Temps past 3 days:
Thursday: am:96 afternoon:97
Friday: am: 96.4 pm:97
Saturday: am: 96.6 pm:97.3
Will begin iodine supplementation with 37.5 mg and 200 mcg selenium daily and measure temps. Will also monitor how I feel and get a more extensive blood panel in a couple weeks.
Thank you for all the help everyone!
Very eager to hear your next update.
I just found this forum, and your problem sounds very much like mine except that my SHBG varies from 73 nmol/L to as high as 120. Iāve been chasing this problem for two years; no solution yet.
Looking forward to hearing about your iodine and selenium supplementation results.
What do your other liver values look like? I was in the same boat but I think I might have found something that helped me. At least with my case.
What have you tried to lower your SHBG?
I tried Nettle Root extract, Tongkat Ali, Boron, milk thistle, and a product called Unleashed (divanyl, stinging nettle basically). All were meant to lower SHBG but I never got a positive correlation on a test.
The only time a supplement moved my SHBG was with Calcium D Glucarate. It went from 54 to 37 in about 3 weeks. Im still taking it and have labs in a few months to see if it is still working. I think maybe my liver had some dysfunction with the phase 2 detox route and it was causing increased SHBG.
Do you take any meds? Any luck with any other supps?
Iāve actually been feeling a lot better, although I have also toned down my exercise drastically. Overall, I do think the supplementation has helped. I havenāt been checking temps, but I still suspect it may be a bit low. Iāll start tomorrow and provide you with updates!
Iām planning to get new blood tests right after the New Years to see if levels have optimized and go from there.
Men,
So late on reply hereā¦
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. Iād 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 ālook at youā and insisted everything was fine,. Because I beat my chest at him about how Iāve been decreasing in recuperation and energy in the last several months and not linearly w/time, he referred me to an endocrinologist whoās 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 Iād done a baseline when I felt great to know what normal looks like for me. Donāt 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, etcā¦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 ā 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; Iāve 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 thatās 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 didnāt get after root cause; therefor the approach was not sustainable, so I off-ramped the chrysin and DIM. Iāve 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 donāt feel that my supplement regimen should affect my ALT. Except for the āoutlierā 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 Iād 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 didnāt 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 Iāve used for years, which is still plenty. Have done this for two weeks and noted slight improvements in libido.
Through it all:
ā¢ no exogenous hormones of any kind
ā¢ I meal prep and almost never miss (perhaps to the point of being overfed)
ā¢ Never eat fast food, candy, or any type of nutritional pornography
ā¢ Do not drink alcohol at all
ā¢ Daily protein intake varies 260-405g/day; recent months, included in the total is 100g/day isopure whey; 2 scoops each smoothie described
ā¢ Min 150 oz filtered water/day intake
ā¢ Have experimented with varying levels of fat and carbs; never less than 120g fat/day
ā¢ Daily caloric intake varied from 2900-3650 as calculated in excel
ā¢ I use filtered water and keep all my food in glass or stainless
ā¢ No history of TBI or cancer
Normal supplements included:
ā¢ probiotic renew life ultimate flora menās complete
ā¢ ashwaghanda (quit this 4 weeks ago)
ā¢ SAMe 200mg
ā¢ Vit C 2000mg
ā¢ Zinc
ā¢ Vit D (my levels vary from ~40-70) 200IU
ā¢ Coq10 (not ubiquinone; I use ubiquinol) 200 mg/day
ā¢ Glucosamine w/chondroitin
ā¢ PQQ
ā¢ Krill
ā¢ Omega 3
ā¢ Melatonin
ā¢ Valerian root
ā¢ 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 6ā0, 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. Iāve 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 āclean upā 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.
Itās 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.
You know some people just have genetically high SHBG, Iāve seen guys chase their tails in an attempt to lower it and fail. You need to stay the hell away from plant based diets, this raises SHBG levels significantly. TRT threw me below the threshold of whatās considered low SHBG so a plant based diets is even more critical now.
Your SHBG is too much out of control for you to be able to change, usually when SHBG gets to 40 and above it starts taking control of your free T. Mind over matter doesnāt work in this instance, Iām not considered a quitter by a long shot, I just know when I see a battle that canāt be won.
Your liver is ruining and otherwise great hormone levels as I see on a daily basis, Iāve seen guys pituitary glands pushing in excess of 1500 ng/dL of testosterone in an attempt to deal with SHBG not even as high as yours.
Your SHBG however doesnāt seem overly efficient, thereās a variability in the stickiness of SHBG from person to person where a certain individual is able to grab ahold of more than one T molecule per SHBG protein.
Also you T status is being inflated by your high SHBG, if your SHBG somehow lowered to 40, your T levels would shrink significantly. However your FT would increase significantly as a result. You require TRT to get over the top of that monster that is high SHBG, which will only further increase with age. You present SHBG levels of someone 40 years older, you canāt change genetics by diets and determination unfortunately.
I admire your attempts to change your situation though. Large weekly doses of T and a AI to control E2 will be important, HCG will help keep the boys hanging and fertile. Muscular guys usually respond to TRT pretty fast, Iām envious as a low SHBG guy response is slower as Iām skinny guy with some muscle, but effort is require to build muscle.
Please talk about iodine response and current body temps.
Current TSH and fT4?
fT3 is the only active hormone, there is no T4 receptor
fT3 should be tested
ALT can easily be elevated by sore/injured muscles. Avoid training and be fully recovered for lab work.
Thanks for these insights guys.
I did research the genetic markers for high SHBG and I do not have them. I do suspect that something in my environment is pushing hepatocytes to make more SHBG. Iāve offramped coffee even since December 5th, since it has no effect on hepatocytes. I didnāt get another blood panel yet, but I certainly still feel like shit and donāt think it has done anything to help.
On a caloric basis, Iāve not nearly eaten a plant based diet ever. My normal diet, other than the increased plant intake via smoothies, consisted of 10 ounces of broccoli florettes, 10 spears of asparagus, and 8 ounces of sweet potatoes daily. Most of my other carbs were made up by low-sodium rice cakes, to be clear. Note that my SHBG and ALT did not appear to be responsive to the plant intake, just my free and total testosterone, as well as estrogen. Also note that the preliminary literature Iāve read suggests that low protein intake ia one thing that drives up SHBG, which is certainly a zone that I have never been in. So Iām not quite clear on how my plant intake would increase the SHBG, especially considering that the vast majority of the time I have had the SHBG problem, my diet has not been very plant-based at all.
You bring up a good point on SHBG efficiency. It got me thinking that perhaps this plant intake via smoothies that I was experimenting with changed the dissociation constant for my SHBG. Iāve been doing the smoothies from September until early January, religiously, daily. What I have read, SHBG not only binds with testosterone, it also grabs DHT and estrogen as well, although itās bond/association is strongest with testosterone.
I also tried N-acetyl cysteine (NAC). I had taken it off and on for a couple years Bring this problem period of 2014 to present, after I found out how helpful it is with glutathione and liver function. However, I also read some studies, albeit with regards to PCOS women, and it seem to significantly stimulate hepatocytes to increase SHBG in a very statistically significant and reliable fashion. I am not sure if the mechanism would apply to me or not, so I got rid of the NAC was n March 2017, although it does not seem to have made a difference.
I am completely tracking what you said with regards to total testosterone, and itās inverse relationship with SHBG, and help my SHBG artificially inflate my total tea. My data reflects exactly what you are saying, as SHBG goes down, so does total T. Using an online testsoterone calculator, it is very clear that if my SHBG were to behave, I would only need a modest amount of total T to get a very handsome free T.
KSman - I would have to go back to my records, but I have done at least one full panel with 12 days of complete and total rest and good sleep, and it did not make one difference in my ALT or SHBG. I also have one or two panels back from 2005 and 2006 when I was training very aggressively, but obviously younger, and my ALT was fine then. By all estimates, I was eating approximately 260 g of protein per day back then, when I look back at all of my logs from back then. I put almost everything in excel now, but did not do that back then, so this is an estimate.
In October 2017, my last panel, my
free thyroxine= 1.38
TSH= 2.65
FT3= 106 ng/dL.
I forgot to report triiodothyronine/FT3 ranges above, so here it is:
triiodothyronine (80-200 ng/dL): 97.8-106
(Except for the one low value listed in the range here, all of my triiodothyronine values were from 103.3-106.)
I want to reiterate, and not in a pejorative or elitist way in anyway, shape, or form, that I have not taken any types of exogenous hormones here, so I am confused why my body decided to act up like this only a few years ago.
I am still strongly suspicious that something I am doing in life is really pissing off my liver, and that this is what is driving up the SHBG.
I almost want to say that it is my total food intake, which is why I have experimented with bringing my protein intake down to the 270 g per day range while increasing my fruit/fructose intake and dietary fat intake to maintain calories. This does not seem to have helped really, though, which is why am contemplating the 5-day modified fast. (Google āfasting mimicking dietā)
Iām not sure how to comment or get an idea on my iodine response?
What should I be doing for waking temperature/what thermometer is the recommended instrument for measurement?
Do you think it could be the cumulative effect of the supplements that I am taking, or my protein intake/dietary intake?
What other potential sources of perturbation do you think are possible/likely, aside from the ones that we have mentioned here?
You seem to be eating healthy, healthier than myself I might add. Remember we are under environmental assault daily by chemicals, it may not be anything your are ingesting but breathing. Consider where you are living, in near a shipping port or by a freeway? Exposure to chemicals?
You want a good old mercury glass thermometer.
I donāt believe those considerations/airborne threats apply to me in my situation.
Iāve even changed skin care products to EWG-approved items. Only thing I can think of is to get a mattress guaranteed free of flame retardants (not sure if mine is; unread most are not free of them.)
Other consideration is that while my serum vit d is great, Iāve barely seen sunlight from 2014-present; not nearly like I used to.
Clearly I am desperate to find root cause, so some of what I sound out might seem far fetched.