T Nation

Help with Low Free Test / High SHBG

Posted this on Excel Male Forums, but wanted to post a few other places as well

New to the board, but have been browsing for a bit. Figured I would reach out and see if I could get some advice. Brief history, have been working out on and off since 18 or so. Messed around with pro hormones and did a few cycles when I was younger (never followed a PCT correctly, because I was an idiot). 34 now and just been feeling kinda blah for a long time, started doing labecause of ED (which they attribute to anxiety and say I should just use viagra or cialis, two different urologists said this. I wanted to really know the root cause, but I don’t have the best luck finding good doctors who will work with me). One urologist I saw was quick prescribe TRT. I’ve been debating going on that, but I want to be safe and do things the right way. Dad had two heart attacks, with quad bypass on his second one, his dad had heart problems, and his brother my uncle just died of a heart attack last Sunday, so I am a bit afraid to run anything.

Testosterone levels were lower last year, but SHBG didn’t seem to be that high either. I noticed this year that my total test seems good, but SHBG is quite high thus free test is low. Which I assume is why total is up so much now. Any ideas? I’ve tried researching, but I cannot seem to find a ton on it. Figured a lot knowledgeable people were here and maybe someone could help me out. I also considered trying to see an Endo, not sure if they’d be of any help

I’ve attached labs from last year and then two different sets I had drawn this year. I can provide cholesterol and all of that if needed as well. If that last set of labs isn’t readable, please let me know.

Thank you in advance for any info you can provide.

-Brandon

2018_test_labs2|690x246

The labs do not show for me.

Is there anything that points to a possible reason your SHBG is high? Any liver issues, elevated E2, low DHEA? How is your thyroid? Some just have high or low SHBG levels, but if you can fix SHBG, you may not need TRT.

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Looks like I am having issues attaching labs. Trying to attach again.

2018 Labs

SHBG is by default diet related unless you’re using medication or some other special context. You may not need TRT at all indeed, and I’d suggest doing a thorough hormonal panel starting with liver lipids, Cortisol and DHEA would be nice additions, prolactin.

How active and muscular are you? Is your diet low in calories and in carbs? In fructose particularly?

2018 labs continued

Keto? Intermittent Fasting?
Medications? Alcohol or pill abuse at anytime?

Just did separate replies to post the labs. Waiting on the second second from 2018 to be approved. AST and ALT seem fine, not aware of any liver issues. E2 seems fine per sensitive estradiol test. I think I’ve gotten all the labs for thyroid and it is ok. DHEA needs to be tested as I dont recall ever pulling labs on it.

No to all of those. I don’t take any meds at all, like not even tylenol or anything like that, unless I really have ti. Supplement wise I normally do creatine, fish oil, magnesium, taurine, garlic extract, mk-7, protein powder, and then heart solve and cardio solve.

No medications at all.

What else would I need to test for liver? AST and ALT are on the “2018 labs continued”. I’ll have to order Cortisol, DHEA, and Prolactin.

Pretty active, I’m at the gym at least 3 days a week and will do sprints 3-5 days out of the week as well. I’m like 155 and mostly all muscle, I drop weight if I don’t hit the gym. Metabolism is rather fast. Diet is good for the most part, dont eat a lot of junk often. I typically do fruit daily, so decent amount of fructose would come from that I assume.

Might not be the absolute answer, but creatine DOES increase SHBG.

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My view on SHBG is that even if you do reduce it, your total T will go down as well and you still wont have great free T.

The high total T number is misleading as SHBG increases the half life of T so you’re not actually producing that much T, it just stays in the blood longer and so gives a higher reading.

If you want to increase free T without TRT I would say you need to focus on ways of increasing testosterone naturally as well as finding the cause of high SHBG as just focusing on SHBG won’t work.

Your first set of labs back this up - when your SHBG was normal, total T was only 396.

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Sorry, should’ve said I wasn’t taking Creatine at the time. I just recently started back on it about two weeks ago. Prior to that I hadn’t taken any for months.

second what @hd44 said.

Thanks for the input man. Thats why I got further labs after 2017 as I felt my T was low, but of course pdoc says it’s in range. I got back into working out more and doing more compound lifts, so had it tested again this year. Saw total
T first and was like nice! Until I saw SHBG and free T. there any known proven ways to increase it naturally?

Problem is finding a doctor who will work with me to determine what the high cause of SHBG is. My pdoc is useless and has no clue. She also said my T level being at 396 was completely fine though as well.

I’m not opposed to TRT. Just haven’t researched it enough to know how truly safe it is long term. Raising hematocrit and such concerns me. Mine is already 47.8 not on anything. With all the health problems in the family I guess I’m hesitant as well. Dad also has diabetes and prostate cancer, but my PSA level right now is on .7, so not too concerned there. He also doesn’t exercise, eats bad, and drinks a lot.

Based on my labs in your opinion would you recommend TRT? What about Clomid, think that would be worth trying solo? As I said my urologist prescribed me TRT. It’s just he doesn’t seem very knowledgeable on all the labs that are needed. I’d have to get those done myself. He’d check hematocrit and test levels, but that’s about it.

Again thanks to everyone replying

Thinking of this again - SHBG is actually not THAT high. Low T low SHBG is probably the worst situation - often seen in metabolic syndrome people. Good that you’re not another low carb no fructose guy :slight_smile:

Indeed SHBG yields “false” high T. So my opinion is training hard + being lean and active and mostly muscle (+ real life stuff) = probably a lot of stress. That’s where blood DHEA could be helpful, alongside Cortisol testing.

Have you ever had fasted insulin checked? HbA1c? How’s your typical fasted glucose? Thyroid? LDL/HDL?

Just so you know as I’m being consistently tested around 10-11% on a dexa - I found out that feeling better meant a LOT more liver glycogen to spare muscle glycogen use (neoglucogenesis) which isn’t desirable, unless you’re training obviously. Up to 10 fruits per morning (avoid fat and fructose) + orange juice and glucose (dextrins/powdered oats/whatever) periWO is the current dose. The more “favorable” the body composition the faster you’re burning through carbs. If you don’t provide enough your adrenals and/or thyroid will pull the brakes.

True, low SHBG would be much worse from what I’ve seen. Haha, no I def have carbs and fructose.

I’ll have to order those off of discount labs or somewhere. Unfortunately it’s a pain trying to talk my doc into writing out the labs I need.

Yes, I have lipids and HBA1C. Will reply and post those.

Dont know much on thyroid stuff, but here are numbers on that.

Free T4 - 1.17 (Range 0.58-1.64)
Free T3 - 2.85 (Range 2.50-4.30)
TSH - 1.08 (Range 0.34-5.00)
Thyroid Peroxidase Antibody - 29 (Range 0-59)
Thryoglobulin Antibody - <0.9 (Range 0.0-4.0)

Thanks for all the info man.

Here are 2018 lipids

sept_2018_lipids

That was another reason I was hesitant on TRT. It is tough for me to keep HDL up, even with eating pretty good most times and cardio. I have of course increased cardio since 2017 and also eat alot more veggies.