30 Y/O, High-Normal TT, High SHBG Question+ Some Science

Pharma / TRT Testosterone Replacement
1

Hello all, I’m new to this site. I’m looking to understand as much as I can about my situation and options.

Symptoms:
Sexual Function:
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.

Weight Lifting:
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.

Energy:
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.

Result:

TT: 780 ng/dl
LH=5.4 (1.5-10)
SHBG:75 nmol/l (20-68)
TSH: 1.67
T4=17.6 (11-20)
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.

Question:
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

2

You feel like shit because your SHBG is so high.

That’s really all there is to it. Your free test is hurting.

Don’t worry about numbers so much. Only as a reference. You KNOW your SHBG is high. So chase feelings, not numbers.

In your case, even though your free test might be acceptable, its too low for you. Causing symptoms.

Im a high SHBG guy myself.

Any meds? Keto/IF?

3

No med, I resisted SSRI (for anxiety + mild depression, my GP wanted me to try) after my concussion.

I take Omega3/Vit D/Whey protein. I tried 5-htp, tryptophan and tyrosine for mental wellbeing but never had any effect.

I wasn’t following a keto diet or IF when I took the SHBG test. But sometimes I do to lose weight. I did IF (60hours fast once a week) for a some weeks I think 2-3 months before the SHBG test.

4

Testosterone is not alright, high SHBG is overstating your testosterone status. SHBG is binding up most of your bioavailable testosterone making it look high when in fact it’s not, if SHBG was lower your body would be using more bioalailavle testosterone and so it would be lower.

Most doctors are unaware that a man could have low testosterone with a high Total T, in your case free T has more lab value. TSH really tells you nothing about the thyroid, my TSH is .91 (optimal) and was just diagnosed with Hashimoto’s disease. You can’t trust TSH to give you any lab value on thyroid status.

My Free T3 and Free T4 look perfect, doctors refuse testing Reverse T3 or aren’t even aware the test exists of understand it’s relevance. There was a guy in the UK who had Reverse T3 28 ng/dL which is 13 points above ranges and didn’t show any concern, said it’s fine. rT3 steps on the brakes and prevents you from overexerting yourself to the point of death.

You need TRT.

5

Thanks for the replies. I kind of knew it was going to go that way eventually since I had my varicocele detected 5 years ago.

Problem is: good luck getting a doctor to do TRT in CANADA with a total TT of 780. Hopeless. No idea what I’m going to do yet. Maybe go around and ask in “known” gyms. Maybe that’s not a good idea, don’t wanna die of infection either. Maybe there is no out to this.

About TSH: I understand that TSH is only useful when it indicates a clear problem (i.e. when it’s high). I ll investigate that with morning temp for sure.

6

Fasting like that increases SHBG. Eat clean for a few months and retest.

7

I have not yet to check my Reverse T3 and not based off of what you said I am really interested on looking into it. But I have a question before I do.

Where is a good place for someone Reverse T3 to be at in other words what are good levels. I have check out my other thyroid hormones but when I looked into my history Reverse T3 has never been checked