Considering TRT -- High SHBG, Low Estradiol, Symptoms

Pharma / TRT Testosterone Replacement
1

Hi all – long time lurker here. Hoping to get your advice on a recent blood panel.

Stats/Backstory 5’8", 181 lbs, BF 12%, 515/335/635, train four times a week. Ex D-1 baseball player, been training seriously since 17. Began powerlifting post-baseball at 21, have been competing in strongman since 25. Am 30 now and been experiencing ED and really low libido for the better part of a year. Onset was surprising and rapid – was still having wet dreams once a month at 28/29. When the ED/low libido began, I figured it was only sleep and stress related – I had started a pretty rigorous joint PhD/JD program, which I’m still in, and thought well hell, I’m just getting older. But then the real horror story – the girl of my dreams (a model and actress I’ve known for years) visits me in New York, we go to hook up, and I…go soft in her mouth. Red flag, you think?

So – the blood results:

Total testosterone: 763ng/Dl (249 – 836ng/Dl)
Estradiol: 13.00pg/ml (11 – 43pg/ml)
SHBG: 76.60nmol/L (16.5 – 55.9nmol/L)
Free Androgen Index: 34.6 (30 – 150)

Observations: Total testosterone is great…but SHBG is sky-fucking-high, and estradiol is really low. I’m also assuming that given high SHBG and a low Free Androgen Index, my free testosterone can only be described as “in the toilet,” too.

Notes: I don’t smoke, nor do I drink; supplement with zinc, mag, D3, and boron daily; diet is programmed by Renaissance Periodization and hovers around the 40%carbs/30%protein/30%fat split.

What I’m wondering is, how to go about correcting this imbalance? Supplementing with testosterone seems like taking a shower in the rain. Given that my immediate desire is to reclaim a libido, a proviron-only cycle seems worthwhile, given that at 50mg a day, studies have shown it doesn’t suppress natural testosterone production the way masteron does. On a related note, is the low estradiol something to worry about/try to correct, or should I leave it be?

Many, many thanks in advance, men, and looking forward to hearing from you all.

2

“sky fucking high”. So you know how I felt at 120.
:slight_smile:

I wanted to be a fan of Proviron and tried multiple times to make it work for me, but I tried too late - after I started TRT. You are going to get a butt load of suggestions, and I’m going to guess that they will ALL suggest TRT.

Remember however, that Proviron is illegal in the US. I performed my testing outside the USA for that reason. Just FYI on that.

Looking back, my doctor commented that we should have tried Clomid before TRT; I would have tried that or Proviron if I could have obtained it at the time - but my doctor was of the same belief that everyone here shares – “throw enough Testosterone at it and SHBG gets reduced”. I proved him wrong.

Estradiol is a weird thing. I had levels that were “<5”, and I have had levels that were at the top of the scale. FOR ME, neither end of the scale has helped me. Guys on this board will tell you that, when they found their Estradiol “sweet spot” – they “knew it” immediately. I’m not there.

3

Mine was even higher… 150+ SHBG to start with.

Keep in mind that right now your total T is only high because your body is basically holding on to every bit of it it can, so it’s never really being used. Once you start freeing it up, your total T levels will likely drop significantly as T gets freed up and used. Your body may or may not be able to actually produce enough. I’m guessing it probably can’t. Also keep in mind it’s very difficult to only lower SHBG without shutting down natural production. I don’t know any high SHBG guys that have had success with going that route actually.

So… trying Proviron certainly won’t hurt anything but I would not have super high hopes on it. I would consider regular ol TRT if you don’t get the results you want out of Proviron.

4

Looks like you were right about that so far, though it is only one suggestion. I just read your thread too – thanks for that link and for keeping a log in general. I have access to pharma-grade proviron, and am thinking this is the route to go. Can retest my TT/free t after a month of use, and see if total test is crashing. Thanks much.

5

That sentence scares me. I read these two studies last night that argue otherwise:

As I’m not a scientist, and am simply taking the research at face value, I’d love to know what you all here think.

6

Being not as suppressive as Mast, is well, like being not as big a disaster as 9/11. Increased androgen levels cause suppression, proviron is not going to raise your levels as much as Mast so it’s less suppressive. Your E2 is likely low because you have very little free T. You need Free T to aromatise into E2. Taking just Mast or Proviron is problematic. Increased androgens put the brakes on test production, but you’re not taking test so you test levels will drop. If you actually shut down, your test levels will disappear - which is bad for a variety of reasons. You can have high androgen levels but little to no testosterone. Have you been doing a lot of dieting/calorie deprivation to maintain weight for your weight class? How is your diet? What meds or supps are you taking?
I think an extended cycle followed by a solid PCT should be on the table for you, just to bring that SHBG into range and then go back to start.

7

Thanks all for the help so far.

@hardartery: diet is pretty stable. 280 protein/400carbs/80-100 fats. Supplements include d3, boron, zinc, magnesium, creatine.

I just received thyroid and other test results back. Doctor says I have a low white blood-cell count, and AST is high, meaning “my liver is mildly inflamed”? Thyroid is apparently normal, however.

TSH 1.60 0.40-4.50 mIU/L
T4,FREE 1.3 0.8-1.8 ng/dL
PROTEIN, TOTAL 6.7 6.1-8.1 g/dL
— — — —
ALBUMIN 4.6 3.6-5.1 g/dL
GLOBULIN 2.1 1.9-3.7
UNITS: g/dL (calc)
ALBUMIN/GLOBULIN RATIO 2.2 1.0-2.5 (calc)
BILIRUBIN,TOTAL 0.9 0.2-1.2 mg/dL
BILIRUBIN,DIRECT 0.1 < = 0.2 mg/dL
ALKALINE PHOSPHATASE 66 40-115 U/L
AST 43* H 10-40 U/L
ALT 43 9-46 U/L
BILIRUBIN,INDIRECT 0.8 0.2-1.2 mg/dL
WBC 3.3* L 3.8-10.8 Thous/mcL
— — — —
RBC 5.16 4.20-5.80 Mill/mcL
HEMOGLOBIN 16.0 13.2-17.1 g/dL
HEMATOCRIT 47.3 38.5-50.0 %
MCV 91.5 80.0-100.0 fL
MCH 31.0 27.0-33.0 pg
MCHC 33.9 32.0-36.0 g/dL
RDW 13.9 11.0-15.0 %
PLATELET COUNT 209 140-400 Thous/mcL
MPV 7.3* L 7.5-12.5 fL
TOTAL NEUTROPHILS,% 48.2 38-80 %
TOTAL LYMPHOCYTES,% 36.2 15-49 %
MONOCYTES,% 12.9 0-13 %
EOSINOPHILS,% 2.4 0-8 %
BASOPHILS,% 0.3 0-2 %
NEUTROPHILS,ABSOLUTE 1591 1500-7800 Cells/mcL
LYMPHOCYTES,ABSOLUTE 1195 850-3900 Cells/mcL
MONOCYTES,ABSOLUTE 426 200-950 Cells/mcL
EOSINOPHILS,ABSOLUTE 79 15-500 Cells/mcL
BASOPHILS,ABSOLUTE 10 0-200 Cells/mcL

Any and all help interpreting if any of these are contributing to my symptoms – low motivation and brain fog in particular – would be much appreciated.

8

@hardartery I also took a supplement called Warrior Undefeated for about two months, which after looking up its active ingredient, am now realizing is a mild AI – androsta-3 5-dien-7 17-dione. Beginning to think I crashed my estrogen unknowingly, which leads me to wonder if I should run an extended PCT of nolva for a while before starting test?

9

I would definitely give it a go, it isn’t likely to hurt anything.

10

Okay gentlemen. Two month check-in is complete. I ended up taking 25mg of proviron for a month, and combined it with better sleep habits and more food. I’ve received new test results, and am wondering what you would recommend.

First, the numbers:

TT: 712 ng/Dl (249 – 836ng/Dl) (was 763)
Estradiol: 15.25pg/ml (11 – 43pg/ml) (was 13)
SHBG: 45nmol/L (16.5 – 55.9nmol/L) (was 77)
Free Androgen Index: 55 (24-104) (was 34 on a 30-150 scale)
Prolactin: 313miu/L (86 – 324 miu/L) (previously untested)

Estradiol is still very low. FAI has improved, though is also still low-ish; SHBG has improved, though considering the blood was drawn two weeks after last using proviron, I’m assuming this reflects the improved sleep more than anything. Prolactin is high – what’s the deal there?

As a recap: I’m now considering TRT, and I’m wondering if you all had any take on these numbers/TRT for me/help in general. Apologies if I’m @-ing you but have never talked here! It only means I’ve read your posts/logs elsewhere and appreciate them all.
@unreal24278 @iron_yuppie @dextermorgan @hardartery @traveling-man @bcostigan41 @blshaw @bkb333

Many thanks.

11

TRT improve my liver enzymes and low testosterone causes more inflammation in my body. TRT might improve your liver profiles. Metabolically speaking TRT will increases metabolic rates and this may allow for improved liver function.

12

@I_AM
Your prolactin isn’t high. Mine is 50% higher than yours. Nothing to worry about. The low estrogen is interesting and probably means low free T but that’s just a guess. I don’t know enough about Proviron to know if SHBG stays lowered after discontinuing use but I guess we’ll know in time. The main thing is how do you feel now? Is the only issue you’re dealing with ED & low libido? TRT definitely helped that for me. I’m literally hard more than I’m not hard these days. Gets a little awkward unless I’m in Walmart. I wake up in the middle of the night with a raging urge to pound hot chicks. I don’t know if you’d have the same result but it worked for me. If you need help getting on TRT I can connect you with my doctor. He’s $150/month out of pocket. There’s plenty of docs out there. TRT isn’t a walk in the park in the beginning though so make sure you know all about that before you decide to start.

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13

Like Dex said, you really need to know Free T – that’s the single most important biomarker if you’re considering TRT.

You said your SHBG has improved (proviron will lower it, as you found), but I spun my wheels trying to lower my SHBG through medications and only felt worse as it got lower. The jury is still out regarding the ‘science,’ but I personally would recommend not wasting time on that – get your Free T checked, and if it’s low as expected (given low E), TRT is your move. I take 250 mg per week because of my high SHBG.

14

What was your libido like Pre-TRT (earlier years, and then right before starting exogenous hormones)? Mine has always been pretty tame. Guessing this is the most extreme you’ve experienced?

15

I would give it a little more time, personally. The numbers all look pretty good, honestly. I would really be hesitant to screw with natural production that is that high, on the off chance that it will solve a problem that it likely will not help with. I don’t suggest this much, but I would consider trying a run of Nolvadex or Clomid. It’s more likely to up your E2, and also give you an idea as to whether or not androgen deficiency is the problem.

16

That doesn’t necessarily mean that. Muscle damage from weight lifting or other strenuous activity can cause liver enzymes to raise for up to seven days. The enzymes are also in muscle tissue and not just from the liver. Both my ALT and AST were elevated a lot more than yours a couple years ago. If I remember correctly they were up around 70 with the same range. Doc sent me in for ultrasound and there was absolutely nothing wrong with my liver.

Not saying your’s are elevated for that reason but doc saying that without evidence, is jumping the gun. My doc caused me a lot of stress making me worry about that when in reality it was a non issue.

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17

Anti-depressants had a lasting impact on my libido even 10 years after stopping them. I could get it up and have sex for hours but was rarely that into it. It was kind of like leg day. You know you have to do it but if there was a choice you’d rather watch TV. Don’t get me wrong there were times when I was super into it especially with someone new but after a few months into a relationship it became leg day again.

On TRT I’m like a 16 year old that just found a porn stash in the attic.

18

How much are you taking again?

19

How much T or porn?

20

Bahaha. T. Not the d.