T Nation

37 Y/O High SHBG, Low T, Help Needed


#1

-age - 37
-height - 193cm
-waist - 32 inches (81cm)
-weight - 80kg (176lbs)
-describe body and facial hair -
Full beard (patchy in a couple of places but Tom Hardy thickness of moustache and good full beard on chin). Hairy legs and arms. None on back. Sparse on chest.

-describe where you carry fat and how changed - don;t have much body fat, although have notice more than previously on back of my neck.

  • health conditions, symptoms [history]
    Have been a startup entrepreneur for last 15 years. High stress and lots of uncertainty. 2 year custody battle with ex 2014-2016 – also very stressful.
    Started to lose interest in work in early 2016, thought I was having a mid life crisis - this continued throughout the year. Went to my family Dr and she said “probably stress”, nothing needed. She took blood tests (not sure what as didnt share with me) just said “normal - nothing to worry about”.
    Continued to get worse symptoms, particularly very emotional and reactive. Low sex drive. ED. Then started waking during the night, every night, unable to get back to sleep. Cold hands and feet. Felt like i was having a nervous breakdown. Got really bad!
    Went to a private Dr that specialises in Hormones and Thyroid, in December 2016. He tested for hormones and thyroid as well as vitamins and minerals. Lab results as follows:
    Test date 14 December 2016
    Dr’s Evaluation of my results: low Testosterone, low DHEA, sub-optimal Thyroid Function
    Blood tests show: low manganese, low zinc, low B2, low B1
    Actual numbers:

Cortisol 7.1 ng/ml (3.7-9.5 Morning)
Cortisol 1.9 ng/ml (1.2-3.0 Noon)
Cortisol 2.2 ng/ml (0.6-1.9 Evening)
Cortisol 0.8 ng/ml (0.4-1.0 Night)
Estradiol 31 pg/mL (12-56)
Testosterone 382 ng/dl (400-1200)
Ratio T/SHBG 0.3 (0.7-1.0)
DHEAS 83 (70-325)
SHBG 52 (15-50)
PSA <0.5 (<0.5-4 – Optimal 0.5-2)
Free T4 1.0 (0.7-2.5)
Free T3 3.3 (2.5-6.5)
TSH 1.4 (0.5-3.0)
TPOab 13 (0-150 – 70-150 borderline)

Manganese 9.2 nmol/L (9.0-40)
Zinc 9.5 umol/L (11.5-20)
B1 Thiamine (ETK activation) 1.28 (>1.25 deficient)
B2 Riboflavin (EGR activation) 1.37 (>1.30 deficient)

Treatment Plan Prescribed
clomiphene 50mg one alt days to boost test levels naturally
zinc picolinate 60mg at night
manganese 50mg one daily
B Complex 1-2 daily
DHEA 50mg daily

Started Clomid first – felt better almost straight away, like I had new batteries – almost too intense at first as became instant workaholic again! Sex drive came back too.
Started on the DHEA and sex drive died almost overnight. Consulted Dr and he advised to stop DHEA.

Retested with my local GP on 26 Jan 2017

Serum testosterone 33.2 nml/L (9.0-29.0) (to give like for like to previous test, this is 958 ng/dl - VS 383 ng/dl in December)
SHBG 81 nmol/L (17-56)
Free androgen index 41 (>35)
Serum FSH Level 9.7 iu/L (1.0-12.0)
Serum LH 8 iu/L (1.0-10.0)

free T4 (15 pmol/L (10-22)
TSH 0.99 mu/L (0.30-5.50)

Additional test with Private GP on 8th Feb 2017

Estradiol 54 pg/mL (12-56)
Testosterone 877 ng/dl (400-1200)
Ratio T/SHBG 0.6 (0.7-1.0)
DHEAS 105 (70-325)
SHBG 52 (15-50)
Cortisol 20.7
PSA <0.5 (<0.5-4 – Optimal 0.5-2)

Treatment Plan Prescribed
Dr advised me to stop Clomid for 4 weeks and see whether there was any improvement.
He also said I could retry with DHEA, which I started on March 19th, 8 days prior to retesting.
Retest done on 27 March
I had much more extensive tests done. Will list the key elements but can share more detail if needed:

Follicle Stim Hormone 5.69 IU/L (1.50-12.40)
Testosterone 481 ng/dl (400-1200)
Free testosterone 0.248 (0.30-1.0)
SHBG 57.93 (16-50)
Estradiol 17 pg/mL (12-56)
Luteinising Hormone 4.19 IU/L (1.70-8.60)
DHEAS 116 (70-325)

Total Protein 67.3 g/L (63-83)
Albumin 38.6 g/L (34-50)
Globulin 28.7 g/L (19-35)

Liver Function
CK 269 (38-204) (HIGH)

Kidney Function
Sodium 146 (135-145) (HIGH)

I calculated my Bio-available Testosterone to be 5.25 nmol/L = 31.4 %
This takes the Albumin into account.

I am feeling less energetic these past few weeks. On the flip side my ED has disappeared and I have had more of a sex drive back (DHEA?). But feeling way more mentality tired and foggy headed…have been hitting the caffeine to get through the day. Not sure whether this is from overwork or from the T levels dropping so much in a month.

Now wondering where to go next – start back on Clomid? Or TRT?
I have 3 kids so don’t plan to have anymore.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
No none. Full head of very thick hair!

-lab results with ranges
As above

-describe diet [some create substantial damage with starvation diets]
No cows milk due to lactose sensitivity.
No to minimal gluten.
Lots of paleo style meals, but also crave sugar a lot at the moment, so eating fair amount of refined carbs like bread (gluten free), crisps and dark chocolate.

-describe training
Tennis once per week.
Cycle to work – 4 miles per day
Crossfit – twice per week

-testes ache, ever, with a fever?
Sometimes feel aching in left testes. But not sure if this is psychosomatic!
Had it checked by Dr for lumps and he said all was normal

-how have morning wood and nocturnal erections changed
Yes every morning and very strong since starting on the DHEA.


#2

fT4 and fT3 should be mid-range or higher, both are low.
TSH should be closer to 1.0
Your hands and feet are cold because fT3 is low
see last paragraph in this post to further self-eval thyroid function.

You are probably iodine deficient. You labs suggest that you are not located in UK.
Location determines how iodine is available. Iodized salt is best option, but not generally stocked in UK. You do not get any iodine via dairy foods.

Stress can increase rT3 that interferes with fT3 at T3 receptors making things all the worse. You can get rT3 tested.

Low thyroid function lowers energy levels and contributes to fat gain and lethargy.

50mg clomid is bad because it drives up E2 levels and when you stop, the lingering E2 shuts down T production. Elevated E2 drives up SHBG. SHBG lowers FT and inflates TT with SHBG+T that is not bio-available.

Is manganese been confused with magnesium? Most are magnesium deficient and that can show up as crampy leg and foot muscles.

You need more iodine in your diet AND a high potency B complex multi-vit with trace elements including iodine+selenium and that does not list iron. Normal males need to avoid added iron. Your low B vit labs indicate a poor diet that may impact your children and iodine is very important for them as well.

Take 5000iu Vit-D3, see if you can find tiny oil based capsules.

CK HIGH:
Creatine kinase in the blood may be high in health and disease. Exercise increases the outflow of creatine kinase to the blood stream for up to a week, and this is the most common cause of high CK in blood.[8] Furthermore, high CK in the blood may be related to high intracellular CK such as in persons of African descent.[9] Finally, high CK in the blood may be an indication of damage to CK-rich tissue, such as in rhabdomyolysis, myocardial infarction, myositis and myocarditis. This means creatine kinase in blood may be elevated in a wide range of clinical conditions including the use of medication such as statins; endocrine disorders such as hypothyroidism;[10] and skeletal muscle diseases and disorders including malignant hyperthermia,[11] and neuroleptic malignant syndrome.[12]

So muscle soreness or injury/bruising possible cause.

You were dehydrated for your labs and/or loaded up on crisps before. When doing fasting lab work, do not be thirsty, drink water.

Your first labs never tested LH/FSH - not good practice to start TRT etc before getting those.

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

  • advice for new guys
  • 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

Thanks for your help. I am based in the UK, but my DR uses ZRT Labs in USA.

My most recent tests for Thyroid show:

TSH - 1.23
FT4 - 15.6 pmol/L (10-22)

I’ve ordered an oral thermometer. I’ve also ordered test for rT3 and fT3.

Magnesium levels and D3 levels are good as per recent test results:
25 OH VITAMIN D - VITAMIN D = 118.5 nmol/L (50.00 - 200.00)
Magnesium 0.96 mmol/L (0.60 -1.00)

This is probably because I already supplement with 450mg Magnesium Malate per night and 5,000iu Vit-D3. I also supplement with Biocare B-Complex twice daily.

They also tested for:
VITAMIN B12 334 pmol/L (140.00-724.00)
FOLATE (SERUM) 11.96 ug/L (3.89 -26.80)

Not sure which iodine supplement to use. Kelp seems to be the mean option, but contains only 500 ug per dose. I read http://drlwilson.com/Articles/IODINE.htm and he’s talking 50mg! Any advice?
I also found drops by Lugols. But Dr Wilson says that all other supplements than Kelp are toxic sources of Iodine over time. ?

I’m back to see my Dr about T levels in 2 weeks. I will remain off Clomid for the time being and ask him about Nolvadex. Seems this is the recommended route to take for a restart attempt?

Thanks
Patrick


#4

Here are my latest results. It does indeed seem that the rT3 levels are high and could well be the culprit. Any advice on how. to tackle this?

Many thanks
Patrick