T Nation

21 Y/O Hormone Optimization Advice? - SHBG


#1

Hello guys, I’m here to investigate the problems I’ve been having and get some advice. I would really appreciate it if anyone could help me out.

-age – 20

-height - 6’2”

-waist – 32”

-weight – 90kg

-describe body and facial hair – Both body hair and facial hair have always been very thin and I am known among friends as having the least hair. Facial hair only first appeared at the age of 19 when I began first steroid cycle and is still no more than bum fluff. Hair on chest and abdomen is blonde and hardly present (my father also had very little chest hair at my age).

-describe where you carry fat and how changed – I have always been relatively lean, never exceeding 14% bodyfat even during bulking diets of 4000 kcal. I maintain an average bodyfat % of around 12%. Recently bodyfat has increased very slightly and muscles look more soft (steroid use has been discontinued and this is to be expected).

-health conditions, symptoms – In relation to low testosterone my symptoms include:
• Loss of libido - I currently have little interest in sex but will sometimes feel inclined to “spank the monkey” but this is more due to habit than desire. I haven’t really looked at a girl with lust in a long time. This has not always been the case, however I have ALWAYS had to use viagra during sex which is of course very annoying and embarrassing and this was a deciding factor in beginning steroid use. During steroid use, libido is unbelievably high.
• Brain fog - This can sometimes be a problem for me which certainly is not ideal as I am an engineering student. I often am unable to concentrate on what someone is saying or while reading which is frustrating. I know that I am as capable, if not more than my classmates but when this happens, I feel like an idiot!
• I often feel tired despite getting 8 hours per night consistently, and going to bed/ waking up at roughly the same times. I sometimes take modafinil (a narcolepsy drug/ nootropic) in order to stay alert during class.
• From time to time I experience mild depression/ anxiety which I have alleviated mostly through meditation.

In May of this year I began my third steroid cycle (50mg Dianabol each day and 500mg Testosterone Propionate each week) at the end of the second week, I noticed my feet itching in the night so I looked into it the next day to find that this was a symptom of liver toxicity. I went to the GP and got my liver enzymes tested and the lab results showed an ALT value of about 450 30-50!! All other liver results including Gamma GT were within range. I discontinued my steroid use (did PCT) immediately and have not touched them since. I had my liver enzymes re-tested 5 weeks later and all values were within range. I thought this to be very strange as the cycle was by no means particularly hepatotoxic and I was only two weeks in. I rarely consume alcohol (less than 10 bottles of beer per month and none during steroid usage) and my last steroid cycles were sensible and spaced well apart. I do not know if there can be any connections drawn to this with Low T but I thought it worth mentioning and if anybody has some advice or knowledge they can share it would be welcome.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever – Neither of these. Steroid cycles: Cycle 1 - Equipoise 500mg/wk, Test 200mg/wk 12 weeks. Cycle 2 – Dianabol 30mg/day weeks 1-3, Test 500mgwk 12 weeks. Both cycles with correct ancillaries and PCT and spaced sensibly apart. Liver protection used during Dianabol consumption.

-lab results with ranges – see below

-describe diet [some create substantial damage with starvation diets] – Diet is generally good, no starvation diets. I currently have a very balanced diet and am getting plenty of vitamins and minerals including selenium and iodine.

-describe training [some ruin there hormones by over training] – I have been doing hypertrophy based training around 5 times per week since the age of around 16 (seriously at least).

-testes ache, ever, with a fever? – Testes ached at one point when I started my first cycle.

-how have morning wood and nocturnal erections changed – Morning wood happens occasionally, maybe once per week but is not solid. Same with nocturnal. I never get spontaneous erections during the day.

Lab Ranges:

9th May (just before 3rd steroid cycle)

Testosterone 15.3 nmol/L 7.6 – 31.4

7th November

DHEA Sulphate 11.41 umol/L 0.44 – 13.4
Follicle Stim. Hormone 2.95 IU/L 1.5 – 12.4
LH 4.22 IU/L 1.7 – 8.6
Testosterone 19.21 nmol/L 7.6 – 31.4
Free Testosterone (calc.) 0.277 nmol/L 0.3 – 1.0
SHBG 52.06 nmol/L 16 – 55
Free Androgen Index 36.9 Ratio 24 – 104
17-Beta Oestradiol 64.96 pmol/L 44 – 156

Hormone blood tests were done through private labs as I was told by my doctor that she “would never dream of checking my testosterone”

I can also provide a CBC (all within ranges) and liver enzyme test if needed.

So obviously free test seems to be the main problem here, I am no newbie when it comes to this stuff but I am pretty much out of my depth when it comes to free test and SHBG so any advice or recommendations for resources to learn about them would be much appreciated. One thing that did occur to me was that I have noticed that after I finish my PCT, for a few weeks my libido seems to be very good but after that it diminishes. I was wondering if this was due to lowered SHBG on cycle which takes a few weeks to build back up? I know it is not due to steroids still being in my system as when I have noticed this, I have only been using short acting esters.

Further notes:
• I do not feel cold when others do not and in fact I am more likely to feel warm.
• Outer eyebrows are not sparse.
• I knew the risks of using anabolics and did not go into it blindly. I do not believe that they have had a substantial effect upon my hormone levels (unless an expert tells me otherwise); I was having problems before I began them and this was part of the reasons for me doing so.
• I am not sure how relevant this is; I began puberty very late when compared to my school friends. I seem to remember only really hitting puberty at the age of 14 when others had started at around the age of 12.

Some questions I have:
• What could be causing the FT/SHBG issue?
• Is there anything that can be done to resolve the FT/ SHBG issue?
• If low FT is the problem, will TRT be as effective as it would have been if TT was the problem?

Thanks for reading, I look forward to hearing any advice.


How to Lower Very High SHBG/Creatine Kinase Levels w/out Permanent Damage to HPTA?
#2

Anybody have any ideas?


#3

You cannot move SHBG directly.
SHBG made in liver to scavenge estrogens, the female blueprint.
When your liver was a mess, E2 would have been very high and SHBG may still be affected by that. Orals are dangerous.
Less E2 and more bio-T will help.
Your high SHBG is creating a lot of T+SHBG that inflates TT and reduces FT. TRT with E2 near 22pg/ml 80 pmol/L will help that shift. Otherwise wait and see, but given your history, that does not seem like a place to be. SHBG may be slow to shift.

These are the standard reading:

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • HPTA restart

#4

Hi @KSman, thanks for getting back to me. You think that the liver problem could be the cause 6 months later? I was wondering whether or not there may still be a problem with my liver and was considering getting another enzyme test. Yes I have definitely learnt my lesson and wont be touching orals again, if any gear at all.

By this do you mean that TRT seems the better of the two options?

I have ordered a thermometer and will post body temp soon.

Thanks I’ll give them a read if I haven’t already.


#5
  • I was suggesting, that your goal should not be going back to where you were before.

#6

Instead of jumping on self administered TRT (which I am currently very tempted to do given my worsening symptoms) I am trying to get to the bottom of my elevated SHBG.

After reading @KSman 's response which suggested that my problem may be due to my liver, I decided to get liver enzymes tested:

Liver Function
BILIRUBIN 5 umol/L 0 -20
ALKALINE PHOSPHATASE 92 IU/L 40 -129
ASPARTATE TRANSFERASE SAMPLE HEAMOLYSED
ALANINE TRANSFERASE 20 IU/L 10 - 50
CK 151 IU/L 38 - 204
GAMMA GT 21 IU/L 10 - 71
Kidney Function
SODIUM 143 mmol/L 135 -145
UREA 4.9 mmol/L 1.7 -8.3
CREATININE 94 umol/L 66 -112
Proteins
TOTAL PROTEIN 79 g/L 63 -83
ALBUMIN * 54 g/L 34 -50
GLOBULIN 25 g/L 19 -35
Minerals
CALCIUM 2.57 mmol/L 2.20 -2.60
Corrected Calcium 2.41 mmol/L 2.20 -2.60
Gout Test
URIC ACID 343 umol/L 266 - 474
Iron Profile
IRON 22.3 umol/L 10.6 - 28.3
T.I.B.C 56 umol/L 41 - 77
TRANSFERRIN SATURATION 40 % 20 - 55

An additional, less in-depth liver test was carried out but this shows similar results.

I found three possible causes of SHBG that could be relevant to my situation (others included pregnancy):

  • Liver Disease/ Cirrhosis
  • Hyperthyroidism
  • Hypogonadism/ Decreased sex hormone production

For a while now I have been worried about my liver after my enzymes were significantly raised for a brief period during a steroid cycle and I assumed that the elevated SHBG was caused by this. I am now not so sure about this; liver enzyme tests suggest that my liver is fine (although problems can not always be seen through bloodwork) and cirrhosis/ liver disease, when related to drugs/ alcohol is due to long term abuse not a brief period of stress. The recent tests were also taken during a time when I was drinking more alcohol than I usually would (Christmas period). Furthermore in people with liver damage, Albumin is usually below range and mine is actually above for some reason (not sure why). My doctor also tells me my liver is fine, although she came to this conclusion after feeling my abdomen to check that it was not enlarged so I am not sure how she can be sure of this. If my problem was caused by the liver stress from the steroid cycle which was about 10 months ago now, surely my SHBG would be slowly falling, as I have been avoiding liver stress ever since apart from a few drinks now and then (and I mean a few). Recent hormone test results however, show that my SHBG is now at an all time high (just above range).

After finding that Hyperthyroidism was a cause of elevated SHBG I looked into it and found that I had some symptoms such as almost constant nervousness/ inability to sit still, an inclination to feel warm when others are not and some others, I got some thyroid bloods done:

Thyroid Function
THYROID STIMULATING HORMONE 0.954 mIU/L 0.270 - 4.200
FREE THYROXINE 20.24 pmol/L 12.000 - 22.000
FREE T3 5.75 pmol/L 3.100 - 6.800

I don’t know much about thyroid tests but I’m pretty sure a TSH of 0.954 means I don’t have hyperthyroidism.

So that leaves me with hypogonadism, my test results posted in my original post show low FSH and mid range LH. KSman says that the high amount of SHBG bound to test is ramping up my total test meaning TT seems higher than it really is. Could it really be as simple as having low testosterone production and therefore having high SHBG? I recently got another hormone test on the NHS and the results were as follows:

Testosterone 16.2 nmol/L 7.6 – 31.4
Free Testosterone (calc.) 0.216 nmol/L 0.3 – 1.0
SHBG 59 nmol/L 16 – 55

Next week I have an appointment with a different younger doctor in the hope that she will refer me to a private endo. If that falls through I will most likely self administer which I wouldn’t actually mind but I don’t want to be using underground labs.

This post is more of an update but any advice would be greatly appreciated! Thanks


#7

FT is low and your conclusions seem valid.
Low FT is helping increase SHBG but something else is too.

Hyperthyroidism: Please check oral body temperatures as per the thyroid basics and also during times where you feel overheated and times when you do not. Hyperthyroidism can come with weight loss.

yes, TSH looks good
fT4 is well above mid-range
fT3 is above mid-range
You still need to check oral body temperatures and if low, suspect elevated rT3
You profile also matches early stage effects of thyroid nodules that can progress to hyper later. Sometimes see this as a known progression from low iodine intake and elevated TSH that leads to nodules that release thyroid hormones independent of TSH control, which leads to lower TSH and elevated T3, T4. While these considerations may not be what is going on, one should strive to understand and not pronounce that that one does not have a thyroid issue. TSH is never is a complete picture.

SHBG levels are a balance of effects of testosterone, estrogens and other health conditions. SHBG lowers FT and creates more T+SHBG that inflates TT and then TT can provide a misleading indication of T status. FT says hypo and TT says “no problem”. Your E2=65 pmol/L seems decent, but with low FT, that makes you quite estrogen dominant and perhaps that is what the liver sees then creates more SHBG. SHBG is produced by the liver to scavenge hormones and the liver then picks up the SHBG bound hormones for metabolization.

So you try to fix your HPTA or you start TRT. Almost all docs will look at TT and laugh at you. So finding the right doc would be critical. You can also look as the HPTA restart sticky. Your path is not clear.