With low E2 and high SHBG we have to wonder what is pushing up SHBG. Low FT can contribute to this and yes that means that in general the HPTA is unstable at times.
In this situation with young males and low LH/FSH we need to be concerned that prolactin might be the HPTA suppressive agent. Get prolactin tested. If elevated, a prolactin secreting pituitary adinoma is suspected and a MRI determines if there and large enough to be imaged. Not rare at all. Easily managed with 0.5mg/week dostinex, so not a major burden. If advanced can press on optic nerves, so not something to ignore.
SHBG can also be up from a liver issue. AST/ALT labs are helpful. Liver an also not be clearing E2 properly and serum E2 increases then SHBG up as a natural consequence.
NHS has a well deserved reputation for under serving male hormone problems. All of the common wealth counties suffer from the same defects.
FSH is probably a better measure of your LH status then LH itself as LH is released in pulses with a short half life and a lab can catch a point in the curve. Similar issues with FT when measured directly. However, calculated FT is probably representative.
SHBG+T is not bio-availalbe, something that your doc does not understand and he has no interest in thinking about these issues. You should be treated based on low LH/FSH, low FT and symptoms, TT should be ignored as a decisive criteria in this case. TRT would push SHBG down if TRT is done right.
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.