T Nation

High SHBG - Should I Worry?


#1

I've been suffering from depression, and when I recently had a blood test I asked the doctor to get my testosterone measured. Most came back in range, but my SHBG was high and Vitamin D was low.

Age: 43
Height: 6'3" / 190 cm
Weight: 210 lbs / 96 kg
Waist: 36"
Facial Hair: Reasonably thick, can grow a full beard
Body Hair: Relatively light
Body Fat: Some around my waist, and I think that I've got some gynecomastia

Health

I'm suffering from depression, and taking Setraline 100 mg / day to treat it, along with seeing a psychologist.

Asthma, using Ventolin and a preventative inhaler.

I've never used any hairloss drugs. I've also gone bald. There might be a correlation there.

I've never taken any anabolic steroids, peptides, or whatever is the flavour of the month in bodybuilding circles.

Hormones

Testosterone: 18.5 nmol/L (= 534 ng/dL) (9.7 - 27.8)
SHBG: 67 nmol/L HIGH (17 - 56)
Free Testosterone (calculated): 231 pmol/L (= 6.71 ng/dL) (170 - 670)

Estrogen, prolactin, LH and FSH were not checked.

Thyroid

TSH: 1.26 mU/L (0.5 - 5.0)
FT3: 4.5 pmol/L (3.2 - 6.4)
FT4: 16.7 pmol/L (11.0 - 22.0)

Vitamins

Folate: 22.4 nmol/L (Over 7.0)
Total B12: 277 pmol/L (200 - 700)
Vitamin D: 18 nmol/L LOW (50 - 250)

Other

Albumin: 47 g/L (36 - 47)
Globulin: 29 umol/L (5 - 30)
Iron: 16 umol/L (5 - 30)
TRF: 2.6 g/L (2.6 - 3.2)
TRF Sat.:25% (10 - 45)
Ferritin: 282 nn/mL (30 - 500)
ALT: 16 U/L (5 - 40)
AST: 20 U/L (10 - 40)
GGT: 17 U/L (5 - 50)

Last time I had my Ferritin levels checked they were 296. The doctor (a different one) said that they got concerned.

I didn't have my cholesterol levels tested this time, but they're above range and seem to be persistently so.

Diet

It's not great at the moment. I'm eating a calorie deficit (500 to 700) most days, and the macros probably come out around 50% carbs, 30% fat, 20% protein.

I've been taking a 5000 iu Vitamin D supplement for the past month. Nothing else in use, but I might add Vitamin B.

Training

Just getting back into it after a lay-off. I'm hitting the gym two or three times a week, and not pushing anywhere near hard enough to be over-training.

Libido, etc.

My libido is basically non-existent, and there's a bit of ED going on. These things are symptoms of depression, and SSRIs are notorious for making them worse. I'm not in a relationship, so it's not really too much of an issue, but I think they're useful as general health markers.

Questions

The main one is should I worry about my SHBG levels? A couple of people I've spoken to have said that since testosterone is in range it's not something that's of concern.

Looking at the causes of high SHBG, I think that I can rule out most of them: Liver disease (the associated tests don't show anything outside of range); HIV (I think it's routinely checked, and nothing showed up); alcoholism (I'm teetotal); hyperthyroidism (I'm not out of range); not taking Clomid or other medicines that might raise it.

My suspicion is that my E2 levels are elevated, and I really need to get them checked.

The other question is for KSman: Why don't you like SSRIs? You suggested someone change to Wellbutin in another thread.


21, On Thyroid Meds. Low FT, High LH, High SHBG. Read All Stickies
Depression, High Ferritin, High E2, High SHBG, Low Free T
KSman is Here
#2

SSRIs’ rewire your brain and can leave some emotionless. Sexual side effects are really bad. Hard to get on or off of these drugs. Wellbutrin does not have any of those problems.

Some drugs load up the same enzyme pathways in the liver that also clear estrogens from the blood. Elevated estrogens depress LH/FSH and T while increasing SHBG. So your fix could be getting off of that AD medication. Asthma drugs may be a factor as well if SSRI is the problem. Getting off of Sertraline to see what happens would be difficult.

You need E2 lab data.

I can’t see why ferritin was ever a concern.

Retest vit-D25 to see if 5,000iu vit-D3 is working.

Do you think that your T and sexual issues predate Setraline?
Some get put on SSIR’s for their symptoms when the problem was really only hypogonadism.


#3

Thanks KSman.

I don’t think that the SSRIs are being entirely helpful. I’ve noticed emotional shutdown along with other side effects. I suspect coming off them would be painful too.

I’ve been on them for about 2 1/2 years. I noticed my libido dropping a couple of years before that. I didn’t pay it that much attention, as I haven’t been in a relationship for a long time, but rather took it as a marker that something might not be right.

I’ll discuss Wellbutrin with my doctor next time I see her in a few weeks, along with getting E2 and Vitamin D checked. I’ll follow up this post at that point.

I’m in Australia, and GPs get a bit concerned about Ferritin levels about 300 ng/L. When I got tested last time I was pushing that level (296 ng/L), and hence it was highlighted.

One last question: How valid are free testosterone calculations in your opinion?

El Chaos has pretty similar numbers to mine for TT, SHBG and Albumin in his thread at:

But his free and bioavailable T were measured lower than my calculated values. But if I run his through the Nebido calculator they come out slightly higher.


#4

For TRT guys, hematocrit should be checked as it can be high. If iron is a concern, avoid iron fortified foods and men’s vitamins should not contain any iron. Serum iron was low. I have seen swings in serum iron labs and do not have much faith in them as something to drive supplements or iron intake reduction. Hematocrit, RBC and ferritin are useful.

Stopping SSRIs can be quite unpleasant as one gets lighting strikes in the brain, or so it seems. Tapering down the dose first is probably going to make things easier.

Sounds like low T contributed to your getting diagnosed with depression.


#5

Thanks again KSman.

My current plan of attack is that I’ll get E2 checked next time I have a blood test. That’ll probably be in a month or two, as I want to give the Vitamin D supplementation some time to kick in. I’ll either try to see an endocrinologist off the back of that, or find a good integrative doctor in these parts.

I’ve heard coming off SSRIs is a nightmare, and, as you said, the trick is to taper the dose. I had some pretty severe side effects when I started, which is an indicator that stopping will be worse for me. Ah well, something for me to look forward to. I’m working with a psychologist at the moment, so any changes are waiting until the current programme is done.


#6

SHBG also binds with E2. If your SHBG is high, you may have low E2 … not high. No way to know unless you get it checked.
Exogenous testosterone drives down SHBG, which will increase your free test, and raise your E2.


#7

The final step of getting off of a SSRI can be done over a long weekend, but might spoil the event.

You can already be on Wellbutrin.


#8

A quick update.

I hit the top of a waiting list for an operation somewhat faster than I expected, so I’m currently recovering from that.

I’d discussed antidepressants with my doctor just before I went in for surgery. Wellbutrin isn’t available here, so what we decided to do was for me to come off my current one, see how I’m going, and maybe try something else in a month or two if I need it.

I haven’t had any further blood tests done as yet. I’m scheduled to have a few things re-checked early next year, so I’ll probably get E2 piggybacked onto that.


#9

Perhaps by another name?

http://www.pbs.gov.au/medicine/item/8465M-8710K

May be restricted to uses such as smoking cessation.
Maybe there would be some way to try it out.


#10

I realize this may be illegal but you can order wellbutrin from an online pharmacy. There are ones in india which don’t ask for a prescription and if they don’t ship directly to Australia you can ship them to a mail-forwarding service in another country.

I wish you could drink alcohol on wellbutrin it’d be perfect.

Otherwise, I suggest you try Tianeptine and/or n-acetyl-semax. They work AMAZINGLY well in combination and if you look at the research on the and hippocampal shrinkage/remodeling you can see why they’re so good. Here in the states you can get them without prescription legally.

I’m very interested in reading about evidence of SSRIs permanently rewiring the brain. I’ve heard it from several smart people. Including KSMan, I think. Would love a link to an article or something…I’ve been searching for the longest time for something that stops my panic attacks that’s not an SSRI. I’m to the point where I feel like I need to go on one.


#11

Wellbutrin may be poison if you are prone to anxiety/insomnia. I found that out the hard way. A panic attack lasting pretty much an entire week from only a couple of doses.


#12

Thanks.

Dosing antidepressants is tricky, and generally done on a trial-and-error basis. KSman likes Wellbutrin, but it might turn out that it disagrees with me.

Then you’re really into luck of the draw with generics. I’ve had different side effects off the same brand of Setraline because the formulation changes between batches. One gave me headaches, another hives, and so on.

I’m currently tapering my dose of Setraline, and will discontinue it in about a week. I’m generally feeling better, though I might be having a headache from withdrawal. Or it might be from having surgery on my nose last week. The plan is to come off them completely for a bit and see how I go. If I’m not having a major depressive episode then I’ll probably stay off them.

K_ I don’t think that SSRIs are the devil’s own drugs. I found them useful, but more recently the side effects have been getting to be more of an issue than the problem they were meant to be treating.

Incidentally Tianeptine isn’t available in Australia either. I’m not having any luck am I? :slight_smile:


#13

Tianeptine isn’t all it’s cracked up to be anyway.

It’s recently been found to be a bit of an opioid, which makes most people feel good initially (like any opioid) but like any opioid that goes away eventually.


#14

OK, an update on the tapering process.

I was running 100 mg / day of Setraline, and dropped to 50 mg / day a fortnight ago. The withdrawal hasn’t been too bad so far.

I’ve felt a bit weak, tired and dizzy, and had a few headaches. Flu like symptoms are apparently common when you come off, plus I also had a septoplasty and turbinectomy (or nasal surgery) just before I began the process, so it could be that. I seem to be sleeping a lot, though I had a bout of insomnia last night, and weirdly vivid dreams.

(Last night’s involved getting lost in the middle of Amsterdam, though it didn’t actually look familiar. Probably why I couldn’t find my way around it!)

On the positive side, I’m feeling less zombie like, and have been starting to get more of a drive to get on with things in the last few days. I think that I get slightly stronger bouts of anxiety or depression, but these pass quickly. I’m not getting the suicidal ideation (in fact I believe that can be an SSRI side effect), which is a relief. My libido has kicked back in again, after being flatlined for months.

I’ve not noticed any weight loss. I put on about 5 kg / 10 lbs each time I started on a new dose, but managed to diet down. I think that I’m a kilogram or two down, and look a touch leaner. Sugar cravings seem to have dropped off.

Overall I feel quite a lot better. The plan to give myself a month off the drugs and see how I go makes sense. I’ll probably take a last dose of Setraline on Friday as I’m not likely to be working at the start of next week.

Going back to the original point of my thread, I saw a reference to high SHBG levels being correlated to depression. So that’s probably something to look into once I’m a bit more stable.


#15

"I saw a reference to high SHBG levels being correlated to depression."
There could be different explanations.

If SHBG is elevated because E2 is elevated, that could be depressing. For natural guys, T would be lower and T:E2 would shift a lot. For TRT guys, we know that libido and mood are easily compromised by elevated E2.


#16

I had a chat to my doctor this morning about my gynecomastia, and I brought up a suspicion that Klinefelter’s Syndrome might be a possible cause.

Klinefelter’s is a relatively common genetic condition whereby an individual gains one or more extra X sex chromosomes. If you paid attention in biology, you’ll know that a male has an XY pair, whereas a female has an XX pair. Someone with Klinefelter’s will typically have XXY instead, though there’s a mosaic form with a mixture of XY and XXY chromosomes in different cells, or XXXY / XXXXY as a more extreme form.

The characteristic body type of someone with KS is tall, long limbed, and with broad hips. Gynecomastia is common. Body hair tends to be sparse, frontal balding is generally absent (of course I missed out on that one!), testosterone levels can be low or low-normal, and the testes tend to be small and firm.

There are a few health risks associated with it, in particular infertility, depression, and an increased chance of several cancers.

Interestingly enough, my doctor had been at a conference recently, and it’s typically under-diagnosed. In adults it tends to be spotted when a couple goes in for fertility treatment, and the husband is found to be shooting blanks.

So I’m currently waiting a bunch of test results, including: Karyotype, testosterone, estradiol, LH, FSH, prolactin, and probably a few more I’ve forgotten. I’ll post details when I get them.


#17

That looks very comprehensive.

Get E2, prolactin, LH and FSH tested.
These are fundamental to your testosterone levels and gyno.


#18

I got two sets of blood tests done, the first was more comprehensive and the second was to re-check testosterone levels.

7th December

Vitamin D: 87 nmol/L (50 - 250)
TSH: 2.11 mU/L (0.5 - 5.0)

FSH: 6.6 IU/L (1.5 - 9.7)
LH: 5.9 IU/L (1.8 - 9.2)
Prolactin: 266 mIU/L (90 - 400)
E2: 46 pmol/L (= 12.5 pg/mL) (< 160)

T: 12.8 nmol/L (= 368 ng/dL) (9.9 - 27.8)
SHBG: 37 nmol/L (17 - 56)
Free T (calculated): 243 pmol/L (= 7.03 ng/dL) (170 - 670)

12th December

T: 16.1 nmol/L (= 464 ng/dL) (9.9 - 27.8)
SHBG: 35 nmol/L (17 - 56)
Free T (calculated): 339 pmol/L (= 9.45 ng/dL) (170 - 670)

OK, the good news is that my Vitamin D levels have normalised, and SHBG has fallen. I’m slightly suspicious because it’s pretty much halved since the initial blood test in August. Maybe it was a rogue reading.

TSH is up. My guess is that this is cortisol / adrenal related because I’ve recently come off an SSRI and my head is a bit messed up. I’ll see how it looks next time it gets checked, but I’m not immediately concerned. KSman will no doubt be recommending iodised salt. :slight_smile:

My overall testosterone levels are down, in fact the first of the two readings is getting towards the low-T end of things.

My E2, FSH and LH levels don’t point at Klinefelter’s Syndrome. These are normally elevated. So I might be suffering from hypochondria instead. I’ll find out when the Karyotype comes back in a week or two.

Similarly neither E2 or Prolactin offer any clues to my gyno. More questions…


#19

Check your body temperatures as per the thyroid basics sticky.
Thyroid problems do create depressive symptoms.


#20

I’ve been doing a bit of digging on thyroid values. There’s an article on PubMed that states SSRIs have been found to raise TSH.

My previous TSH value was 1.26 mU/L (whilst using Setraline), and my latest was 2.11 mU/L (shortly after discontinuing it). If 2.0 mU/L is a desirable upper bound then I’m a fraction above that. I want to try to get some earlier values, but my suspicion is that it’ll probably move back into range without intervention over time.

I’ve seen a couple of hearsay references to SSRIs pushing up SHBG levels, but nothing academic. That might explain why it’s dropped after coming off the pills.