T Nation

32, Fit and Healthy but Tired and Depressed. Low Free T and High SHBG

Hi guys.

I’ve got some test results and would really appreciate some pointers on what’s my best course of action. I got the TRT Check Plus from Medichecks in the UK. I lift weights about 3 times a week and do cardio about twice a week. Diet is pretty good and I take a multivit. I don’t drink much or smoke. Any advice would be welcome!

Their comments are:
TRT Check Plus (Testosterone Replacement Therapy) 13 Sep 2017

We note that you are taking this test as a general health check.

You have a slight increase in your haemoglobin. This is not at a level that causes concern. However I would recommend that you continue to monitor your full blood count whilst you are taking testosterone replacement therapy.

Your neutrophils (a type of white blood cell) are decreased. I recommend rechecking your full blood count in one week to ensure that they are stable or have returned to normal.

If you develop symptoms of infection, or are feeling increasingly unwell in the interim then you should see your GP or attend an A&E dept. Low neutrophils can make it difficult to fight infection.

Your lymphocytes show signs of fighting an infection.

You have an elevated creatinine level. This could simply be due to engaging in heavy exercise or eating a protein rich diet, however it can also be a sign of kidney damage. I recommend that you discuss this result further with your GP.

Your liver function is normal with no sign of infection or inflammation.

Your CK level is high, indicating either having high muscle mass, or engaging in heavy exercise or a protein rich meal prior to testing. If this is unexpected then I would discuss it further with your GP.

You have normal levels of proteins.

Your ferritin level is normal indicating healthy iron stores.

You have a high level of HDL cholesterol, this is reassuring as it is protective against heart disease.

Your thyroid stimulating hormone, thyroxine and T3 are all normal which suggest healthy thyroid function.

You have normal testosterone, however there is a decrease in the amount that is available to bind with your body tissues. If you are experiencing problems such as low libido or erection problems then you may want to discuss this further with your GP.

There is a slight increase in your prolactin, this is not at a level that causes concern.

Your prostate result is reassuringly normal.

The key numbers are:


TOTAL PROTEIN 76.1 g/L 63.00 - 83.00
ALBUMIN *51.1 g/L 34.00 - 50.00
GLOBULIN 25 g/L 19.00 - 35.00


TESTOSTERONE 18.6 nmol/L 7.60 - 31.40
FREE-TESTOSTERONE(CALCULATED) *0.283 nmol/L 0.30 - 1.00
17-BETA OESTRADIOL <18.4 pmol/L 0.00 - 191.99
SEX HORMONE BINDING GLOB 49.1 nmol/L 16.00 - 55.00
PROLACTIN *325 mIU/L 86.00 - 324.00

That’s right where my SHBG sits at, for now at least, it went all the way up to 70 before. Any medications? Drinking/pills in past? SHBG is made in liver, goes up if it is stressed. Some people is it genetically higher.

Right now I’m seeing if I can lower mine using Aromasin (also for e2 control). Have had positive results in past.

70 is off the scale dude, the upper range listed is 55! ! No meds for me and not drinking that much recently. I have not been very stressed either.

I did have a vomiting bug a few days before the blood test - wonder if that could have skewed things e.g. the lymphocytes comment.

Please post all thyroid labs.
Post hematocrit, RBC, hemoglobin, ferritin.

Evaluate your overall thyroid function via oral body temperatures, see below. Many/most in UK can easily not be getting enough iodine and Vit-D3. If you do not consume dairy foods and sea food, you are screwed. Both thyroid and Vit-D have significant effects on energy and immune system.

Check that your multi-vit contains 150mcg iodine and 150-200mcg selenium and your lab comments suggested that you might need to avoid iron in vitamins, also breads, pasta, rice, cereals - read the labels. Many men absorb iron too easily. Men’s formula vitamins are iron free.

Dehydration can shift your lab numbers. Drink water if preparing for fasting lab work.

E2 very low, may be affecting brain function in its own way.

Other labs:
AM cortisol -at 8AM or 1 hour after waking up

If you do more thyroid, labs should be TSH, fT3, fT4 [please not T3, T4].

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.

Thanks a lot man. I will read the stickies A-Z over the weekend. I have been taking Vit D for the last few months and plan on eating more fish.

Here is all the info I received (includes TSH and FT3 and a Cortisol test from 12 months ago).


Cortisol elevated at night could be affecting sleep.

High CK: Please have fully recovered and not-sore muscles for next lab work.

Be fully hydrated for next labs.

Find this data: "Your TSH, thyroxine and T3 are all normal"
Thyroid lab ranges are useless, so “normal” is meaningless.

Ferritin is ample for T4–>T3 conversion.

Body temps!

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I had similar numbers to @tomkill, though my SHBG tended to bounce between 40 and 60 nmol/L, and my free testosterone level was a bit lower.

I was diagnosed with subclinical hypogonadism due to elevated FSH and LH levels. As these haven’t been checked, I’d try to get them included in your next set of tests.

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I am in similar shoes so take my advice with a scoop of salt. But I noticed that you have both high SHBG and peak cortisol. Perhaps supplementing with DHEA could be worth a try? But firstly, get your full blood work done.

DHEA on cortisol: https://www.ncbi.nlm.nih.gov/pubmed/12544381

DHEA has also shown tendencies to lower SHBG (however unreliable).

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I could not find the original article to eval what “decrease” amounted to. We do not know if DHEA has a direct effect or via brain and a calming effect [less stress].

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