T Nation

High SHBG, Prolactin, and TSH, Low FT


#1

I have been checking my blood levels for several years-usually just once per year with a general CBC/Chem/Basic Hormone panel. Levels for Testosterone have been somewhat on the low end of normal for the past few years, but even lower now, so I had more complete tests run to check more parameters.

Background:
45 years old, 5’ 10", 190# , waist is 32-33", body fat % right now probably 12-14%.
Have a full head of hair, facial hair grows regularly, but has always been a little patchy. Legs and forearms have good amount of hair, have never had much of any hair on my torso.
Fat is carried mainly in lower abdomen, but seems spread out pretty evenly over waist, butt, and hips.
No health issues that I have had to receive meds for, outside antibiotics for dog and cats bites, as I am a veterinarian (None in the past 2-3 years).
Diet is very strict most of the time. I competed in a few natural bodybuilding shows in my late 20’s and have stuck to that type of diet for the last 25 years. High protein, moderate fat, carbs are mostly fruits and vegetables, except for peri-workout Plasma.
Training is typically 4-5 days per week. Normally follow a Meadow’s-type plan, with the exception being that I incorporate a Deload week after every 3 weeks of training, otherwise I tend to feel over-trained. After completing the 12-week program (which I have stretched to 15 weeks with the Deloads), I’ll normally do a 3-4 week simple 5X5 plan which is about 3 training sessions per week.
No issues with morning wood or getting erections, although quality of erections is not as good as it used to be.
Overall feeling has been one where I do feel more tired than usual, considering I sleep pretty well (and about 7.5-8 hrs) each night, and maybe having more difficulty with recovering from workouts. Mentally, some brain fog and/or “lack of caring” seems to take place where many days by early afternoon, especially at work, I’m just counting down the # of patients that I need to see before I can get out of the office. I realize that some jobs may suck and this would be normal, but I have never really felt this way until the past couple of years.

Blood results:
Glucose 95 (65-99)
Uric Acid 4.2 (3.7-8.6)
BUN 23 (6-24)
Creatinine 1.16 (.76-1.27)
Na 142 (134-144)
K 5.0 (3.5-5.2)
Cl 101 (96-106)
P 3.5 (2.5-4.5)
Protein 7.3 (6.0-8.5)
Albumin 4.8 (3.5-5.5)
Globulin 2.5 (1.5-4.5)
TBil .5 (0.0-1.2)
ALP 41 (39-117)
LDH 149 (121-224)
AST 23 (0-40)
ALT 24 (0-44)
GGT 15 (0-65)
Iron 112 (38-169)
Cholesterol 177 (100-199)
HDL 49 (>39)
LDL 108 (0-99)
PSA .7 (0.0-4.0)
Total Test 559 (348-1197)
Free Test 7.5 (6.8-21.5)
DHEA 159.9 (71.6-375.4)
Estradiol 18.4 (7.6-42.6)
SHBG 54.3 (16.5-55.9)
A1C 5.5 (4.8-5.6)
Vit D 48.9 (30-100)
WBC 5.7 (3.54-10.8)
RBC 4.94 (4.14-5.8)
Hemoglobin 14.9 (12.6-17.7)
Hematocrit 44.6 (37.5-51)
Platelets 259 (150-379)
LH 5.4 (1.7-8.6)
FSH 11.7 (1.5-12.4)
TSH 2.96 (.45-4.5)
T4 6.9 (4.5-12.0)
Free T4 1.45 (.82-1.77)
Free T3 3.1 (2.0-4.4)
Reverse T3 18.9 (9.2-24.1)
Thyroglobulin Antibody 1.0 (0.0-0.9)
Prolactin 17.9 (4.0-15.2)

Morning Temps past 2 days-95.9, 96.5
Mid-Afternoon Temps past 2 days-97.4, 97.4
Late day Temps past 2 days-97.2, 97.1

So it obviously looks like Thyroid is an issue from the high TSH to the too low temps (I normally don’t feel cold). In evaluating diet and supplement, I am definitely well short on Iodine. My salt has Iodine, but I only use a very small amt, so that needs to increase. I just got some Iodine and Kelp supplements that should bump me to over 4mg per day, but is that enough? Do I need to get the higher dose, like the 12.5mg, to get levels normalized quicker?

What about the SHBG and Prolactin levels? It certainly explains at least some of the low Free T. Should I start to pursue TRT with a doc or wait until I get Thyroid hopefully straightened out with increased Iodine?


#2

You really have a good grasp of things and have done most of my work for me. I do not need to ask for much or nag for thyroid items! :+1:

Your labs suggest dehydration. Please drink water in your lab fasting.

Over training and/or lack of recovery is a stress that can push up rT3, and this gets more severe when thyroid function and/or T is low as adrenalin is compensating for a loss of natural energy.

LH:FSH ratio is odd, should be nearer to 1:1.
When FSH is really dominant, we need to consider that a FSH secreting testicular cancer might be responsible. Anything feels odd with your testes? When on TRT, we expect LH&FSH–>zero and testing then can rule in/out a cancer. So some screening is advisable. But we so see some odd FSH:LH at times and while FSH levels are steadier with a longer half-life, LH is quite the opposite and you may have caught a trough. Repeat LH/FSH might be useful later.

SHBG is quite high and your low E2 is obviously not a cause. SHBG is made in the liver and liver pathologies can increase SHBG, but we see no issues with AST/ALT/GGT and your consumption of alcohol seems low-moderate.

SHBG levels increase with estrogenic states (oral contraceptives), pregnancy, hyperthyroidism, cirrhosis, anorexia nervosa, and certain drugs. Long-term calorie restriction of more than 50 percent increases SHBG, while lowering free and total testosterone and estradiol. https://en.wikipedia.org/wiki/Sex_hormone-binding_globulin#Conditions_associated_with_high_or_low_levels

High SHBG means that there is lots of non-bioavailable SHBG+T that inflates your TT and TT thus overstates your T status. Also reduces FT. Your FT:TT thus is low. But FT is pulsatile with a short half-life, even shorter with your high SHBG and we are faced with a a bad signal:noise ratio. A calculated FT might be useful and cut through the noise as TT and SHBG levels are quite steady.

Hemoglobin, RBC and hematocrit also speak to lower T status than TT implies.

TSH sucks. T4 is well below mid-range, fT4 is good, fT3 is good, low body temperatures suggest that rT3 is blocking fT3 at T3 receptors. Thyroid binding globulin may be lowish, that that is neither here nor there.

Prolactin can be elevated by some meds, orgasms, hugging {babies | puppies | kittens} so avoid for 3 days before labs. You seem a bit old for presentation of a prolactin secreting pituitary adinoma.

Your thyroid antibodies suggest that you may have issues from high TSH and a lack of selenium. So you need to eat one or two Brazil nuts per day or get 150-200mcg in a supplement. With your anti-bodies, I would like to see you taking selenium for 3 weeks before an major iodine supplements.

A good multi-vit, no iron for men, with iodine and selenium would be good as well as a spectrum of other trace elements that are mission critical for many enzymes.

Most are magnesium deficient. A lack can show up as increased BP or leg/foot cramps. See ZMA sold here in the biotest store.

DHEA-S is suboptimal. Take 25mg DHEA with a meal that has fats and avoiding high fiber foods. Ditto for EFAs [fish oil, nuts, flax seed oil/meal] and Vit-D3.

So what to do. Your FT says you need TRT, most docs will shutdown on TT. SHBG is a problem. E2 liver clearance appears good. A1C wants diet change, but we can be quite confident that low T and low thyroid function are lowering insulin sensitivity and these can be fixed. Your apparently low T production [FT] and strong LH/FSH suggest that testes are not working well, but no orga system in your body can function properly with your low thyroid function. Get on selenium and other trace elements for 3 weeks, then start IR and monitor body temperatures and mental clarity that must be suffering now.

Please read the stickies found here: About the T Replacement Category

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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.


#3

Thanks for the detailed reply.
How long should I do the IR before checking thyroid levels again and should I get T levels rechecked at that time as well? I have some Selenium on the way so will start that as soon as it arrives, then do IR after 3 weeks. I’m doing blood tests out-of-pocket through LEF, so I want to do what is needed, but not spend excessively if not needed.

A couple of strange things regarding supplements that make me think levels may have been even further off. Prior to the blood test I was taking Elite Pro Minerals, Flameout (3 caps per day), D3 (5-7000 per day) and a supplement with Stinging and Dwarf nettle extract (282mg per day). I also was taking 50mg DHEA on a 5 on/2 off schedule. This makes me think that certainly my DHEA levels would have been considerably lower than they already were without the supplement.
I’m not sure if the Stinging and Dwarf nettle extract would help that much, but it could have been lowering the still high SHBG as well.


#4

When you do IR, you will monitor progress via oral body temperatures and should keep the thermometer in your pocket. You will also be observing changes to energy levels, mood and clarity of thought. Lab tests are not that useful at this stage. In any case, IR leads to expected/normal increases in TSH so TSH labs results have no value at this time. And TSH levels can be slow to fall in response to anything that will lead to it dropping.

DHEA dosing can be tricky as some do not absorb it well. DHEA, EFAs, Vit-D3 should be taken with meals that have more fats and less fiber. Taking with oatmeal would the the worst.

DHEA and other hormones can be reduced via low levels of pregnenolone which is made in the mitochondria [cholesterol–>pregnenolone]. Note that mitochondria are regulated by fT3 so there is a thyroid connection that also regulate energy levels [APT]. https://en.wikipedia.org/wiki/ATP_synthase

Add AM cortisol to your lab list and do at 8AM or 1 hour after waking up. No coffee and try to be relaxed, not blitzed by traffic jams.

A significant amount of pregnenolone is generated in the testes.
Also see: https://en.wikipedia.org/wiki/Steroid_hormone

With regard to rT3 concerns, there can be associated concerns with low cortisol and low DHEA is a concern because as an adrenal hormone, it may be part of a broader pattern, as you will see from the thyroid basics sticky, this involves consideration of stress, major stress events, accidents, infections/inflammation etc. DHEA levels start to drop in men and women in their 30’s, so lower values are not unexpected. Some guys freely convert DHEA–>E2 in their adrenals when they take DHEA supplements, clearly not happening in your case.

Speaking of a good multi-vit, look at LEF’s two per day.

How much selenium were you getting in Elite Pro Minerals? I am not familiar with that product. How long were you taking?

You have a lot of things to consider and should review my post as you climb the learning curve, but you should manage that quite quickly.


#5

I’ll adjust timing on some of the supplements to try for better absorption.
Then Elite Pro Mineral Support is the Biotest product, with no Selenium in it. I have been using the LEF Minerals, but not consistently, so I probably wasn’t averaging more than 25mcg per day.

I forgot to add that I did have Cortisol checked, it was 13.9 (6.2-19.6) in the AM. The only caveat is that I took some coffee with me to have after my 7:30 AM draw because I was heading straight to work from there, and managed to absentmindedly take a couple of gulps (probably 4 oz) 5-10 minutes before I got to the facility. I didn’t even think about it until I got back into the truck and realized my coffee wasn’t full. So I’m not sure how much of an effect that would have on the cortisol level, although it has to be something.


#6

Elitepro Minerals has 200 mcg of selenium if you are taking all seven capsules: