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Does TRT Make Sense For Me? (Bloodwork Included)

Hello guys,

I have been feeling like shit for the last few years: no libido, ED, too emotional at times, weak 1RM’s in the gym, brain fog, just to name some.

I am a otherwise healthy 27 year old male. 190cm, 84kg, 9% body fat(blood work was done at around 12-13% body fat btw). Never cycled thus far.

Here is the bloodwork that I have had done recently(added everything that I thought would be relevant):

SHBG - 60 nmol/l (11-52)
Total test - 28,0 nmol/l (8,8-32,0)
Free test - 306,0 pmol/l (198-619)
TSH - 3,3 mu/l (0,4-4,0)
FT4 - 15,3 pmol/l (10-24)

Prolactin - 274 mu/l (100-300)
Cortisol - 489 nmol/l (150-700)

ASAT - 39 u/l (<40u/l)
ALAT - 39 u/l (<45u/l)
Gamma-GT - 11 u/l (<55u/l)
Hemaglobine - 9.0 mmol/l (8,5-11,0)

Diet:
Lots of vegetables, lots of viber, high fat, lots of eggs, lots of lean meat.
Usually around 120-150 gr fat, 150-180 gr protein and rest carbs. Totalling about 3500 calories when not cutting. Recently cut out walnuts, after eating 30gr a day for the last few years. Seems like walnuts increase SHBG?

Training:
5/6 days a week on some sort of push/pull/legs split. Main focus on hitting the compounds relatively hard and frequent.

Is TRT the solution for the high SHBG and prolactin? It feels like total test is on the high side, but is not coming to it’s right due to the SHBG?

Anything else that I should get tested? this was all drawn via endo. However, she claims everything is “ok” and therefor no action will be taken.

high shbg. details on diet please.

shbg will lower free T.

prolactin a bit high. might want a pituitary MRI.

cortisol a bit high. stressed?

might want to wait for others to confirm

training? also if you’re really 9% bodyfat you might want to bulk and eat man.

calorie deprive ups shbg

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Added diet and training details in original post. Pretty sure it’s on point. Getting plenty of fats, lots of vegetables, complex carbs, lean protein. Focusing on getting plenty of EFA’s (hemp oil, fish, nuts). I have read that walnuts/almonds increase SHBG, I ditched those.

I’m currently at the end of my cut, that’s why bodyfat is low. I was planning on ending the cut at 8%. Bloodwork was done at around 12% bodyfat though, and after a “maintenance week” aka refeed week.

Not stressed at all, sleep is on point.

High SHBG will lower Free T as seen in older men, diet and lifestyle can be factors. A lot of inexperienced doctors would say you’re normal, they would be wrong and symptoms are more telling than any lab testing. The stigma surrounding TRT will be the reason doctors push back, mention you feel depressed and they won’t hesitate to prescribe drugs.

I’m on TRT and recently didn’t feel right, Free T was 16.0 (ranges 6.8-21.5) and had moderate symptoms of low testosterone, increased the dosage and feeling better. TSH is indicating thyroid is suboptimal, normal TSH is <2.5 according to the studies doctors seem to never bother reading.

Doctor thought it was a good idea to not test the active thyroid hormone, because testing the inactive hormones is a good idea [sarcastic]. Free T3 is the only active thyroid hormone.

Reference ranges for TSH and thyroid hormones

The evidence for a narrower thyrotropin reference range

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An MRI is ridiculous advice for prolactin of that level.

Did you have any other hormones that were off? how did you go about TRT seeing that your doctor wouldn’t say you have low test? self medication?

Since my doctor wont help me anymore, should I go to private lab testing to test FT3?
My TSH was 3.9 last year and 2.4 a few months ago, so it has been on the higher side for quite a while.

I respond very quickly to TRT or dosage changes, my TSH likes to fluctuate between 0.5-0.8 closer to the 1.0 optimal range. Free T3 is slightly above midrange at 3.6 (range 2.0-4.4). Sick care doctors are usually no help until you are 100% fu**ed, this is how sick care operates.

You want to optimise your health, whip out the wallet and go private. Doctors who participate in managed healthcare must work within the confines of the insurance companies very narrow guidelines and make it difficult to get approved for treatment.

The standards for treatment are low, we know insurance companies always make it difficult to pay out on claims, healthcare is no different.

A thyroid panel consisting of TSH, Free T4, Free T3, Reverse T3 and antibodies is needed. Seek doctors in anti-aging or even these anti-aging telemedicine clinics who smartly refuse to take insurance for reasons already mentioned.

I use Discount Labs. I would add LH and FSH to you list of labs, LH = stimulates the testicles to produce testosterone.

Good information, thanks.

I agree with you on the healthcare system. They dont help at all, if you go in argument with them they come up with some stupid BS. My endo didn’t even want to test my T3 and estrogen that I requested. TT and FT would give enough information she said. I had already lost faith in her.

I’m very interested in going via the private clinic route, however there don’t seem to be any in my country (the Netherlands). I have heard there is a respectable clinic in Brussels (Belgium) but something close would be nice. Anyone know any options in the Netherlands?

I’ll make sure to do a full thyroid panel, FSH, LH via private labs. Anything else that I should have tested that is currently missing in my bloodworks?

Ask around the pharmacies for a list doctors that prescribe testosterone. I would add CBC-complete blood count, but at this point TRT is needed anyway.

TRT is new field of medicine and few doctors know what labs to order as this area of medicine had been largely ignored until now.

i have a tumor with normal prolactin. if op wants to check everything before TRT an mri is viable. mine seems to be non functional tho

OK, so by that logic everyone with normal prolactin levels needs an MRI to check for a tumour.

Whilst we are at it, lets go and get every body part and body function tested first before starting TRT.

not saying he needs to do it now. just recommending if he wants to rule out everything before trt. its just a recommendation. Also my prolactin was measured differently. i scored 13 from range of 3-15 so i tho his prolactin was a bit high.

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What is he ruling out, if his prolactin levels are normal?

i dont see op lh and fsh acth or igf1

i gotta admit my old endo did mri before checking prolactin (yeah i know) and thats how we figured i have a tumor.

prolactin normal, acth a bit high, low lh and fsh and both low total and free

suggesting my tumor is non functional but might be harming lh.

i have seen my lh below 1. acth have been a bit high everytime we checked it

im just helping out op. if he doesnt want to do an mri now or later on its k.

edit: i do suggest checking thyroid, lh and fsh. i heard thyroid issues can increase shbg

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thanks for adding diet. yeah i have seen the almonds and walnuts increasing shbg and also olive oil. im a high shbg guy. i have seen shbg at 74 ish. dont know if peanuts are related but i do eat peanut butter hehe.

i don’t think one food can up shbg so high. shbg is a mistery.

i heard keto or low carb diets increases shbg. my carbs are 300 ish everyday and still high shbg lol

i even went to a gastro for more info and nothing seems to be wrong.

it also can be genetic

i have yet seen 1 endo who cares about shbg. i think one tested it but said it was fine when it was high and gave no explanation in why is high. i always ask other docs for labs

Thanks for all the input guys. I appreciate every advice. First I would like to rule out any hormonal disbalance. Therefore, I will order a blood test first.

I will include the following:
-full thyroid panel
-LH, FSH

Should I include estrogen?

@Riaero
I read in a research document that walnuts could increase SHBG by 10-20%. That is quite some. Not sure if same goes for peanuts. I replaced the walnuts with Brazil nuts, which don’t have the negative effect and even contain boron which supposedly has a positive effect on SHBG. They even taste better, win-win!

I also read that high fiber stimulates SHBG.

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i edited my post. thyroid issues could increase shbg.

dude why didnt endo tested lh and fsh? wtf
how will the doc knows if its primary or secundary lol.

e2 for sure

igf1

i haven’t read about peanuts. i have read about pistachio, almonds and walnuts. but again, in a control way of eating the benefits outweights the negative. i don’t think a small amount will increase it by 10-20%. but i admit i did reduced the intake of almonds.

the only thing i saw about fiber is that it did actually increase shbg BUT it was tested with a diet low fat high fiber (eh?)

The liver produces SHBG, dietary changes might see a small increase/decrease in SHBG, nothing dramatic to the effect you require. Suboptimal thyroid hormones would see SHBG decrease, so if you have suboptimal thyroid hormones and require treatment, SHBG will increase.

If we had LH labs we would see how well the testicles are being stimulated to produces testosterone. Estrogen testing is always a good idea, it can help guide TRT protocol decisions.

You more than likely need TRT and thyroid treatment if you want to have a high quality of life.

exactly. clomid, liver, carbs, thyroid are the major things i see that decreases/decreases shbg.

genetic? dunno

low bodyfat undereating? dunno

I guess it was a bit wishful thinking that skipping the nuts would fix my problem.

Besides further bloodwork, should I first focus on “fixing” my high TSH or go directly towards the TRT route? I’m a bit confused. I’m not gonna lie that TRT sounds like a good option to me. I just hope I can find a clinic or doctor that is willing to support. It’s pretty much impossible to even go to a different doc where I live.