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33Y/O. Low Free T, Low to Average Total T, High SHBG, Low LH

Testosterone results Thyroid results

I’m a 33 male. I received blood work results indicating very low free testosterone levels of 129 pmol/L (normal range 200-600), high SHBG of 64 nmol/L (normal range 15-50), and normal to low total testosterone of 10.3 nmol/L (normal range 6.0 to 28.0).

The symptoms I have been experiencing are low libido, rarely do I get morning wood (although I do get erections when aroused, and am able to climax without issue), anxiety (may or may not be related!), very boney physique with little muscle despite daily exercise, insomnia (may or may not be related), and extreme fatigue. Despite being thin (63kg) for my height (182cm), I have immutable fat around my waist: a very feminine characteristic. I’ve dieted for years and have never been able to lose this fat. I also have acne (at age 33!) despite taking care of my skin and applying benzoyl peroxide every day (I’ve tried a bunch of other treatments, too).

When I was around 20yrs old, I had mild gynecomastia which I addressed surgically.

I have been on a keto diet for about 12 months (and have lost a few kilos I’ve never been able to lose before, but I look even more boney than I did before I started!).

My thyroid has been examined and cleared (the results I’ve attached indicate my TSH was a little low but this has now moved into the normal range following a subsequent test).

My GP initially brushed off my low free testosterone and my high SHBG, but when I pressed him, he suggested that I should see an endo. I saw the endo (Australia) and he told me I did not have a Testosterone problem. He basically attributed my physique, and my problems, to my “genes”. I found his answer to be thoroughly unhelpful.

I will be having more blood work done soon to see if my levels have changed.

Assuming my new blood work is the same, what sort of treatment regiment should I consider given my results (I know I should be asking this of my endo but he is terribly unhelpful and I feel that this community has more knowledge about this condition). My primary goal is to increase my energy levels, and, if possible, improve my muscle mass. I would like to adopt a conservative approach, and one which will not shut down my nature T production or lead to any long term complications (i.e. I do not want to look like a body builder - that is completely unobtainable for me with my lanky physique - I just want to look and feel healthier).

I afraid you have experienced the idiot doctor syndrome, TRT is very taboo in your country and heavily regulated by the government and doctors do not want to prescribe it. Your Free T is below the reference ranges and still your doctor makes excuses, your genes need healthy testosterone levels. Drive any man’s testosterone into the ground and he will have feminine characteristics.

Your high SHBG is binding up the majority of your free testosterone which is why it is so low, doctors worldwide are sex hormone ignorant. In my experience endo’s are the worst doctor you could possible see for sex hormone problems, none of them have any knowledge in this field of medicine which is why your endo dismissed an obvious red flag that is your high SHBG and low Free T.

If your doctor understood what high SHBG represents and its influence on Free T, his tune would be quite different and a proper diagnosis would be possible.

You will no more increase muscle mass and energy than an 80 year old man at these levels. Your high SHBG is going to hold you back as you may never produce enough testosterone to compensate for high SHBG and therefore will always suffer low Free T. In your case Total T should be ignored because none of it is bioavailable.

TRT is it for you, Clomid will not work for you do to high SHBG which Clomid will increase to the point Free T will be near zero. You need to find a new doctor.

Thank you mate. It astounds me that medical professionals are disinclined to help those with genuine T problems, preferring to assume that everyone who asks for T is a juice head.

Given my stats, do you think Testosterone C injections are all I need, at least initially? Do I need to stack it with anything, noting that I’m seeking a fairly conservative regime rather than big gains?

Is there another option besides T-ie something that will stimulate my natural hormone production (noting that my LH is quite low)?

Thnx

You will likely need more testosterone than most men do to the high SHBG, larger dosages once or twice weekly will be needed in order to force SHBG to decrease enough to increase Free T high enough for symptom relief.

Test ethanate 60-70mg twice weekly or 140-160mg once weekly.

A lot of doctors were taught in medical school give a man TRT and it will give him prostate cancer, these fairytales have been blown out of the water and proven false, yet doctors still cling to these teachings.

Add to that none of them even know how to design a proper TRT protocol based off your blood biomarkers, when doctors don’t know how to do something, they tend to not want to do it at all because if something happens to you they get in trouble.

It’s no wonder they don’t want to prescribe TRT, skill, no knowledge and no clue.

There is nothing else besides TRT, TRT or BUST.

Thanks again for the advice!

I’ve been again to the doctor and have fresh blood work.

In short:

  • Total Testosterone is now 20.8 nmol/L (6.0 - 28.0) - this has increased significantly from my last test earlier in teh year.
  • SHBG is 63 nmol/L (15 - 50) - this remains very high
  • Free Testosterone is 287 pmol/L (200 - 600) - a little higher than last time but still quote low (owing presumably to the high SHBG count)
  • FSH is 4 IU/L (1 - 8) - this has increased.
  • LH is 1 IU/L (2 - 8) - this is low, as it has been in previous tests.
  • Prolactin 72 mIU/L (45 - 375)
  • Oestradiol 104 pmol/L (<150) - this has increased but I don’t know what to make of this value
  • Progesterone 1.6 nmol/L (<4.1)

Based on my latest results, my GP has prescribe me with Testosterone enantate 250mg/ML once a week. But now that my Total Testosterone values are much higher that they were previously I’m having second thoughts about going down a TRT path, particularly if it will destroy my natural testosterone production and lead me to a lifetime dependence on testosterone injections.

I’m at a quandary as to what to do next: my free T is terrible, my total T fairly respectable, and my SHBG is extreme. I’m a very slim guy but I still have a bit of fat around my waist, very little muscle, and most importantly, I’m experiencing very low energy levels. My sleep patters are also fairly impaired despite practising great sleep hygiene.

Any advice would be most appreciated!!

Your Blood numbers and your body size sound very similar to me. I have started on 150mg of Test E a week split into two shots, sub q and my first 6 week bloods showed a dramatic drop in SHBG and have got my free T just over high range.

The advice I got was to focus on getting my Free T up and other than maybe changing my protocol frequency a little Im feeling great and starting to put on muscle.

Hi rogan_jr - what were your primary symptoms, apart from inadequate muscle growth, that motivated you to go on TRT given that you had relatively strong total test levels?

Are you concerned that you will now need to remain on TRT indefinitely?

Hi mate, basically I was tired alot whether I worked out or not. When I did work out it would take me 4-5 days sometimes to recover energy levels and stop hurting. Mood and motivation had taken a fair drop too.

I’v always been interested in “optimising” my T levels so I’v always been open to the idea to go onto T at a certain point in my life.

It was the symptoms and ultimately seeing my low Free T level that made me decide now, although it was frustrating knowing I had really good T production that was being bound by my super high SHBG

It is a big commitment that I would never give advice on but personally I’m happy with the idea of managing my levels into the future.

Thanks mate - your experiences are helping me further develop my thoughts on this subject.

Did you consider going on Proviron/Mesterolone to lower SHBG before embarking on T supplementation?

Are you on anything to control your E2?

Thnx mate :slight_smile:

I did look into other ways of lowering SHBG but the gist I’v got is that gets harder as you get older (though I may be wrong on that) and that still wasn’t likely to up my Free T enough to have a dramatic effect. I have heard of some people having results with Proviron etc so don’t let me put you off trying.

The philosophy I have picked up on here and other forums concerning E2 is to avoid adding more chemicals into the mix unless we really have to. On the sort of low doses TRT users are on there shouldn’t be any need for any sort of control and to ride out any potential E2 sides at the beginning of treatment and see if they settle.

Personally my E2 seems to have gone down a tad alongside the SHBG.

And no problem mate, forums like this are a goldmine of information.

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Hey guys - thanks to all who have contributed to this thread (in particular rogan_jr and systemlord). I’ve found a new doctor who looked at my numbers and was willing to prescribe TRT (to my surprise!) He acknowledged that I didn’t fit the clinical definition of hypogonadism (which is an unduly narrow definition in Australia) but he thought that I’d benefit from the treatment nonetheless. He was also open to my choice of treatment protocol.

So, I’ve now been on T for 10 days, performing subQ injections every 4 days of .35 ml of Sustanon 250 (equating to approx ~88mg of T per injection, or 170mg across an 8 day period). Obviously I’m still learning about this so if my protocol is terrible please call it out!

My energy levels have significantly improved, and my anxiety (which I think was a product of me feeling so fatigued and unwell all of the time) has also dramatically improved (and here I was thinking that I had a generalised anxiety disorder!). Thoughts of a sexual nature are now more common. I haven’t noticed in changes in my body composition but that’s to be expected in such a limited amount of time. Really hoping that some of my immutable (and feminine) fat deposits around my waist/ass will slowly disappear. I’m now going to the gym 3-4 days a week for 20-30 minute sessions.

The one significant negative that I’ve experienced, however, is insomnia. I had insomnia before starting T, but it seems to be worse now (I went from 5 hours a night sleep pre TRT to 2-5 hrs per night over the last 8 or so days). Despite sleeping terribly, my energy levels are better than what they were before TRT when I was sleeping longer - go figure…

I’m hoping that my sleep will improve once my body adjusts to the TRT. I don’t have labs since starting TRT - I’ll need to wait another month for that. I’ve tried a huge range of supplements to get my sleeping under control (including the usual melatonin, zinc, magnesium, vitamin d, sodium, potassium etc) without a huge amount of success. I don’t consume caffeine or other stimulants either. Sleeping pills (Zolpidem, Benzos, etc) are ineffective.

Has anyone else experienced insomnia whilst on TRT and did it eventually resolve for you?! I was really hoping that TRT would be the key to fixing my sleep and I am a little disappointed that it seems to have made things worse for me :sadpanda:

Hey narcissusford, just dropping in to say that your situation is/was very similar to mine except that my SHBG is high but not quite as high, and I have v low FSH akin to your v low LH. My free test is below the bottom of the range, also: Feeling Resigned. Normal TT, Very Low Free T and FSH (2 Years Later)

I appreciate all the inputs from you and the others in this thread. I’m at a cross-roads as it sounds like you were, so it’s interesting to read your experiences. Like you, I’m wary of committing to something like this for life

Recently I’ve been wondering whether there were ways to lower SHBG or albumin (which I gather also impacts free T), but the suggestions made by systemlord and others suggest this is unlikely. Which is a shame, because my total T levels are fine so TRT in some way feels like overkill for my situation… if it’s the only option, though, it’ll be worth it to be rid of my fatigue/fog/dizziness/libido issues

Anyway, just a note to say thanks for the contributions. Please update this thread with any notable discoveries along your TRT journey

The tricky thing about high SHBG is it inflates Total T status making it look higher when in fact T status is actually lower since Free T is being drained, in this case LH is a better indication of T status.

Western lifestyle is leading to an imbalance in all hormones, even disinfectants are changing gut bacteria causing obesity and insulin resistance in children. We evolved surrounded by viruses and germs and now we live in clean environments full of chemicals.

A recent study shows we are passing microplastics in our stools and mosquitos are eating plastic creating new food chains.

Mate, thanks for your contribution, too. I read the link you embedded. It is a difficult decision to make. No doubt about it. I also have a teeny bit of health anxiety too which made it more challenging to pull the trigger! No ones wants to initiate a process that will result in a life-long need for medication, let alone medication that must be administered via regular injections. I get the dilemma you now face.

So how did I come to the decision to treat with TRT? Well I knew I was not feeling right, that my body composition was ‘off’, that my energy levels were not what they ought to be for a guy of my age, that my sleep patterns and anxiety levels were not normal, that my libido could be stronger, and that my labs demonstrated without any doubt that I had an issue in this department. I was also aware of the RISKS of NOT taking Test - have a look at the diseases and illnesses that a person with low Test is more likely to develop. For me, the negatives that I was dealing with on a day to day basis, and the long term risk of low Test, were of a sufficient magnitude to tip the dial in favour of treatment. I was also mindful that if I didn’t enjoy benefits from the treatment after 2-3 months that I could always discontinue and go down a restart protocol - so the idea that this is ‘forever’ once initiated is not quite correct: this option does give you the opportunity to ‘try before you buy’ and personally test how and to what extent T is benefiting your life. From what I understand, most guys are still able to produce pre TRT levels of Test within a couple of months of discontinuing TRT.

To put is simply, we only get to live once and I don’t want to go through life feeling (and looking) weak and fatigued when an entirely safe option exists to reverse this.

So far I’m happy with the energy boost it has given me and I’ve only been taking this for a little over a week. Whether I continue on TRT is something I cannot yet say - it will depend, I think, on whether my sleeping patterns improve - this being the most significant side-effect that I’m experiencing at the moment. But you might be one of the many people whose sleep is unaffected by, or even improved by, TRT.

Good luck mate.

Hiya mate, glad you found a decent doctor and are having some results on T.

How are you finding consistency with every four days? Iv moved up from twice a week to e3d after feeling fatigued on the day before my jab.

And I did find I was waking up more than usual in the first month or so but thats stopped now though if I do wake up early I feel energetic enough to get up, whatever time it is.

Thnx mate - I feel it is still too early for me to comment on the adequacy of my current protocol. What I will say is that I haven’t felt a noticeable crash or a massive high so my overall energy profile is stable. I feel I’ll have more of an idea of how the T is effecting me once I’ve been on it for a little longer.

Apart from sleeping issues, my only other issue is that I seem to experience a mild allergic reaction to the Sustanon at the injection site. I’ve tried multiple different injection sites and within 12 hours of injecting I’m left with an inflamed, sore red lump. It goes away in about 5-6 days, and the pain isn’t severe enough to motivate me to stop, but it is an annoyance. At first I thought it was my injection technique, or perhaps I was practising poor hygiene, but this doesn’t seem likely given that it has happened every single time. Oh well - I’ll live with it until I can try another T product.

I hope you’re doing well!

Yes doing very well thanks.

I get the same thing, some of the lumps got quite inflamed but that settled too. Iv changed to a different T mix that’s in a different oil and I still get the lumps but way smaller. Like you said it’s easy to put up with considering the results. I think of it as a mini nut slowly releasing T haha.

Hi all

I have my results, 6 weeks from starting TRT (note that my levels on 08/02/18 are representative of my levels just before starting TRT).

Are you can see, my Total Test has doubled (from 15.2 to 31.7 nmol/L, putting me at the very top of the range) and my Free Testosterone has trebled (from 198 to 611 pmol/L, again, putting me close to the top of the range).

Blood work was taken at a trough right before my next injection (I inject SubQ every 4 days) so I’d imagine my levels are a little higher than this 24 hours after pinning.

I’m pretty happy with the T results.

BUT I am concerned about two things: my sensitive oestradiol test (i.e. E2) is quite high at 130 pmol/L but still within range (this is the equivalent of 36 pg/m for you US-folks), my Progesterone sensitive is “Low” at <0.6 nmol/L (the range is 0.7 to 4.3), and my sensitive DHEAS is 5.0 which is low normal (the range is 4.3-15 umol/L).

These things would not concern me but I am experiencing intractable insomnia (this is my most oppressive symptom - I can only achieve 5 hours a day, most days) and fatigue and weakness. Could any of the above explain my symptoms?

All other blood work is normal except that my white cell count is low at 3.6 x109/L (4.0-11.0) and my Neutrophils are also low at 1.2 x109/L (2.0-7.5). My white cell count and my Neutrophils have been low for over 12 months which incidentally is when my insomnia became worse. I do not have progesterone or DHEAS panels from 12 months ago, unfortunately.

Thanks for your help guys

Do not be overly concerned with the numbers, only symptoms or lack thereof. TRT can worsen sleep apnea so be aware. If you are feeling this good after only 6 weeks, you’ve only scratched the surface of what TRT is going to do for your quality of life.

You need to give TRT at least a year before the full effects are present.

Thanks systemlord.

The thing is, I do have symptoms (insomnia, fatigue, etc) which I was hoping TRT would ameliorate. Appreciate it is still early days, but I haven’t noticed any improvements to my sleeping patterns - hence I’m querying whether my low progesterone, and somewhat low DHEA could be the cause. I’ll do some searching…