T Nation

Help Interpreting Hormonal Imbalances


#1

Hi guys. I trust this site and would like to get some input to help make sense of whats going on with my body. I have done a lot of research on my own but there is so much information out there and it can be overwhelming. I have my next appointment with my endocrinologist soon and I want to go in as informed as I possibly can.

  • I’m 25 years old. I’m 5’11. I weigh about 165lbs. My waist is 32/34.
  • Most would describe me as very lean but I actually carry a lot of extra body fat. I have a very thin neck, wrist and ankles. I have always carried extra fat around my chest and nipples. The rest of my body fat is all centered around my waist (love handles) and thighs.
  • I can grow a full beard but it’s not very thick. I have very little chest hair and no back hair. My thighs and calves are very hairy.

The following symptoms first began sometime around late 2014 or early 2015. I dont smoke or drink.

  • I constantly feel tired/fatigued and feverish throughout the day (hot flashes?). I have lost my motivation/drive and have been dealing with bouts of depression. I suffer from anxiety and have trouble sleeping. Although I am extremely dedicated to lifting weights and tracking what I eat I can’t put on muscle or lose fat effectively. My sex drive is really low. I can get an erection but it doesn’t get as hard as before. I don’t really have spontaneous or morning erections any more.

  • I have been tracking what I eat for several years now. The calories have always been based on whether I was trying to gain muscle or lose fat. I usually stuck with a 45 carb, 30 protein, and 25 fat split. I try to eat as healthy as I can. I never under ate during a caloric deficit.

  • I supplement with garlic, apple cider vinegar, green tea and turmeric daily.

  • I stick with a upper/ lower body weightlifting split. I go to the gym 4× a week when attempting to build muscle and only 3× when losing fat. I always gave my body enough time to recover but I was still constantly sore.

  • The only supplements I take are a pre-workout, creatine and bcaa.

  • Here’s the twist * On October 31, 2017 I was diagnosed with Testicular Cancer. I had a testicle removed November 2, 2017. It was found very early and in January my oncologist told me I was officially cancer free. No chemo or any other medication was needed. The cancer was not responsible for the symptoms stated earlier because it was discovered in the very early stages and I’ve had those other symptoms for years.

Here are my Labs from when I finally went to see an endocrinologist after I had surgery. I was actually supposed to go see the endocrinologist the day after I found out about the cancer and had to reschedule for December.

Taken 12/8/2017 at 10 am fasted @ Quest

TSH: .86 ( .40 - 4.5 mIU/L)
T4, free: 1.2 ( .8 - 1.8 ng/dL)
ACTH, PLASMA: 17 ( 6 - 50 pg/mL)
DHEA SULFATE: 210 ( 85 - 690 mcg/dL)
FSH: 14.6 ( 1.6 - 8 mIU/mL) HIGH
LH: 13.9 ( 1.5 - 9.3 mIU/mL) HIGH
ESTRADIOL: 55 ( < OR = 39 pg/mL) HIGH
TT, TOTAL, LC/MS/MS: 679 ( 250 - 1100 ng/dL)
TT,FR(DIALYSIS): 69.9 ( 35 - 155 pg/mL)
CORTISOL 8 AM: 13.4 ( 4 - 22 mcg/dL)

After these results I changed my diet to try and lower E2 and might as well try to raise TT also. I started taking Vit D, Zinc, Magnesium, and Dim. I started eating more dietary fat and ate a few natural foods that should help lower estrogen like grapes, oranges, pomegranate juice and broccoli/cauliflower.

At my next endocrinologist appointment I was told I would have to be completely cleared from my cancer before they could help me. Flash forward to when I’m cancer free and I had more blood work scheduled by my endocrinologist.

Taken 2/14/2018 at 12pm unfasted @ Quest

FSH: 29.8 ( 1.6 - 8 mIU/mL) HIGH
LH: 22.9 ( 1.5 - 9.3 mIU/mL) HIGH
ESTRADIOL: 50 ( < or = 39 pg/mL) HIGH
SHBG: 96 ( 10 - 50 nmol/L) HIGH
TT, TOTAL, TC/MS/MS: 854 ( 250 - 1100 ng/dL)
TT,FR (DIALYSIS): 54.5 ( 35 - 155 pg/mL)

As you can see TT did go up and Estradiol did decrease slightly but now I have to deal with the sky high shbg. I don’t really know what to make of these results and I have a hard time finding another similar case.

I want some advice on possible treatments or courses of action going forward before I go see my endocrinologist in March. I want to make sure I do what is best for my health and I’m not at the mercy of my endocrinologists’ decision.


KSman is Here
#2

Hi, not sure why nobody has responded yet. I’m no expert on this but the high E2 can definitely cause a lot of those symptoms. I’m guessing you feel like a bitch?

You will probably be asked to provide body temperatures too, so I would start recording them so that you can provide them upon request.

I had the problem of high SHBG too and TRT sorted that out. High SHBH causes lowered free test because all the test in your body is bound to the SHBH. Yours seems to be in the lower end of the range which isn’t ideal. I don’t believe there is a way to lower SHBH without TRT.


#3

You need to run the above down first.


#4

Hey thanks for the reply! I have my appointment this Monday with my endo. What exactly did trt look like for you? Was it injections, gel or something else? I’m not very knowledgeable on specific trt treatments.

As far as body temperatures go, would any thermometer do? I don’t even own one.


#5

Would this require some sort of treatment? I read somewhere that the high fsh and lh could be caused by the high shbg and low ft. I don’t remember exactly what the article said but it was something along the lines of my body is not able to use free TT because it is all bound up so it keeps sending the signal to produce more, hence the high fsh and lh, even though my total TT levels are high.


#6

Hi josebnls,
Apart from the testicular cancer. I have the exact same symptoms as you, very high SHBG, low Free Test, normal to high Total Test, with high LH & FSH.

I created a thread a couple of days ago with no response yet, its long but have a read:

Long story short, I went to an endo 3 years ago who said there was nothing wrong with me. Tried an anti-depressant, and apart from a reduction in anxiety, all the symptoms are still there.

Got my bloods re-done in Feb this year with similar results and have an appointment with another endo on the 8th of march. I have been doing so much reading in the mean time to prepare my self for the appointment. One thing i’ve learnt is don’t accept treatment with Danazole as even though it will reduce SHBG, it will also crash your total T. I think the problem is trying to find an endo who specialises in male hormone imbalances/trt.

Please keep me updated on what happens with your endo appointment on Monday.


#7

Personally, I self administer because docs are pretty clueless here in the UK. I hear that most guys have trouble with the creams and that injections are the best method. You need to inject twice a week (eg. Monday and Thursday) to keep blood levels stable. You will also likely need an aromatase inhibitor (AI) to control estrogen. There is plenty of information about them on the forum. If you plan to have kids at some point and don’t like the idea of pea-testies, then you need to look into human chorionic gonadotropin (HCG) too.


#8

I actually read through your post the other day because it was so similar. I started tracking it hoping to learn from your replies.
I’ll make sure to avoid Danazole at all costs. I’ll make sure I post what my endocrinologist tells me monday.


#9

I’m not knowledgeable enough to self administer. I wouldnt know where to get the injections or how much to take. How do you keep track of your blood levels?


#10

Possibly, but you need to make sure that’s what is driving elevated FSH/LH. Free T is not bound to SHBG, too much of your total T is. Only 0.6% of your TT is free.


#11

Bro, you don’t have access to YouTube? You can find directions on every single injection method there is as it relates to trt. You can educate yourself. Start now.


#12

Yeah I have access to YouTube but I don’t typically search for videos about trt injections. I was also under the impression that you needed a prescription to get testosterone legally.


#13

Hi josebnls, how did you go with the endo appointment? I’m interested on hearing the verdict.


#14

My endocrinologist wants me to go have an mri to check my pituitary gland. I had a feeling she might want to do that because of the high fsh and lh. I’ll make an appointment for my mri tomorrow and I’ll go back to my endo as soon as I have my results. I’ll keep you posted. I’m also curious to see how your appointment goes this week.


#15

Thanks josebnls, did you ask any questions in terms of treatment if your pituitary gland is fine.

I will let you know what happens with my endo appointment on thurs.


#16

I didn’t ask anything because she said she wanted to see the results of the mri before we did anything else.


#17

It would make sense that your LH and FSH increased after the removal of one testicle since it’s the only way your body can increase testosterone production to previous levels. Maybe your LH and FSH levels we’re already high because the cancer was interfering with T production within the sick testicle.

You have very high E2 even though you are not over weight. This suggests aromatase overexpression (increased conversion of T to E2), which is a risk factor for testicular cancer and is most likely genetic. Other possibility being liver clearance issues.

Your pituitary seems to be doing a good job trying to achieve decent levels of testosterone but the high E2 is inflating your SHBG that eats up your available T. I wonder if a simple aromatase inhibitor would fix you right up.


#18

I never heard the term aromatase overexpression but you’re right about it potentially increasing chances of testicular cancer. I read an article that said that men with high estrogen were at a higher risk for TC.

If the mri comes back normal on my pituitary gland I’ll ask about an aromatase inhibitor.

Do you think that lowering estrogen will be enough to drive down my sbgh back to normal levels? Everywhere I’ve looked it seems that the consensus is that the only effective way to lower shbg is with trt. I would like to avoid trt if possible so this would be ideal for me.


#19

No way, while E2 levels do effect SHBG not nearly enough in your case.


#20

I think I took the term from this article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868612/
I’m not an expert on the subject by any means buy it’s my understanding there are many genetic variations of aromatase enzyme expression in males. Some guys just convert more T to E2 and obesity makes this worse.

I have no idea how much lowering E2 could affect your SHBG. There is definitely a connection so it might be worth trying before trt. You are just basically fighting an uphill battle with only one testicle and high E2 & SHBG.