Help Interpreting Bloodwork: Large Drop in Free T, High SHBG

I’ve been feeling in the slums for a while now, maybe a couple years all in all. Fatigue (never feeling “refreshed” and always wanting to nap), low libido, brain fog/slow brain, loss of muscle/strength, horrible recovery times from the gym, depression, loss of drive socially and professionally, feel “weak” not just physically but my personal attitude. I can clearly remember a few years ago I had none of these issues. So I started getting blood work done to try to hone in on what might be happening.

I‘ve tested my hormones in the past (like 2015) out of curiosity. Didn’t go crazy with the tests though; just testosterone, general thyroids, and estradiol. In 2015, it was 991 for testosterone, normal/in-range thyroid, and 18 for estradiol. Unfortunately, I don’t have the actual labs or details, just notes I made on my phone.

I did one test in July 2017, here are the results:

  • Testosterone, total: 610 ng/dL (348-1197)
  • LH: 9.2 high mIU/mL (1.7-8.6)
  • FSH: 1.5 mIU/mL (1.5-12.4)
  • Estradiol: 11.3 pg/mL (7.6-42.6)
  • Bilirubin, total: 0.8 mg/dL (0.0-1.2)
  • Albumin: 4.6 g/dL

Not sure why I didn’t investigate the issue then, but I didn’t. I remember making the appointment with my PCP but had to cancel due to scheduling conflicts. Flash forward to January 2018, still feel bad, get retested but decide to go more in depth. Here are the results:

  • TSH: 1.990 (0.450-4.500) uIU/mL
  • T4 total: 10.2 (4.5-12.0) uh/dL
  • T3 Uptake: 27 (24-39%)
  • Free Thyroxine Index (T7): 2.8 (1.2-4.9)
  • Testosterone total: 730 (264-916) ng/dL
  • Testosterone Free: 21.97 high (5.0-21.0) ng/dL
  • % free testosterone: 3.01% (0-4.2%)
  • Estradiol: 17.6 (8.0-35.0) pg/mL
  • Albumin: 4.6 g/dL
  • Bilirubin: 0.9 mg/dL

Walked away thinking that if everything looks fine, then it’s all in my head. My diet is clean and balanced, no drinking, lots sunlight, lowered stress from work, no environmental toxins, no drugs (except prescribed Adderall). Saw a therapist to maybe help mentally (but I haven’t noticed a change, to be honest). I still felt bad, maybe worse, so I did a more comprehensive series of tests. July 2018…

  • TSH: 2.09 (0.4-4.5) uIU/mL
  • T4 total: 11.1 (4.5-12.0) ug/dL
  • T4 Free: 1.5 (0.8-1.8) ng/dL
  • T3 total: 125 (76-181) ng/dL
  • T3 Free: 3.4 (2.3-4.2) pg/mL
  • T3 Uptake: 29 (22-35%)
  • Free Thyroxine Index (T7): 3.2 (1.4-3.8)
  • T3 reverse: 22 (8-25) ng/dL
  • Thyroglobulin Antibodies: <1 (<=1)
  • Thyroid Peroxidase Antobodies: <1 (<9)
  • Testosterone total: 789 (250-1100) ng/dL
  • Testosterone Free: 83.1 (35.0-155.0) pg/dL
  • FSH: 1.6 (1.6-8.0) ug/mL
  • LH: 3.9 (1.5-9.3) ug/mL
  • Estradiol: 19.0 (8.0-39.0) pg/mL
  • DHEA-S: 264 (85-690) ug/mL
  • SHBG: 66 high (10-50) nmol/mL
  • Ferritin: 41 (20-345) ng/mL
  • Iron, total: 89 (50-195) ug/mL
  • Albumin: 4.6 g/dL
  • Bilirubin: 1.2 mg/dL

Following getting these results, I went to a doctor who I thought was a male hormone/health specialist but she walked in and told me that I was too young to be experiencing anything like what I described and mentioned the blood results were “strange but meaningless”. Not the best experience.

I’d love to hear what y’all think and/or recommend I do. I’ve started taking iron supplements to boost the related levels but that’s it. All the labs were done within 1 hour of waking up in the morning. The dramatic drop in free test from high to lower than mid-range is strange to me as is the high SHBG.

Personal info:
Age: 26
Height: 70”
Weight: 159#

P.S. I used a different lab for the third/latest tests which is why the reference ranges are a bit different

Your Reverse T3 may causing problems, it might be negating good Free T3 levels. Reverse T3 competes for the same receptor as Free T3 and blocks Free T3 from the T3 receptors, a general rule is Reverse T3 needs to be less than 15 ng/dL unless Free T3 is lower, than Reverse T3 needs to be lower. This may be why TSH isn’t optimal at 1.0, everyone is different though, I have TSH 0.9, Free T3 at 3.6 and Reverse T3 is 22.4 and still have normal body temperatures.

You should evaluate yours using a glass thermometer upon waking and 2pm in the afternoon, temperatures reflect Free T3 status (getting into the cells) as it’s the most potent thyroid hormone. Test temperatures over weeks to see consistency, thyroid problems can be intermittent, so one test could be fine one day and days later thyroid acts up again. Blood tests are a snapshot in time of a constantly moving, fluctuating target.

It could be the stress of having low testosterone do to high SHBG (made in liver) could be elevating Reverse T3, depression, stress and chronic sickness (cough) will increase Reverse T3. SHBG scanvanges sex hormones so the body doesn’t clear out testosterone too quickly, but when elevated it gets greedy and binds up too much of your testosterone. Diet can raise SHBG, a diet based on lots of veggies, medications and alcohol.

Usually the only thing that can lower high SHBG is lots of androgens, high testosterone. High SHBG guys usually two large weekly injections and some need supraphysiological doses, however regular blood donations (therapeutic phlebotomy) may be necessary to keep hematocrit at bay.

Doctors are scared shitless of giving a young man TRT for fear of getting slapped with lawsuits, this is the reason why doctors prefer to try other methods at restoring testosterone levels first, this way if lawsuites come the doctor can say he/she tried other methods first. Clomid is an antagonist which can increase LH and therefore more testosterone, but not recommended for high SHBG guys as it raises SHBG as well, not good for you.

Young men will be effected more than a middle aged man when free testosterone is low, so unless you can find the cause to high SHBG, TRT is your only hope. Finding a knowledgeable hormone specialists will be difficult inside your insurance network, going private you have a better chance of finding a knowledgeable hormone specialists. If you find someone knowledgeable, TRT is within your grasp.

There really are only a handful of knowledgeable TRT doctors in the US. Dr. Saya of Defy Medical is one of them and offers telemedicine for those living across the country. I’m with Defy Medical.

Thanks for the reply systemlord!

Why a glass thermometer? A digital one wouldn’t be useful for this?

So, basically it could be a reverse T3 issue or it could be the high SHBG? Or a little of both.

Diet wise, I’m not sure mine would be contributing to the high SHBG. I don’t drink and I’m not having a whole bag of veggies everyday. I’d say maybe a fistful of veggies with lunch and dinner.

I’ve thought about calling Defy. The reason I didn’t go through with setting up the initial appointment was that I was afraid that since my free T is still “normal” that I’d get the response of “this is just how it is” and be out $250.

Defy Medical is about anti-aging or optimizing health and will even prescribe peptides to increase growth hormone naturally to levels seen in your late teens. Defy doesn’t play these games that other doctors play, they will give you TRT if your below 550 ng/dL or are less than optimal. High SHBG plays a big role in hormones, if elevated it’s more likely a big part of the problem as it’s over the ranges.

I bought a high end digital thermometer and it’s still off by a large margin, glass is the only way to go.

@systemlord I was wondering something and I thought you would be thebtite person to ask. I haven’t been able to figure out what causes someone to lose sensitivity??? And how to fix it??

Your hormone being off can affect sensitivity. I suppose thyroid problems could also be responsible.

Well I know it has something to do with my hormones but I can not figure out exactly what causing it. Wethere it’s my testosterone or my E2 or my thyroid I don’t even know where to begin. Thought out my journey my sensitivity is one thing that has never came back and I feel like if I can figure that out then it will fix the rest of my problems. I was just wondering if you have heard of other people having sensitivity problems and what they did to fix it.

When my e2 is too low I lost sensitivity. And happens less but when e2 to high.

I thought that was the root of the problem as well but my doctor has accomplished gettin my E2 at very good levels i am currently at 21pg. But for some reason my sensitivity still has not come back. Do you have any other suggestions??

An E2 of 21 could be too low for you, low E2 is bad for erections and sensitivity. You wouldn’t pick a number where you think you would feel good for Total T would you?

Perhaps E2 is fluctuating, dipping below 21 for most of the time and you only caught it at peak. Also free testosterone is expected to be lower with high SHBG. I think testosterone is more a problem than thyroid. I think TRT will increase Free T and the stress reduction from having more Free T could improve/lower RT3.