27 Y/O, Extremely High SHBG, Low Free T, Low Prolactin, Normal TSH and Estradiol

Recent Labs (Fasted, done at 8 AM):

SHBG - 95.6 nmol/L (Range: 16.5-55.9 = Abnormal)
Albumin, Serum - 4.6 g/dL (Range: 3.5-5.5 = Normal)
ALT - 43 IU/L (Range: 0-44 = Normal)
AST - 70 IU/L (Range: 0-40 = Abnormal)
Glucose - 69 mg/dL (Range: 65-99 = Normal)
Prolactin - 3.0 ng/mL (Range: 4.0-15.2 = Abnormal)
TSH - 1.470 uIU/mL (Range: 0.450-4.500 = Normal)
Estradiol - 10.2 pg/mL (Range: 7.6-42.6 = Normal)
Testosterone, Serum - 399 ng/dL (Range: 264-916 = Normal)
Free Testosterone - 3.6 ng/dL (Range: 9.5-26.5 = Abnormal)

Symptoms / Issues: Urinating frequently at night, occasional night sweats, little to no sexual desire, no morning wood, ED, lack of energy / motivation.

I take Iodoral and use iodized salt. I am not on a restricted diet and am well-fed.

Other stats: 5’11, 185lbs, exercise daily and lift weights 4 times per week. I have abs / definition, body fat estimated 11 - 13%. Definitely leaner and more fit than the average gym goer. Bench 275, Squat 365, Deadlift 450 as approximate maxes.

I honestly have no idea why my free test is so low and SHBG is so high. I’ve been lifting weights for almost a decade and just feel like I got the short end of the hormonal stick apparently.

Should I pursue TRT? Any advice would be appreciated.

Old thread with old labs:

Your estradiol is not normal. They gave you the wrong test ( ECLIA METHODOLOGY). I can assure you your E2 is below range right along with your free T. Next time you run blood work have them do Estradiol sensitive for accurate results.

Regarding high SHBG. List all medications, past present.

Drinker? Drugs?

I don’t drink and don’t do drugs.

I am currently taking several supplements:

Fish Oil
Whey Protein
Pre-workout sup
Activate Xtreme

I have also taken Finasteride and Accutane in the past.

Your insanely high SHBG is inflating your TT, if you were somehow able to lower your SHBG near midrange by non pharma means your TT would be incredibly low compared to now. Your FT is low because SHBG is high, T binds to SHBG and when you have too much SHBG your FT shrinks, TRT is the only way to decrease SHBG far enough to free up some of your FT.

If you eat plant based diets stop now, plant based diets increase SHBG, just because plant based diets are good doesn’t mean there good for everyone. If you don’t do TRT your situation will worsen with time. Finasteride is most likely the cause of your symptoms, your symptoms while on Finasteride are the common ones most experience.

This is your problem. Need to read about Post Finasteride Syndrome.

I have heard Accutane can cause similar issues, I took it when I was a teen for acne.

But Finasteride is a terrible drug that causes these types of issues for a lot of people.

If you start to get discouraged in your reading, don’t be. I have read several reports where people reversed the effects through natural processes. There are whole boards dedicated to this. Start reading.

I took Finasteride 4 years ago for a few months. At this point is there anything I can even do for it? I experienced some bad symptoms on it (itchy nipples - they didn’t get gyno, but itched; and oily / non-white ejaculation), but the symptoms stopped after I stopped taking it.

Why do plant-based diets increase SHBG? This is my first time hearing this.

There’s no cure for Post Finasteride Syndrome, some guys have recovered while some guys never do recover. TRT is your only hope at this point. If anyone can help you it would be Dr. Crisler, he’s on a mission to restoring men damaged by Finasteride. It’s also possible that you are just low T without the Finasteride issues.

Guys, I am going to see my urologist next week. I had labs taken again and had similar numbers to what is in the original post. It seems like I have secondary hypogonadism, since the Total T is low, and LH is low.

I think it would be wise to ask for TRT. Should I ask to have an AI and HCG as well?

Large weekly doses of test is the only thing able to suppress overly high SHBG.

Thanks. How about an AI and HCG? Should I start with just TRT and see how that goes or should I ask for AI and HCG also?

Me personally I like to dial in TRT first, then once I feel great add HCG, this way I can tell if HCG is actually doing anything for me. Throw a guy on TRT, HCG and an AI and it becomes difficult to know what’s doing what. I’ve heard of guys stopping HCG years later finding that they feel so much better without it.

However if trying for a baby the choice is already made for you. It will do no harm to add HCG months later, you may not notice anything, you might feel better or you might feel worse. At some point you should try it and see how you body responds.

Nelson Virgil over at another forum tried HCG earlier in life and felt nothing from it, now later in his years he feels fantastic on HCG, our bodies are always changing.

I am wondering if since I have secondary hypogonadism, if it would be wise to start with HCG and an AI and not TRT and see what happens. Since I have low LH I should in theory produce more testosterone again.

My main concern would be that the SHBG could still be inflated. I know TRT would lower that. Just not sure if taking TRT is the right call just yet.

Also, recent tests showed my TSH as 0.98 uIU/mL (a healthier level) so I would be surprised if there are thyroid issues.

SHBG - 95.6 nmol/L (Range: 16.5-55.9 = Abnormal)
ALT - 43 IU/L (Range: 0-44 = Normal)
AST - 70 IU/L (Range: 0-40 = Abnormal)

Have you been training and sore or non recovered muscles for labs? [AST/ALT] If not, there is some possible concern re liver function. SHBG is made in the liver to scavenge sex hormones and sometimes a liver problem is associated with high SHBG.

Sometimes SHBG is just high in some guys with no known reason.

High E2 can increase SHBG, you do not have that. Low T can increase SHBG and TRT might reverse this to some extent.

TT is not normal as high fraction of SHBG+T inflates TT which then overstates your T status and TT should be disregarded. On TRT your TT needs to go higher than normal and FT or Bio-T is your dosing guide. You will most likely need more T than others.

Neither E2 or prolactin is causing your secondary. Any blows to the head that could have damaged the pituitary? A MRI could visualize but would not change the outcome.

Night sweats or hot flashed could be low E2
Your bones and brain need more E2 to work right.

Prostate may change with TRT.

Was that lab work from Labcorp?

Thyroid and iodine: Please post oral body temperatures - see below.

At your age you would need hCG to preserver fertility. And hCG alone might work.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.