T Nation

High SHGB, Low FT, Normal TT, High TSH

What’s up guys, I’m 24 years old recently had bloodwork done due to low sex drive. I eat healthy, workout regularly, and get good sleep.I have ran a Test E cycle and that was a year ago before I got sober. I did get bloods after PCT and everything looked good, but it was only TT, LH, and FSH. Rite now I am on suboxone due to opioid abuse and recently got bloods because I suspected it was lowering my testosterone and causing low sex drive. The results appeared somewhat normal.
TT: 564
FSH 4.7
LH :10.9
After reading some more and wondering about the high LH I decided to get another test a week later that included SHGB and FT. Thats where things get shitty, the latest labs show
TT: 663
LH: 4.7
FSH: 4.4
SHGB: 87 (16-59)
FT: 7.5 (9-26)
Estradiol: 10.0

I definitely feel the low Free T, I’m always in a shitty mood, fatigued, can’t make gains in the gym, no sex drive or morning wood. Now even after high school I had some of these symptoms, but I was already abusing drugs pretty heavily so it’ could have been because of that. My liver is healthy and in range on the lab so maybe it is a thyroid issue, or maybe the suboxone? Is there anything I can due to get my FT back up and lower my SHGB. I know TRT is something that would help, but it would suck starting so early. I am making an appointment with an Endo In my area ASAP.
Thanks for the help.

Your shbg is real high causing your FT to be bound up. I have been on methadone for about a decade and suboxone for a couple years before that. It tanked my t to double digits. Long acting opiods do that. My shbg is low off the charts tho so something else is causing the high shbg

When you have higher levels of SHBG, you typically need a higher dose of testosterone to ensure there is enough free T available. Starting TRT would be a good option for you.

Correct, suboxone causes endocrine dysfunction and lowers testosterone. It’s not an easy choice but the only way to possibly correct the endocrine dysfunction and stop potential permanent damage is stop the suboxone.

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Yeah I suspected it could but because it’s only a partial agonist I wasn’t sure. Also there is a study on suboxone and testosterone levels that shows it didn’t have a profound affect. Here’s the link

So my test is probably a lot lower than 600 because of the SHGB? Say if I were to stop suboxone and my test went up but my SHBG stayed high, I’d still be screwed because of FT?
Could a Thyroid issue cause that high of SHGB?

Check out this study https://www.ncbi.nlm.nih.gov/m/pubmed/15483091/
It shows that suboxone doesn’t lower testosterone like methadone does. I’m sure everyone’s different and they only used 16 people but it is interesting. The high SHGB thing really sucks

Low thyroid function would see SHBG decrease, hyperthyroidism would see it increase. I have seen guys with very high SHBG and presenting with hypothyroidism which sucks because now SHBG is going to be skyhigh.

So let’s say you have hypothyroidism and need thyroid medicine, SHBG will increase.

Oh wow so SHGB is a bitch to figure out. I have an appointment with an endo tomorrow and if they try to treat with clomed, that will only make my SHGB even higher too rite?
Really my best option is TRT then?

There is nothing to figure out. It’s an easy solution. I know you guys prefer to complicate your lives but sometimes the most simple answer is the best one.

Queation: How do I raise my free T because of x y z?

Answer: Increase your dose.

Correct, clomid increases SHBG decreasing Free T into oblivion in men with high SHBG.

Clomid will not correct your high SHBG, it will worsen it.

TRT is it, or BUST.

Yeah I understand. I figure the endo will be reluctant to do TRT because of my age, so was hoping there would be another treatment that’d lower my SHGB and increase FT.

Age has nothing to do with it. If you are symptomatic at 22 years old, what difference would that make?

Went and saw my Endo today. After discussing history of head injuries, drug abuse, suboxone, and symptoms he ordered serval specific blood tests. I know for sure cortisol, growth hormone, testosterone, thyroid, and a pituitary lab that includes a bunch of stuff. I asked about TRT and he didn’t really think I will need it. Said my body has enough testosterone, whatever that means, and that I will be a patient for life and go infertile if I did do it. He said he will know everything about me and the situation when we get the new lab results back and will go with treatment from there. I go back and see him in a month.

How did he determine that, labs? Labs show you are abnormally low in Free T. Sounds like your endo is blowing smoke up your ass! Your Free T is below range and still you doctor says you have enough Free T even though it’s abnormally low.

Endo’s are very anti-TRT and probably still believes TRT causes prostate cancer which is the real reason why he is trying to persuade you from going on TRT. If he prescribes TRT to a 50 year old and he gets prostate cancer, well it’s common. If it were to happen to a young guy in his 20’s, well this endo doesn’t want trouble.

Anyway you qualify for TRT based on your labs.

He sounds pretty against it. Would you rather be on something for life or feel like shit for life? I think I’ll take the testosterone.

Your numbers are quite close to mine. I just started 140mg/week + HCG, so here’s to hoping it helps.

If you’re willing to go private (i.e. have to pay out of pocket), there are other places you can see that will be much more open to giving you the testosterone that you need to get your free test up which should make you feel a lot better.

Yeah I honestly am not sure. He said my FT was a little low and my SHGB a bit high which meant my TT was lower than it appeared too. I told him I can get an erection but I don’t get morning wood anymore and have no sex drive. He also examined my balls and said they were a little small. I feel like he thinks it is fine if I have just enough testosterone to be in range on the labs. I would prefer to feel better and do TRT than get the runaround for sure. Can HCG can keep you fertile while on TRT?
I’m going to explore getting a second opinion.

Thanks for the reply’s

Got some more bloods back.
Prolactin is 17 (7-15)
I do have a puppy at home lol
Cortisol 18 (8-19)
ACTH 29.2 (7-63)
DHEA 267 (211-492)
Estrogen 20 (7-42)
TSH 3.1 I know it should be close to 1.0
T4 6.7 (4.5-11.7)
T3 1.21 (.80-2.0)
Free T4 1.17 (.93-1.70)
Thyroid perox.ab 9.1. (<60)

I read the thyroid sticky and am going to get some iodine and thermometer tonight. Also wondering if I should get Ft3 and Rt3 checked. Still waiting on testosterone results

Iron deficiency and hypothyroidism can overlap and one can cause the other, I would recommend an iron panel. You’re not supposed to have sex or play with puppies within 24 hours of checking prolactin.

T4 should be midrange and this is a reason for elevated TSH, T4 (stored thyroid hormone) is converted to free hormones, so if there was more stored hormones there will likely be more free hormones available for tissues.

Your pituitary increases TSH and thyroid is working as fast as it can, if it was able to manage, TSH would decrease closer to 1.0.

T3 isn’t very useful in diagnosing hypothyroidism, hyperthyroidism is another story, but multiple studies show falsely normal values for T3, you need Free T3 tested.

Normal TSH is <2.5, 95% of the population have a TSH <1.15.

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Thanks for informative reply. I purchased iodine 2% solution and an iron supplement. My diet has been out of wack the last couple months due to long hours at sea. I work on a boat and it’s just junk food and burgers on there, so maybe I am iron deficient. Should I record my temperatures and supplement with iodine ? Or just hold off and try to get bloodwork done. I don’t have an appointment with Endo for a month

The body can compensate from body temperature losses through adrenaline and other means.