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Extreme Fatigue. High Levels Of Iron, Shbg and Testosterone


Hello, everyone!

I am 23 years old male and I would like to ask you for some help about my problem. A couple years ago I started getting tired when I do some physical activity. Unfortunately, this fatigue escalated as time passed by. Today I get really exhausted by doing normal stuff like climbing stairs, riding a bike or slow running, which is absolutely not normal, because I am an athlete in perfect physical shape. I feel the fatigue only when I do any physical activity and the feeling is like my body cannot supply my cells with enough energy or oxygen. My pulse is increasing very fast and I just get tired too quickly. At first, I thought that my hemoglobin levels are low, but they are just fine.

I did a lot of medicine tests. I started with complete blood test, minerals, hormones, liver enzymes (ALT, AST, ALP, GGT), heart holter monitoring, etc. Everything is perfect. I am completely healthy. My thyroid gland is fine too. I don’t have Hashimoto.

Recently I did another blood test which showed the following results, which are not normal:

Iron (Fe) – 40.6 (normal range: 11.6 – 31.3 μmol/l)
SHBG – 83.52 (normal range: 14.5 – 48.4 nmol/l) – That is almost twice as the highest normal range
Free testosterone - 0.49 (normal range: 0.204 - 0.657 nmol/l)
Total testosterone – 40.22 (normal range: 7.6 – 31 nmol/l)
Total bilirubin - 23.1 (normal range: 3.4 - 21 μmol/l)
Direct bilirubin - 8.5 (normal range: 0 - 8.6 μmol/l)
Glucose on empty stomach – 6.1 (normal range: 3.5 – 6.1 mmol/l)

My glucose levels on empty stomach are high, but I don’t have diabetes. I did an oral OGTT (drinking 75 glucose) and everything is fine. The test showed that my glucose and insulin levels are fine. Glycated hemoglobin is okay too – 5.3% (normal range: 4 – 6 %).

I eat well, I am in pretty good physical shape, I don’t have fat, I have no stress issues, I have no depression. If the fatigue is based on stress, I just don’t know where this stress is coming from.

So, my question is, do you think that my elevated levels of iron, SHBG and testosterone can cause this extreme fatigue or the problem is somewhere else? And if yes, what do you suggest me to do about it?

If you need any other information, I will provide it. The doctors have different opinions about my condition, that’s why I am searching for different opinions here, because I know that in this forum there are people with exceptional knowledge. And yes, as many of you already know, some doctors tell me that my blood tests are completely fine, even though I don’t feel well.

I really appreciate you taking the time to read about my problem and give your suggestions how to deal with it. Thank you to all of you!


You have no testosterone available to the body, it’s all bound up in SHBG. One thing that happened to me once I lost my testosterone productions is I became a diabetic overnight, some men lose glucose control when testosterone is low. Your FT is bottomed out, stupid doctors!

Your situation will continue to deteriorate, TRT is really the only thing that can force down your high SHBG. Most doctors will fail to understand much of anything regarding male hormones as it’s not even taught in med school.

You need to find an cash pay only doctor to get competent care, insurance doctors aren’t permitted to spend the necessary time to balance your hormones. Once you hit normal ranges whether it be 450-800 their done with you, they will refuse to balance your other hormones that are affected by restoring testosterone levels.

You have a lot of similar systems I had when I was low T, the fatigue and inability to climb stairs was the worst.


Any meds?


According to whom, your doctor? This is ending up more difficult for your doctors than most informed patients, this should concern you. Low thyroid function can mimic low T symptoms and most doctors also fail at diagnosing thyroid disorders. Your doctors are clearly struggling.

Labs always tell the full story.


alphagunner - No, I haven’t used any medications since I am in this condition.

systemlord - Well, according to the laboratory results. I have tested TSH and FT3. Their levels are in the normal range. I did thyroid ulstrasound too. What other tests should I do to determine if I have any problems with the thyroid gland?

You are also saying that I have no testosterone available to the body. I cannot understand. My free testosterone is 0.490 and the normal range is between 0.204 and 0.657. My free testosterone levels are in the normal range, aren’t they? And my total testosterone is also not low, but it is higher than normal.

I am asking you, because I am confused. I have read a lot of information about this topic and I have also heard a lot of different hypotheses about my condition and my laboratory results. As you said, the doctors are struggling and they clearly don’t know what they are talking about. Unfortunately that is the truth. Some people (which are not doctors, but they have knowledge in this area) have said to me that the fatigue is caused most likely by the elavated iron levels. They say that my testosterone levels are not cause for concern. And in the end, I just don’t know what to do, because I can’t treat myself with medications on my own.


Obviously if fT3 is in range but at the bottom of the ranges, this isn’t fine. It’s disease management, mainly doctors will wait until things are really bad up before acting. This saves healthcare costs while you suffer.

Thyroid labs?


Here are the exact results from my test:

TSH - 2.23 mIU/l (normal range: 0.27 - 4.20)
fT3 - 5.23 pmol/l (normal range: 3.10 - 6.80)

I don’t have low body temperature, I don’t feel cold, I don’t have dry skin or depression issues.


Your FT is low, 14.7 ng/dL = 1.27 %, needs to be 2-3% to be normal. Clueless doctors go by FT measured directly, it’s wildly inaccurate do to the short 1 hour half life, your FT could be low an hour later. You need to calculate FT using SHBG calculator. fT3 looks great.

You need to go private, TRT is too difficult for most doctors. The truth is doctors don’t learn anything about male hormones in med school, so everything they learned is through trial and error, don’t go down on their error and become a negative statistic.



Unfortunately you are right about the doctors. I can confirm that from my own experience.

Bioavailable Testosterone level from my blood test is 12.9 nmol/l (normal range: 4.78 - 14.9) and the Albumin is 48.4 g/l (normal range: 35 - 50).

I used the calculator you have posted here. The results are the same as the results in my test:

Free Testosterone: 0.493 nmol/L = 1.22 %
Bioavailable Testosterone: 12.9 nmol/L = 32.2 %


Your iron is too high and fatigue is a common symptom of this. Furthermore, high iron can damage vital organs if left too long.

When trt raises my iron, I donate blood and this fixes the issue. You might want to look into why your iron is raised and keep an eye on it in future.


What was your iron level, before you donated blood? And also, did you have fatigue when iron was high, like I do?


You have something similar to what I have going on. Your iron is too high which is a very bad thing. You also need to get your ferritin and iron saturation tested. If both of those are elevated then you need to be tested for hemochromatosis. Once your iron stores are full in your body it will begin to store iron in other places like; pituitary, heart, testicles, liver etc. Which will damage all of them over time.


everest - I have already tested ferritin + iron-binding capacity.

Ferritin - 136.5 ng/ml (normal range: 30 - 400)
Iron-binding capacity - 53 μmol/l (normal range: 45 - 72)

What can you say about these results?


I would say you need to evaluate your diet and see where all the iron is coming from. If you can, donate a pint of blood or two,to get rid of the extra iron. Your ferritin is at a nice level so your body isn’t storing extra iron in places it shouldn’t be and you don’t have uncessecary inflamation so that’s a good thing.
This is just my interpretation from my own research though, it’s still a good idea to get an opinion from a doctor if you can. As for your hormones I don’t know too much on that topic as I’m waiting for similar help on my own thread.


You are acting like a dumb ass doctor saying that things are normal when you really needed to post everything with ranges. Does not matter that docs say…

SHBG is screaming out for deeper understanding.
SHBG is made in the liver to scavenge sex hormones for return and metabolization. Some liver conditions/diseases can increase SHBG. You need to find what has changed in your liver. Higher E2 increases SHBG and higher T levels decrease SHBG.

Your non-bioavailable SHBG has inflated your TT so that TT overstates your T status while FT is reduced.

Have you been in a tropical climate with associated diseases?
Has anyone actually looked at your blood under a microscope?

Post your waking and mid-afternoon oral body temperatures so we have them.

When things started to go badly for you, was that preceded by a blow to the head or whiplash?

Have you used an oral hair loss drug, steroids or prohormones?
Some react very badly.

Do you get leg cramps or can tighten a muscle and have it lock up? That is magnesium deficiency, see ZMA sold in this site’s Biotest store.

Are you Vit-D3 deficient?

When things go bad with one’s body, problems that your body used to ignore or tolerate can be significant.
Serum iron is affected by what you age the day before and should not be used alone to drive changes.

FT=.49 midrange
SHBG - very high
AM cortisol - do at 8AM or 1 hour after waking up.

10,000iu Vit-D3
fish oil
100mg Ubiqinol form of CoQ10 - get the spelling correct, this is not ubiquinone.
natural source Vit-E
high dose B-complex multi-vit with trace elements including 150mcg iodine and 200mcg selenium

Energy levels affected by fT3, CoQ10, anti-oxidants.

You may not have an iron problem, need to see CBC and hematocrit. Ferritin is actionable. Serum iron is greatly affected by what you ate the day before so you cannot act on it alone. I have had low iron and high iron lab results and doctors running on that.

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.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re Thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab numbers and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


@KSman - Thank you for your reply! If all of the doctors had your knowledge, there would be much less people like me searching for help in the forums.

I will post my latest CBC results. These results are from a test I did a couple of weeks ago.

WBC - 6.08 10^9/l (NR: 3.5 - 10.5)
RBC - 5.36 10^12/l (NR: 4.5 - 6.5)
Hemoglobin - 163 g/l (NR: 130 - 180)
Hematocrit - 0.478 l/l (NR: 0.41 - 0.55)
MCV - 89.2 fl (NR: 82 - 96)
MCH - 30.4 pg (NR: 27 - 32)
MCHC - 341 g/l (NR: 320 - 360)
RDW - 11.7 % (NR: 11 - 16)
MPV - 10.6 fl (NR: 7 - 12)
Glucose (on empty stomach in the morning) - 6.1 (NR: 3.5 - 6.1)
DHEA-S - 10.78 μmol/ (NR: 4.3 - 12.2)

Progesterone - 2.06 nmol/l (NR: 0.7 - 4.3)
Estradiol (E2) - 92.47 pmol/l (NR: 28 - 156)

Liver enzymes

AST - 15 U/l (NR: 0 - 34)
ALT - 15 U/l (NR: 0 - 55)
GGT - 19 U/l (NR: 0 - 50)
ALP - 41 U/l (NR: 0 - 150)

Here are also some results from a test I did 2 years ago. After that I haven’t tested prolactin and thyroid hormones:

Prolactin - 138 mIU/l (NR: 86 - 324)
TSH - 2.23 mIU/l (NR: 0.27 - 4.20)
fT3 - 5.23 pmol/l (NR: 3.10 - 6.80)

You are telling me that I need to find what has changed in my liver. Should I do any specific test about that?

When things started to go badly for me, that wasn’t preceded by a blow to the head or whiplash. I don’t have any head injuries.

I have never been in a tropical climate with associated diseases. Also, no one have looked at my blood under a microscope. No one have recommend me to do that.

I have never used any hair loss drugs, steroids or prohormones. I don’t get leg cramps too. I don’t do drugs. I don’t drink. I don’t smoke. I haven’t tested whether I have Vit-D3 deficiency. I haven’t tested cortisol too. I have to do that.

During the years, I have taken different supplements to see if they can affect my symptoms somehow, but with absolutely no results. I have taken Vit-D3 (2000-3000 IU a day), Magnesium (orotate, aspartate, citrate - 400-1500 mg a day), ZMA, Fish oil, CoQ10, Vit-C, Vit-E, B-complex (100-150 mg a day).

I haven’t taken iodine and selenium.

I will measure my body temperature for 2-3 days and I will post the results.