T Nation

High SHBG, Low Free T, High Total T. Confusing Bloodwork


#1

Hello, new here, and before I get flammed, I know the decisions I made when younger were stupid. Yes, I was an idiot. I will accept any flamage if given. With that being said, I have posted this in another forum and decided I would post it here to see what anyone may have to say:

I’m 22, coming up 23 soon, with a list of symptoms that lead me to think low T. I also have a history that would lead me to think that I do in fact have low T.

From about 17 years old to 20 years old, I started using pro-hormones which then lead to anabolic steroids and peptides. (I know, flame me if you want, I’ve learned my lesson.) I quit using them at the time I did because I felt as if my body was going to give up on me. I was pretty much consistently on the whole duration of my experimentation, always using pretty low doses except for the first cycle.

Once I came off drugs completely, I did used Clomid, Nolvadex, and Arimidex for probably a good 6 months, maybe less, because when I made the decision to come off steroids, I had been on a cycle for about 7 months using a cocktail of drugs but all very low doses. Before I even started taking steroids, I was heavy into alcohol and drug use, which may have played a roll in where I am at today.

Ever since coming off, I have felt lethargic, no energy, depressed, lost about 35lbs but no fat gain, low libido, I don’t think about sex or women like I used to, I feel weak, no drive or motivation, anxiety, I’m very passive now. If I work out I will get extremely tired for atleast 2-3 days following.

I’m taking blood pressure medication (linsinopril 10mg) and have been prescribed klonopin 1mg 2x daily or as needed for anxiety. I just started these two medication about 3 months ago. My blood pressure was constantly 140/80 at the doctors, but now its dropped a bit to the 120s/70-80s. I feel like I may be on BP meds for the wrong reasons.

I’m quite lost and confused as all doctors have told me I’m fine, except for the bio hormone specialist, but I just don’t feel like a 22-23 year old should. I feel worn out and like I’m 70 years old. Maybe someone can chime in and point me in the right direction.

9/17/14:
Total T - 463
SHBG - 49
DHEA sulfate - 444
Estradiol - 27
Free T4 - 1.41
Free T3 - 3.7
TSH - 4.4
Vit D - 29

1/26/15:
Cortisol (Tested at 1:58 pm) - 21
Total T - 494
Free T - 10.9
SHBG - 30

06/02/15:
Estradiol - 26
Vit D - 36

09/10/15:
TSH - 2.8
Free T4 - 1.17
Free T3 - 2.7
Cortisol - 18 (tested at 8 am)

02/05/16:
Total T - 790
Free T - 12.7
SHBG - 56
Estradiol - 18.5
Estrone - 16
TSH - 2.3
Free T4 - 1.13
Free T3 - 3.4
THYROID PEROXIDASE AB - <1 Reference range <9 (IU/ML)
THYROGLOBULIN AB - <1 Reference range <4 (IU/ML)

04/05/2016
Total Testosterone - 957 (348-1197 ng/dl)
Free Testosterone - 15.1 (9.3-26.5 pg/ml)
SHBG - 53.5 (16.5-55.9 nmol/L)
Estradiol - 6.8 (7.6-42.6 pg/ml) LOW
LH - 8.2 (1.7-8.6 mIU/mL)
FSH - 7.4 (1.5-12.4 mIU/mL)

I thought it was werid how my total test levels jumped up by 500ng/dl over the past year and a half or so? My doctor told me not to worry about the SHBG too, she said it was fine to be that high even though it was out of the range.

I visitied with a bio hormone doctor recently who looked at all my labs and he was not hesitant to want to put me on 100mg cyp a week, desiccated thyroid, and cortef. I was rather shocked, but he believed that with sucha a protocol he could get me off of the BP meds and the Klonopin which is my ultimate goal cause neither of those help with my symptoms. If not, making them worse. I did not make this attempt as pricing was outrageous and I’m trying to avoid hrt at this point but I would consider it.

My objective is to avoid TRT or HRT, but if it meant changing the way I feel, I would definitely consider them.

Is it possible for me to be suffering Adrenal Fatigue? I have been through some serious stuff through all of this and with my super high anxiety it has me thinking I may be suffering from it, especially since I wake up in a panic in the mornings and pretty much feel anxious all day.

If someone with more knowledge can chime in and help out that would be great, until then I will do my own research on things.

And if anyone is wondering I’m 6’4" about 185lbs (I sometimes feel under weight at my height and weight) and I eat healthy 90% of the time, making sure to get in the ball park of 3000 calories each day, while the remaining is not caring what I eat and enjoying food with friends or family. I also just recently started lifting weights again and that has been helping me feel a little better but also I tend to get extremely drained after workouts. I’m talking sore ans fatigue for maybe even a week after training with moderate intensity. I also do yoga on non lifting days.

From the time I got off the steroids and up until recently I had ate very poorly and did not exercise. My sleep has also been pretty compromised since the start of using PEDs and still up until this day, but I’m working on a good sleep schedule, I just can’t seem to get deep, restful sleep, always waking up and tossing and turning, which I know is not making me feel worse as well.

If anyone has any advice or tips, I thank you, and thank you for taking the time to read my post.

-Runup


#2

I calculated your free testosterone numbers, and got the following:

  • 9/17/14: Free T = 7.45 ng/dL
  • 1/26/15: Free T = 11 ng/dL
  • 2/5/16: Free T = 12.8 ng/dL
  • 4/5/16: Free T = 16.8 ng/dL

The consensus seems to be that a calculated free T below 6.5 ng/dL is indicative of hypogonadism, although some doctors and endocrinologists go up to 7 or 8 ng/dL. Other than the draw on 9/17/14, you’re well up from that cut-off.

I’m not a doctor, nor do I play one on TV, but I reckon that TRT wouldn’t be needed in your case.

If you want a bit of reading, this article (PDF) gives opinions from several experts.

Depression and anxiety can mess up your sense of well being and kill your libido. Some medications have side-effects that can exacerbate this, and Klonopin is one of them, though it’s a less common occurence. It might be worth trying a different drug.


#3

I do not think there’s a very significant problem with your numbers, especially the latest ones. Your FT in the 2014/15 was less than what it should be, but the latest ones seem decent enough to not cause such issues. I do not have as many issues with FT of 6.8 ng/dl. I also have high shbg, shbg can inflate TT to greater numbers than FT or bioT suggests. So it makes sense to look at these numbers to make a diagnosis and whether you need replacement.

I would deeper into other issues personally before jumping on TRT, thyroid function can be a possible issue, you should also consider whether anxiety and depression are a cause of your problems rather than symptoms, some lifestyle changes may well be beneficial. A FT of 15 does not indicate severe problems at all, it’s good considering long term steroid/pro hormones abuse.


#4

@equalo212 I calculated your free T as 8.44 ng/dL given your numbers on your thread.

I’ve seen various cut-offs for calculated free T proposed between 6.5 and 8 ng/dL, so you’d come slightly over that line. That might explain why you weren’t showing problems.

But, as with all these things, it’s better to treat the symptoms and not the numbers. :slight_smile:


#5

Yes, It’s always variable upon one’s symptoms. I have gotten other bloodwork done and my fT has been lower after that and even above that once. It will fluctuate, i also saw your thread, I think you should really consider HRT dependant on your symptoms. My main symptoms since 2-3 years have been severe fatigue which is sometimes better and sometimes insufferable. My sex drive is very low, though i do not have ED issues. I get hard but i don’t feel like it, if you know what i mean. I have been making changes to my lifestyle in the past year even before i thought my problems could be T related since i’m so young. I think i’ll go for HRT in the near future, nothing has got me to feel that sexuality again. I have also been very dedicated towards lifting and have only managed to gain about 5-6 pounds muscle net in my 6 years of lifting despite various changes in training style and diet regimes. Other factor is that, if my levels are such at 25, there’s not a lot of hope of me magically getting better as i get older. It’s only going to go down with age, so i am thinking of cutting my losses and go for it. I am concerned with fertility ofcourse at my age so i am being extra cautious and probably going to go extra save and cryopreserve my semen in addition to hCG.

When i referred to his symptoms, i was referring more to anxiety and depression which is not all due to T, it has alot of factors and T is one of them. His T is not so bad to cause such problems in itself, i have very minor anxiety which is expected with such T levels but not depression or other mental issues like that. Though everyone shows different symptoms on different levels.

All in all, i am starting to think that it’s better that problems are treated rather than papering over the cracks and suffering further. For me, HRT 2 years down the line after experimenting on things suggested on the internet with minimal effect does not make more sense than an expert monitored treatment.

@runup2020 As for your problems, You should read up more on Adrenal fatigue, although your cortisol 8am suggests some parts to be okay. Thyroid could also need some work.


#6

@equalo212 I live in Australia, which has got some of the most restrictive guidelines for TRT in the world. I don’t know if it’s an option, and so I’m not really pursuing it. But this is hijacking someone else’s thread…

I do agree that @runup2020 should be looking into treatments for anxiety and depression. I suffer from the latter, and symptoms do overlap with low T. In fact I meant to say something on that earlier, but got distracted.

Low free T is associated with persistent, mild depression (dysthymia), and I believe that there is some evidence that TRT can help. In fact, it was historically used as a treatment before the development of things like SSRIs.


#7

Thanks for the replies fellas.

I’m going to exhaust other area before committing into any kind of hrt since my blood work does show I’ve had a pretty decent rebound over the years since I have been off of stuff and cleaned up my lifestyle.

I think my best bet now is to dig deeper into thyroid and adrenals then if I still have issues go from there.

My main concern was the elevated SHBG. The klonopin and Linsinopril could play a part in that but I also used growth hormones and I’ve read low levels of growth hormones can cause it to elevate.

I also have a history of alcohol and drug abuse but I’ve been rather clean except for the occasional outing maybe once or twice a month.

My anxiety as of now is pretty tame and I’ve began to reduce the amount of klonopin from 1mg 2x a day to .5mg 2x a day.

I also wouldn’t consider myself to be “depressed.” I do have depressive episodes mainly because my body feels old and worn out, thus I get sad. Maybe I’m just used to the “amped” up state I was in for a while. My GP put me on zoloft and I used it for about a week and I stopped it. I felt like a robot with no emotions and my little sex drive that I’m trying to hold on to completely disappeared.

My main area of concern is my energy levels aren’t the greatest and I usually have a huge decline after lunch.

Maybe I’m thinking too into this stuff and causing issues that aren’t really there by thinking there may be an issue, but something just doesn’t feel right.

I got a thermometer to check my temp about a week ago and have yet to see 98.6 during the middle of the day. When I got out of bed this morning it was at 96.2, but who knows how accurate this Walgreens thermometer is. Part of my symptoms are cold hands and feet, but the strange thing is I’m very lean/skinny right now. I don’t gain any weight what so ever. I’m really thin as of now but I do have a moderate amount of muscle and my lifts are slowing starting to increase. I’m going to log my temp this week and post back with what I’ve gotten but I do believe each of you are right in looking into other areas first. I’d much rather avoid hrt at this point in time. My goal is to be med free and feeling great. I pray I can achieve that.

Thanks


#8

I’ve been on Zoloft in the past, and have suffered the side effects. I had a couple of very rough weeks when I started, and the same again when I upped the dose, so things might have got better if you’d stayed on it.

Finding an antidepressant that works is normally a trial and error process. There are genetic tests that can help now. That said, if you don’t think you need an antidepressant then you’re probably best off them.

Your slow progress in the gym might simply be because you’re used to faster gains when you were on a cycle. Building muscle naturally isn’t a quick process, unfortunately.

I think that there’s too much focus in this forum on getting hormonal levels in the optimal range. For example, doctors won’t treat a TSH level until it gets over 5, because side-effects for the medicine can be worse than the symptoms. We all get a bit of OCD about the numbers.

Lastly, I’ve read that a high protein diet can reduce SHBG. I don’t know if it’s broscience, or there’s actual research behind it. But it might be worth experimenting with.