T Nation

31 Y/O. Normal TT, Low Free T, Very High SHBG, Low DHEA


#1

Hey guys, I could use some advice. I am going to see my Dr. to start TRT in one hour, but I am still not certain that exogenous testosterone is the best treatment in my case. I’d feel alot better if some of you pros could read over the lab results attached to this post below and let me know if you think I should be on TRT? My Dr. is proposing 200mg T-Cyp Weeky with Anastrozole and hCG (the added hCG was my idea, he wasn’t going to use it initially). For the last 9 weeks I’ve been dieting and eating only T boosting foods, taking a number of T booster supplements, lifting 2 hours daily… etc, trying to raise my T, and it doubled, but is still very low ( see below). Should I just give up and start TRT? or should I try supplementing DHEA possibly starting thyroid treatment and then retesting in a month? My total testosterone doesn’t seem to be a problem, it’s like my free testosterone is low because my absurdly high SHBG levels are binding to all of the Free T rendering it useless? Also based on my seemingly low FSH and LH levels it looks like I may have secondary hypogonadism is this correct? Doesn’t this mean I should first try an HPTA restart protocol or possibly clomid before jumping to T-Cyp?

Thanks,
Gary M.

HDL Cholesterol:
2012/03/20: 35 mg/dL (LOW)
2013/03/08: 36 mg/dL (LOW)
2016/11/04: 48 mg/dL (NORMAL)
2017/08/24: 52 mg/dL (NORMAL)

LDL Cholesterol:
2012/03/20: 133 mg/dL (HIGH)
2013/03/08: 119 mg/dL (NORMAL)
2016/11/04: 131 mg/dL (HIGH)
2017/08/24: 101 mg/dL (HIGH)

Glucose:
2012/03/20: 92 mg/dL (NORMAL)
2013/03/08: 51 mg/dL (LOW)
2017/08/24: 93 mg/dL (NORMAL)
2017/11/09: 92 mg/dL (NORMAL)

Thyroid Stimulating Hormone (TSH):
2012/03/20: 1.61 mIU/L (NORMAL)
2013/03/08: 1.29 mIU/L (NORMAL)
2016/11/04: 2.20 uIU/mL (NORMAL)
2017/08/24: 4.54 uIU/mL (HIGH)
2017/09/08: 2.25 mUI/L (NORMAL)

Total Thyroxine 4 (TT4):
2017/09/08: 6.7 μg/dL (NORMAL)

Free Thyroxine 4 (FT4):
2016/11/04: 1.34 ng/dL (NORMAL)
2017/08/24: 1.51 ng/dL (NORMAL)
2017/09/08: 1.10 ng/dL (NORMAL)
2017/11/09: 1.33 ng/dL (NORMAL)

Total Thyroxine 3 (TT3):
2017/09/08: 82 ng/dL (NORMAL)

Free Thyroxine 3 (FT3):
2017/09/08: 3 pg/mL (NORMAL)

Reverse Thyroxine 3 (RT3):
2017/09/08: 17 ng/dL (NORMAL)

T-Uptake (Thyroxine Binding Sites):
2017/09/08: 34 %

Free Thyroxine Index:
2017/09/08: 2.3

Thyroid Peroxidase Antibodies (TPOAb):
2017/08/31: 17 IU/mL (NORMAL)
2017/09/08: 17 IU/mL (NORMAL)

Anti-Thyroglobulin Antibodies (TGAb):
2017/08/31: 2.6 IU/mL (HIGH)
2017/09/08: 2.6 IU/mL (HIGH)

Total Testosterone (TT):
2016/11/04: 376 ng/dL (LOW-NORMAL)
2017/08/31: 324 ng/dL (LOW-NORMAL)
2017/09/05: 610 ng/dL (NORMAL)
2017/11/09: 569 ng/dL (NORMAL)

Free Testosterone (FT):
2016/11/04: 5.3 pg/mL (LOW)
2017/08/31: 2.6 pg/mL (LOW)
2017/09/05: 7.7 pg/mL (LOW)
2017/11/09: 3.7 pg/mL (LOW)

Follicle Stimulating Hormone (FSH):
2017/11/09: 1.5 mIU/mL (VERY LOW-NORMAL)

Luteinizing Hormone (LH):
2017/11/09: 2.6 mIU/mL (LOW-NORMAL)

DHEA-Sulfate:
2017/11/09: 91.9 ug/dL (LOW)

Sex Hormone Binding Globulin (SHBG):
2017/11/09: 105.8 nmol/L (VERY HIGH)

Albumin:
2012/03/20: 4.9 g/dL (NORMAL)
2013/03/08: 4.9 g/dL (NORMAL)
2016/11/04: 5.2 g/dL (NORMAL)
2017/08/24: 4.6 g/dL (NORMAL)
2017/11/09: 4.9 g/dL (NORMAL)

Cortisol - AM (Blood):
2017/09/05: 14.5 ug/dL (NORMAL)

Prolactin:
2017/11/09: 13.6 ng/dL (NORMAL)

Creatinine:
2012/03/20: 0.89 mg/dL (NORMAL)
2013/03/08: 0.84 mg/dL (NORMAL)
2016/11/04: 0.85 mg/dL (NORMAL)
2017/08/24: 1.00 mg/dL (NORMAL)
2017/11/09: 1.01 mg/dL (NORMAL)

BUN/Creatinine Ratio:
2016/11/04: 12 (NORMAL)
2017/08/24: 11 (NORMAL)
2017/11/09: 08 (LOW)

AST (SGOT):
2012/03/20: 29 U/L (NORMAL)
2013/03/08: 24 U/L (NORMAL)
2016/11/04: 31 IU/L (NORMAL)
2017/08/24: 65 IU/L (HIGH)
2017/11/09: 36 UI/L (NORMAL)

Sodium, Serum:
2012/03/20: 138 mmol/L (NORMAL)
2013/03/08: 139 mmol/L (NORMAL)
2016/11/04: 145 mmol/L (HIGH)
2017/08/24: 141 mmol/L (NORMAL)
2017/11/09: 140 mmol/L (NORMAL)

Calcium, Serum:
2012/03/20: 9.9 mg/dL (NORMAL)
2013/03/08: 9.8 mg/dL (NORMAL)
2016/11/04: 10.5 mg/dL (HIGH)
2017/08/24: 9.4 mg/dL (NORMAL)
2017/09/05: 10.1 mg/dL (NORMAL)
2017/11/09: 9.7 mg/dL (NORMAL)

Chloride, Serum:
2012/03/20: 103 mmol/L (NORMAL)
2013/03/08: 103 mmol/L (NORMAL)
2016/11/04: 99 mmol/L (NORMAL)
2017/08/24: 98 mmol/L (NORMAL)
2017/11/09: 95 mmol/L (LOW)

Vitamin B12:
2017/08/31: 1082 pg/mL (HIGH)

Vitamin D, 25-Hydroxy:
2017/09/05: 11.3 ng/mL (VERY LOW)

Mononucleosis Test, Qual
2017/09/05: Negative
2017/11/09: Negative

EBV, Early Antigen, Ab, IgG:
2017/08/31: 13.8 U/mL (HIGH/POSITIVE)
2017/11/09: 12.1 U/mL (HIGH/POSITIVE)

EBV Ab VCA, IgG
2017/08/31: >600 U/mL (EXTREMELY HIGH/POSITIVE)
2017/11/09: >600.0 U/mL (EXTREMELY HIGH/POSITIVE)

EBV Nuclear Antigen Ab, IgG
2017/08/31: 441.0 U/mL (EXTREMELY HIGH/POSITIVE)

Cytomegalovirus (CMV) Ab, IgG
2017/08/31: 6.40 U/mL (HIGH/POSITIVE)

Cytomegalovirus (CMV) Ab, IgM
2017/08/31: <30.0 (NEGATIVE)

CMV PCR:
2017/08/31: Negative (NO CMV DNA DETECTED)

Hepatitis B Surface Antibody QL:
2013/03/08: Borderline

Hepatitis B Core AB Total:
2013/03/08: Non-Reactive


#2

TRT is it for those with high SHBG, TT means nothing if FT is low. FT is what gets the job done, TT is only a reservoir for FT. Your gas tank is full but your engine is starving for fuel. Your doctor is right to start you out on a high dose do to your super high SHBG, if you hadn’t included your SHBG results I still would have known do to your FT levels. I’ve seen guys here who have TT at the very top of the ranges only to have super high SHBG which is in essence low T do to it being bound up in SHBG, in either case FT is non-bioavailable. By the way your TT is quite low for your age, these lab ranges fail to account for age. Your TT wouldn’t be bad if you were 90 years old. President Trump even has you beat at 446 ng/dL at 71 years old! Any T boost you get through supplements and dieting gets immediately locked up in your high SHBG, in other words you see none of the benefits. Restarts rarely work as your parts are already showing their weaknesses otherwise you would be fine. Everyone I’ve ever known to try a restart falls back down to previous levels within months.


#3

I do not see that E2-estradiol has been tested.
SHBG is made in the liver and estrogens increase SHBG and higher FT decreases. SHBG might be influenced by effects of viral infections on the liver.

We really need lab ranges. “normal” is not useful, we look for issues withing normal.

Post ranges for T3, T4, fT3, fT4

TSH should be nearer to 1.0
thyroid lab ranges are mostly useless.
See later about checking overall thyroid function via oral body temperatures.
You might have problems from a lack of iodine caused by not using iodized salt. High TSH+time and harmful and if selenium deficient you can get thyroid autoimmune disease and you test positive for that.

Post history of using iodized salt?

Where are you located?

Suggest:
high potency B-complex multi-vits with trace elements including 150mcg iodine and 150-200mcg selenium.
5000iu Vit-D3 tiny oil based capsules, take 25,000iu first five days.

Get 25mg DHEA from USA vitamin displays, one per day.

DHEA, Vit-D3 are fat soluble. Take with meals that have more fats/oils. Do not take with high fiber foods such as oat meal. Test DHEA-S later to see how well you are absorbing. DHEA is made in the adrenals, noting that cortisol looks good.

Vit-D is very important for immune function and so is thyroid status. Given your viral issues, you need to take action.


Please read the stickies found here: About the T Replacement Category

  • 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.


#4

https://drive.google.com/drive/folders/1bfXOxnP6m4YuzTI4w6H4A02134QFVd5z?usp=sharing

That’s a shared google drive folder with all of my labwork going back to 2010.

My old doctor actually didn’t test Estradiol even though I requested that he test it so I have never had my estradiol levels tested.

Thank You for the advice. I just did my first injection of depo-testosterone 200mg with .5 mg anastrozole twice weekly. Do you think I should stop treatment and pursue other solutions?

My vitamin and mineral supplementation is already top notch, and my nutrition/dietary stuff is all in very good order. I already supplement Iodine, Selenium, D/D2, D3 (These are in my life extensions Mix supplement). I take life extensions Mix (14 capsules daily), Jym Omega 3, Life Extensions Mitochondrial Energy Optimizer, Life Extensions Super Bio-Curcumin, Vitacost ToCoQ10, Life Extensions AMPK Activator, Life Extensions Cognitex, And two testosterone booster supplements daily(Fettle Excellence Phoenix and Neovicta Alpha). I workout 2 hours a day 6 days a week, I eat vegan and get enough protein via supplementation. I don’t drink or touch drugs and i don’t smoke.

Should I stop depo-T and try and fix this naturally? I already spent 3 months getting my vitamins/minerals/diet in order and retesting (the most recent test was after making all these changes) but I did not supplement DHEA.

I also hear that for people that may be secondary there’s a chance that supplementing with just hCG alone could work? I could use more insight into that.

Thank You,
Gary M.

PS. I am located in the USA(california) and I do use regular iodized salt, there’s iodine in some of my supplements as well.


High T, FSH, SHBG, Low E2 No Libido. My Lab Results
#5

I’m still not sure what the best course of action is for someone with my lab results…

It looks like I’m probably secondary hypogonadism, and that my low Free T is most likely due to the excess SHBG? I know that SHBG correlates in some way with the thyroid, and low DHEA seems to be able to cause changes in SHBG… does anyone here think it might be possible to fix my Free T problem naturally by supplementing DHEA and taking levothyroxine for the sub-optimal thyroid levels?

I really wish there was some way to figure out the actual cause of these endocrine issues I’m dealing with and fix them, and not just treat the symptoms, specifically with exogenous testosterone that could render me infertile and comes with a whole host of potential dangerous side effects…

It’s hard to say yes or no, but it almost does seem like I have a thyroid issue (not just hashemoto’s antibodies) from the TSH results jumping around so dramatically.

I would really like to treat things as naturally as possible personally.

Any help is greatly appreciated,
Thanks,
Gary M.


#6

There’s lots more side effect staying low T, if done correctly TRT has no side effects. HCG can help keep you fertile. Your SHBG is just too damn high, TRT is your only hope. You can blame on living in a toxic environment, these kinds of things never happened 50 years ago.


#7

That’s what I was afraid of…

Iv’e read that it may be possible to lower SHBG if i fix my low DHEA levels, I could really use a definitive answer to that? If that’s the case it may be worth it to stop depo-T treatment immediately and let it clear my system, supplement with DHEA for a few months and re-test my levels…

But if fixing my low DHEA wont fix my high SHBG levels then it’s pointless to try. I’m doing as much research as I can, but I cant find much about how DHEA and SHBG levels correlate with each other, just that first mention…?

I also read that it may be possible that I have high SHBG due to a thyroid issue (even though my thyroid levels seem relatively OK most of the time, I do have TGab and TPOab antibodies, and my TSH tests very high once or twice)… and that fixing the thyroid imbalance would lower SHBG and thus fix my low Free T… but I can’t find much of an answer on this one either? It appears that I have literally twice the amount of SHBG that I should have, thus lowering my SHBG by 1/2 would increase my Free T 2 fold or more…

I dont think an HPTA restart would help, because my TOTAL T levels are fine, so even though my LH+FSH seem relatively low, it must be enough to stimulate the production of adequate total levels of testosterone…,

I guess ultimately I just want a definitive answer on wether or not fixing my low DHEA would fix my high SHBG? and or if fixing my unstable thyroid could/would fix my HIGH SHBG? in either case raising my Free T?

Thanks,
Gary M.


#8

Both my parents do have thyroid issues too, and both my sisters, so it runs in the family. Mom has hashemoto’s dad has graves. Dont know if this information helps.


#9

If you have a thyroid issue and it’s resolved SHBG will then increase, not decrease. I think you’re grasping at straws because you want to avoid TRT, you want it to be true. SHBG is made in the liver, lot’s of people have low DHEA and don’t suffer from thyroid issues. Doctors will take one look at your TSH and send you on your way, they’re not going to commit medical suicide prescribing you thyroid treatment when you’re routinely under 2.0. Females tend to have more issues with thyroids, just because other family members have it does mean you will.


#10

Thank You, this answers most of my questions definitively.

You are correct that I am both grasping at straws and want to avoid TRT.

I just feel like TRT is treating the symptoms while giving up on finding the root cause of the issue and fixing it.

Thanks,
Gary M.


#11

Your liver is the biggest problem, it’s making too much SHBG. It’s possible it’s just genetically high SHBG, people seem to end up all over the ranges without a known cause.


#12

I am on day 9 of TRT. 200mg Depo-T once weekly, with .5mg anastrozole twice weekly.

I have already started to notice significant testicle shrinkage and this is one of the many reasons I didn’t even want to start TRT…

I’ve asked my doctor to add in 250 IU hCG EOD (I don’t want to be pinning anything this often but I don’t think I have a choice at this point)…

What should I be doing here? Should I add in hCG and cycle off of the Depo-T and do PCT the same way you would with high/steroidal doses?

I’m only 31 and want to preserve my natural production as much as possible and preserve fertility, my main interest in starting TRT is to help with muscle mass, I’ve been lifting hard for 2 years and cant put on muscle at all, or get below 17% body fat.

I’m intrigued by something I read about rich piana recovering his natural T production using hCG alone, is this realistic? I’m fairly confident that my low T is secondary causes…

At this point the speed of testicle shrinkage/atrophy is alarming me greatly and I’m very close to giving up on this TRT experiment, even though I am experiencing alot of emotional/mental benefits.

Thanks,
Gary M.


#13

Your testes will always shrink a lot when you first start TRT or increase dosages, months later they will start hanging again a little less than before you started TRT without HCG. With HCG you’re back to full size. Note some don’t feel well on HCG.


#14

This makes me feel alot better.

I asked my Dr. to test my free & total testosterone, estradiol, DHT and DHEA (9 days into TRT now). I’m going to get those tested now before starting hCG and again in a few weeks after starting hCG (I’m going on monday to pick up the hCG and starting it). I haven’t noticed any of the side effects of high estradiol, my feet swelled a little for the first 2 days starting TRT but other then that I’ve only had positive effects so far.

It worries me that I’m already on 200mg Depo-T weekly and he hasn’t ever tested my estradiol levels, and now we are adding in hCG and don’t know my estradiol levels… I would have preferred to start on a lower Depo-T dose WITHOUT the armidex and work my way up to keep things simple, but it didn’t work out that way.

I had to pay out of pocket for a 10 week supply of Depo-T and will most certainly have to pay out of pocket for the hCG, so I was thinking about using the Depo-T like a steroid stack and running on it for 10 weeks and then cycling off and doing PCT just to keep my natural production going… that is as opposed to the blast & cruise methodology… is there some negative to doing this in my situation?

TBH I’m kind of considering doing the Depo-T+hCG+Armidex for 10 weeks, cycling off and doing a PCT, and then trying hCG alone to fix my testosterone problem (being that I’m secondary I think). Is this plan at all logical for someone in my position?


#15

I’m curious,

I’m already 10 days into 200mg/weekly Depo-T with .5mg anastrozole 2x weekly.

I’ve already noticed significant testicular shrinkage (they don’t hang as low), if I were to completely stop treatment with the goal of trying to get back to where I was BEFORE treatment as quickly as possible, what would I need to do? would I need to do some sort of PCT?

After experiencing this side effect, and doing some more research, I really wish I could backtrack and try supplementing with DHEA and a few other things to see if my Free T levels improve, and if not, I’d prefer to try hCG monotherapy before moving onto Depo-T.

But it’s too late now, and I’m not sure what the best way to backtrack would be?

Thank You so much!,
Gary M.


#16

Why would you want to return to a state of sexual dysfunction, you have not thought this through. DHEA increases Test in women, but increases estrogen in men. If there was another way your doctor would have done it first, you do understand you balls will hang again right? They aren’t doing you any favors making you feel like pure crap and it will get worse as you progress lower in T levels with more age. Who cares if they’re shrunk up for a few months, it’s not like the general public will know about it. I would gladly cut my balls clean off for all the benefits I have been noticing lately. Why aren’t you on HCG together with TRT? Most guys are.


#17

I understand where you’re coming from, but I just turned 31, have no idea if I’m ever going to want kids someday, etc.

I’m also secondary, my total testosterone levels are fine, it was my Free T that was low due to elevated SHBG. I read a direct link between DHEA deficiency and elevated SHBG in men, and I have a DHEA deficiency – I’m thinking had I tried to supplement DHEA my SHBG may have come down and Free T may have raised. I also had a vitamin D deficiency I could have maybe given more time to treat.

I also have low LH/FSH and it seems like hCG monotherapy is alot less damaging on fertility and harms natural production alot less while pretty much providing much of the same benefits? I don’t mind pinning e.o.d if it means I get symptomatic relief with less risk/more natural approach.

You really think I’m waisting my time trying these other approaches?


#18

I’ve never heard anything remotely similar, your SHBG is sky high and no amount of DHEA is going to make a difference, if it did tons of guys would be doing exactly that and wouldn’t bother with TRT. DHEA raises estrogen which raises SHBG.

Don’t waste anymore of your life chasing your tail, give it a few months and you understand what I’m saying. You’ll look back a laugh, ask your doctor about HCG as this is a sure way to stay fertile on TRT and will make you balls hang just like they did before. I’m not on HCG and my balls are hanging, maybe 20% less.


#19

Thanks.

I’m still in the process of deciding, I go to pick up hCG tomorrow from the compounding pharmacy, I believe it’s for 250IU e.o.d I hope this is a good dose to go along with 200mg test-cyp once weeky.

I’ll try adding the hCG and re-assess the situation.

Can I ask, about how long would it take for natural production to shut down entirely on a cycle of 200mg test-cyp (assuming I was planning on cycling off / I’m split on that decision)?

Thanks.


#20

It doesn’t happen right away, it could be months before it happens. You could start the HCG in a month and you won’t have to worry about it. There are lots of guys having babies on TRT even without HCG. I noticed about a month ago my dosage was increased and my balls pulled up a bit for about a month, but now are starting to hang again, this seems to happen to me everytime I increase dosages or increase the frequency of injections.