T Nation

Bloodwork Results: Elevated SHBG/Low Free T

After getting recent blood work completed. I’ve had similar results between two different tests a year or so apart. I’m looking to run in optimal ranges, but I am getting mixed reviews from talking to different specialists and doing my own research on the options I have in front of me. I wanted to get any information I can before making commitments to anything. Any knowledge would be appreciated. Thank you!

Total 616 N
Free 47.9 L
Bioavailable 98.6 L
FALBUMIN, Serum 4.5 N

I should add the endo I took these results to is looking to start TRT treatment with HCG. He offers a 200mg dosage then reevaluates once started. I’m looking to run in optimal range as mentioned, but I am in no means trying to take advantage of treatment if it isn’t necessary.

I also talked with with another HRT Center who advised me I have enough testosterone in my body but it’s not being utilized. He suggested multiple ways to try to lower SHBG. Some with treatment, some without containing OTC supplants with slight adjustments with lifestyle changes. One option with treatment was micro-dosing TRT with HCG + Boron.

Just an example of the different types of feed back given here.

It’s difficult to find knowledgeable TRT doctors anywhere, you’ll find doctors doing all sorts of drastically different things, only a few get things right.

SHBG is not something easily manipulated, the liver does what it wants. You can become obese and insulin resistant which will lower it, or you can throw excess testosterone to suppress it. Your pituitary gland is lazy, it should be increasing LH to get more testosterone out of your testilcles.

When SHBG is high, LH is a better indication of T status. As far as microdosing TRT to decrease SHBG, the opposite is true for high SHBG men. Excess testosterone is what lowers SHBG, microdosing is best for men with low SHBG or those sensitive to estrogen.

The boron is a long shot, you might as well consume Jack’s magic beans. High SHBG is a mix of genetics and cutting, starvation diets to look leaner. This increases SHBG and lowers testosterone at the same time and before you know it FT is very low.

If you were somehow able to decrease SHBG 63->20, your TT will drop lower than half of what it is now and you would still be stuck with low testosterone. So fixing SHBG naturally is a colossal waste of time because at the end of the day testosterone is still low.

Appreciate the in-depth response and you taking the time to write back.

As a call to action your referring to my only option being replacement therapy or continue to ride our these results? Do you consider the protocol listed above from the endo that is referencing TRT + HCG the option that makes the most sense?

Thank you!

Or are you referring to looking into LH levels before taking on a TRT protocol?


You should start TRT in isolation adding HCG after you are all dialed in, the reason for this is because not all men tolerate HCG, a lot get bloating, mood and libido problems because it increases estrogen then needing drugs to counteract which can then cause even more problems.

If you start TRT and HCG, I don’t see how you will ever know if the symptoms are coming from the TRT side of things then needing an adjustment to the dosage, or if it’s the HCG causing the problems. Once or twice weekly will do fine unless you are having problems with estrogen, then more frequent dosing may be necessary.

No, if your LH is <3 this would indicate not much testosterone is being produced at all. LH will be almost completely suppressed (.2) while on TRT, so no need to test it.

I never mentioned this, but I’m 31 years old. What would be the protocol used after being on TRT for some years then wanting to have children?
Would the HCG be enough while continuing treatment, or would you have to pause on treatment all together during this time frame?

Appreciate the input earlier as well. Before adding HCG I’ll make sure to have TRT fully dialed in with completed lab work!

It usually is all that’s needed. There’s always FSH that could be added as well for the baby making but it’s more expensive so people don’t take it regularly.

You could always try to add low dose HCG back once you’re stable and things are good on TRT only just to keep the balls going. It’s just a lot to try to dial both in simultaneously because you can’t tell which is causing what.

Thank you for the information. You added validity to what @systemlord referenced above to me as well regarding the TRT/HCG protocol.

Once stable on TRT what would be the dosing recommendation for HCG weekly? I’ve seen mixed reviews on dosages. I fully understand it’s case by case with each individual based off response, but is there a standard effective dosage being used that you’ve seen?

Also, would running HCG long term along side of your TRT impact when it comes time to have children if you’ve been using both for years prior, or is it more beneficial to use strictly for when it’s time. I know it’s being used for other benefits then just fertility reasons, and why so many are running them both together like clockwork.

Appreciate it!

TRT, HCG and FSH should do the trick. HCG will wake up the testicles and FSH will start sperm production. Some guys just are force to deal with the added side effects to HCG just until such time you get the wife pregnant.

HCG is dosed at a minimum twice weekly because of the 24-36 hour half-life. You can dose the HCG is smaller doses to mimized sides effects. As far as using HCG aloneside TRT, some men have no problems having kids on TRT in isolation, usually the guys that aren’t expecting kids are the ones who are surprised.

Noted. How is the FSH treatment done if needed? Your referencing this only to be used if TRT in isolation, or with added HCG isn’t doing the trick, correct?

As you mentioned the sides of HCG possibly from higher dosages… Are you pro or con running HCG long term alongside of TRT in smaller dosages as part as your normal treatment?

I am pro using HCG long term if you don’t have any negative sides. Some guys feel like crap taking it. Myself included.

FSH is injected the same way HCG is

If HCG is not enough, FSH to the rescue. Your chance go up when using HCG and FSH rather than just using HCG.

Well if your adrenals don’t need the support that HCG provides, HCG will only create negative symptoms. Only you can answer is HCG is going to work for you long term because positive response is varied by the individual, but if HCG provides and benefit without symptoms, there is a long term health benefit.

What side effects do you deal with personally while on HCG and what dosage were you running?

Are you currently running it long term and have you been able to minimize them based of your select dosages if so?

I’d like to run it as well.

Is running HCG to tell if your responding in a positive way the best option, or would be checking your adrenals be something you look into before administering HCG?

What dosage did you consider effective, but low to minimize sides?

@pushathlete236 I’m on my phone so it’s hard to type a ton

But I am no longer using it. Both times I tried I felt crappy and my main issues (genital sensitivity and delayed ejaculation) got worse. It may have been a case of if I had ridden it out that it would have improved with time, but I didn’t give it long. I was originally on 500IU’s twice a week then the second time I tried 250IU’s twice a week. Both times within a week or two I felt like crap again.

However… some people have the opposite experience and it actually improves sensitivity and makes them feel great.

I don’t know why some people respond well to it and others don’t. It’s pretty weird.

No worries and thank you for the insight once again!

Yes, most I talk to on it claim they feel much better while using both simultaneously. Definitely a hard one to pin point

200 MG was the dosage given to start split twice weekly at 100 mg.

Do you suggest starting at this dose then getting labs done, or would you start with 100 or 150 mg weekly then reevaluate your numbers as you can always increase if needed?

That’s too high a starting dosage. We don’t yet know how sensitive your HPTA is to testosterone. I would start out either 150mg weekly or 70mg twice weekly, you can always increase the dosage if necessary and it will be easier on you as far as having to decrease the dosage and be left with the symptoms going from very high levels to lower levels.

I was thinking and had a feeling you’d suggest that. I’m glad I did reach out again.

I appreciate the help over the last few days!