Beating Down SHBG - 1st Bloodwork Interpretation Post-TRT

Pharma / TRT Testosterone Replacement
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Hey guys,

34-yo male here, in good shape & always have had a clean diet, never any drug use (PED, recreational, prescription or otherwise). Always have had a high libido & zero ED, but increasingly struggling with depression, moodiness, lack of motivation. Maybe the biggest indicator of T issues was I’ve been lifting for ~5 years but lean body mass gains are minimal, and any fat gained usually gathered around the hips. Worth mentioning that I started going bald (receding hairline, not crown) in my early 20s but that runs in the family too so idk.

Started to follow bloodwork on my own several years ago and found that I have naturally good TT but extremely high SHBG resulting in rock-bottom free T levels. Other hormonal markers seemed middle of ‘recommended’ ranges. The oldest complete bloods I have from OCT 2019 show:
TT: 10.58 ng/mL
SHBG: 74 nmol/L
Free T: 8.5 pg/mL (29.5 pmol/L)
Estradiol (plasma/serum): 33pg/mL
FSH: 7.14 mUI/mL
LH: 1.59 mUI/mL
Prolactin: 7.26 ng/mL
DHEAS: 1950 ng/mL (5308 nmol/L)

Last year some of the symptoms around depression & motivation seemed to get worse, so I started considering TRT as I understand this can be a way to drive down SHBG.

Last bloodwork pre-TRT in May of this year had SHBG at 68.2 nmol/L and free T at 10 mg/mL (34.7 pmol/L). Up to this point I’d been doing everything else possible to reduce SHBG (9mg boron daily + crucifers at every meal) but no real effect so I decided TRT was the answer.

Unfortunately I live in a mega-cucked Euro country where even mentioning T is frowned upon, TRT doesn’t exist and docs usually refuse to prescribe blood tests for T levels. So I am self-prescribing, administering 75mg IM of Test Enanthate every 3 days, so a bit above 150mg/week.

Just got my first blood lab back after 9 weeks on this protocol, here are the results:
TT 14.7 ng/mL (51 nmol/L)
SHBG: 56.60 nmol/L
Free T: 20.9 pg/mL (72.5 pmol/L)
Estradiol: 58pg/mL (213 pmol/L)
FSH: <0.3 UI/L
LH: <0.3 UI/L
Prolactin: 17ng/mL (360 mUI/L)
DHEAS: 2329 ng/mL (6320 nmol/L)
Pregnenolone: 0.3 ng/mL (0.95 nmol/L)
TSH: 1.71 mUI/L
fT3: 3.4 pg/mL (5.2 pmol/L)
fT4: 1.2 ng/dL (15.4 pmol/L)

The rest of the bloodwork (vitamins, cholesterol, platelets etc) all in recommended ranges but I can provide that too if it helps. Might be worth mentioning as well that I’ve been cutting fat during this same period (500-700 cal daily deficit, hit around 20% while trying to bulk and cutting down to 10% again).

Overall I feel good, had the early honeymoon & that dropped off a bit but the depression is gone and biggest impact I’ve seen is results in the gym. That said, my libido is wavering a bit - definitely less horny, when I see hot chicks it’s more appreciating them like art rather than animal desire like before. I’m ready to go once a girl is in front of me but otherwise interest is def down. I used to struggle a bit with porn/jacking off from the horniness, but completely stopped since starting TRT. No ED, but orgasms feel less intense & satisfying and semen volume is down - I know HCG can help with this but I want to focus on just 1 med for now. I also kind of feel a numbness, detachment or lack of focus/drive I never really had before.

I’ve been reading past topics here for weeks now but I’d like some help interpreting these bloods & maybe tweaking my protocol if needed. Main things I’m wondering are:

  • SHBG successfully reduced 25% & free T more than doubled, both now within ‘normal’ range but ideally I’d like to drive SHBG down lower and push free T to top of normal range (~40 pg/mL). Would it make sense to bump my protocol to 200mg/week & if so, is that sustainable?
  • E2 needs to be higher for these levels of TT, I read elsewhere here that the ratio is important and mine is way out of whack. Could reducing SHBG also help with E2 levels and restore a good ratio? If not, what are my options - and would this maybe address the libido issues?
  • FSH and LH are super low, not sure if this is a problem. The prolactin is also at the high end of the range (I didn’t have sex, cum, hug babies or pet any dogs for 48 hours prior to this blood draw). Are these major concerns?
  • Thyroid stuff is all solidly in the middle of ‘normal’ ranges as per my lab but I’ve seen people here suggesting my numbers might be high

Since I’m doing this without any doctor’s guidance, you guys’ experience would be a huge help answering these questions, and I’m all ears to anything else that raises your eyebrows as well.

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It is an option, and sustainable.

It is not. You are on testosterone, it will be zero. Do not waste any more money checking these hormones.

Probably not of concern.

They are fine.

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You can decrease this be getting lean and lowering fat mass, mainly the belly fat.

Some guys have lower libido at higher E2 levels.

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Thanks for the clarifications, sounds like dialing in my T is all I need to focus on for now.

I know free T is what really matters, but are there possible negative effects of remaining at higher TT levels despite mid- to lower free T? I’m already just under 1500 ng/dL TT with my current dose, if I bump to 200mg/week there’s no concern about remaining at even higher TT long-term?

The other option I see is switching from 75mg E3D to 150mg once per week, which apparently has a greater suppressive effect on SHBG, but I’m wary of the extra side effects from lower frequency.

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You may not get any, i dont. Cant tell any difference between day 1 and day 14 after injection.

Currently doing a mini blast but usually 125mg Sustanon E7D works perfectly with no sides.

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The Free T is the only thing that affects your tissues.

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Given your situation, doubtful.

I would go with whatever dose and schedule provided the most benefit for you. I do not hear guys tell me they feel better with once weekly dosing. What they tell me is they do not feel better with more frequent dosing, so what’s the point? Might as well go with just once.

Good luck working this out.

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Thanks for the insights here, guys. :clinking_glasses: Sounds like there’s only one way to find out. I’ll start doing a 150mg bolus E7D and (if I don’t have crashes from the start) I’ll keep that up for 6 weeks then see how I feel, retest & report the results here.

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Checking back in here after a couple of months on the new protocol - after the above discussion, I changed to a single weekly 150mg injection of Test E (from 75mg E3D over the preceding couple months).

Felt some immediate effects, all of the undesirable secondary effects related to libido & orgasm quality are totally gone - everything sex-related is back to exactly how I felt prior to starting TRT, very good. There seems to be something to the hypothesis of less frequent, larger-dose injections fixing sexual dysfunctions.

Last Wednesday I did a partial blood draw now that a couple months have passed in order to see the effect on the main indicators:

Total T : >15 ng/mL [2.49 - 8.35], Unfortunately they don’t specify above 15 here
SHBG: 50.4 nmol/L [18.3 - 54.1 for men under age 50]. Down from prior values of 68.2 pre-TRT and 56.6 on initial protocol. First time in my life within normal range.
Free T: 25.2 pg/mL [8.3 - 40.1] or 87.4 pmol/L [28.8 - 139]. Up from prior values of 10.0 pre-TRT and 20.9 on initial protocol

The only other thing I got checked here was the blood analysis, and it came back all normal except:

Hematocrit 51.5% [39 - 53]
Hemoglobin 17g/dL [13 - 18]
Ferritin 64ng/mL [30 - 400]

The past few weeks I’ve been feeling a bit of heaviness in my chest, or as if I could ‘feel’ my heart. I assumed this was from the hematocrit, so Friday I went and did a standard blood donation, felt better after. Then Sunday morning I was having coffee and reading, felt the chest pressure come back and some tingling in my left arm. Out of an abundance of caution I went to the ER, they did a full heart check and nothing is out of the ordinary. Just saw a cardiologist who said I might have some minor dry pericarditis (i.e., not from water retention) but even then no strong evidence for it. He put me on Colchicine for a month with high-dose aspirin just in case.

I have no personal or family history of cardiac issues, my blood pressure is in the high-normal range, over the past month my resting heart rate avg was 51bpm and nocturnal HRV avg was 77ms. By all accounts my heart function looks normal. I am unvaccinated but have had Corona ~3-4 times (twice confirmed), so I’m suspecting the pericarditis (if I even have it) could be due to that. I also considered it could be heart enlargement from TRT, but I have no historic cardio exams so no way to know.

Good news from all that is when the ER did my bloods, the hematocrit came back at 43.4% and hemoglobin at 15 g/dL, so the blood donation 2 days prior did the trick. That said, I am a bit concerned with the low ferritin - if I keep donating every 8 weeks, I’m concerned it will drop too low to keep donating and I’ll have to stop TRT to fix the hematocrit. @systemlord I think you’ve had success supplementing with iron for this reason?

My intent had been to do a fuller blood panel this week with lipids, E2, thyroid etc. but my veins are wrecked from the last few days so gonna hold off a bit - and I feel great otherwise, so I don’t expect to have any issues there.

Looking at my T numbers, it looks like it would make sense to increase the weekly dose from 150mg to maybe 175mg then 200mg in order to get closer to my target of the high end of Free T range, ~35-40 or so. But with the weird heart stuff now, I’m going to hold the protocol as-is until everything clears up then look at increasing. I’m exploring a one-off consult with some more open-minded endocrinologists in nearby countries just to get a professional take on my panels here before I keep experimenting further.

Any thoughts you guys have are welcome, and I’ll check back in here with a wider panel + numbers once I tweak the protocol further.

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The fT assay used here is a “direct” immunoassay and way off (note the units and then what is the calculated %fT?). Using Vermeulen calculator:

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Vermeulen calculated estimate typically 10-20% high compared to current gold standard equilibrium dialysis method. So let’s say 0.8*14.7 = 11.8 ng/dl

Your original fT is in a good range for healthy fT levels (10-20 ng/dl).

Tread carefully.

More info (very good thread to learn about units and details of fT before you put yourself on testosterone…pay attention to units):

You are self-medicating based on a practically useless free testosterone assay (windsock).

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TT assay here is useless as you don’t know what your actual TT level is. Given you are running above physiologic you will need LC/MS-MS.

The reference range for the direct fT assay (in relation to what you are registering) is sending you in the wrong direction if you seek TRT.

Get educated on fT measurement and try to find an accurate fT assay where you live (equilibrium dialysis / ultrafiltration). Confirm for yourself.

Given all the heart related COVID stuff going around right now probably not a great time to be testing how lucky you are OP.

If you take dosing up some more you will be running absurdly high fT level. FYI.

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Great info @readalot, thanks. My understanding has been that TT is less relevant in my case with high SHBG levels, and running supraphysiologic TT levels wouldn’t matter if the bioavailable fT was in normal ranges. I also know that normal ranges vary by country - the max ‘normal’ range here in EU is lower than the US standard, for example.

The thread you linked to says that there’s a misleading RIA test - that’s exactly the one my lab is using. So from what I understand, unless I find a lab using equilibrium dialysis, the fT readings could be totally inaccurate? Part of my motivation in starting this was to get SHBG down to normal ranges, which I finally am with the current protocol. But if the fT was actually in normal range, high SHBG would be irrelevant - I only care about that in terms of how much of TT remains bioavailable.

If that’s the case, I might have actually ended up basically running a cycle without realizing it, in terms of actual T levels? Reassuring that all the heart metrics have come back clean (bloods, EKG, ultrasound, x-ray, BP, etc.), so I’m not too worried about some random issue suddenly cropping up short-term with no warning. But as you said, not something I want to fuck around with long term.

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Great summary. Some newer thinking on the TT/fT thing with respect to HPTA control/feedback loop:

If you look there is some good evidence that HPTA controls fT not TT. Hence if true, trying to lower SHBG is pointless. If on TRT, pointless as well. Body eliminates fT not TT.

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Example (pay attention to units).

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Diet is a big deal. You need to understand how SHBG works. If you are on a kito / no carb diet, your SHBG and reverse t3 thyroid will likely be high. Add carbs back into the mix. Otherwise no clue what to tell you if thats not the case, excep that T boosters and other pharmaceuticals can also increase SHBG.

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I’m on a standard diet, about 40:40:20 protein:carbs:fat, tried keto once 6 years ago but haven’t done it since. No T boosters or anything else, although I did try ecdysterone last winter prior to TRT. My liver enzymes (ASAT, ALAT, GGT) are all in normal range.

I’m guessing this is either a genetic predisposition, or something related to pre-natal or early childhood development factors. In any case, the high SHBG is a consistent thing going back years.

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Especially to its role with respect to TT and fT.

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I had the same problem when my ferritin was low.

Yes, 140 mg iron chelated daily. When I was getting regular phlebotomiess every 30 days, my ferritin would bounce back to about 77 after 2-3 weeks.

There’s a type of iron, can’t remember which type that goes right towards building up your ferritin.

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Checking in again after another few months holding the protocol at 150mg test E E7D. Latest round of bloods showed all normal for lipids, blood cell counts & hematocrit - donating every 2 months as per standard recommendation seems to have fixed that. @systemlord I’ve been taking ZMA daily since forever without also taking copper to balance. Apparently a bad Zn:Cu ratio can inhibit iron absorption; I added copper for a couple months and the chest discomfort disappeared. I’m dropping both the ZMA and copper now, should be good moving forward.

Hormone side:

  • Estradiol: 27 pg/mL [11.3 - 43.2pg/mL]. Down from 58 pg/mL four months prior.
  • Prolactin: 9 ng/mL [4.04 - 15.2 ng/mL]. Down from 17 pg/mL four months prior.
  • TSH ultra-sensitive: 2.32 mUI/L [0.27 - 4.20 mUI/L]. Up from 1.71 mUI/L four months prior.
  • SHBG: 59.2 nmol/L [18.3 - 54.1 nmol/L for men under 50, I’m 34]. Up from 50.4 nmol/L four months prior.
  • Bioavailable T: 1.08 ng/mL or [1.0 - 3.70 ng/mL for men under 35]. Note that they lab ran the wrong test here, previously I was getting RIA Free T and this time they ran RIA bioavailable T. So no direct comparison but still too low.

@readalot took your advice and during a recent trip to the US got a dialysis of Free T done through Marek/Labcorp. Results were:

  • Total T: 1057 ng/dL [264 - 916 ng/dL]
  • Free T (dialysis): 0.8% [1.5 - 3.2%]
  • Free T (serum): 85 pg/mL [52 - 280 pg/mL]. Note my previous RIA free T assay done here in France while on TRT had me listed at 25.5 pg/mL or 87.4 pmol/L [8.3 - 40.1 pg/mL or 28.8 - 139 pmol/L]. The RIA assay could be wildly inaccurate as you said, or one of the labs might have swapped out the units here - 85 & 87.4 look suspiciously similar and an error margin of 3x or more is pretty shocking.

Hard for me to understand the latest dialysis lab, other than observing that the T levels are still lower than desired.

I’m bumping my protocol to 200mg E7D. Keeping injections infrequent because this approach allegedly drops SHBG more. But the last few weeks I’ve had no libido and I’m guessing the fact that my E2 dropped by half is probably related. If this doesn’t correct itself, I may consider more frequent injections if that might boost E2 levels.

Only other possible intervening factor I can see is that I just finished a moderate cut (300-500 kC daily deficit) for the past 3 months. Just had a DXA scan that put me at 8.5% BF, so going to shift here into a slow lean bulk and hold BF at 8-10%. I’m guessing the cut could have dampened my E2, which might take a few weeks to bounce back.

As I mentioned before, I do not do keto or anything of the sort + I’ve stopped drinking completely since this summer. I’m a fan of Ray Peat and am going to take on his diet approach fully, a carb-centric approach with fruit and dairy as the primary energy source, minimizing starch. Some people over at the Ray Peat forum have had luck dropping SHBG with this kind of ‘reverse keto’ approach, so we’ll see.

You guys see anything else here worth nothing? Seems like all I can do is increase dose then wait & see…

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Yes, increasing the dosage was inevitable. More androgens should hammer down the SHBG and increasing the Free T.