T Nation

31 Years Old, No TRT or Anything Else, Crazy High SHBG


#1

31 Years Old
175cm, 5’9" Tall
30 - 32inch waist
78kg 171.6lb

  • Have joe dirt, dirty sanchez facial hair
  • androgenic hair all over legs but it is fine, fairly hairless upperbody, very small amount of androgenic hair around the sternum/inner chest
  • Carry fat around love handles, lower abs. Glutes, groin and arms are also some of last places to lean out, need to get well past 8 pack to get seperation in delts and triceps.
  • Not sure fat storage pattern has changed, but there is more of it, I would cut down to 78kg ripped to shreds, now I’m quite soft, something like I was 78kg 8% now more like 12%

Symptoms History
Somewhere in last 2 years my very high libido slowly started waning to the point I hadn’t noticed it was completely gone, I’d basically been doing a chore and acting to satisfy my girlfriend, literally NEVER think about sex at all, recently had a vacation on my own, not once did I have an erection or even think about it. Erections work I just have ZERO desire or interest, it is literally going to work to plow the misses.

Sharp contrast to my entire life, libido always very high, usually sex and if not masturbation 3x day pretty much every day was the norm, couldn’t make it past 3 days without something or would usually have a nocturnal emission, now is undeniable to myself something is very wrong

Looking back I cannot maintain the same lean mass, strength and body fat at this weight as I used to, its still ok, but it is a backslide

There may be subtle brain fog, zest for life or energy issues but not sure, its happened gradually where I may not notice

  • Using no drugs, Rx or OTC whatsoever, no hairloss or prostate drugs ever, have had very very few drugs even OTC in my life, last time I even had a paracetemol or something like that was nearly 10 years ago, I just never take anything unless I have to, I have done 6 weeks of 40mg/day anavar(yeah stupid) followed by clomid about 4.5 years ago, seemed to recover fine still had a good 2.5 years or so of raging libido afterwards, no impediments in training/bodycomposition

  • Diet varies over time but is ALWAYS almost completely whole foods, make everything myself from scratch except for eating out for lunch either once or sometimes twice a week where its anything goes,

  • my usual maintenance is around 2700 calories that I’ll usually go over a little,
    main carbs are tons of fruit mainly apples bananas grapes mandarins tons of blueberries and raspberries, bit of rice, always a big serving of beans or lentils everyday, sometimes bread,
    main proteins are whey+casein, beans/lentils, tons of my own homemade yogurt(.5-
    1L/day), some nuts everyday rotate between a few, macadamias often, 2 brazil nuts
    everyday, not meat everyday but when I do its alot
    Fats: Try to keep it at >90g a day as I seem to do better, all fats from above protein
    sources, only oils I use are olive, macadamia and avocado, love butter and do that a bit
    but usually save my dairy fat for the yogurt, lots of whole olives too, also lots of cacao
    nibs, cocoa powder or 90% dark chocolate

I am aware of iodine and have exclusively used Iodized salt for years, usually 2 metric tea spoons(5ml?) a day minimum
Every meal has tonnes of veggies, start each day with heap of broccoli, kale, spinach, eat shit loads of garlic, 300g of onions and tomatoes a day minimum in my cooking, other staples I go through a lot of would be capsicums(all colours), red and green onions, carrots everyday, lots of butternut squash, lots of red cabbage, little bit of kimchi etc, lots of shit

I do actually eat that way all of the time and have done for years, I will eat any and all entrees mains desserts junk when I am out for a lunch though or theres a family/friend event on, so about 10% of my meals are whatever

I don’t skimp on calories either, though have done cuts over the years pushing calories low, never noticed much from them, last proper cut was about 8 months ago, got lean, but was below 75kg, literally the lightest I have been in years, so LBM must be down a little, libido was shot before I even started, and still is now, so there was no change throughout

Training

  • Like to train 6 days/week atm but it is lower volume not super hard, spreading 3 days work out over six really cause I like the routine of doing it first thing in the morning every morning, do 10 sets max in about 30min and done, split is:
    mon overheard press/chin up 5 sets x 8 reps each, then done thats it
    tues barbell curl/tricep pushdown 5 x 8
    weds front sq 5 x 5 - 8
    thurs bench press/seal row 5 x 8
    fri sometimes bent arm pullover/wrist roller 5 sets each sometimes nothing day off
    sat deadlift 5 x 5

The intensity is not that high on these just getting the work in, I love training Ive hit things like 3xbw dead and other decent lifts and body comp in the past so I know somewhat what I’m doing, but things don’t really improve anymore so I’m often working hard but cruising maintaining

Do no formal cardio but ride around low intensity on my bike while running my dog most days, 30-60min, do all errands on bike with trailer or walk around alot

  • Testes, no symptoms to report, maybe bit less plump than they use to be?.
  • Morning wood not always there, when it is it’s a bit weaker, biggest thing I notice is if I do wake up with morning wood it does not stick around! it is like instantly deflating to where I don’t notice it was ever there, would use to be waking up with a very strong erection that would just stand around pretty much until it was taken care of
  • Nocturnal wood I don’t notice

Lab results
Units Range
testosterone 20.2 nmol/L 6.0-28.0
SHBG 79 nmol/L 15-50
Free Test 231 pmol/L 200-600

FSH 3 IU/L 1-8
LH 2 IU/L 2-8
E2 108 pmol/L <150
Prolactin 140 mIU/L 45-375

TSH 1.32 mIU/L 0.50-5.00

			               desirable range

Cholesterol 4.5 mmol/L
HDL 2.5 mmol/L >1.0
LDL 1.9 mmol/L <2.5
Non-HDL 2.0 mmol/L <3.9
Triglyceride 0.3 mmol/L <2.0
LDL/HDL ratio 0.8
Chol/HDL 1.8

Glucose 5.1 mmol/L 3.0-5.4

So there we have it, I recently got blood tests suspecting low T mainly from my evaporating libido, but also adding a bit of low energy, brain fog, deteriorating bodycomp as pieces of the puzzle, and got this puzzle back

Test looks surprisingly good to me, e2 not too high either, tsh seems where I want it, I’ve never had a blood test for lipids so that was interesting, HDL is crazy, good to know the diet and lifestyle is good for that, glucose higher than would have liked/thought

But then the big ones, SHBG is crazy high and sure enough free T is almost below range! far below where it should be given my total T, perhaps this could account for my problems, but if so, how do I fix it?

Also total T is good, thats about 580 ng/dL I think, so my bodys been producing that, and yet my LH is damn near rock bottom? All seems weird and I have no idea what it all means or what could cause it

Tried to be thorough but it’s late, let me know if I’ve missed anything


#2

Very well written and organized!

Where are you located? Affects diagnostic and treatment options.

SHBG is made in the liver to scavenge sex hormones from the blood. Elevated E2 increases, more T decreases. Your E2 is not bad, but with low FT, E2 makes you estrogen dominant which is not good for SHBG

TT=20.2 is overstating your T status as high SHBG creates a lot of SHBG+T that inflates TT and SHBG+T is not bio-available.

Liver problems/conditions/disease can cause high SHBG. Liver labs AST/ALT can be useful, but if muscles are sore or not recovered, results can be high from that. So labs would require planning/preparation.

Starvation diets can increase SHBG.

You have secondary hypogonadism complicated by high SHBG with possible liver complications. Problem is not high -ve feedback from E2 or prolactin.

Suggested treatment:

  1. Get on SERM to increase LH/FSH and T, using anastrozole to keep E2 near 80 pmol/L. This will recover testes and may shift SHBG down, which may be slow. You will do labs for TT, FT, SHBG, LH/FSH
  2. Later, proceed from the HPTA restart sticky noting that you have completed the first phase.

I am sure you have seen the following.

Please check oral body temps as per last paragraph to eval overall thyroid function.

Did you ever not use iodized salt?

Any starvation diets?

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.


#3

Thank you very much KSman!

  • in Australia: Treatment options are fairly poor, I have failed at finding a doctor that will work with me and actually order satisfactory tests, I am a very low income earner and just do not have the money to continue to pay for their consult, that leads to referral to an endo who has an even more expensive initial consult(some crooks $400!!) and is even worse to boot! Then try again and go through the exact same costs again to arrive at you’re a young man you’re fine.

So I have absolutely no faith in the legitimate route at this point and no means to truly go that way, I’ve only finally just gotten these tests done as I’ve found a clinic that lets you order your own tests through them online(I’ve never been able to find this in aus), but you pay for everything privately.

So I can do all my own testing but maybe not as often as I would like due to expense and my means, as for medications I have not had much trouble tracking down everything, was thinking based on my symptoms my T would be tanked and if so I was going to say fuck it and get some test, self medicate while doing my own testing to manage levels and e2, much quicker, cheaper and more reliable then the hacks that have been stealing my money, try again the proper way in my 40s, hopefully with a better medical culture with more TRT knowledge.

But this has seemed a bit more complicated so threw a spanner in the works, however what you say about SHBG and total T makes sense, combined with the LH makes me think that may be the route regardless.

Liver: I have liver and blood values I will add them below, didn’t last night just because it was late for me and I was half asleep, they were taken on a tuesday, had not trained that day, but had done overhead press and chinups on monday, nothing on sunday.

I rarely drink anymore and when I do its quite little, may go months without a single drink, had friends wedding a month ago and had maybe 6-8 drinks, nothing since. Have drank more in the past but progressively less and less over the last 6 years or so.

Starvation: I definitely have done very hard diets in the past, but hard and fast, always seemed better to stick to physically and mentally to cut, big dips in calories but for the shortest time possible seemed to effect my metabolism far less than the “cut 5% calories for 12-16 weeks” thing, so I would do quick cuts of like a month of 1500cal/day with maybe 2 4000cal days/week, rip 2 or 3kg a fat off then straight back to about 2700-2800 cals was my preferred method, rarely more than once a year, max I think is twice but its hazy now.

Salt: Did not grow up with iodized salt, switched to it exclusively as soon as I read about it, and many years ago now but I think when I did, I also did an iodine “loading” phase with a strong iodine supplement just in case to fully load my stores and then iodized salt ever since, all this was early twenties, around 23 I think.

Body Temps: I have seen this, I am going to get a thermometer as I don’t have one, symptom wise I don’t notice anything, don’t feel cold, wear shorts and flip flops almost year round deep into our southern winter, it doesn’t snow, but still gets cold, never ever use heating actually, sleep in very cool dark room and feel quite toasty warm in the morning

Restart: Here’s my biggest omission from last night I don’t know why I blanked on it, I don’t take just about anything but I did try a ‘cycle’ of nolvadex and aromasin last year! Was frustrated with lack of progress with any docs and very suspect of my T so got ahold of pharma tamoxifen and aromasin, did not have access to the testing I do now so it was very much a shot in the dark, I can’t say I noticed much from it.

I ran them for the last quarter of the year, so start sept to end of dec:

  • 10mg tamoxifen/day(1/2 a tab)
  • 6.25mg(qtr of a tab) a/day or maybe everyother day I can’t remember, that was as small as I could get the tab
    Continued the aromasin about 3 weeks after the tamoxifen I think, finished mid/early jan

As I said no tests so kinda stupid, did not notice much while doing it, definitely no libido, I definitely went with tamoxifen as I remember when I did clomid(no ai then either) after the anavar I felt like a bitch on her rag with a ton of anxiety! So did never want to touch clomid again, no thanks, definitely had a strong libido along with it at the time though(~4.5years ago, had no issues beforehand then, or for long while afterward)

So here are the last of the bloods
Electrolytes:
Sodium 141 mmol/L 135-145
Potassium 4.4 mmol/L 3.5-5.2
Chloride 102mmol/L 95-110
Bicarbonate 32mmol/L 22-32
Urea 6.1 mmol/L 2.5-8.0
Creatinine 107 umol/L 60-110
eGFR 79 mL/min/1.73m2
Calcium 2.29 mmol/L 2.15-2.55
Adjusted Calcium 2.26 mmol/L 2.15-2.55
Phospate 1.27 mmol/L 0.75-1.50
Uric Acid 0.30 mmol/L 0.18-0.47

Liver Function:
Total Protein 75 g/L 60-82
Albumin 42 g/L 35-50
Alkaline Phosphatase 57 U/L 30-120
Total Bilirubin 7 umol/L <25
Gamma GT 16 U/L <51
AST 33 U/L <41
ALT 31 U/L <51
Globulin 33 g/L 23-39

Iron Studies
Iron 14.3 umol/L 10.0-30.0
Transferrin 2.31 g/L 2.10-3.80
Transferrin Saturation 25 % 15-50
Ferritin 115 ug/L 20-250

General Haematology:
Haemoglobin 137 g/L 130-180
RBC 4.20 x10^12/L 4.50-6.50
PCV 0.40 - 00.40-0.55
MCV 95 fL 80-99
MCH 32.6 pg 27.0-32.0
MCHC 343 g/L 310-360
RDW 12.3 % 11.0-15.0
White Cell Count 4.1 x10^9/L 4.0-11.0
Neutrophils % 40 %
Neutrophils 1.6 x10^9/L 2.0-8.0
Lymphocytes % 49
Lymphocytes 2.0 x10^9/L 1.0-4.0
Monocytes % 9
Monocytes 0.4 x10^9/L <1.1
Eosinophils % 2
Eosinophils <0.1 x10^9/L <0.6
Basophils % 1
Basophils <0.1 x10^9/L <0.3
Platelets 214 x10^9/L 150-450
MPV 10.5

Liver function looks ok to me but I’m ignorant in the area, definitely some oddities in the blood, borderline low haemoglobin, low Neutrophils, high MCH, I don’t eat a low iron diet, iron and ferritin looks ok, could be higher but not too low, though I wonder if the low haemoglobin is just a knock on effect from low test

Like said in earlier post energy or zest for life is not at it’s best but when training do not notice any real endurance problems.

So that’s all I can remember to address at this point in time, let me know what I’ve forgotten!


#4

I did not see hematocrit in your labs. If <.42 I would be concerned about a GI blood loss and suggest an occult blood test that detects blood hidden in your poop. You are young enough that a routine endoscopic screening will not trip over anything.

Your blood issues that you noted are more typical of very low levels of T which you do not have.


#5

Thanks KSman

Hematocrit is PCV(packed cell volume) I believe. And it is .40 the bottom
of the range

GI bleed wonder what could cause it?

Blood typical of low test but if all bound to shbg, could my very low free
t still cause the same ?