Blood Results Advice - Possible TRT?

First post here but I’ve lurked for a while. I’d really appreciate some advice.

47 year old. Symptoms include lack of libido, fatigue and lack of motivation. I was a stone heavier when these tests were done. Intermittent fasting has helped me lose weight but the original issues persist.

TSH 1.650 mlU/L (reference 0.27 - 4.20)
FSH 5.5 mlU/ml (reference 1.5 - 12.4 U/L)
LH 5.3 IU/L (reference 1.7 - 8.6 U/L)
Prolactin 139 mU/L (reference 86 - 324 mU/L)
Testosterone 17.48 nmol/L (reference 8.6 - 29.0)
SHBG 61.5 nmol/L (reference 18.3 - 54.1)
Free Androgen Index 28.423 % (reference 35.0 - 92.6)

I had a follow up test to try and determine why SHBG was high.

Serum Globulin 20 g/l (reference 24 - 37)
Free Testosterone 9.0 pmol/l (reference 4 - 30)

Endocrinologist then decided I wasn’t a candidate for TRT.

The elephant in the room is your SHBG is binding up the majority of your testosterone SHBG+T which is not the active form of testosterone. SHBG is a protein made inside the liver and isn’t reversible, the liver basically dictates SHBG production and you deal with it by throwing excess androgens at it to suppress it.

The high SHBG situation is making things look better than they really are, excess androgens lowers SHBG and you will need at least 35 nmol/L to ever have enough Free T. Most doctors don’t even know what SHBG does, a complete lack of understanding.

If you were somehow able to reduce SHBG by 50%, again not reality, you would see Total T closer or below 10 nmol/L and your situation would still see Free T on the lower end. Doctors are taught in range is normal, but for testosterone this is not true because of how the endocrine system functions. An example, if you get your ferritin tested and you score 65, next week you levels will be about the same, but your testosterone levels are always changing, fluctuating from one day to the next.

You could have a Total T of 17 nmol/L today, tomorrow your Total T could be 8 nmol/L. So you get tested on the day when levels are 15 nmol/L instead of tommorow when your Total T is 8 nmol/L, expect now you are a candidate for TRT if you test on the second day instead of the first. Most men need to have higher than mid range Free T levels to feel normal with no symptoms, some even need Free T levels to be at the top of the reference ranges.

The majority of sick care or socialized medicine doctors, endocrinologist’s receive zero education in sex hormones in medical school which is why your endo has made a gross error failing to understand the implications of high SHBG and that your T production is quite low if you remove the high SHBG from the equation.

It’s common to see doctors worldwide fail miserably at properly diagnosing a testosterone deficiency, most don’t have enough education to make the diagnosis because sex hormones has been ignored for many decades do to a false belief TRT causes prostate cancer creating the situation we face today, complete and utter ignorance getting a proper diagnosis. You need TRT or things will not get better because SHBG increases as we age binding up more and more Free T as Total T value increases and again the latter is the inactive form of testosterone.

Spend enough time on T-Nation or any other forum and you’ll see men in your same situation being told they are normal and they all share one common denominator, high SHBG and Free T on the lower end. When you have tens of thousands on men searching the internet trying to find out what the F*** is wrong with them after being told by their doctor that they are normal, you know something isn’t right and that’s why you’re here on T-Nation.

This tells you doctors are getting it wrong.

Thanks so much for the detailed reply.

I realised there is a bunch of stuff to add to the initial post which I forgot to type.

These results were from January this year. I’m a stone lighter now but my symptoms haven’t improved. I read about supplementing with boron and stinging nettle root to reduce SHBG, which did seem to improve things initially, but that seems to have plateaued.

I had hepatitis A when I was a teenager. I wonder if that’s something that might have affected my liver and could be responsible for the high SHBG?

I’m vegetarian. I had read that vegetarian diets can cause high SHBG. I’m not sure if that’s true.

I guess ultimately, as you say, I could try and lower my SHBG, but it’s still not going to raise my free T that much.

My GP took blood and came back with the results, telling me, “it’s normal”, but wouldn’t share with me the actual numbers.

The endocrinologist I saw was private and said I was just one of those people outside the 95% where the reference range applies and there was nothing he was prepared to do. Bit of a slap in the face considering the money he charged.

Keto (which I’ve used successfully multiple times and really like) is prone to raising SHBG. I’ve seen too many folks post on here about it after doing it. I don’t know enough about a vegetarian diet but I would think there are some things you just aren’t able to get from veges alone. What was your reason for going vegetarian?

I have heard boron does lower SHBG, but never enough to make a difference and/or usually the liver finds a way around it.

It doesn’t really matter, you can’t go back in time and change it and at the end of the day you still need TRT. You need to find a doctor where all he does is TRT everyday all day, but if you go to an ordinary doctor, odds are he specializes in other areas of medicine and not necessarily TRT and is operating outside his main area of expertise, I can tell because he has missed the obvious problem.

You should be entitled to you money back because your doctor is wrong.

I’ve been vegetarian for about thirty years. It started off as an animal rights thing when I was a teenager and just stuck. I don’t really miss it as there’s plenty of meat replacement foods around, but if it’s having a detrimental effect on my body I might be inclined to start changing things up.

Intermittent fasting has actually been really good for weight loss, but again, if that’s making my SHBG worse, I’d ditch that too.

I wonder if the endocrinologist I saw was more involved in thyroid issues. This was in Edinburgh at a large private hospital which I probably shouldn’t name and the consultant has since retired. I probably shouldn’t name him either.

I’ve had a look at local private men’s health/TRT clinics and I couldn’t find anything. What’s the general consensus on the online clinics, like Optimale?

This has been a game changer for me. I can’t eat clean all the time so IF has helped offset that to some degree. Plus I just feel better on it.

This is the case more often than not, the prostate cancer taught in medical school is enough to scare most doctors away from TRT, plus TRT is low cost, low profit potential otherwise big pharma would have pushed doctors in another direction. Patents on TRT ran out several decades ago.

If there are no patents on drugs, doctor don’t go near it because there is money behind the unpatented drugs/hormones.

Never hear of them, I’m signed on with Defy Medical, they are the ones who spotted my deficiencies while my managed healthcare doctors didn’t know what the hell was going on.

They were able to determine iron deficiency without actually looking at iron panels, MCH was bottomed out and then weeks later dropped below range and critical anemia hit.

Thanks so much for all the replies.

After a bit more research, I’m going to get some bloods done by Optimale and see what kind of protocol they recommend.

I think trying to go back to my GP and asking for any help on the NHS is going to be a waste of time.

I’ve had some results which I wanted to share and get some feedback if that’s possible.

Full Blood Count
Haemoglobin 154 130 - 170 g/L
Red Blood Cells 5.12 4.40 - 5.80 x1012/L
Haematocrit 0.465 0.380 - 0.500 L/L
Mean Cell Volume 90.9 81 - 98 fl
Red Cell Distribution 12.8 11.5 - 14.4 %
Mean Cell Haemoglobin 30.2 27.0 - 33.0 pg
MCHC 332 300 - 350 g/L
Platelets 277 150 - 400 x109/L
MPV 9.30 7 - 13 fl
White Blood Cells 5.8 3.0 - 10.0 x109/L
Neutrophils 2.91 2.0 - 7.5 x109/L
Lymphocytes 2.16 1.2 - 3.65 x109/L
Monocytes 0.33 0.2 - 1.0 x109/L
Eosinophils 0.26 0 - 0.4 x109/L
Basophils 0.06 0 - 0.1 x109/L

Albumin 43.1 35 - 50 g/L

Cholesterol 4.62 0 - 5.0 mmol/L
HDL 1.09 >1.1 mmol/L
Triglycerides 1.49 <1.7(Fasting) mmol/L
LDL 2.85 <3.0 mmol/L
HDL Cholesterol ratio 23.6 >20 %
Non HDL Cholesterol 3.53 <4 mmol/L

FSH 6.2 Men 1.5-12.4 IU/L

  1. Follicular 3.5-12.5
  2. Ovulation 4.7-21.5
  3. Luteal 1.7-7.7
  4. Postmenopause 25.8-134.8

LH 5.7 Men 1.7-8.6 IU/L

  1. Follicular 2.4-12.6
  2. Ovulation 14.0-95.6
  3. Luteal 1.0-11.4
  4. Postmenopause 7.7-58.5

Oestradiol 145 41 - 159 pmol/L

Testosterone 22.50 8.64 - 29 nmol/L
SHBG 56 18.3 - 54.1 nmol/L
Free-Testosterone(Calculated) 0.346 0.2 - 0.62 nmol/L
Prolactin 123 86 - 324 mU/L

Thyroid Function
TSH 2.29 0.27 - 4.20 mIU/L
Free T4 19.0 12.0 - 22.0 pmol/L

PSA (Prostate) 0.325 <2 ug/L New range

@thefreek I have same total testosterone(I use the same scale, are you in Europe?), less SHBG and more free testosterone and yet I plan to start TRT as well.

At your age you dont have other hope. If this will make your decision easier Im 30. Most important are symptoms. If you have most of the low testosterone symptoms your body needs more testosterone. Another person with these levels can feel fine. That’s why ranges dont work at all.

If you want any numbers most people feel really well at the top or even slightly above top of these ranges.

@vonko1988 Thanks for commenting. Yes, I’m in the UK.

My SHBG has reduced since my last test. Not sure if it was losing weight, or the supplements I’m taking (boron, magnesium, zinc, vitamin D) but it’s still high. Maybe that’s as low as I can get it without TRT?

My symptoms haven’t changed, If anything, some have actually worsened.

Some of the supplements like boron make me feel crappy, but Im over responder. I think you should not waste your time hoping on supplements. This is a doomed battle, trust me I waged it one and a half year and researched and tried every possible supplement that can increase your T.
On the other hand I think you should continue taking these supplements because they have many benefits, except the boron. Dont try to lower SHBG. This is again a doomed battle. Also no matter how much you lower it you still will be suboptimal. And low SHBG is associated with early mortality. The best doctors in the world are against lowering it this way! You need more T man, thats it. are prone to prescribing TRT to a patient like you that has not terrible levels, but they charge expensively. The problem in UK is that enathate is expensive, I think one ampule was like 16 pounds. And this is the best ester you can use. Dont go for the cheap sustanon! If you like to take your chances with customs I can tell you where in Serbia you can get good enanthate for 1.5 pounds per ampule from the pharmacy.
There is another option for scrotal cream from a Greek Pharmacy, its not that expensive :wink:

Could the E2 level on my blood results be linked to the high SHBG? Would that be something that would account for my symptoms?

Is there anything I can do naturally to reduce my E2 level? Would this reduce the SHBG accordingly?

According to the Tru-T calculator your FT is 19.71 ng/dL (16-31 ng/dL) and is closer to the bottom end, high SHBG is the reason. Your high SHBG is either genetic, from starvation diets known as cutting or the liver has been damaged somehow. In either case it is not reversible in most cases unless medications is the cause.

TRT or excess androgens is what will suppress SHBG, nothing else will.

I have no idea how much thyroid hormone is making it into the cells because fT3 and rT3 weren’t tested. There are no T4 receptors in the body, only T3.

Lose weight and eat healthy foods. You may very well have estrogen sides on TRT, you will either need a low dosage AI or more frequent smaller injections. The latter should be attempted first.

If he starts TRT don’t you think his SHBG will drop to the upper 30s/ lower 40s?

@systemlord thanks for the detailed reply.

I guess I was hoping that it was estrogen that was causing the high SHBG and a natural/cheap solution was possible.

Trt will lower your SHBG

I do and in fact I was think it would drop to about low 30’s if he isn’t underdosed.