T Nation

High SHBG But Normal Test

Morning all,

Thanks for previous responses on previous threads-

So over the last 2 years I’ve started TRT then bottled it when I had itchy breast tissue and last minute U-turn when considering the long term commitment and cost.

I’ve had various blood works and it always comes back test in mid levels with high shbg giving me free T right at the bottom of normal range-

I have spells of horrendous brain fog
Fatigue that flattens me for days- recovering from exercise takes forever.
E.D

I’m really struggling with the concept of “free t” and how most of the usual medical profession (NHS gps) are oblivious to it!

I’m 38 in a few months and think I’m going to be trying this again but with more commitment to seeing it through.

Anyway- would love to hear from others who had normal testosterone levels (mid range or more), but high SHBG and have had success with TRT- especially if youve been on long term?

Its the concept of shutting my hpta axis down when my body does actually produce testosterone properly thats bothering me.

BUT- I feel like absolute shit!

Any insights welcome

I have many patients in your situation, total testosterone 750-900 (250-1100), free testosterone 30-55 (35-155) and SHBG 60-90 (10-50). A weekly injection of 150-200mg puts them at 800 total, 150 free, 50 SHBG and feeling much better.

This is also common with women, especially if on contraceptives, sky high SHBG, decent in range (2-45) testosterone, and free test of 0.something (0.1-6) with zero libido. Have to run total test to 80 to get free test to 5.

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Thats interesting Highpull. Is there any reason you favour once per week for this situation?

Do these patients need an ai with a single weekly shot? I’ve read a lot that more frequent tends to produce less estrogen through aromatase?

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Easily 80-90% do just fine on TRT with once weekly dosing.

Occasionally, not very often.

In theory, yes. The high level is not as high and the low is not as low. Of my guys, of those that switched to multiple injections more than half went back to once (from twice) or twice (from daily or every other day) a week. For me, even with dropping the dose from 200mg to 120mg a week, I had higher E2 at trough with 40mg every 60 hours injection than 200mg every seven days.

Your results may vary.

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You’re making me want to try once a week since I’ve missed doses etc and never been able to tell the difference. (I’m high 60-70 shbg while on TRT, 210mg/week gets me to high end of normal on free T and 1500+ total)

Have there been any issues with anxiety or anything like that with what I’m assuming is a pretty big spike in the beginning with a single “big” dose like that? Or is that not even really a thing?

Yes, that was exactly me over 8 years ago. You are correct that most docs are oblivious to the concept of Free T and the effects of high SHBG on the male. I know from experience that it is real and affects a number of men. I ran across some references many years ago that i have since lost that discussed a genetic link that affects about 10% of men. We add extra sugar molecules to the SHBG protein and that effectively doubles the half life of the protein. We produce SHBG at a normal rate, but it sticks around twice as long and has double the effect as it does in guys with normal SHBG production.

Also, SHBG-bound T is protected from liver metabolism, so it is not uncommon for us to even be in the slightly higher end of the normal range for Total T. That’s why Total T is a more than a worthless test for guys with high SHBG, it gives the false illusion that we have excellent T levels. SHBG-bound T does not cross the blood-brain barrier where we need it to feel normal. So, while it’s true that we may have normal to high Total T, we feel like $#!t because our brain is starved for T.

My approach is to treat with TRT with a sufficient dose such that you saturate the SHBG protein so that enough T spills over that you keep Free T in the target range (which may vary from person to person). See the graph below for the data I used to calculate my optimal T dose.

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Thanks guys- I’ve had a few readings where my total T has been in the 20s (think the ref was 5-30) and it had my GP looking at me like I was mad suggesting my T was low!

Nothing close to what I read about here. I would say it is rare.

Over reaction for the most part, but there are always exceptions. I come from a time when we were taking 200-800mg test a week on top of other AAS. Most I ever took was two 400mg injections a week though I usually took 200-500mg a week. Nobody complained of anxiety unless they had a bad workout.

If I was taking 400mg twice a week and missing my lifts, I had anxiety…

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Highpull- are you a medical professional prescribing trt? Im assuming from the previous post you are… n

Out of interest what proportion of your patients use HCG?

There are basically 2 main clinics in the UK- one doesn’t seem to use HCG and the other pretty much starts everyone on Test Cyp and HCG.

I’ve got 2 children and don’t intend to have any more so fertility isn’t an issue- actually shooting blanks would be a positive side affect- is there any other reasons to include HCG?

Off the top off my head, maybe 5 to 10%. Closer to 5%.

In my opinion, only other reason is testicular atrophy.

Some guys like to take it every so often, especially during the summer as they feel it helps them lean up, which is likely due to the increased testosterone. Many report feeling no difference though. I don’t have them take high doses.

Wow, you just described my case perfectly. I hope I had a doc like you since the beginning. Congrats.

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Anyone else able to talk from experience here? Lying in bed again completely flattened from trying to exercise yesterday:-(

Another set of results back. Always the same.

Above mid total test but bottom end free T and feel knackered all the time. No libido ED. Gyno (despite already having had surgery- its.coming back).

Albumin 42.9 ref 35-50
SHBG 63.4 ref 18.3- 50.1
Total T 23.6 ref 9-29
E2 105 ref 41-159
FREE T 0.333 ref 0.2-0.62
Prolactin 145 ref 86-324
Free androgen index 37.2 ref 24-104

I’m really struggling with the idea of shutting a healthy hpta system down because my SHBG is high making me feel like shit.

Boron not doing owt

Anything else I can do?

msm similar results to yours, of which shbg is around 40 but the libido is zero, still fatigue, no morning erection for a year, incomplete erection, lack of motivation, mood swings. I think the problem is also with shbg. doctor wants me to try low doses of winstrol or proviron. if nothing changes here, then clomid for a month and then trt. Life sucks. I sleep 8-10 hours and in the morning I have no strength for anything. the penis seems smaller at all not supplied with blood. the testicles are also much smaller.

Don’t know what else to tell you, but you need to get over shutting down natural production in order to feel better. You have a medical (genetic) condition that results in an over production of SHBG. I struggled with it for years and tried every ‘natural’ treatment out there and the only method I found that would treat the problem is to saturate the SHBG protein with T so that enough spills over into free T to allow you to feel normally.

The problem is (probably) only going to get worse as you age because SHBG typically increases with age. I began noticing problems in my lat 30’s, getting worse into my late 40’s, and becoming intolerable in my mid 50’s. My only regret is that I waited so long to seek treatment. Then again, finding a doc that understood the concept of Free T was not easy either, but that’s another story.

I’m 37. UK based and youve basically got 2 physicians privately in the country who you can go to.

One tends to go with weekly Test E and no HCG

The other goes with daily test C subq + hcg.

I know this is generic but each physician does have a style if that makes sense.

Anyone know which would be better with high SHBG issues?

What country are you based in that they want to try a low dose Winstrol as medicinal?

Netherlands. I just do not know if it will not worsen my condition, but I have to somehow see if through interaction in the system something will improve.

Not true mate. There’s a few I know of: optimale, BMH, Men’s health clinic, Leger clinic. Probably others too in London but no doubt very expensive private docs.