High SHBG - Should I Worry?

[Graemsay]

This is a follow up to a post in @flash74’s thread. I don’t want to hijack it, so I’m moving it here.

I wrote:

@Graemsay

Dr Zentner diagnosed me as hypogonadal based on my LH and FSH numbers. One was at the top of the range, and the other was above it, and he said that indicated my pituitary was screaming for more testosterone, but it wasn’t being produced.

And the indefatigable @KSman replied:

@KSman

That sounds like primary hypogonadism, where the testes do not work. Were your testes examined?

I agree that it sounds like I’m primary. My body has eunuchoid proportions (upper to lower segment ratio is 0.9, arm span is about 10 cm / 4" greater than my height), which suggests it’s something that’s not been entirely right for a long time.

I don’t know what the cause is, and I’d like to find out. Healthline has a list, but I’m not sure if any really apply.

My testes were not checked. Would it be worth arranging an examination? If so, what tests? Ultrasound?

If I stick on TRT (as per the protocol above), how long is it likely to be for natural testosterone levels and fertility to be impacted? I was considering getting the latter checked as a baseline.

Lastly, my experiences so far.

I had my first injection on Thursday 16th February, and took my first dose of Anastrozole on the Friday.

I was quite bloated on Saturday and Sunday. I suspect that this might have been water retention.

Libido picked up over the first few days, which surprised me. I’d expected there to have been a bit of a lag. But it’s been a bit like a badly tuned radio, in that sometimes it’s there, and sometimes it’s not. However it dropped off sharply on Friday, about a week after the shot.

Appetite is up a lot. I’ve been spending a lot of time at the gym, so that might be the cause.

Mood was down for the first few days, I felt very irritable, but then improved. It’s also tailed off a bit since Friday. I don’t expect TRT to cure depression, but any little helps.

I feel really sore the day after taking a dose of Anastrozole. I’m not sure if this is gym or E2 related.

[KSman]

You should inject T twice a week and dose anastrozole at that time.

The half life of anastrozole means that it take around a week for a given dose to build up to final serum levels.

Anastrozole can make joints ache if dosed too high, but not muscles.

[Graemsay]

The problem is that my prescription is for pre-loaded syringes, rather than a vial. I know that other people have emptied these out, and then split the dose, but I haven’t looked into it, nor do I know where to buy the necessary supplies.

I don’t know if it’s possible to get syringes with a lower dose. Something to ask my doctor when I next see him in about six weeks.

The aching was probably exercise related. I’ll keep an eye out for it.

[Graemsay]

I’ve been running TRT for nearly two months now, and am due to see Dr Zentner in about a week for my first check-up.

I didn’t have blood tests back when I last posted, so here are my pre-TRT numbers.

Hormones

Testosterone: 17.7 nmol/L (= 510 ng/dL) (9.9 - 27.8)
SHBG: 59 nmol/L HIGH (17 - 56)
Free Testosterone (calculated): 251 pmol/L (= 7.23 ng/dL) (170 - 670)
E2: 87 pmol/L (= 24 pg/mL) (<160)
Prolactin: 212 mIU/L (90 - 400)
FSH: 7.9 IU/L (1.5 - 9.7)
LH: 9.5 IU/L HIGH (1.8 - 9.2)

TT seems to bounce between about 12 and 18 nmol/L, whereas FT is more consistent at 230 to 250 pmol/L.

It was the high FSH and LH that was used to diagnose me as being hypogonadal. It sounds like compensated or subclinical hypogonadism in my case.

Thyroid

TSH: 1.4 mU/L (0.5 - 5.0)
FT3: 4.8 pmol/L (3.2 - 6.4)
FT4: 18.9 pmol/L (11.0 - 22.0)

TSH was 3.26 mU/L last time, but has dropped back to a decent level with no effort from me.

Other

PSA: 1.32 ug/L (0.25 - 2.2)
Albumin: 43 g/L (36 - 47)
Globulin: 26 umol/L (5 - 30)
ALT: 16 U/L (5 - 40)
AST: 16 U/L (10 - 40)
GGT: 14 U/L (5 - 50)

Protocol

I’ve been following the initial protocol for two months: 250 mg Primoteston Depot as an intramuscular injection every two weeks, with one tablet of Anastrozole per week, split into two doses.

I know it’s not optimal, but I wanted to see where it got me before I started adjusting things.

Results

The main things that I’ve noticed has been an increase in libido, or, more accurately, I now tend to have one. Before it felt rather theoretical.

My mood has improved a bit. I’d probably characterise TRT as being equivalent to a 50 mg per day dose of Sertraline / Zoloft, but without the side effects.

However, it’s not been a consistent benefit. For the first four shots, this is what I felt:

1. I felt good the first week, and back to normal on the second.
2. I felt good both weeks.
3. The injection didn’t feel as though it had an effect, and I felt more-or-less back to my old self both weeks.
4. I felt good the first week, and back to normal on the second.

My suspicion is that the second injection shut me down, which is why things weren’t so good for the third shot.

I’ve been running the injections every other Thursday, and if the effects wear off, I tend to feel them slipping on the following Thursday or Friday.

This week I had a depressive episode on Monday and Tuesday, and I think that I’m still feeling the tail-end of that now. I’m not sure if this is down to brain chemistry or crashing my hormones.

I’ve not noticed any significant muscle gain or fat loss. I thought that my traps might be looking a little bigger, but that’s it. Weight has been pretty stable, around 98 to 100 kg (215 to 220 lbs) over the last couple of months, and that’s including being away on holiday for a few weeks.

Side Effects

Other than a bit of bloating, the odd extra spot, and body hair thickening slightly in a few places.

The injection site can be a bit sore for a few days.

I’ve had a few joint issues. There’s a bursitis on my left elbow that’s slowly clearing, and my left knee and ankle have been clicking a bit. I don’t know if these are injuries or from crashing my E2.

I had gynecomastia before I started, despite my E2 being low normal. There was an article posted in another thread suggesting that LH could be a cause, which I suspect might be the case with me.

My nipples have been a bit tender in the last week, and there was a bit of soreness a day or two ago, but I haven’t noticed any changes.

Adjustments

I’m not really feeling the benefits in the same way that a lot of people seem to be. I don’t feel a significantly better, so there’s a consideration of stopping TRT.

Before I do, I’d like to try making some adjustments:

• Increase the frequency of injections. I’ve heard that weekly is better than biweekly for those with high SHBG.
• Bump up the dose.
• Add HCG to the mix.

I’m currently using preloaded syringes that contain 250 mg of Testosterone Ethanoate, which makes splitting a bit more difficult. An easy way of achieving the first two would be to inject once per week. That would put me at the very high end of the scale, which is generally frowned on around here.

I want to add HCG, particularly as fertility is likely to be a problem for me before TRT is thrown into the mix.

[Graemsay]

I’ve been along to see the doctor for the first follow-up today, and these are my latest numbers. These were taken a week after a shot.

Testosterone: 47.4 nmol/L HIGH (= 1366 ng/dL) (9.9 - 27.8)
SHBG: 38 nmol/L (17 - 56)
Free Testosterone (calculated): 1173 pmol/L HIGH (= 338 pg/mL) (170 - 670)
E2: <44 pmol/L (<12 pg/mL) (<160)

My current protocol is:

• 250 mg of Testosterone Ethanoate every fortnight.
• One Anastrozole tablet per week, split in half.

I was quite surprised by the numbers, as I felt as felt things were dropping off about seven or eight days after the injection.

So what’s the plan?

Dr Zentner said to reduce the Anastrozole dose by half. I think that the dosing equation (which I can’t find) is pretty linear, so that should get my E2 around the optimum 85 pmol/L / 22 pg/mL level.

He wasn’t keen to up to dose, but suggested splitting it on a weekly basis. I’m using preloaded syringes, so would inject half of the contents (125 mg) each time.

If that doesn’t work, then he said to try injecting a whole 250 mg syringe every ten days. A third option, which wasn’t suggested, would be 125 mg every five days.

I’m probably going to experiment with all three protocols and see how I get one. I’ll post updates in the next month or two.

[trtnoob]

@Graemsay sorry to dig up an old thread.

Did you end up trying the 125mg / 5 days?

[Graemsay]

@trtnoob in the end I ran 250 mg every ten days. I tried every five, but preferred the less frequent, bigger doses.

[trtnoob]

Did you notice much drop off at all at any point through the 10 days?