T Nation

High SHBG, High Prolactin, Low Free Test


Hi guys,

I just got my lab results back and was wondering if someone could help me make sense of it. It seems I have extremely high SHBG levels and also elevated Prolactin.

I was considering going on TRT due to usual low-T symptoms (probably caused by the large amount of SHBG reducing my Free-T) but not sure if this is the way to go?

A lot of people seem to suggest that super high SHBG is usually a sign of a different type of problem but I had my thyroid checked and all seems to be OK.

Could anyone give me some insight into whether I should look to proceed with TRT?


Test Results:


TESTOSTERONE 26.3 (7.60 - 31.40) / 759 ng/dl
FREE-TESTOSTERONE 0.297* (0.30 - 1.00) / 9 ng/dl
OESTRADIOL 54.6 (0.00 - 191.99)
SHBG 84.8* (16.00 - 55.00)
PROLACTIN 326* (86.00 - 324.00)


_FREE T3 4.22 pmol/L 3.10 - 6.80 _
_FREE THYROXINE 16.8 pmol/L 12.00 - 22.00 _


Testosterone levels look great, but you’re right in that your super high SHBG is killing your free testosterone. So it’s as if you have little testosterone in your system do to your high SHBG, which large doses of T will decrease it to where you’ll benefit once you get your free T to increase. You’ll face a real challenge in your county since the doctors are the problem, most would look at your TT and assume you’re fine. I know of another person in your country where his T levels are high but SHBG is also high and doctors don’t seem to think his SHBG presents problem even though his Free T is low like yours. TRT is the only treatment available that will decrease your SHBG.


By the way forgot to add that I’m 35.


Thanks for your detailed reply @systemlord

I have access to some Sustanon 250 over the counter in the country I’m travelling in right now so I am considering purchasing because as you quite rightly say - doctors are reluctant to help me.

Reading the boards, am I right in thinking that people with VERY high SHBG generally benefit more from large single doses of T rather than smaller amounts more regularly? So a small amount EOD wouldn’t work as well as a large weekly dose?

Do you think it be worth starting out with .5ml (125mg) per week initially and seeing how things go ? Or would a larger dose be more beneficial as a kickstart to get my Free-T levels up?


That’s a good starting dose but might need to go a little higher to bring down SHBG, the higher the dose the lower SHBG will be. You’re going to require AI to help limit E2 though. It’s the reason why low doses are a must for guys with low SHBG, otherwise ours will be so low we won’t benefit much at all. It will be a challenge to find a knowledgeable TRT doctor, but it’s not impossible. Maybe in a few years you’ll be able to run your own blood tests through these websites who send everything in the mail, then you’ll have access to labs so you can monitor everything yourself until such time doctors pull their heads out of their ***!


@systemlord So you’d suggest it would be better to take a single higher weekly dose (say 200mg) once a week rather than injecting twice a week or every 5 days etc?

Am I right in thinking the single large dose is more likely to cause Estrogen issues which is why Arimidex or similar is usually required?

Would it be best to start out with just T for now or start immediately with the anti-estrogen as well from day 1?

As I am essentially self-medicating right now just want to make sure I start off with a sensible plan and make sure I purchase/take everything correctly…


The large the dose of T the lower further reduction of SHBG, it’s all going to depend where in the SHBG range you feel best, some are more sensitive to high SHBG than others. Standard AI dosing is 1mg per 100mg of T, so if you do 200mg the 2mg of AI per week. I don’t know many who can take more than 150mg of T without an AI. You could always split the dose twice weekly if you’re having problems with sky high E2, it’s not always about labs, it’s about how you feel. I feel pretty damn good on two small injections per week and I have low SHBG, most low SHBG guys are on EOD protocols otherwise they feel little benefit. Everyone’s different.


I have read multiple people state that increasing their test to lower their SHBG did not work for them.

Also, there are other treatments for SHBG, but not easily available, but there are. Stanazolol, Proviron, Danazol all lower SHBG. Also Aromasin will lower SHBG as it is a steroidal AI (currently what I am doing, and I am having good results).

Medications is a big one. Lisinopril alone increased my SHBG by 20 points.


Are you overweight?
Diabetic? - which seems to lead to high SHBG

Some liver problems will elevate SHBG. SHBG is made in the liver to scavenge SHBG.

Some guys have unexplained high SHBG.

fT3 and fT4 should be mid-range or a little bit higher.
fT3 is thus low
TSH should be closer to 1.0, 1.82 is a concern.
See below re using oral body temperatures to find out more and not references to iodine and iodized salt.

Where are you located?

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 number 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 Thanks for the response and sorry it’s taken a few days to respond…

I would say that I am probably a little overweight (10-15 lbs) and I am based in the UK. I’m not diabetic although my mother is.

It’s interesting that you mention thyroid - so the lab numbers are really not that great? Do you think I should be investigating a potential thyroid issue as well as the high SHBG?


Yes that’s also my concern with starting TRT in that it possibly won’t have any effect on the SHBG. Also my overall test is actually pretty decent so I’d definitely like to take into account ways to try and bring the SHBG if possible.

The only medication I take these days is a statin (Crestor) for high cholesterol. However around 5 years ago I was previously on Propecia/Finasteride for around a year and it seems there are links to that and high SHBG?


Many people will tell you that because your Total Test is fine that your testosterone is also fine. This is BS. I was in the exact same situation as you with elevated SHBG, great total testosterone, and low free test. I felt like shit. Started TRT almost 4 weeks ago, and I’m feeling much better.

As far as solving elevated SHBG…I have yet to find a single person who has done so. There’s plenty of theories floating around the male health forums, but I have not found anyone who has significantly lowered their SHBG without the use of pharmaceuticals.

I spent the last year trying everything under the sun. I started iodine and desiccated thyroid to take care of my hypothyroidism. I did parasite cleansing, mercury detoxing, liver cleansing, meditation, etc… I’ve tried AI monotherapy. I tried lowering my thyroid dosage. Nothing changed my SHBG or the way I felt.

I’m not telling you to go hop on TRT, but do NOT let anyone tell you that it shouldn’t be considered.h High total testosterone is not the most important variable. Free testosterone is what matters most, and there are studies that back this up.


@dabah2014 Good to know. Thanks for the response.

May I ask what dosage you are running per week currently and if you’re using an AI?

What have been the most noticeable benefits for you after four weeks?


My doc started me high on 200 mg a week. I’m a little uncomfortable with it, but he’s been doing this for 14 years and comes highly recommended.

He also put me on an arimidex dosage of .25 mg twice a week and HCG 500 IUs twice a week.

I’ve noticed increased energy, diminished anxiety, better digestion, less inflammation, and better mood. Unfortunately, my libido has not improved whatsoever which was one of the main reasons I began. I’m only on week 3 though, so there’s still time for improvement.


Libido can take the longest to return, so many other things have to be right for libido to function. 3 weeks is nothing, even if you were 3 months in I would say the same thing.


I’m glad to hear that, because I’ve seen no improvement. But as you said, it’s still early on.