T Nation

Back on TRT, 2nd Lab Results in Low SHBG, High Free T, Not Feeling Great

33 years old former athlete here 5 ft 8, 180 pounds diagnosed with low t in the past and after being on anti depressants celexa for 10 years low dose 10 mg daily, the symptoms of being tired all the time, not recovering from workouts, no endurance, less sex drive, shitty sleep, waking up not feeling rested, I went to regular doc and she said lets try a new SSRI, we did called Vybrid for over a month and it didn’t do much, but gave me stomach problems. Went to psychiatrist who wanted me to take Vyvance for day time sleepiness/ ADD and thats when I decided to get my hormones checked again because I am an addict and in AA so I told him no to the Vyvanse. I told him about the past low t and he suggested that could be a factor. Went to local Male Clinic and now am back on TRT. I say back, because I tried this in 2014 with little success, took test Cyp got up to 200 a week with HCG twice a week 500IU back then, no AI, never felt any better for 7 months then stopped. Fast forward 3 years, I have two little kids and get tired after playing with them for 5 minutes on the swing set. Pretty sad, also my running endurance was only about 10-15 minutes before I would need to start walking. I don’t smoke, don’t drink, binge eat on occasion, have been sober for better part of 10 years.

New Protocol to start on 2/27 was 25 mg clomid daily, 240 mg test cyp twice a week and AI Anastozole 1 MG three times a week. I hoped for the best, felt cautiously optimistic, felt a little better the first few days, then more of the same, but then found it hard to sleep, waking up in the middle of night, taking a long time to fall asleep. Thought it was the clomid and the more I read about it on the forums got me concerned. I didn’t feel great, work motivation no better, daytime sleepiness, and after 2.5 weeks of this I was back to drinking 4-5 cups of coffee a day to get through the work day and my sleep sucked. So I called doc and said I feel like crap could it be the clomid?
I remember the only benefit I got from the 7 months of trt in the past was I slept better and thought a better protocol would be to get on HCG, he agreed and said Clomid was probably jacking up my E2.

Here my labs from pre TRT first visit with Dr. from Vitality Spa where I live. He said he would like to put me on Clomid alone to start, but may take a while to feel something. I said Im sick of being tired all of the time and not feeling life. So now after ditching the Clomid after two weeks I am back on HCG three times a week 200, test cyp 120 twice a week and 1 mg anastrazole three times a week.

In addition to this I’m taking 1 25 mg DHEA, Vitamin D 5,000, Vita Prostate 1 a day, and Iodine/sillenium supplement once a day.

Testosterone 190 ng/dL 550 - 1100 Abn
Free Testosterone 5.66 ng/dL 5.5 - 22.4
DHEA 173 ug/dL 300 - 690 Abn
Dihydrotestosterone pg/ml
Estradiol 40 pg/mL 7.6 - 25 Abn
Progesterone 0.6 ng/ml 0.5 - 1.4
Luteinizing Hormone 4.3 mIU/ml 1.5 - 15.2
Sex Hormone Binding Globulin 12.2 nmo/L 20 - 62.5 Abn
PRL 8.2 ng/mL 2 - 29
Follicle Stimulating Hormone 2.9 mIU/ml 1.6 - 8.0
Human Growth Hormone ng/mL 0.49 - 0.97
Insulin Like Growth Factor 159 ng/ml 312 - 469 Abn
Cortisol 17.8 ug/dl 14 - 22
Thyriod Stimulating Hormone 1.84 mlu/ml 0.4 - 2.25
T3 Free 2.9 pg/ml 3.0 - 4.5 Abn
T4 Free 1.03 ng/dl 0.6 - 1.8
REVERSE T3 ng/dl 8 - 25
Parathyroid hormone pg/mL 12 - 88
Thyroglobulin Antibody 1 0.1 - 5
Thyroperoxidase Antibody 1 0.1 - 9
Cholesterol 154 mg/dL 150 - 200
HDL Cholesterol 61 mg/dL 40 - 60 Abn
LDL 82 mg/dL 60 - 130
Triclygeride 108 mg/dL 30 - 150
Apolipoprotiein B mg/dl 51 - 153
Apolipoprotiein A-1 mg/dl 140 - 186
Homocysteine 9.5 5 - 8 Abn
Ferritin 18 ng/mL 200 - 380 Abn
Glucose 120 mg/dL 70 - 95 Abn
Hemoglobin A1c% 6.2 % 4 - 5.2 Abn
Insulin 10.1 1.9 - 23
Vitamin D 18.9 ng/ml 60 - 100 Abn
Vitamin B-12 888 pg/mL 600 - 1200
Folate 13.9 ng/mL 5.4 - 20
Magnesium 1.9 mg/dL 1.6 - 2.6
Globulin g/dL 2 - 3.5
Hemoglobin 13.8 g/dL 13.7 - 17.5
Hematocrit 41.7 % 38.8 - 50.0
Red Blood Cell 4.82 M/ul 4.63 - 6.08
White Blood Cell 7.9 K/ul 4 - 10.8
Mean Corpuscular Hemoglobin 29 % 25 - 32
Mean Corpuscular Hemoglobin Concentration 33.1 g/dL 32 - 37
Mean Corpuscular Volume 86 FL 79 - 100
Platelets 246 K/ul 160 - 400
Iron 39 ug/dl 65 - 175 Abn
Gamma Glutamyl Transferase 38 IU/L 7 - 64
Calcium 9.4 mg/dl 8.6 - 10.3
Total Protein 7.9 g/dL 6.4 - 8.3
Aspartate Amino Transferase 19 U/L 0.0 - 40
Alanine Aminotransferase 20 U/L 0.0 - 40
ALK PHOSPHATASE 65 U/L 40 - 150
Albumin 4.6 ug/ml 3.4 - 4.8
Blood Urea Nitrogen 17 mg/dl 6 - 20
Creatinine 0.5 mg/dL 0.8 - 1.3 Abn
High-sensitivity C-reactive Protein 3.3 mg/L 0.0 - 0.5 Abn
Total PSA 1.75 ng/mL 0.0 - 4

Just got my second labs yesterday after 3 weeks of treatment they are as follows (and I know its ridiculous they didn’t check more especially the CRP and Insulin like growth factor bc they were so off the first labs.

Testosterone 996 ng/dL 550 - 1100
Free Testosterone 28.7 ng/dL 5.5 - 22.4 Abn
DHEA 512.8 ug/dL 300 - 690
Estradiol 9 pg/mL 7.6 - 25
Dihydrotestosterone pg/ml
Sex Hormone Binding Globulin 16.5 nmo/L 20 - 62.5 Abn
White Blood Cell 10 K/ul 4 - 10.8
Red Blood Cell 4.82 M/ul 4.63 - 6.08
Hemoglobin 14.4 g/dL 13.7 - 17.5
Hematocrit 42.9 % 38.8 - 50.0
Mean Corpuscular Volume 89 FL 79 - 100
Mean Corpuscular Hemoglobin 29.9 % 25 - 32
Mean Corpuscular Hemoglobin Concentration 33.6 g/dL 32 - 37
Red Cell Distribition Width 15 % 11.5 - 16
Red Cell Distribition Width fL 35.3 - 48.9
Platelets 275 K/ul 160 - 400
Neutrophils percentage 67.5 % 34 - 71
Lymphocytes percentage 25.4 % 19.3 - 53.1
Monocyte percentage 5.9 % 4.7 - 12.5
Eosinophils percentage 0.7 % 0.7 - 7.0
Basophil percentage 0.5 % 0.1 - 0.2 Abn
Neutrophil 6.8 K/ul 2 - 6.9
Lymphocytes 2.5 K/ul 0.6 - 3.4
Monocytes 0.6 M/ul 0.0 - 0.9
Eosinophils 0.1 K/ul .04 - 0.54
Basophil 0 M/ul 0.0 - 0.2
Total PSA 2.6 ng/mL 0.0 - 4
FSH 0.3 2.5 - 10.2 Abn
Luteinizing Hormone 0.1 mIU/ml 1.5 - 15.2 Abn
PRL 7.24 ng/mL 2 - 29

So my question is, will TRT work for me? Any suggestions on the second labs to bring up with Dr. I have a phone consult with him tomorrow late morning. I know my SBHG is low is this why I dont feel much better? The Dr. said that there are 5 % of guys that are fast metabolizers of T and convert it quickly to Estrogen. I’ve read about Metabolic syndrome and am scared of this as I do have about 15 pounds of fat right in my belly which has been extremely stubborn to lose even though Im eating a calorie deficit and working out 4-5 times a week. I have a ? about Insulin like growth factor which mine was abnormally low on first full panel and the CRP was extremely high, Any help is appreciated!

Your levels are too damn high for a low SHBG man, you need to quit thinking big with low SHBG. Lots of thyroid labs missing, no fT3, fT4. Low SHBG men have a lot of free hormones, this means a ton of free estrogen and this is why you do not feel good.

You need to shoot for midranges or just slightly above it otherwise your free testosterone is going to convert too much free estrogen and you’re going to continue to feel like crap. This is why you felt terrible on 200 mg a week.

You are a hyper excreter with low SHBG. For this reason you need small injections every other day. You might be able to get away with two injections a week.

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Systemlord, thank you for your response, I will ask the doc about every other day shots also read that different kind of T, Propionate may work better for low SHBG guys?
You are right on the thyroid labs, not sure why they weren’t tested on the second blood panel, its one of my main concerns. They want me to sign up for a concierge 200 dollar a month plan that locks you in for 12 months and so far I said no until I see that its helping me feel better.

Does Anastrazole not help with the Free Estrogen ?
Also could low SHBG indicate a metabolic problem? I have a lot inflammation in my body indicated by high CRP, and before Trt, was getting sick a lot every few weeks in the winters the last two-3 years, I do have two small kids, but my wife doesn’t get sick. Just really want to not be so fatigued all the time and need help with this puzzle.

Interesting enough the Endocronoligist I had seen last year, who opted to do nothing about my low levels at that time to see if my body would recover on its own has called me to remind me of appointment next Tuesday. Thinking about seeing her and asking a lot of questions.

You don’t recover from 190 testosterone, that’s extreme hypogonadal, maybe if you were in the mid 400’s.

Cypionate is perfectly fine, not everyone does well on propionate. They didn’t test free hormone for thyroid because they don’t know to, inexperienced. Inflammation lowers SHBG and testosterone fights inflammation, remove TRT and inflammation could take over. Low thyroid hormones has more to do with SHBG levels and getting sick, low thyroid function lowers SHBG.

Why get locked into a financial straight jacket? If they know what their doing, repeat business should be a guarantee. I completely missed that you are on 1mg AI three times a week, jesus if you want osteoporosis keep it up! That’s an insane dosage of AI! This isn’t candy they are handing out.

My advice with low SHBG you shouldn’t be aiming for high normal levels, too many free hormones to deal with. Lower AI and test dosage. AI’s help lower estrogen, but if you don’t have any left… Too aggressive protocol.

See only lab ranges.

Do not test HGH!
Only IGF-1 is needed.

Ferritin 18 is very low.
Iron low,
CRP=3.3 is a big inflammation indicator
PSA needs to be watched

Do you have digestive issues? Could be a low level GI bleed. Healthy males do not have low iron, typically they need avoid iron supplements and fortified foods.

TSH too high, should be near 1.0
fT3 is low, should be near mid-range.
fT4 ditto

  • thyroid lab ranges are quite useless, doctors will think perfect - but not.

Do not test LH/FSH on TRT

You might have had metabolic syndrome, TRT will help a lot, but you also need optimal thyroid function.

Get homocysteine tested to detect cardiovascular inflammation.

Glucose high
A1C high
SHBG low

  • indications of diabetes

Take 5000iu Vit-D3 every day.

Are you taking a statin drug to lower cholesterol?

Please evaluate overall thyroid function via oral body temperatures - see below.

Thyroid can cause a lot of mood and energy problems as well as weight gain and more+++

Training on low-T and low thyroid function was/is risky - stresses adrenals.

Leg or food cramps? Magnesium deficiency, see “ZMA” in this site’s Biotest store.

Get occult blood test to detect blood in your poop. Not visible to the eye.


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 numbers 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.

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KSman, I appreciate your response, I went back to my first lab panel on the ranges for reverse T3 and Parathroid and they were not checked! They are blank and not checked, only the FT4 and FT3 which are low.

I have had digestive issues in the past, gastritis- inflammation of the stomach lining and acid reflux. I ordered an iron supplement and took for two days last weekend and since then the stomach pain/acid reflux has come back and been hurting all week, trying not to get an acid reducer, but don’t like taking tylenol much less ib profin. Was concerned with low iron, but not sure why it would be low. Interesting you say it could be lower GI bleeding, I have had a lower GI scope before and came up with the Gastritis back in 2014 when I got married and had first kid and was stressed no ulcer though. I have had mucus like white strands in stool on and off for a while, but was told it was probably lipids, fat that didn’t get digested for some reason.

I have also had since 2010 a thing called orbital pseudo tumor which is inflammation in the orbital muscles behind my eyes, feels like a headache/migraine and this has showed up a couple times a year since and has been treated with prednisone for a few weeks at a time. It is non-specific orbital inflammation, they could never tell me what caused it and if it would come back! Got tested for Graves Disease, Auto Immune markers everything came back negative.

I do not take a statin drug to lower cholesterol, the only thing I take for prescription now is propanolol which is a beta blocker a few times a week for work anxiety and meetings.
I don’t have leg cramps, or food cramps, but a lot of It band hip soreness from running which usually goes away after see chiropractor and get adjusted and stretch every couple of months.

When you say risky training on low T and low thyroid function do you mean to be careful during workouts here in the beginning? I have been working out 4 times a week with weights and one to 2 cardio 30 min runs, its hard on my body, and obviously am still tired all the time, is this over training?

Also good point on metabolic syndrome, I have been doing intermittent fasting 16 hour fast 8 hour feed window the past 3 weeks and have not lost much weight at all, which is really frustrating, leads me to believe there is some pre diabetes insulin resistance going on. Will stick with the Vitamin D-3 5000 iu. Will read the stickies again on overall thyroid function.

I talked to my Dr. and he said to give the protocol and my body a little more time to adjust to the T protocol, he said to come in to the office in 2 weeks and he’ll run a full thyroid panel, will make sure he adds the homocystein test, he said to stick with 240 test Cyp a week, 1 mg anastrazole 3 times a week and 500 iu hcg three times a week. Is this protocol setting me up for failure? Should I cut this dose down and see how I feel? Your guys help is so appreciated, this puzzle has me doing more research online than ever before am just starting to get up to speed your guidance and advice will be absorbed and utilized! Not sure I really trust this new Male enhancement Dr. He said my results looked pretty good and that low SHBG is not a problem and that I should be able to experience a lot of positive results from TRT.

Systemlord, you mentioned I’m on a too aggressive of a protocol, do you have any recommendations on dosages from here for a low SHBG guy?

It’s difficult to recommend a particular dosage for the simple fact I don’t know how your body responds to testosterone, it’s not linear. I would drop your dosage 10-20mg at a time and go slow, because you could sail past your genetic sweat spot and not even know it.

You know I may have spoke to soon in my own case, they are low SHBG men who hyper excreters and hyper metabolize testosterone so these guys will need higher levels. I’m one of those guys, 100mg weekly isn’t enough for me.

What is your SHBG and weekly test dose, systemlord?

I was on 50mg twice weekly, no AI, no HCG. Muscles are still a little soft, erections still a little soft. SHBG sits between 18-20 nmol/L but I’m one of those guys who has dreadfully low estrogen in relation to my TT. When I was low T I had a TT of 225 and a FT of .72 ng/dL which means my estrogen was unreadable.

I need more TT to get my estrogen up in range which is strange for the fact I’m 33% BF. My thyroid has always been closer to hyperthyroidism, TSH .580, midrange T4, lower fT4 which suggests excellent fT4 ->fT3 conversion which corresponds to body temperatures of 98.7.

I’ve noticed after a dosage increase I become hyperthyroid, body temperatures are 98.9 degrees at 10am. It shouldn’t be a surprise that I’m a skinny fat 6 ft man.

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@drew714, I’m gonna say it because I don’t see anyone on this thread saying it flat out… lower the test! And especially lower the arimidex! Your estradiol is a 9! That’s terrible. You are crashing and burning bro. When my E2 was that low my eyes were straight rolling back in my skull in the afternoon. I couldn’t keep myself awake if I wanted to. Let your E2 come back up. 3 mg a week of arimidex is was to much. Your Testosterone levels are over 900 so you could afford to drop the dosage a bit.

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Thanks for the advice all day, I’m going to cut the arimidex in half and lower the T. Not sure what to lower the T dose to though, any thoughts?
Also as a reminder I was on Clomid to start with this regiment and my second labs were from when I was on Clomid 25 MG a day, Test 240 mg a week split in two doses and the 3 mg arimidex, (1 mg 3 times a week) I felt like crap so Doc drew blood only at 2.5 weeks in and those were my levels, high t and low E, made the switch to HCG last week, still feel pretty sluggish and waiting for something positive to happen, approaching 4 weeks in on Tuesday. My fear is that the Clomid was driving my test way up when coupled with the Cypionate 240 a week and I was crashing my E2 with the AI my body was like WTF.
I had tried trt in the past in 2014 and was on 200 mg a week and hcg 500 iu twice a week and didn’t feel much different, did it for over 6 months the last two months at the higher 200 dose and got bronchitis and a super low reading after being on cough syrup for a week and missing a dose and the nurse PA at the only Testosterone clinic in town at that time suspended me when she saw my testosterone at 80, my E2 was 6, she sent me to endocrinologist who said to let my body recover when she checked my test and it was at 300 in the beginning of 2017. Funny that the endo didn’t check estrogen or T3 when she ordered a “full work up” I have a follow up with this Endocrinologist this coming week, and am going to ask her a bunch of ?'s since I already hit my deductible this year and the visit will only be like 50 bucks.

This endocrinologist told me point blank last year that my low t was a secondary issue, that LH and FSH were both working, which they were albeit on the very low side. She said the low T was being caused by something else not my pituitary or my testicles. I’m trying to figure out why, but more than why, how do I fix it and feel optimal.

Also had a ? for you guys about leaky gut - candida, could gut issues as Ksman mentioned have a big part in low T symptoms? Any advice on healing those issues is it worth spending time pointing the flash light on them?

In my personal opinion there are just to many variables here. If I were to give advice I’d say drop the test down to 100 mg a week and drop the ai. Run that for 6 weeks and do bloodwork. If your test is to low at that point you could either A. Increase test dosage or B. Incorporate HCG (also starting at lowest dose). I would not use clomid with trt anymore. Keep a close eye on estrogen sides but I doubt you will need an AI on just low dose test.

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Yup I agree. Sounds like an estrogen issue. Don’t forget the HCG increases the natural production of T as well. So taking 250mg of t and then hcg means your taking even more. I believe 250 is what body builders use. Most trt protocols start at 80 and max at 200.

But yeah if your estrogen is low I’d just stop it until my next boood test. I would rather have it be a little high than super low. Read up on the symptoms so that you know if it’s going up or down.

Research the hell out of this subject and do not rely on your doctor alone. They know allot but when it comes to TRT most docs are not with the times.

I was very hesitant to start until I absorbed tons of material and asked a million questions.

Hi Drew.

Any updates here? I was searching for something else and saw this. There are so many things going on in your labs.

Did you ever get ferritin up to 100-150? You will likely need pills for this, while testing Hemo/hematocrit.

Vitamin D up to mid range?

What happened to your blood sugar? You’ll never feel tuned up with insulin resistance, if you have it. A few other things in your labs could cause this (vit D, poor thyroid signaling). You could try otc insulin sensitizers, lipoic acid/chromium, or perhaps metaformin if you do in fact need it.

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