T Nation

23 Yr Old with High SHBG, Normal T, Low Free T and Low Iron

#1

3 Month Update in TL:DR format:

  1. Chased my own tail for a few years with low libido, poor sleep, severe anxiety, indecisiveness, brain fog.

  2. Saw several doctors in Australia (GP’s) and one 'hormone specialist’
    who didn’t help and most chuckled that a 23 year old could have a T-problem.

  3. Came across Jay Campbell’s podcast and book and realised I was right all along. Registered on this forum back in November and got advice on which doctor to see.

  4. Made an appointment with the doctor, who immediately recognised that I’m a candidate for TRT because of massively elevated SHBG levels. This is what the other doctors missed, they only looked at Free T + Total T, completely ignoring SHBG and the function it plays.

  5. Was prescribed 250mg of Primoteston Depot (Test E) every 2 weeks. I changed the protocol to 125mg once every 7 days. After a month, I knew I needed more and bumped it to 125mg every 5 days, which measures around 175mg weekly.

  6. In those 3 months life has improved drastically. I feel like I’m waking up from a very unpleasant dream where I was a slave to circumstances and I’m regaining control. Libido is back. Deep sleep. The pump in the gym is unreal. Gaining clarity for who I am, what I want and how to get there.

  7. Here are the new lab results:
    Testosterone Total: 54 nmol/L (11.5 - 32.0 range)
    SHBG: 47 nmol/L (15-50 range) // used to be above 50 so this has lowered
    Free Androgen Index: 114.9% (15-100 range)
    Free Testosterone: 1136 pmol/L (260-740 range)

Biochemistry and Haematology are fine.

**My concern: Oestradiol is 145 pmol/L which is 39.5 pg/ml, and it used to be 25-27.5 pg/ml prior to TRT. Should I start taking Anastrozole, how much and how frequently? Also, regarding SHBG I heard it’s possible to bring it down by taking Stinging Nettle Root, is it effective?

Appreciate your help lads.

ORIGINAL POST

Hey lads!

Welcome to my post…

The reason I’m here is to ask for advice and guidance.

I first started noticing symptoms of low energy, low sex drive, crippling anxiety and depression back in 2015. I don’t remember how, but I suspected that my testosterone could be the cause and went to get tested.

The doctor didn’t know much about T and only tested me for Total Testosterone and TSH. The numbers came back normal, the doctor reassured me that everything is ok since the numbers are normal and that I should focus on stress-minimization strategies.

I did, yet nothing changed.

I went back for testing - with the same doctor. (totally my bad - I know.) This time she ordered a full panel. The numbers came back within ‘normal’ ranges. Even thou my Total and Free T with in the lower average ranges mostly suitable for a 40 or 50 year old.

I moved on and wanted to change my life before doing anything radical like TRT.

As a result…

during 2016-2017 I drastically cut down on the use of alcohol, smoking and recreational drugs. I started lifting weights regularly, doing intermittent fasting 16-8 protocol and sleeping at least 8 hours every night. I take cold showers, meditate every day and don’t watch porn.

Yet, no matter what I do the following symptoms persist:

  • Low energy / motivation / life enjoyment
  • Rare morning wood and absence of daytime erections
  • Brain fog and indecisiveness
  • Low confidence and anxiety
  • Bones hurting and clicking all the time

I came across Jay Campbell’s TRT Revolution Podcast and soaked up 25 hours of knowledge and purchased his ‘Definitive Testosterone Replacement Guide’.

Equipped with more knowledge and determination to get help, I found a ‘hormone and anti-aging specialist’ in Sydney and got blood tests done with him.

Today, I got my results back. My doctor considered my results normal and nothing to worry about…

  • SHBG massively elevated.
  • Total T is normal.
  • Free T is low for my age.
  • Iron is incredibly low.
  • Cholesterol is high.

Nothing to worry about?

Righto. I can’t trust doctors anymore and I would sincerely appreciate some proper guidance on this situation.

Thank you.

EDIT:
Medications: None. (Occasionally take Vitamin D & Magnesium supplements)
6’1, 170 pounds, lean build.

51 pm
Screen Shot 2017-10-24 at 11.26.51 pm.png1060x599 62.3 KB

#2

Its odd that your SHBG jumped from 23 to 63 in a year. Still, you have adequate free T both tests. Mid range is not a 40-50 year old man. Some men have higher T than others, I don’t see it being a testosterone issue.

#3

I’m learning you just can’t trust doctors anymore, their flawed individuals just like anyone else. their not magically special simply because their doctors. These days you have to take an interest in you health because doctors these days triage people and don’t take the time and energy to figure out what’s causing your symptoms, the word normal is thrown around far too often. There’s a huge diversity on this planet for everyone to be thrown into these ranges whose data is seriously flawed to start with, these ranges are taken from a population of sick, obese people with low testosterone and add those to the normal range. Your high SHBG should be a red flag for any knowledgeable doctor, all your free T is bound up inactive. TRT is the only treatment able to decrease your elevated SHBG, it is strange how your SHBG climbed so much in only a year, most people never in their life have a jump in SHBG quite like that. I believe your lifestyle changes brought about the change in SHBG.

#4

List of medications. Past or present. and also get your liver checked. High SHBG is indicative of liver strain. Meds are really important here though, especially with an increase like that. Lisinopril alone made my SHBG jump 20 points.

#5

Hey alpha,

currently, and both recently, no medications used.

In 2016, after being tested I did a course of LGD-4033. That was 18 months ago.

#6

You’re 100% right systemlord and I’m learning this lesson right now. I’ve started to take an interest in my health, and it’s overwhelming at first because it’s hard to know where to turn for useful information. Having found this forum I’m more confident in my desire to understand and optimize my health to live an awesome life.

Systemlord, I made a lot of changes in 2017 to my life and all of them have been positive for my mind, body and spirit. Yet, felt this hormonal turbulence going on inside me and now with high SHBG - I’m more driven to figure out what’s going on.

Australia has the toughest laws in the world to get prescribed TRT. As per advice from a fellow forum member, I was advised to look in the LGBT friendly doctor section as they very frequently deal with hormones and I have booked an appointment for next week.

If you are reading this, and know a great TRT doctor in Sydney, shoot me a message!!

#7

Maybe you would benefit from Aromasin monotherapy. It would lower your SHBG as well.

#8

I’m seeing the doctor on Tuesday, will post an update on how that goes.

#9

It has been a month, and i guess he isn’t coming back … but @ghouligan, if you do by chance see this message, please update your thread! Thanks.

#10

I’m here! Cheers for checking up on me.

I’ve gone back for all-round tests and the results are as follows:

  • Iron levels have gone up into the mid-range and thus are not a concern.
  • Cholesterol has been tested 3 times in 3 weeks and has remained
    consistently elevated with no evident cause.
  • ANDROGEN: Free T, Total T and SHBG results came back almost identical
    to previous. SHBG went down from 65 to 50.
  • LIVER & GALLBLADER: All results are normal, however I do have
    gallbladder polyps and I’m getting a repeat ultrasound of my liver soon,
    with a potential gastroendoscopy later on.

My new-regular-GP is LGBT friendly and advertised himself online as
hormone-specialist, yet has no experience with TRT whatsoever and we had
difficulty communicating about ANDROGEN studies.

I have an appointment booked with the infamous Dr.Z who’s flying down from
Perth to Sydney next week.

#11

I saw the infamous Dr.Z from Perth last week and the experience was
wonderful.

Unlike the other doctors I have been with, I feel that he genuinely
listened to what I had to say and was wiling to help.

After explaining my story and showing my number, he said that I was right
and that TRT could be massively beneficial to my health. He found that in
every androgen studies test done, my SHBG was double of my total T which is
a ratio indicative that my free T is really low because it keeps getting
taken by the SHBG. He drew diagrams to explain how it all works inside the
body and said he would be happy to work with me to find the right balance
for long-term health.

I told him that I wanted to try Testosterone Cypionate 100mg every 4th day.
To my amazement, Testosterone Cypionate isn’t available for prescription in
Australia AT ALL.

As a result, he prescribed me 250mg of Primotestone Depot (Test E) once
every 2 weeks.

I need some thoughts from you guys: whether it’s best to do 250mg every two
weeks, or split that into 125mg once a week? If so, how can I do that with
prefilled syringes that contain 250mg while maintaining sterility?

Really appreciate all your help so far.

#12

Oh dear every 2 weeks, you need to split that up once weekly. I usually never recommend weekly dosing unless the guy has high SHBG. The problem with injections every 2 weeks is your T levels shoot above the top of the range and by the second week take a deep plunge which might allow for SHBG to rise again while everything else is lower and you’ll end up feeling it. You wouldn’t want a finely tuned sports car running at optimal only some of the time would you? I’m amazed at how easily you got treatment in Australia of all places, Australia is strongly against TRT! 125 mg is a good starting point, you may require more to get over the top of that SHBG.

#13

Yeah, I did a shot of 125mg last night. I agree with you that 125mg may be a bit low for me, but it’s certainly a fantastic start. Especially in Australia, where testosterone is supremely difficult to get prescribed. I’m seeing my doctor again in January, to examine my results and see if we can bump it up to 150/175mg weekly.

Any advice regarding using a SYRINGE of PRIMOTESTON DEPOT for 2 injections rather than 1? I can obviously replace the needle used, but is that sterile?

#14

Once you open the glass vial, store the remaining test in syringe and place cap on needle and store in cool dry place. The problem really is doctors are scared to prescribe, afraid of getting in trouble. The doctors that know what they’re doing have nothing to fear. Hopefully in time things will change and perhaps all countries can have access to the medically seal glass vials that can be punctured multiple times making dosing much easier.

#15

Actually it’s a syringe with a separate needle, see the photo attached. So my question is, after I’ve used the syringe with a needle once, and then dispose of that needle, would it be safe to get a brand new needle, put it on the syringe and inject the rest?

p.s. the photo is not mine, dont worry about the expiration date
Primoteston Depot

#16

Oh I see, that’s actually way better than the ampules design. All you would need to do is replace the needle, inject and toss out needle, then when it’s time for another injection install new needle.

#17

That’s the plan. How long have you been on TRT?

#18

I’ve been on TRT for 8 months. I was put on weekly injections which for a low SHBG guy is inadequate, join this forum and 17 weeks in I start injecting twice weekly which felt like a step in the right direction. I then read about others who had SHBG slightly higher than mine who had noticed big improvements switching to an EOD protocol, so I made that move 6 weeks ago and within the first week knew it was by far the biggest difference I’ve noticed yet on TRT. I could only imagine where I’d be right now if I had started out on EOD injections. You hold onto your testosterone a little too well, we low SHBG guys dump most of our T into our urine via kidneys, we need to get our free T high since we are dumping a lot of it.

#19

I learned the interaction between high SHBG and testosterone from my doc. And now I’ve learned how it works in the reverse from you!

What is the most positive life change you have experienced from 8 months of TRT?

#20

So far the biggest improvement is my mood/personality, even my family is stunned. I will find my family around the corner asking/talking about where this personality is coming from, even the looks I get from family is eye opening. There are three stages with how TRT affects you, first is mental/mood/energy, then improved workouts with quick muscle recovery, then finely erections return in full force lastly do to slow improvements in venous leakage.

I would say in the last month I’ve noticed the most difference in muscle tone and my brother noticed my veins in my arms are starting to show, he told me he never saw that before at any point in my life. My SHBG 4 weeks after starting TRT was 18 nmol (pre-TRT 25) which is just barely below the threshold of low, I’m hoping the smaller more frequent injections will help. Naturally produced testosterone has little effect on high SHBG, often guys SHBG starts climbing and his testosterone increases to compensate for low free T, but is a losing battle. Me being 70 pounds overweight and having type 2 diabetes only lowers my SHBG, when I get the strength I will start working out at the gym to try to increase my SHBG.

Testosterone that injected has a profound effect on SHBG levels, which is great news for you!