T Nation

Bloodwork: High SHGB, Low Free T. Advice?

35yr old 5’7 185lbs workout 3-4 days a week only for about 3yr. Lack of motivation depression anxiety hard to build muscle and keep stomach fat down. I eat pretty healthy and got my blood work back and my family doctor says “all within range.” Long time reader of the site 1st post.
1st test
Sex Hormone Binding 56.3 nmol/L 16.5 - 55.9 nmol/L
Testosterone, Free 7.2 pg/ml 8.7 - 25.1 pg/ml
Testosterone, Total 492 ng/dl 264 - 916 ng/dl

2nd test 10 days later
Sex Hormone Binding 56.4 nmol/L 16.5 - 55.9 nmol/L
Testosterone, Free 9.5 pg/ml 8.7 - 25.1 pg/ml
Testosterone, Total 530 ng/dl 264 - 916 ng/dl
Other labs
TSH 3rd Generation 2.540 UIU/ml 0.400 - 3.800 UIU/ml
LH 1.5 miu/ml
Males: 1.2 - 10.6
FSH 2.9 miu/ml
Males: 0.7 - 10.8
Estradiol 25 pg/ml <=53 pg/ml
Prolactin 4.6 ng/mL ng/mL
Reference Range for Males: 2.5 - 17.4

Hell man, I certainly wouldn’t usually be the first one to comment on a post since I’m relatively new to this as well, but your ranges are right close mine and I’m 40yrs old. “In range” isn’t really nearly optimal from what I’ve gathered around here. There’s a lot of guys who know more about this stuff than I do but for what it’s worth.

E2 doesn’t seem bad.

Some people might argue that your Total Testosterone is normal (I probably wouldn’t agree given your other numbers)

Free Testosterone serum is pretty low to me

SHBG is WAY TOO HIGH.

How long do you train every day and what kind of workouts do you do? Cardio, Endurance, Strength, Bodybuilding?

You need to seek private care because few doctors world wide are skilled at diagnosing a testosterone deficiency, in the world of hormones in ranges doesn’t mean you won’t have symptoms.

Doctors are mostly idiots and critical thinking and analytical thought does not seem to be needed to practice medicine, for those doctors, “in range” is normal and “out of range” isn’t.

Your Free T is in a range of someone much older, an elderly man to be precise and you doctor has failed at a most basic level of understanding. Your high SHBG is making your midrange Total T look better than it really is, what’s going on is your Free T is being siphoned by your high SHBG therefore inflating what really is low testosterone which is confirmed by low normal LH. If you were able to take a magic pill and cut your SHBG is half, your Free T would increase and Total T would landing you in lower range.

A lot of incompetent doctors would classify you as normal for the fact that Total T is within the normal range, but your Free T is hovering above and below range probably trading places every couple of days. You need Free T to be high normal 24/7 to see symptoms melt away.

Something you need to understand about managed healthcare, do to zero knowledge, doctors are taught to treat the reference ranges and ignore symptoms, in range is normal therefore treatment isn’t necessary. Beyond in range or out of range, you doctor knows nothing!

The problem with these ranges is they don’t account for age, doctors believe it’s alright for a 35 year old man to have the same levels as an 80 year, all it takes is critical thinking and analytical thought to figure out this is not alright for younger men to have the same testosterone as an old man.

What’s going on here behind your back is according to your insurance, you don’t qualify for TRT do to being “in range”, representing a transparent desire on the part of the insurance companies to deny treatment and thereby reduce costs.

Insurance companies wield all the power for when doctor can take action, doctors has no say so whether or not you get treatment, that’s why the reference ranges exist.

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Mostly strength training less then an hour each time with the program I’m on. I feel like I’ve had this issue for why to long 3 doctors ago I went in for low Lobido total T was the only thing he ran and it was 430ish but determined it was the Zoloft I was on so he discontinued it. Sorry forgot to mention I’m back on the Zoloft seems to stabilize my mood but my lobido is in the bottom range lol and my motivation and energy is crap. How should I respond to my doctor and do you think my testosterone is an issue?

Doctor wants me to take 50mg clomid for 90 days to increase my T levels to see if my “side effects” are actually related to my Testosterone prior to TRT. From what I’ve read on this forum 50mg and the length of time seems excessive?

Clomid dosing is excessive which indicates your doctor doesn’t prescribe clomid often, it he did he would have gathered it’s an excessive dose for many.

@systemlord Advice for stating 25mg EOD?

A 12.5 EOD can work, 25mg EOD is also good. I have seen some men do well on 25mg every 3-4 days, everyone is different.

Here are my new labs still waiting on Estradiol results. This is after running 6 weeks 25mg clomid EOD and anastrozol .25mg M-W-F. My first 2 sets of labs are from my family doctor and current labs by urologist that prescribed the clomid so 2 different labs on the blood. So confused I almost wonder if the current labs are wrong my SHBG drops by 20+ nmol/L? And the new free test ranges are strange? Here again are my previous 2 labs and current.
1st test
Sex Hormone Binding 56.3 nmol/L 16.5 - 55.9 nmol/L
Testosterone, Free 7.2 pg/ml 8.7 - 25.1 pg/ml
Testosterone, Total 492 ng/dl 264 - 916 ng/dl

2nd test 10 days later
Sex Hormone Binding 56.4 nmol/L 16.5 - 55.9 nmol/L
Testosterone, Free 9.5 pg/ml 8.7 - 25.1 pg/ml
Testosterone, Total 530 ng/dl 264 - 916 ng/dl
Other labs
TSH 3rd Generation 2.540 UIU/ml 0.400 - 3.800 UIU/ml
LH 1.5 miu/ml
Males: 1.2 - 10.6
FSH 2.9 miu/ml
Males: 0.7 - 10.8
Estradiol 25 pg/ml <=53 pg/ml
Prolactin 4.6 ng/mL ng/mL
Reference Range for Males: 2.5 - 17.4

3rd current labs
Total T 627 ng/dL Range 285-950
Free T 138 ng/ml Range 50-247
Testosterone % 2.2. Range 1.8 - 3.2
SHBG 33 Range. 10-74
Albumin 4.3 g/dL. Range 3.7-5.0

Few things can cause SHBG to decrease so dramatically, thyroid is one of them. Too bad no TSH/Free T3/Reverse T3 testing on 3rd set of labs.

Your 3rd set of labs showed highest testosterone reading so far, if it proved to much for you thyroid to increase metabolism as testosterone increased , it could cause SHBG to decrease.

Please explain what you mean I’m a little lost?

Somebody suffering from hypothyroidism would see their SHBG levels decrease. Sometimes a guy starts TRT and thyroid cannot function under an optimal testosterone environment, but may be fine with testosterone lower as the demand on thyroid is lower.

Coming in for questions rather than answers here, given my treatment is similar to yours. What have you noticed in your symptoms? Better? Worse? No change? What treatment are you doing moving forward?

@systemlord - Are you suggesting the higher T could have impacted his metabolism in a negative manner? Because the increase in T was too sudden? The new SHBG range is good for his free T, right?

Hi heyyou, That last set of labs looks pretty dam good from your other two. Hoaw are you feeling?
My advice is when your E2 number come in adjust your AI if your E2 is too high or too low. Don’t do anything else until you do a new blood test. If your next blood test look like the last I’d say your doc is doing great and you are on your way to recovery.

If you want and can talk your doc into check out the thyroid fine I got no issues with that.
When I got my TRT protocol tuned in my thyroid number turn around and they look great.
I can’t belive it but I think TRT fixed my low free T3.

@tnation11 @hrdlvn my Estrogen came in at 19.6 Range 10-42. My doctor is not doing a great kid he wanted me on 50mg clomid daily and 1mg AI daily as well. However I modified from what I’ve learned. After my last set of labs my doctor asked how I was doing after the increase in test and then proceeded to say “I would not even prescribe you TRT based off of your original test results because very few men walk around with that high of a total testosterone number.” What a joke! I stopped the clomid I felt blotted and just not amazing. My erections and anxiety have been a lot better and I haven’t felt as tired. Honestly if I had continued and pushed my T higher I think I would have felt much more of an improvement. Now I’m going to see how I feel over the next 30 days.

19.6 is about as low as I would ever want to go. My SHGB runs 24-29 and I love an E2 of 24-27 anything over 35 and my dick quits working. I can fix it with cialas but dam holding a good E2 is cheaper. I think you are doing great and so close to figuring this out.

@heyyouguys - I have very similar blood lab ranges to your first couple labs, with the exception of e2 (my runs really low, at 7.2) I’llpost my labs from clomid treatment next week.

You’we seeing how you feel over the next 30 days without taking anything? Or continuing clomid and/or the AÍ?

I tapered off Clomid and AI. I’m not going to take anything and will be seeing a more progressive independent hormone specialist the end of April. I want to see how I feel if my test drops back down.