T Nation

28y, High E2/SHBG, FT 9. Doc Says It's Normal


#1

Hello guys,
I’m new here and english isn’t my native language so please forgive any typos.

For the last years i have been experiencing bouts of depression and huge anxiety amounts that wouldn’t leave off.
I haven’t had any morning woods in years and have very low level ejaculations. Lot of pain in muscles and difficulties to concentrate. Very low self confidence (like on the verge of crying after bad situations at work etc…) and lately i found myself crying over tv shows or movies and i also could not stand the sight of blood in movies, which is something that never disturbed me before (like suddenly being a 6 years old girl…).
I was fine a few years back with a lot of self confidence, no anxiety at all, no depression. I remember taking a lot of maca/tribulus/vitamins and was also doing a lot of cardio and weight lifting. Sometimes i woke up with a “weird” deep toned voice and my friends would joke about it (“why are you talking like a bear ?”) now i wonder if that was just an effect of high/adequate level of testoterone…

All doctors are saying i am fine but i know i am not.

Here are all the blood tests results i managed to gather :

April 2014
Vitamin d3 : 29 ng/ml, 73 nmol/l

May 2014
Testerone Total : 5.91 ng/ml (2.41 - 8.27) ; 20.5 nmol/l (8.4 - 28.7) ; 591 ng/dl
ACTH 50.7 pg/ml (10.3 - 48.3)

November 2014
Vitamin D3 : 21 ng/mL

July 2015
Oestradiol 38 pg/mL (8 - 50)
SDHA 12.3 umol/L (2.0 - 15.0)
SHBG 41.64 nmol/L (14.5 - 48.4)
Testerone Total : 5.38 ng/ml (2.42 - 8.65) ; 18.67 nmol/L (8.4 - 30) ; 538.5 ng/dl
Free Testerone : 12.5 pg/mL (8.9 - 42.5) ; 43.3 pmol/L (30.8 - 147.3)

April 2016
Sodium 140 mmol/L
Potassium 4,8 mmol/L
TSH u.s 3.752 mUI/L
T3L : 5,4 pmol/L
T4L : 15,9 pmol/L
HDL 0,70 g/L, 1,81 mmol/L
LDL 0,95 g/L, 2,45 mmol/L
HDL/LDL 0.74
ASAT 21 U/L
ALAT 25 U/L
Gamma GT 22 U/L
PSA Total 1,36 ng/mL
PSA Free 0,23 ng/mL
B12 : 1 052 ng/l
Vitamin d3 : 40 ng/mL (30 - 60)
ACTH 9AM : 5,2 pmol/L
Cortisol 9AM : 746 nmol/L
Free Testosterone RIA (9AM) : 8, 9 pg/mL - 30, 9 pmol/L

Thank you very much for your help


#2

We need more labs to help you on here. Please read the stickies and get tested for requested blood work.

Your TSH is high. The range is wide and sometimes unhelpful. I am not usually very paranoid about Thyroid and i think some of the thyroid scare developed from forums is unhelpful. However, levels over 3.0 for TSH consistently does indicate potential problems and you should find a better doctor that’s not an idiot. I would run away from any doctor that tries to tell me that it’s in my head as i would not be imagining stuff for such a long time and i am not retarded.

Coming to T, your fT is not optimal. Some of the assay methods that are used to determine free levels of T are not very accurate, using a calculator to estimate fT/bio available T is a better bet. SHBG binds up T , thus inflating serum TT values as T bound have slower clearance rates, simply by being in the blood longer than would have been with lower SHBG inflates TT values. Bio-T(fT + Albumin bound T ) or fT are better representative no. of T production. I assume that T production is impaired as numbers are similar across blood work done a year apart.

Know that first step is to find a good doctor, avoid local anti aging clinics or such who’d be likely to consider you more as a customer than a patient due to tie ups with pharmacies or by selling drugs directly to you. Hypothyroidism has very similar symptoms to hypogonadism and to me it seems that’s a major issue. Sometimes correcting thyroid issues recover to a degree, T levels.

Please read all the stickies in the about T replacement section, pay special attention to thyroid sticky and bloodwork sticky.


#3

I ran your July 2015 testosterone and SHBG numbers through an online calculator, and your calculated free testosterone came back as 9.94 ng/dL / 345 pmol/L.

I’ve seen various numbers given as the cut-off for hypogonadism with low calculated free T. Most are around 6.5 ng/dL / 225 pmol/L, but I’ve seen as high as 8 ng/dL / 250 pmol/L, which is some way below where you were in 2015.

If you want a couple of references then take a look at these papers:

You haven’t posted SHBG or total testosterone from April 2016, so if you find the numbers then run them through the calculator.

My advice would be to get your depression and anxiety symptoms treated. You probably don’t need TRT at this stage, but may well do in the longer term. (SHBG increases with age, whilst testosterone drops.)


#4

Your E2 is quite high relative to your FT levels and that drives up SHBG. SHBG increases TT and lowers FT.
T+SHBG is not bio-available.

Your E2 clearance in your liver is not good.
Test AST/ALT

Can you edit your post with lab work and add more lab ranges so we can better understand your case?

Where are you located? This affects your diagnostic and treatment options.

See these links found here: About the T Replacement Category
advice for new guys
things that damage your hormones
thyroid basics explained - post oral body temperatures
finding a TRT doc

ACTH 50.7 pg/ml (10.3 - 48.3)
This suggests low cortisol production.
Test DHEA-S
need ranges for AM cortisol


#5

Hello guys,
Sorry for not coming back sooner. I jumped into my car a few weeks back and was about to make a mistake, hopefully i drove to my family instead and somehow managed to see another endo. This time it was a female, i asked her her thought about the testosterone levels and she said that they weren’t that good looking for the age.

Anyway, back to business i guess … :frowning: same old stuff

July 2015
E2 : 38 pg/mL (8 - 50)
DHEA-S : 12.3 umol/L (2.0 - 15.0)

April 2016
Cortisol 9 AM : 746 nmol/L (8 AM ranges : 138 - 690)
AST 21 U/L (< 34)
ALT 25 U/L (< 49)
Fasted glucose : 0.92 g/L (0.74 - 1.06) ; 5.11 mmol/L (4.11 - 5.88)
White blood cells count : 4.98 Giga/L (4.10 - 11.0) they were 8.21 so almost double in 2014
T3L : 5.4 pmol/L (3.1 - 6.5)
T4L : 15.9 pmol/L (11.0 - 22)
TSH us : 3.752 (0.400 - 4.400) (november 2014 :
anti-TPO : <28.0 U/mL (< 60)
TgAb : 30 U/mL (< 60)
Free Testosterone RIA (9AM) : 8, 9 pg/mL - 30, 9 pmol/L
20-39y 8.9/pg/mL - 42.5pg/mL; 40-59y 6.6pg/mL - 30pg/mL ; 60-80y 4.9pg/mL - 21.6pg/mL

Two weeks ago :

Fasting glucose : 0.81 g/L (0.74 - 1.06) ; 4.50 mmol/L (4.11 - 5.88)
Post prandial glucose (+2 hours after meal) : 1.00 g/L ; 5.55 mmol/L (4.11 - 5.88)
Fasting insulin : 7.2 mUI/L (3.0 - 25.0)
HOMA-IR : 1.44
QUICKI 0.362
Post prandial insulin (+2 hours after meal) : 68.4 mUI/L (no ranges)
HOMA-IR : 16.87
HBA1C : 5.1% (4.0 - 6.0)
Creatinine : 7.7 mg/L (7.0 - 13.0)

FSH : 7.3 UI/L (MEN : 1-12)
LH : 6.7 UI/L (MEN : 2.0 - 9.0)
Prolactin : 14.1 ug/L (MEN : < 20 µg/l) ; 298.9 mUI/L
E2 : 40 pg/mL (8-50)
T4L : 15.6 pmol/L (11.0 - 22.0)
TSH us : 3.808 (0.400 - 4.400)
Total Testosterone (ECLIA COBAS) : 4.56 ng/mL (2.49 - 8.36) ; 15.82 nmol/L
Bioavailable Testosterone (RIA) : 1.35 ng/mL ; 4.68 nmol/L
20-35y 1.00-3.70 ; 36-50y : 0.80-3.20 ; 51-70 : 0.30-2.90


#6

Your adrenals may be over-active.
DHEA is an adrenal hormone and is good, but it does not have a control loop.
Describe stress in your life?
Do you get panic attacks?
??

You need to reduce E2 with .05mg/week anastrozole in divided doses.
Liver is not the obvious reason for E2, but some med, Rx and OTC can interfere with liver’s ability to clear E2.

No problems with any diabetic factors.

T4 and T4 look good, are those free thyroid tests - I assume
But TSH should be near 1.0
Your pituitary is needing to hammer the thyroid with TSH to get those hormones produced. What can the problem be?
not enough iodine from iodized salt is a possibility
or rT3 is blocking fT3 and the control system is compensating.
Do you get cold easily?
Please check oral body temperatures as suggested in the thyroid basics sticky, that will tell us what page we are on. I requested this April 29th. It is important.

FSH/LH and your T levels indicate a degree of primary hypogonadism. Unless there is a correctable vascular problem in the testes, you are stuck with this. The problem is not a lack of DHEA for DHEA–>T inside the testes.

Did you read the stickies I suggested earlier?


#7

Acth over the lab range…hmma p.adenoma?..i would check a Head MRI whit contras stuff …high acth=high corti/dhea,and on your blood test i cant see reason why acth whas sooo high


#8

Hello guys,
Thank you for your answers.

I might retest the Free / Total Test and E2/SHBG again soon because they kinda scare me.

Ted > I don’t know for the ACTH. The cortisol is high in the morning and low in the evening, i did the salivary cortisol last year and it was unfortunately stellar. If you think the ACTH is not okay i might ask a doctor to test me for it again.
As for MRI i had one with high contrast to check for multiple sclerosis by another doctor (not endo though) and it came back ok hopefully (mom got it). Are they the same or should i retest again ? Maybe i should give the result to current endo. I could even post them here i guess cuz i have the files on computer.

KSMan > Yes they are Free T3 and Free T4. Last year i was very very very cold, huge anxiety, depressed, it was summer and i had to live under a blanket because i was so cold.
Now i have anxiety, mood swings, can sleep 10 hours a day, don’t feel rested when i wake up.
Lately my throat / thyroid (?) have been very hard, it feels very tight. Last year i had episodes where i tought i would suffocate due to my throat being so tight that i could not breath (as far as i can tell it wasn’t due to anxiety but really was a physical pain), like if someone had his hands on my throat and was trying to kill me.
I had the thyroid checked and hopefully they didn’t find any nodules.
Now i have also very bad memory, very hard to concentrate, poor fluctuating vision during the day. Last year i was loosing a lot of hair and had thirst issues / drinking a lot of water.

Concerning Iodine, i haven’t consumed iodized salt for at least a year (possibily two). Do you think supplementing with iodine could be benefitial ?

Also i have natural thyroid hormone (Thiroyd) on hand, do you think it would help my symptoms/lower my TSH if i was to consume them ?

I will check oral temps, i did last year and they were 35.0 - 35.1 degree C / 95 - 95.18 degree F first thing in the morning.

Edit : i have been thinking about this E2 / SHBG issue, and maybe i am the one to blame for these high numbers ??? Back in 2014 and 2015 i took a lot of pure non-GMO Soy Lecithin at night (around 25-40grams) before sleep because my sleep was so bad and Lecithin gave me dreams and a sense of better / more profound sleep. As i understand soy is pure E2 / estrogens…


#9

The last bit of your post is not the way to think about this at all, yes soy products are bad for males but almost all men consume a good quantity of them every day, it’s everywhere in our food. These things could be factors but not direct causes. You have thyroid and seemingly Adrenal problems as well which may or may not be contributing to hypogonadism. Finding a real good doctor with a clue is the best thing you can do right now.


#10

Hey KSMan,
So i did as you told me and took my oral body temperatures.
They were the following :
36.0 / 96,8
36.1 / 96,98
36.5 / 97,7
36.1 / 96,98
36.0 / 96,8
36.1 / 96,98

Considering the temps and the high TSH, would you suggest taking thyroid hormones ?
I currently have a small stock of Thiroyd (NDT from Thailand…) on hand.
I had to cancel the endo appointment because of my new job and i won’t see him until next month.
If you think taking the NDT might be worth a shot and help me then i guess i should give it a try.


#11

As you seem to be iodine deficient, you should try iodine replenishment. Read all of the thyroid basics sticky. It is VERY important that you have selenium in a supplement. Easily found in many multi vitamins. Look for iodine+selenium. That should address some concerns re your “sore thyroid”.