High SHBG Protocol Advice?

Hi
Brief intro.
Been on TRT since July 2017 under the NHS UK after finding out I was low T as the following numbers show:

Collected: 19 Apr 2017
HORMONE PROFILE
Serum testosterone level 11.9 nmol/L
Serum sex hormone binding globulin level 57 nmol/L
DERIVED FREE TESTOSTERONE 217.00 pmol/L [230.0 - 1000.0]

Collected: 15 May 2017
Serum LH level 4.9 iu/L
Serum follicle stimulating hormone level 12.5 iu/L
Serum prolactin level 113 mIU/L
Serum testosterone level 12.2 nmol/L
Serum sex hormone binding globulin level 59 nmol/L
DERIVED FREE TESTOSTERONE 218.00 pmol/L [230.0 - 1000.0]

Was the put on Sustanon 250 once every 2 weeks - 250mg every 14 days.

I was on that schedule until Dec 2017 when I’d done enough research to know better.
Since Jan-2018 I’ve been on the following schedule:
100mg Enanthate 250 per week divided into two 50mg doses every 3.5 days. Monday PM and Friday AM. Sub-Q.
450iu HCG every 3.5 days along with T shot. Sub-Q.
No AI.

52 years old
6ft
88Kg - 194 pounds.
16% BF
Active - weights, squash, cycling.

General feeling Ok - gym is productive, mood is good maybe bit emotional sometimes. Can make decisions, no brain fog to speak of. Sleeps like a log, about 7 hours nightly. Libido more or less zero and ED issues.

Given the high SHBG I have I need some advice on direction with protocol. Should I stick with it or try a higher/lower dosing as seems to be the case with other high SHBG cases I’ve read?

Seems libido is not coming online as I expected - very disappointing.

The following are labs I’ve had done so far.
Advice/comments very welcome.

05-Feb2018
D.H.E.A. SULPHATE 3.470 umol/L 0.44 - 13.40
FOLLICLE STIM. HORMONE *0.631 IU/L 1.50 - 12.40
LUTEINISING HORMONE *<0.3 IU/L 1.70 - 8.60
TESTOSTERONE *33.2 nmol/L 7.60 - 31.40
FREE-TESTOSTERONE(CALCULATED) 0.402 nmol/L 0.30 - 1.00
SEX HORMONE BINDING GLOB *83.1 nmol/L 19.00 - 83.00
FREE ANDROGEN INDEX 39.95 Ratio 24.00 - 104.00
17-BETA OESTRADIOL 43.2 pmol/L 0.00 - 191.99

27-Feb-2018
HAEMOGLOBIN (G/L) 156 g/L 130.00 - 170.00
HCT 0.459 L/L 0.37 - 0.50
RED CELL COUNT 4.65 x10^12/L 4.40 - 5.80
MCV 99 fl 80.00 - 99.00
MCH *33.6 pg 26.00 - 33.50
MCHC (G/L) 340 g/L 300.00 - 350.00
RDW 12.2 % 11.50 - 15.00
WHITE CELL COUNT 5.8 x10^9/L 3.00 - 10.00
NEUTROPHILS 3.68 x10^9/L 2.00 - 7.50
LYMPHOCYTES 1.42 x10^9/L 1.20 - 3.65
MONOCYTES 0.53 x10^9/L 0.20 - 1.00
EOSINOPHILS 0.12 x10^9/L 0.00 - 0.40
BASOPHILS 0.03 x10^9/L 0.00 - 0.10
PLATELET COUNT 185 x10^9/L 150.00 - 400.00
MPV 10.8 fl 7.00 - 13.00
CREATININE 103 umol/L 66.00 - 112.00
ALKALINE PHOSPHATASE 75 IU/L 40.00 - 129.00
ALANINE TRANSFERASE 25.2 IU/L 10.00 - 50.00
CK *423 IU/L 38.00 - 204.00
GAMMA GT 20 IU/L 10.00 - 71.00
TOTAL PROTEIN 74.9 g/L 63.00 - 83.00
ALBUMIN 44.8 g/L 34.00 - 50.00
GLOBULIN 30.1 g/L 19.00 - 35.00
FERRITIN 174 ug/L 30.00 - 400.00
TRIGLYCERIDES 0.8 mmol/L 0.00 - 2.30
CHOLESTEROL 4.52 mmol/L 0.00 - 4.99
HDL CHOLESTEROL *1.92 mmol/L 0.90 - 1.50
LDL CHOLESTEROL 2.24 mmol/L 0.00 - 3.00
NON-HDL CHOLESTEROL 2.6 mmol/L 0.00 - 3.89
FREE T3 5.01 pmol/L 3.10 - 6.80
FREE THYROXINE 15 pmol/L 12.00 - 22.00
THYROID STIMULATING HORMONE 2.49 mIU/L 0.27 - 4.20
TESTOSTERONE *42.8 nmol/L 7.60 - 31.40
FREE-TESTOSTERONE(CALCULATED) 0.583 nmol/L 0.30 - 1.00
17-BETA OESTRADIOL 125 pmol/L 0.00 - 191.99
SEX HORMONE BINDING GLOB 78.5 nmol/L 19.00 - 83.00
PROLACTIN 208 mIU/L 86.00 - 324.00
PROSTATE SPECIFIC AG(TOTAL) 0.697 ug/L 0.00 - 3.10

08-Apr-2018
HAEMOGLOBIN (G/L) 159 g/L 130.00 - 170.00
HCT 0.468 L/L 0.37 - 0.50
RED CELL COUNT 4.78 x10^12/L 4.40 - 5.80
MCV 98 fl 80.00 - 99.00
MCH 33.3 pg 26.00 - 33.50
MCHC (G/L) 340 g/L 300.00 - 350.00
RDW 12.3 % 11.50 - 15.00
WHITE CELL COUNT 7.2 x10^9/L 3.00 - 10.00
NEUTROPHILS 4.51 x10^9/L 2.00 - 7.50
LYMPHOCYTES 1.72 x10^9/L 1.20 - 3.65
MONOCYTES 0.73 x10^9/L 0.20 - 1.00
EOSINOPHILS 0.11 x10^9/L 0.00 - 0.40
BASOPHILS 0.09 x10^9/L 0.00 - 0.10
PLATELET COUNT 184 x10^9/L 150.00 - 400.00
MPV 11.0 fl 7.00 - 13.00
CREATININE 102 umol/L 66.00 - 112.00
ESTIMATED GFR 70.71 60.00 - 250.00
ALKALINE PHOSPHATASE 66 IU/L 40.00 - 129.00
ALANINE TRANSFERASE 26 IU/L 10.00 - 50.00
CK *524 IU/L 38.00 - 204.00
GAMMA GT 15 IU/L 10.00 - 71.00
TOTAL PROTEIN 65.6 g/L 63.00 - 83.00
ALBUMIN 42.3 g/L 34.00 - 50.00
GLOBULIN 23.3 g/L 19.00 - 35.00
FERRITIN 110 ug/L 30.00 - 400.00
TRIGLYCERIDES 0.76 mmol/L 0.00 - 2.30
CHOLESTEROL 4.73 mmol/L 0.00 - 4.99
HDL CHOLESTEROL *1.63 mmol/L 0.90 - 1.50
LDL CHOLESTEROL 2.75 mmol/L 0.00 - 3.00
NON-HDL CHOLESTEROL 3.1 mmol/L 0.00 - 3.89
HDL % OF TOTAL 34.46 % 20.00 - 100.00
FREE T3 5.1 pmol/L 3.10 - 6.80
FREE THYROXINE 14.4 pmol/L 12.00 - 22.00
THYROID STIMULATING HORMONE 2.86 mIU/L 0.27 - 4.20
TESTOSTERONE *33.4 nmol/L 7.60 - 31.40
FREE-TESTOSTERONE(CALCULATED) 0.407 nmol/L 0.30 - 1.00
17-BETA OESTRADIOL 112 pmol/L 0.00 - 191.99
SEX HORMONE BINDING GLOB *83.8 nmol/L 19.00 - 83.00
PROLACTIN 221 mIU/L 86.00 - 324.00
PROSTATE SPECIFIC AG(TOTAL) 0.966 ug/L 0.00 - 3.10

Best protocol for high SHBG includes larger injections of test. So a weekly schedule would probably be best. Large amounts of androgens lower SHBG, so doing your test dosing this way has lowered some peoples SHBG over time.

Also, with high SHBG, you want to keep your TT at as high as possible.

My SHBG is anywhere in the 37-70 range. Although, when it was in the 70’s it was because of a certain BP med. Ill give you a quick rundown of what I know.

These things increase SHBG (avoid):
Certain meds, (opiates, benzos, lisinopril, Thyroid meds, …)
Almonds/Pistachios/Walnuts
Alcohol (or anything that stresses your liver)
Keto
Intermittent Fasting

There’s a whole bunch of crap that is said to “lower:” SHBG, but I haven’t found anything that works consistently. Here are a few that do sometimes have a small, transient effects. Best cycled and rarely used.

Boron
Stinging Nettle extract
Tongkat Ali (didn’t really feel shit with this, but others have said it works, purity is the issue)
Avena Sativa (haven’t used either)
Calcium D Glucarate (be careful with this one, it can lower e2)

These are said to just lower it but I haven’t seen the results after supplementing heavily with each : Magnesium, Fish oil, Vitamin D

Best protocol that has worked for me is keeping my Total Test as high as I can , without using an AI. I get enough free T to feel pretty good. But still have high shbg.

Hi Alphagunner

Thanks for the prompt answer.

As regards dosage would you say the same amount as current schedule but take one shot of 100mg every seven days or would you see a benefit in increasing the overall dosage?

Again, thanks for the prompt response,

deBooza

I don’t know where your TT is at because I don’t know those conversions. BUT.

If you can handle it, and you aren’t worried about what the doc is gonna say, get your TT as high as possible.

I had bad reactions when I tried to do larger injections (I have some anxiety, PTSD issues), and got into the swing of doing things twice a week. But if you are able to handle it, you may feel better.

Its all about personal preference though. I would rather keep mine in a higher range consistently but avoid an AI. That’s all preference though. I would avoid an AI if possible, but your journey might be different.

I keep my TT in the 900 range on trough, and my SHBG is anywhere between 40-50 these days.

I am consistently making gains (nothing insane, but good progress) and get morning wood everyday. Good sex drive. I don’t keep track of number so much anymore, just go by how I feel.

SHBG is still choking off free T and lowering your estrogen too low, you simply need one larger weekly dose. You may need to start donating blood to keep HCT in check. Libido and erections will not improve until you increase free T.

100mg once weekly isn’t going to cut it, while splitting up our shots twice weekly is a good idea for most, it’s not for you.

When SHBG is high there is a lot of non-bioavailable SHBG+T that inflates TT so it overstates your T status. You need to inject a lot more T and high TT then needs to be disregarded and you need high calculated FT.

E2=80 pmol/L is your target. As you ~double FT E2 will rise too. You will probably need 0.5mg anastrozole twice a week at time of twice a week injections.

Thyroid is a mess. TSH should be near 1.0
fT3 is good at mid-range
fT4=14.4 is below midrange=17 suggesting lack of iodine. Iodine deficiency in UK is very common as iodized salt is only found in a few shops. So your problem may be simple iodine deficiency.

Eval overall thyroid function via oral body temperatures - see below. With your fT3 we expect good body temperatures, TSH suggests that they will be low and we suspect elevated rT3 as the cause. If temperatures are low, read the thyroid sticky noting references to rT3, stress, adrenal fatigue, cortisol and Wilson’s book.

We do expect to see elevated rT3 with low T and low thyroid function when training as that is technically over-training and stressful. However, that is mostly noted with young guys who overcome lost natural energy with adrenalin - until their adrenals get weak.

MCV is high end. Do you have digestive issues or food allergies/sensitivities? https://en.wikipedia.org/wiki/Mean_corpuscular_volume

CK is high which can be muscle damage. Do some research.
Start here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5507674/

Blood pressure and pulse? How changing?

Are you using a statin drug? Can cause above and perhaps a chronic low level cough.


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.

Hi

Thank you very much for the replies.

I am in the process of assessing body temperatures, blood pressure and pulse rate and should have some reliable data by end of month.

Ref Iodine: I’ve been using iodine salt for last 4 weeks and 8 or so brazil nuts daily so may go some way toward the thyroid issues.

Ref CK: I would like to put this down to playing squash the evening before having bloods drawn. I’ll have to pick another day, likely the morning of playing, to draw bloods. We’ll see what shows.

Ref MCV: Yep, think regular donation/phlebotomy is next thing to start scheduling.

I’ll give the new dosage some thought. Probably will be 160mg every 7 days then bloods in another month.

Questions:

  1. Should I maintain Sub-Q or IM for injections?
  2. Is there a difference with weekly dosing as opposed to EOD or bi-weekly?

Thank you for your advice, invaluable.

deBooza

Hi deBooza, did you get Test Enanthate on the NHS, if so how please?

Is your doc ok with self injection + sub q injections? How did you broach that please?

I’m seeing an NHS endo in 3 weeks, hoping to move to self injecting - enanthate would be a lot better than Sustanon - and the NHS seem to favour Sustanon from my reading.

Stay with Sub Q.

The difference in injectoins would be determined by your SHBG. Those with lower SHBG eat testosterone up and need to inject more frequently.

Your SHBG is high, so your Test sticks around for a while and isn’t metabolized so quickly.

Hi mrmeeseeks
I’ll be clear about my doc first. I now know substantially more than my current NHS doc. Even though I’m under their supervision they don’t seem to have learned/researched anything on the subject in all the time I’ve known them. They simply read from the same song sheet every time I have an apt. with them. In the end I stopped banging my head against the wall and went private. Not entirely reassuring.

My doc is Ok with me doing my own injecting. They think it’s IM but I do Sub-Q. I didn’t get any permission as such. I’m the one that collects the scrpt from the chemist. I simply done it myself after the first clinic visit, didn’t reschedule. But I have told my doc this and as no issues have arisen they have let me continue. All I really use them for now is blood testing.

I don’t use the Sustanon because of the issues with multiple esters I’ve read about that say it’s not ideal for TRT. I’m still not convinced about that but the number of guys out there that testify to that cannot be ignored.

I get my testosterone enanthate prescribed privately. It is entirely possible to use a UG lab to purchase it from but I don’t think the mg/ml they are labelled with can be trusted - which would make it almost impossible to dial in any working protocol, not precise enough.

I have a link somewhere that explains what you, in your area, are entitled to on the NHS as far as testosterone esters are concerned but cant seem to find it. When I do I’ll post it here for you. But I know that when I last read it enanthate was indeed listed. So I’ll be asking after it too.

As far as I can see they only use Sustanon because they know no better and it’s cheap !

mrmeeseeks
I can’t find the direct link that I used. You should be able to find what you’re looking for using google. Just type- your area local prescribing formulary into google, then search for ‘testosterone’.

Hope this helps,
debooza

Thanks for this debooza, really appreciated.

I’ve thought about UG labs, but I don’t want to risk infections, abcesses can be very serious. I’ll only use pharmaceuticals.

I figure I’m going to be in this body for another 50 years or so, so want to be quite cautious.

I hear you on going private, that’s my back up plan at the mo.

Hi

Just an FYI.

I found an interesting study that controlled SHBG very well. I’m not advocating either way
that anyone should follow/do what the study found. I thought it would make for some
interesting reading.

Mmmm, odd. While that study is linked the one I meant to post was this one. Not sure why that post is the one that showed up.

Good information in the linked article. Thank you for posting that.

How much test do you inject?. Do you use HCG?

Too high a dose for SubQ unless he takes two shots