Hello all, I’m new to this site. I’m looking to understand as much as I can about my situation and options.
I have a varicocele and small testes (around 12cm3) detected 5 years ago by accident. Noticed a steady decline in sexual function (Ejaculate volume, number of times able to ejaculate/get hard, and libido) over the past 3 years.
I have been trying to gain strength with a 5X5 program for a year. Haven’t gained a single pound on my main lifts during that year of training. My Bench press is at 190 (Bodyweight 185) for reference. I don’t overtrain.
Low energy, sleep 10h+ a day, weight gain (need to fast or cut carbs to not get fat) Some of it started after a concussion I got a year ago.
So I asked for a hormonal profile because I’m having trouble at work due to mental fatigue and low energy (possibly due to concussion). I get in the office at 9am, get sleepy by 12 and need 1h+ nap after work despite having slept 9h+ the night before.
TT: 780 ng/dl
SHBG:75 nmol/l (20-68)
IGF1: 158 ug/L (range 100-300) (concussion can cause HGH deficiency, but IGF1 testing isn’t sensitive for that)
Morning Cortisol: 587 (max : 527, so slightly elevated but was a bit anxious)
So my TT is OK, but SHBG is through the roof. I was suprised my TT was so high despite having varicocele and damaged testes. But then I read this:Sex hormone-binding globulin regulation of androgen bioactivity in vivo: validation of the free hormone hypothesis - PMC
From what I can understand, SHBG serves to increase the half-life of TT in the blood to prevent deficiency in key target tissues. So it is useful when TT is scarce, and the body need to “ration out” the TT.
“[SHBG causes] paradoxical prevention of sex steroid deficiency due to increased circulating ligand half-life (and thus availability), and regulation of the androgen/estrogen ratio”
So SHBG could increase because TT output by testes decreases, which means the body now need to ration out TT with SHBG. The increase in SHBG would thus be an adaptative mechanism to low production of TT.
This also means that my 780 TT is the result of the long half-life of TT in my blood caused by the binding to SHBG. Hence, my TT concentration at a given time does not reflect my actual production of TT.
Is it possible that, despite having 780 ng/dl TT, I would be having significant low TT symptoms? Note that if I compute my free TT from a website I get
Calculated Free TT:10 ng/dl
this is above the minimum by 2 fold.
If fatigue is not due to TT, then it could be due to HGH deficiency, in which case I’m fucked (don’t know how to get the provocative testing).
Thanks for the help