T Nation

31 Yrs Old. 12 Weeks into TRT, Totally Stuck Due to Low SHBG. Help?


#1

I am 31 years old and 12 weeks into TRT.

Please help me as i am really cofused and stuck after my low shbg test came out last week. I am just kind of stuck at 12 th week. Seems like so much things revolving in my head at this stage.

So it is best if i give you what i have done so far.

I had been suffering from a low t issues since 4 years. I belong to developing country where there is no knowledge among the doctors about the TRT protocols. So with much effort i have got the prescription but after that i am all on own. No doc/endo/trt clinic etc.

But having said that i have read a lot about TRT since last two years.

My fasting blood sugar and throid status is in optimal state. O.8 Tsh and morning body temprature 97.8.

Free testosterone test not available in my whole country.

I decided to start with 100 mg per week( 50 mg every 3.5 d).

I ran this protocol for 6 weeks. Labs came out as

Total t 721
E2 44( non sensitive)

The positives after 6 weeks.

Sleep
Mood
Energy
Confidence
General fatigue
Etc

But very below average changes in
Libido
Morning wood
Errection
Orgamsm intensity

So i decided may be the sexual area needs little more test and little low e2

So i bump the test to 120 mg per week. Divided into 2 injections.

Added 0.25 mg a.i arimidex with injections.( 0.5 mg per week).

I ran it for 4 weeks.

The positive changes described above were constant.

The sexual side also did improve at this protocol. I had a bit more libido and somewhat ok errections. But on a scale of 1to 10. Ill give it a 4. On previous protocol it was 2.

Labs after 4 weeks of this protocol

Test 633
E2 22 non sensitive

Then i thought i am doing pretty ok and might close to even dialed in so i thought i needed a bit more e2. Not much increase just a slight. So instead of cutting armidex altogether i decided to increase the test to 140 mg per week. 20 mg increase. So to fine tune my e2 and raise it a little bit for the libido and errections.

Then i started 140 mg per week( 70 mg 3.5D) and same ai dosage 0.25 mg with shots( 0.5 mg / week).

Just one week into this protocol. Cant say much about results so far.

Now i have my shbg test back and reported 14.58 from 19.8. So this made me so so much confuse at this stage.

My confusion is listed in shape of questions below. I really !! Need your help here !!

1)14.58 shbgb is low. What are the side effects of low shbg in relation to TRT. The only side known to my knowledge from What i have read, the test gets cleared from body too quickly. But i had my blood drawn just before my next bi weekly shot and i showed a level of 633. The best i had on peak was 721. So my test levels are not. " clearing quickly ".

  1. Am i at the right protocol right now considering my low shbg?

140 mg test ( 70 mg every 3.5 days)
0.25 mg arimidex with shots.

  1. i am not getting desired results in libido/ errections/ morning wood. Plus i am not recovering from my exercise sessions even after 2 weeks.

Primary question :

What should be optimal protocol for me at this stage considering my

History and dosage ( pls scroll up)
My low shbg 14.58
Very Average libido
Poor errections
Poor muscle recovery

Few options in my mind are.

Returned to my second protocol where i felt the best.
That is 120 mg per week
Instead of doing 3.5 D previously, Now EOD injections. To reduce stress on SHBG. And lower free esteadiol as well ( due to low shbg).

Reduce Arimidex from 0.5 mg per week to 0.25 mg per week divided into two doses of 0.125 mg.

Or

100 mg per week. EOD. With no ai.

Please please help me, remember your knowledge will help a guy doing all his best “on his own”. I can not thank you enough if you have read so far. Please do comment and suggest whats best for me.

Millions of Thanx !!!


#2

With lower SHBG there is less non-bioavailable SHBG+T. This means that TT will be lower and you should not be expecting to get high range TT. And there is more FT. Most here who understand things well will advise that your T dosing is too high.

With 8 threads for your case, it is too much work to review what we have discussed or suggested in the past, so I will not go further. It is better to have one thread for a case. One can keep that alive and also create new threads linking to the old thread where the new data is in the old thread to avoid the new thread ‘forking’ your thread/

There are FT calculators that you can find via WWW.
Can you get bioavailable T tested there?

Are you primary or secondary? LH/FSH lab data determines that.

When you make a T dose change, you need to make a proportional change to anastrozole/Arimidex to keep E2 unchanged. E2=22 was probably a good place to be. Some will offer that with low SHBG, there will be more free E2. But most often people are not aware that SHBG+E2 is bio-available, so that aspect is not well understood.

Libido is a measure of male health and vitality. There could be other causes. Are you exposed to tropical diseases there? I have no idea what other lab tests you may have posted earlier.

Low SHBG can sometimes be associated with diabetes. Fasting glucose or A1C lab data? Have we discussed that before.


#3

I think you were on to something when you scored Test 633 with an E2 of 22 (non sensitive), perfect numbers for a low SHBG guy. You said you felt close to being dialed in at that point, then you got greedy and though more is better, for a low SHBG guys sometimes less is more.

Low SHBG guys don’t require high Total T because we typically have a lot more free hormones than guys with SHBG in the middle and high ranges.

I’m a low SHBG guy (18 nmol/L) and feel terrible in the 800 ranges, I only need 17-20mg EOD to reach 600+ ng/dL which is fine because at this point my free hormones (free T) is already pushing it towards the tops of the free T ranges.

Low SHBG guys would be smart to target free T and not Total T, a guy with higher SHBG and a Total T of 800 will not have the same free T as a guy with lower SHBG and the same Total T. Low SHBG guy will have perhaps double the free T. Free T is the unbound hormone that goes to work for you, Total T is bound and unavailable to your body.

A diet rich in veggies has been shown increase SHBG, perfect for low SHBG guys.


#4

Respected KSman,
I can not thank you guys enough for the guidance that you people offering here for me.

I am very new to Forum posting, so i will definitely keep in mind regarding the instruction of adding data to the same thread instead of creating a new one.

My free testosterone according to the free T calculator is 19.8 ng/dL. Which is really high on a dosage of 120 mg per week.

I am not diabetic and my fasting glucose levels are optimal i.e. 90 mg/dl.

I have secondary hypogodanism.

But my question remains the same !

I was doing good at 120 mg per week ( 60 mg every 3.5 days).
Arimidex 0.25 mg with the injections.

So i know i have to lower my dosage. But how much? This is really confusing for me at this stage. Because i don’t know from where to start.

I know i should be on EOD protocol. But how much total weekly? and how much Arimidex?

Just need a starting point and i will adjust from there.

Thank you again. I can not explain how much your guidance means to a guy who has no medical facilities like many other on the forum.

Best regards.


#5

@systemlord

Please take a look on my reply to KSman. I have same question for you as well.

You said that you only need 20 mg EOD. It means a total of 60 mg per week is enough for you. So you are taking any AI as well?

I was doing good at 120 mg per week ( 60 mg every 3.5 days).
Arimidex 0.25 mg with the injections.

So i know i have to lower my dosage. But how much? This is really confusing for me at this stage. Because i don’t know from where to start.

I know i should be on EOD protocol. But how much total weekly? and how much Arimidex?

Just need a starting point and i will adjust from there.


#6

When I was doing 20mg EOD (80mg weekly) I required an AI, I actually require an AI if I plan on staying above the 500 ng/dL range otherwise to get E2 in a range where there are no symptoms I must retreat to the 300 range and I will not do so. Your SHBG might even come up a bit on these lower more frequent smaller doses since larger doses decrease it.

You’re really at a disadvantage if you can’t get the Arimidex compounded into lower doses, in this case you can dissolve 1mg or .5mg Arimidex in 1 ounce of vodka and play around with dosing. Some are over responders to Arimidex, so even lower doses are required.

You have my vote for 17-20mg EOD, AI dosing will depend on Sensitive E2 labs.


#7

Your replies really clearing up my mind from so much confusion that i had this morning.

Few more queries, thank you for your precious time and knowledge.

  1. You stated that you had an SHBG of 18 and you had a protocol of 20 mg EOD. So what were your free test status at that dosing.

  2. When i started my TRT my initial total Test were 250-300 ng/dl and it was giving me classical low T symptoms. At that stage i had an SHBG of 19.8 to start with ( TRT lowered it to 14.5). So as you stated that even you shoot for 300 total test range. But the confusion here is that when i had 300 total test before TRT i still had low T symptoms, my SHBG was still low, so i must have more free Test in my body even before starting TRT. So why i was symptomatic at that stage?

and as soon as i started TRT my symptoms starts improving? Any logic comes to your mind??

i hope my question makes sense.


#8

@KSman

I have a very confusing question and it is messing up with my mind off and on.

When i started my TRT my initial total Test were 250-300 ng/dl and it was giving me classical low T symptoms. At that stage i had an SHBG of 19.8 to start with ( TRT lowered it to 14.5). But the confusion here is that when i had 300 total test before TRT i still had low T symptoms, BUT my SHBG was still low, so i must have more free Test in my body even before starting TRT. So why i was symptomatic at that stage with more free T?
and as soon as i started TRT my symptoms starts improving? Any logic comes to your mind?
I hope my question makes sense.


#9

Is there a reason why you didn’t mention anastrozolone which is easier to deal with than arimidex simply by cutting the 1mg tablet if needed?

I’m in the same low SHBG/high Estradiol boat and asking my Dr. for an AI, on Monday.


#10

Please clarify. Arimidex is anastrozole.


#11

@KSman

Oh! My apologies, I thought they were different substances and one was only available in liquid form. The “dissolving in vodka” threw me off. So those tabs aren’t easily cut, they crumble or something?


#12

The pills are tiny and cutting to 1/4mg is difficult and arbitrary doses need a liquid.


#13

You need to understand directly measured Free T isn’t an exact science, Free T labs are a best guess. We typically calculate Total T and SHBG to get our Free T using an SHBG calculator, enter your pre-TRT numbers versus now and you’ll see what I’m talking about.

http://www.issam.ch/freetesto.htm


#14

Would doing EOD injections due to low SHBG with Nebido yield the same results?


#15

I doubt anyone has tried it, most would just switched over to ethanate.


#16

No, the half life of testosterone undecanoate is 20+ days, the fluctuation from day to day would be faaaaaaaaaaaar less than cyp or eth, which already have fairly minimal daily fluctuations (although those who hyper-metabolise may have more marked fluctuations)


#17

Could you suggest a weekly protocol with undecanoate?

It is the only ester I have access to


#18

What dose of test r u on


#19

Currently doing 140mg once a week


#20

140mg of test E/C right?

Rough answer is 155mg/wk, will give an exact number later. However test U takes ages to build up, you’d be better off front loading 300mg for the first 2-3 wks then lowering to 155. You could probs even get away with e2w shots with test U