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It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were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>.