T Nation

High SHBG, Low Estrogen, High Total T, Low Free T

I’m male and 29 years old and did some testing because my total T was very low 5 years ago. I started lifting, started to eat healthy und reduced stress. I’m not on TRT.

This is my current lab work:

Total T: 26.7 nmol/L (769 ng/dL)
SHBG: 78.9 nmol/L
Estradiol: 68.8 pmol/L

My total T levels look fine, they were around 400 ng/dL 5 years ago. What bothers me are the very high (off scale) SHBG levels and the very low estrogen levels.

Already tested for hyper/hypothyroidism, the levels were fluctuating, but TSH was always under 4.

My question is, how do i lower SHBG and raise Estrogen to normal levels?
What are reasons for high SHBG?

I appreciate any help.

Increasing Total T-> more Free T-> more estrogen, excess androgens suppresses SHBG.

TRT is how you lower SHBG, nothing else will work. High SHBG can have many causes, genetics, drugs/alcohol, starvation diets and medications all which increase SHBG. Your Total T is high normal but isn’t the active portion of testosterone, your Free T is the active portion and is on the bottom end.

You will need Total T levels >40 nmol/L or 1200> ng/dL to get Free T to move where it needs to go, the problem is no state healthcare doctors can allow it. You need to seek private care from a specialists who isn’t hogtied by NHS guidelines.

TSH anywhere near 4.0 is a big problem, 95% of the healthy population has a TSH <1.5. I don’t see any actual thyroid hormones tested, Free T3 shows how much thyroid is making it into your cells, Reverse T3 if elevated 15> ng/dL can block Free T3 from getting into your cells.

A lot of doctors are ignorant in testing and treating thyroid and sex hormone problems, especially in the UK and surrounding counties because there is no evolution of medicine outside the US.

Reference ranges for TSH and thyroid hormones

First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L. There is also an argument that significant number of patients (up to 30%) with TSH above 3.0 mU/L have an occult autoimmune thyroid disease.

The evidence for a narrower thyrotropin reference range

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group.

Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter. The remainder with higher values are outliers, most of whom are likely to have underlying Hashimoto thyroiditis.

The current reference ranges most doctors follow includes those with hypothyroidism, not the set of standards I want my levels judged by.

My TSH is 0.6-1.01, I do not have a thyroid problem, those that do or are on their way are 2.5>.

You need to know free t3 and revere t3. Tsh under 4 literally means nothing, it should be closer to 1

The rest of your numbers remind of myself at one point or another.

You increase e2 and free testosterone by adding more testosterone. There is no better way. This may or may not being shbg down, but with enough T it doesn’t matter.

Thanks for your replies.

I also have high homocysteine levels (11.2 µmol/L), so i suppose i might have an vitamin b12, folic acid or b6 deficiency which i’m going to test at the lab in two weeks (i’m currently sick, so i’m waiting until it wears off).

Vitamin D is around 60 ng/ml (fixed it around a month ago).

So these are the tests i’m going to take:

  • VB12 + HoloTC, VB6, Folic Acid (for homocysteine)
  • TSH, fT3, fT4

rT3 is not offered at the lab (the lab which offers this test is around 1 hour drive away).
How important is this test?

What else can or should i test?

I first want to try it without TRT, because i’m living in germany and TRT is very hard to do here.
Again, many thanks for your help.

You could have good Free T3 and Free T4 numbers and high Reverse T3 which basically means a large portion of Free T3 is not getting into your cells causing high TSH and hypothyroid symptoms.

You cannot test Free T3 and Reverse T3 separately, there is a fine balance between the two. When you are sick, your body slams on the metabolic brakes increasing Reverse T3 so that you’re not powerlifting in the gym when you body is trying to fight an infection, your body needs its energy to fight off the infection or disease.

Treating the thyroid with thyroid medicine will increase SHBG further lowering your Free T, you must treat both conditions together or your situation will worsen because the usable portion of testosterone will shrink into oblivion.

So, when i have hypothyroidism because of high rT3 and i treat it with levothyroxine, the hypothyroidism gets fixed but at the same time SHBG gets up (and lowers my free T)?

Is this the result of levothyroxine or fixing rT3? When i lower rT3 (in the case it is high) by fixing the what ever underlying disease i have, does this also result in higher SHBG?

Levothyroxine is a synthetic T4. You have a conversion issue and will need a T3/T4 compounded combo or armour thyroid (porcine thyroid which includes T3 and T4).

Thyroid medicine increases SHBG, you increase testosterone to lower SHBG. Highpull is correct, you need a combination of T4 and T3 or T3 only medicine with high Reverse T3 because you have a conversion problem, otherwise T4 will increase Reverse T3.