times and just a hare over the high end of normal. My ALT has been the culprit at ~2X normal most of the time. Normal is (0-42 U/L) for ALT labs I get; my values have oscillated between 68-97 from Dec 2015 to present. I one time had an ALT of 39 in Dec 2016; I’ve never recreated that though and I see it as an outlier. Stopped all training for 12 days once to ascertain training intensity as causal in ALT, and no relief in ALT. Liver ultrasounds have been unremarkable.
By experimenting w/chrysin and DIM, I was able to seriously jack up my total and free T, but that’s when I got the highest SHBG value (122.9), while estradiol went up to 41.4 pg/mL, higher than ever, while ALT went up to 96; crushing. Very high libido and I was a walking boner on this regimen, but it exacerbated my SHBG and ALT issues and didn’t get after root cause; therefor the approach was not sustainable, so I off-ramped the chrysin and DIM. I’ve tried taking approximately four weeks off of supplements during this long period, and it did not seem to help ALT, and in one case, actually seemed to agitate ALT upwards a little bit. I ordered a panel from Life Extension as well to get their options, consulted with doctors at Life Extension, and they insisted that they take way more supps than me and don’t feel that my supplement regimen should affect my ALT. Except for the “outlier” ALT value I mentioned, and the time I jacked Total T to 1080 w/chrysin+DIM, my two lowest SHBG measurements (75.93 and 73.19) coincided w/my two best free T measurements (93.62 and 89.64) and w/two of my lowest ALT measurements (61 and 52).
I did 23andme and examined gene configurations associated w/high SHBG and I did not have any of the weird allele configs I’d read about. I used promethease to do this analysis.
Format below ITEM (lab normal range): my observed range during this period. My SHBG and ALT trend together and as one might suspect, my free T is inversely proportional to the SHBG. There is a ton of data that would be difficult to cogently summarize here. Summary of my salient hi/low readings are as follows:
ALT (0-42 U/L): 61-97
Total Test (249-836 ng/dL): 705.6-1080
Free Test (35-155 pg/mL): 75.15-93.62
SHBG (9-45 nmol/L): 73.19-122.9
Albumin (3.5-5.2 g/dL): 4.2-4.8
Estradiol (7.63-42.6) 6.72-41.4
FSH (1.5-12.4 mIU/mL): 4.4-5.8
LH (1.7-8.6 mIU/mL): 4.37-7.97
TSH (0.27-4.20 uIU/ml): 1.48-2.96
FT4 (0.93-1.7 ng/ml): 1.28-1.39
In a different experiment while still chasing lower ALT and lower SHBG, I was able to ratchet down my estradiol to 6.72 (considered too low) by drinking two smoothies per day with large amounts of kale, red chard, a carrot, mixed greens, an avocado, and broccoli sprouts in them. This estradiol result may have been a lab error and I didn’t retest yet. Libido is miserably low on this approach (I am still on a similar smoothie but less stuff in it); memory is foggy; and free T was the lowest ever at my last panel; no waking erections at all. So maybe the estradiol value was accurate. And my joints and prior injuries are more achy now. Going go back to my normal servings of greens that I’ve used for years, which is still plenty. Have done this for two weeks and noted slight improvements in libido.
Through it all:
• no exogenous hormones of any kind
• I meal prep and almost never miss (perhaps to the point of being overfed)
• Never eat fast food, candy, or any type of nutritional pornography
• Do not drink alcohol at all
• Daily protein intake varies 260-405g/day; recent months, included in the total is 100g/day isopure whey; 2 scoops each smoothie described
• Min 150 oz filtered water/day intake
• Have experimented with varying levels of fat and carbs; never less than 120g fat/day
• Daily caloric intake varied from 2900-3650 as calculated in excel
• I use filtered water and keep all my food in glass or stainless
• No history of TBI or cancer
Normal supplements included:
• probiotic renew life ultimate flora men’s complete
• ashwaghanda (quit this 4 weeks ago)
• SAMe 200mg
• Vit C 2000mg
• Zinc
• Vit D (my levels vary from ~40-70) 200IU
• Coq10 (not ubiquinone; I use ubiquinol) 200 mg/day
• Glucosamine w/chondroitin
• PQQ
• Krill
• Omega 3
• Melatonin
• Valerian root
• ZMA
Also of note is that I have had a resting metabolic rate (RMR) scan that shows my daily expenditures as 2806 cal per day at rest, not counting exercise and activity. Specifically when I took this RMR scan last month, it showed that I was burning 76% from fat, and 24% from carbs, and 0% for protein.
Additionally, I have had three DXA scans since December 2015, and I decreased in my lean tissue compartment by about 4 pounds. Since they were three different models of machines, this difference could be in the noise, as I am not substantially weaker and am in fact stronger in some aspects. I have lost about 10 pounds of body fat since then according to three tests, which looks about right. At 6’0, right now I am 208 pounds, and have gone as high as 225 when I was a little bit more bulky during these ~2 years of chasing the ALT-SHBG problem.
Also noteworthy from the DXA is that I have ~1.9 lbs of visceral fat. Overall body fat right now is 20% as of 5 Dec 2017. I’ve not found substantial data on how much visceral fat I should have, but the limited amount I found suggests that this amount is on the very high end of normal/acceptable based on a study of ~210 healthy European men. Since visceral fat is endocrinologically active, and dumps crap into the blood stream near the liver, it would behoove me to minimize this visceral fat. Not sure how much it plays into the ALT and SHBG, but is probably well within the realm of possible. I am beginning to think that I could be chronically overfed. I never miss meals, and I do stress eat (cleanly) in excess at least one day a week.
My next steps are to conduct a fasting mimicking diet, like that advocated by Dr. Valter Longo. This is a 5-day modified fast w/minimal intake for 5 days. Caloric ratio is ~45% fat, 45% carbs, 10% protein. Plant sources, super low sugar. 1100 calories day 1; then 800 calories/day for days 2-5. Rationale is that perhaps a rest for the liver and some stem cell activity/regeneration will alleviate the ALT and liver burden. This is also a very good “clean up” approach to buy down aging, cancer risk, and much more. Should also substantially slash visceral fat. After that, if little progress, I intend to conduct an even lower time restricted feeding window of only eight hours, whereas these days, I eat within roughly a 14 hour window.
It’s very clear that my body is capable of making a shit ton of testosterone, but I have not yet cracked the code on my ALT, which I think is indicative of liver stress that is driving up SHBG.
Any ideas and recommendations would be greatly appreciated. This is my first use of this forum so if I am breaking etiquette and should post in a new thread, tell me so. Thanks a ton, guys.