High SHBG - Should I Worry?

Pharma / TRT Testosterone Replacement
21

OK, a somewhat belated update…

I had a Karyotype test performed in December, and results came back earlier this week. I’d suspected Klinefelter’s Syndrome because of my body type (tall, long limbs, Eunuchoid proportions) and other symptoms, but it came back clear.

I think that the gyno has been worsening, but I’m not 100% sure if that’s not my brain playing tricks on me. (Ain’t depression fun?) I’ve noticed some tenderness and occasional soreness, so something else to bring up with the doctor.

I’ve also put on around 8 to 10 kg (20 lbs) in the last three months. That’s probably down to depression, or coming off Setraline. But fat accumulation might explain why my gyno is worse.

My suspicion is that the high SHBG levels are what have been driving the gyno. Patient.info has an article saying it can push the free testosterone / oestrogen ratio to favour the latter.

I haven’t checked body temperatures yet.

I’m seeing the doctor next week. I think that the next step will probably be surgery, or working up to that. I wouldn’t mind seeing an endocrinologist, but was told that there’s nothing wrong with me, so that’d be a waste of time.

22

Are you on TRT? any update on freeing more bound T?

23

@gunner223 I’m in Australia, and it’s hard to get onto TRT here. You need to have two blood tests below 6 nmol/L (about 170 ng/dL) to qualify. I’m some way above that.

My SHBG was 35 to 37 nmol/L in December, down from 67. I don’t know if the original measurement was a one-off, or possibly driven up by the SSRI (Setraline) I was taking at the time.

I’m going to have another set of bloodwork later this month to check my cholesterol levels, and will have my SHBG checked as a part of that. I’ve got a problem with gynecomastia at the moment, and the cause hasn’t been discerned, but I suspect it’s down to having relatively low free T.

So things are slowly moving, but where to I’m not sure. I’ll probably post an update here in a few weeks.

24

Thanks for your reply. Hope everything goes well. Just goes to show how stupid some of our doctors are and people expect them to be like gods when sometimes a layman’s 15 day worth of internet reading can help them make more sense than a endo’s whole life’s work. Low FT such as yours and mine levels are severe and some people with TT levels of 300 ng/dl have higher FT numbers and are less symptomatic.

25

There have been studies showing that low free T can cause more symptoms than low TT. I posted a couple of references in another thread recently.

An endocrinologist suggested that 6.5 ng/dL (about 230 pmol/L) be the cut-off point for hypogonadism. I’m sitting at, or just above that, in a couple of of my blood tests, so it’s possible that I’d benefit from TRT. But here in Australia it’s not looking like an option.

26

Well i understand completely, even my doc was not convinced until repeat blood work, he was empathetic(that’s what i looked for) and after finding and learning very patiently about symptoms looked deeper and found that it was actually hypogonadism. I hope you find a doc that is willing too. Best wishes.

27

Last night there was a rerun of an Australian documentary about TRT, the Aesthetics crowd, and steroid vacations. If you’re Down Under (or use a suitable VPN) you can catch it on iView until 28th March.

The presenter, Sabour Bradley, went along to see an anti-aging doctor who is ten minutes walk from my flat. Despite having a TT of 16.7 nmol/L (480 ng/dL), the doctor was willing to prescribe Androgel and various peptides.

So TRT is available privately. Whether I want to go down that route is a different question.

My three readings to date are:

19th August

T: 18.5 nmol/L (= 534 ng/dL) (9.7 - 27.8)
SHBG: 67 nmol/L HIGH (17 - 56)
Free T (calculated): 231 pmol/L (= 6.7 ng/dL) (170 - 670)

7th December

T: 12.8 nmol/L (= 368 ng/dL) (9.9 - 27.8)
SHBG: 37 nmol/L (17 - 56)
Free T (calculated): 243 pmol/L (= 7.0 ng/dL) (170 - 670)

10th 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 (= 9.8 ng/dL) (170 - 670)

As I mentioned elsewhere, calculated free T below around 6.5 ng/dL / 225 pmol/L is indicative of hypogonadism. Two of my drawers are at that level. So there is an argument for pursuing it. I’m just not sure how I feel about embarking on a life-long course of medication.

It looks like I’m going to finish a freelance gig this week, so the plan is to get more bloodwork done next week, and then figure things out from there.

28

Ugh, I’d love to see that program but it is unavailable outside Australia, thus defeating the very purpose of the internet.

29

It’s available on YouTube as a paid programme, but I’m not sure if it’s available outside of Australia.

30

Hi mate, I am in Australia too and am having similar problems. My SHBG was over range. I have seen a number of doctors here with no improvements. The problem is if your LH and FSH is low and you do not have pituitary issues TRT is unlikely to help.

I have been trying to gather a list of us guys having strange problems with testostererone so we can work together.

Cheers

31

Low vitamin D is associated with high SHBG. If you do an internet search some studies to this effect will come up.

So it is possible that addressing low vitamin D helped bring down your SHBG.

32

Latest bloodwork has come through. It was drawn yesterday, on 29th March.

Hormones

FSH: 6.6 IU/L (1.5 - 9.7)
LH: 6.4 UI/L (1.8 - 9.2)
Prolactin: 296 mIU/L (90 - 400)
E2: 50 pmol/L (14 pg/mL) (< 160)
TT: 14.2 nmol/L (= 409 ng/dL) (9.9 - 27.8)
SHBG: 42 nmol/L (15-56)
Free T (calculated): 249 pmol/L (= 7.2 ng/dL) (170 - 670)

TT seems to be sitting in the low-normal range. Free T is generally in the range 230 to 250 pmol/L (about 6.5 to 7 ng/dL). I think that that’s at or just above the hypogonadal range.

Thyroid

TSH: 3.26 mU/L (0.5 - 5.0)
FT4: 18.9 pmol/L (11.0 - 22.0)
FT3: 4.9 pmol/L (3.2 - 6.4)

@KSman will get excited about TSH, and this time I’m concerned. It’s risen from 1.26 mU/L in August, through 2.11 mU/L in December, and is now 3.26 mU/L. It might also explain why my weight jumped by nearly 10 kg / 20 lbs) in the last three or four months.

I want to dig up some older numbers for TSH. I have a suspicion that I could have been iodine deficient prior to arriving in Oz, and since bread here is baked with iodised salt, it might have been corrected, and that might have put me out of balance.

@vincentv if you’re desperate to get onto TRT then you can do it privately. For example, Dr Robin Wilcourt was willing to treat Sabour Bradley on Head First, whose TT was 16.7 nmol/L / 480 ng/dL at the time.

@seekonk my Vitamin D is now 112 nmol/L, and my SHBG is still fairly high!

33

Hey mate,

Thank you for the update.

I have been on TRT and it does not really work. That is the issue.

Even with high T i still have symptoms.

I do not have any ideas for now.

But want to keep working on this.

34

Just got an old value of TSH from the UK. It was 2.87 mU/L on 9/10/14.

It’s probably always been on the high side, rather than rising rapidly in the last few months. So scratch my theory about a bad reaction to increased iodine intake.

@vincentv Are you sure your problems are hormonal? The numbers on your old thread didn’t look too bad, so it could be something else. Depression and low T have pretty similar symptoms.

35

100 percent hormonal. I take testosterone and it wont grow muscles. I was deadlifting 200kg before all this happened. And I can not even gain muscle on TRT at 250mg a week.

I have no morning wood, libido and my hairloss has stopped. I also shave less. 100% hormonal. But we do not know what is effecting the endocrine system. It could be many things.

36

I cannot see that you have reported your oral body temperatures.
fT3 and fT4 should be delivering good temperatures.
But your hypothalamus appears to not seeing adequate thyroid hormone levels.
That would make sense if rT3 was elevated and then temperatures would be lower.

Iodine in bread. Works for people who are not:

  • gluten intolerant
  • dieting
  • diabetics

High SHBG with low E2 is not right. Something else is going on as you are suspecting.
“”"
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.
“”"

See if there is anything here for you: shbg ssri - Google Search

37

Graemsay can you get in contact I am trying to get a bunch of guys together who are having troubles with T. Do you use facebook? Maybe I can send you a link to mine?

38

Firstly I picked up an old set of blood tests (dated 8th May 2015) last week. I didn’t have my hormones checked, however the following values are of interest:

TSH: 1.33 mIU/L (0.5 - 5.0)

Ferritin: 297 ug/L (20 -250)

My total cholesterol back then was 7.0 mmol/L, it’s now 6.2 mmol/L, so going in the right direction.

Ferritin was down a bit (282 ug/L) when I last had it checked. The bloodwork was done with a different lab, whose range is up to 500.

I had a look through the links from the Google search. The only thing that looked possible was a post at the ZRT Laboratory blog. The SSRI could have pushed prolactin up, which in turn would have increased SHBG.

I don’t have any bloodwork for prolactin when on the SSRI, but it was 266 and 296 mIU/L (range 90 to 400) after coming off.

I haven’t taken temperatures yet.

39

Man get in contact with me please.

Your ferritin is not good if it is always that high. Do some research and you will see that under 100 is optimal for long term health. There is a correlation between ferritin levels and whole body oxidative stress. What about transferrin saturation?

40

A bit of thread necromancy here, but it’s probably best to keep everything in one place.

I’d gone along to a male health clinic in Melbourne’s CBD last year to have a chat with their doctor. I’d been having various symptoms, and figured a second opinion wouldn’t hurt. However, he told me that no-one would put me on TRT with my hormonal levels.

I’ve seen a few threads here where people claim their problems are hormonal, but the root cause could be depression. Normally they’ve been through all the local doctors and endocrinologists, and told that there’s nothing wrong, but they persist. I didn’t want to be that guy, and decided to stop looking into TRT.

Late last year I’d had a discussion with my PT about hormonal levels, and it prompted me to take another look. I saw a few references on forums to Dr Z, who’s based in Perth, but has monthly clinics in Melbourne and Sydney. I made an appointment for January, but had to cancel due to work commitments, and the need to get a fresh set of blood tests.

Anyway, I had a draw at the start of the week, and managed to get a very last minute appointment with Dr Z this morning. I don’t have all the values here, but from memory:

FT (calculated): 250 pmol/L (=7.2 ng/dL)
SHBG: 70 nmol/L
TSH: 1.4 mU/L

FSH and LH were around 7 to 9 IU/L. I think that one was flagged as being high.

I’ll pick up (and post) full labs in a day or two from my usual GP.

Dr Z looked at the numbers, and said that I’d not qualify for TRT under the usual guidelines, however my FSH and LH should be around 1 to 2 IU/L at my age, which indicates that my pituitary is screaming at my testes, and they’re not responding, so he thought that I needed it.

He gave me a choice of injections, nebido or creams, and I went for the former. So he sent me off to the local pharmacy with a script for Sustanon 250. After which he showed me how to inject it, and I went off on my way.

My initial protocol is one pre-loaded vial of Sustanon 250 per fortnight, with an Anastrozole tablet per week, split in half. I suspect that I’m going to be told to split the dose, inject subcutaneously, and all that, but I’m not messing around with it at this stage.

I asked about HCG, and Dr Z didn’t think that it’s important. He’s open to introducing it in future, but considers it largely cosmetic, and doesn’t want to make too many changes too fast.

I’m a bit surprised that I got started on TRT today, as I was really trying to find the cause of my gynecomastia. I’ll give it a trial for a few months and see how I feel.

Incidentally, my TSH levels have returned to 1.4 mU/L without any intervention. So that’s one less thing to worry about.