T Nation

High Testosterone, High SHBG, High DHT, High Free T

Hey Guys I’m new to the forum. A little history about me from 21-26 years of age I abused steroids(Young and Stupid ). I literally tried just about every Anabolic you can think of . About 5 years ago I quit cold turkey first 3 months where hell but I managed to survive (Never got any blood work). Strength and Libido returned about 80%. All of a sudden for about 9 months or so things have gotten way worse.

Symptoms:

  • Extreme Fatigue
  • Strength way down
  • Total lack of libido
  • Low blood pressure
  • Body fat going up
  • motivation and vigor are gone
  • Stuck in a constant loop of anxiety/depression/low energy

Physical Stats:

  • 5’11 220lbs about 16% body fat
  • Eat pretty clean lots of homemade European food

Decided to get some blood work done about 9 months ago

Initial Blood Test

  • CBC With Differential/Platelet // All makers in normal range
  • Comp. Metabolic Panel // BUN High 24 // Range 6-20 mg/dl
    // BUN/creatinine Ratio High 21 // Range 9-20
  • Lipid Panel // All markers in extremely good range
  • Testosterone, Serum // 607 Normal // Range 264-916
  • Free Testosterone // 10.9 Low Normal // Range 9.3-26.5 pg/ml
  • TSH // 4.580 High // Range: 0.450 - 4.5

Conclusion:

  • Doc decided to put me on NP thyroid and wants my TSH at 1.00
  • Informed me that a slow thyroid could be causing my symptoms

Lab Test 6 Weeks Later:

  • Testosterone, Serum // 758 Normal // Range 264-916
  • Free Testosterone // 13.5 Low Normal // Range 9.3-26.5 pg/ml
  • TSH // 1.040 Optimal // Range: 0.450 - 4.5
  • SHBG // 80.8 High // Range: 16.5-55.9

Conclusion:

  • A little more energy and less anxiety after the np thyroid treatment
  • New Issue High SHBG
  • Binding to my free testosterone
  • I know that thyroid medication also increases SHBG
  • Even though my SHBG went up results show more free testosterone (Not sure how reliable that is )
  • New Plan of attack lower SHBG
  • Increase carbs, fruits, protein
  • No fasting
  • Boron, Stinging nettle, Cleanse the liver
  • Doc also gave me some HCG
  • 250 iu eod, doc wants to check how my body responds

Lab Results 6 week later

  • Testosterone, Serum // 679 Normal // Range 264-916
  • Free Testosterone // 17.6 Normal // Range 9.3-26.5 pg/ml
  • Estradiol, Sensitive, // 22.6 Normal // Range 8.0-35.0 pg/ml
  • SHBG // 49.6 Normal // Range: 16.5-55.9

Conclusion:
SHBG normalized a bit, Testosterone levels are normal

  • Next step taken wean myself off the HCG and pray to all the gods that my hormones remain elevated
  • Staying on my SHBG lowering protocol
  • Staying on the NP Thyroid medication

New Lab Test 6 weeks later

  • Testosterone, Serum // 558 Normal // Range 264-916
  • Free Testosterone // 16.5 Normal // Range 9.3-26.5 pg/ml
  • Estradiol, Sensitive, // 18.4 Normal // Range 8.0-35.0 pg/ml
  • SHBG // 49.6 Normal // Range: 16.5-55.9
  • DHT // 104 High // No range provided

Conclusion

  • Levels look normal, definitely not optimal
  • DHT is high not to concerned I have a full head of hair on my PSA is 0.5, wish I would of got the high libido side effect that is associated with high DHT.
    New Plan of attack:
  • Consulted with a couple of older gym bros(Kids do not try this at home) that have been cycling for over 20 years
  • We concluded that a HPTA restart would not hurt. Advised not to take clomid that there is a better product out there. Enclomiphene Citrate which is basically clomid without the bad isomers that cause side effects supposedly it’s a lot cleaner and easier to tolerate
  • Studies that I researched showed amazing results
  • Not FDA approved so you can’t get it from the doctor
  • why would the FDA ever approve something that can help millions of men I asked myself (sarcasm)
  • So with the power of a reputable source and the internet I placed an order
  • 1 week later it has arrived
  • Protocol that I will be using
  • 50/50/50/50/25/25/12.5/12.5 slowly wean myself off in the hopes my body adjusts to a higher level that I’m hoping it had when I was younger

Results 3 months later (1 month completely off the Enclomiphene Citrate, from research the chemical should not be in my system anymore )

  • Testosterone, Serum // 954 High // Range 264-916
  • Free Testosterone // 23.6 High Normal // Range 9.3-26.5 pg/ml
  • TSH // 1.150 Optimal // Range: 0.450 - 4.5
  • SHBG // 62.6 High // Range: 16.5-55.9
  • DHEA-s// 394.1 Normal // Range: 138.5-475.2 ug/dl
  • Progesterone // 0.4 Normal // Range: 0.0-0.5

Conclusion:

  • The numbers look beautiful

  • Symptoms Persist
    Positives:

  • Ejaculatory volume has increased 2 fold

  • Morning wood is back online

  • Put 10 pounds on

  • Negatives

  • Most my symptoms remain

  • Would not suggest Enclomiphene Citrate long term, felt extremely sad on it made me question all my life decisions

  • No drive, lack of energy, depression anxiety, loss of interest, takes me 4 ever to heal from the gym even after weak workout

Finally to the question:
Knowing that SHBG has a high affinity for male androgens shouldn’t my free testosterone reflect that ?
If my SHBG is still high how come my free testosterone ended up at the higher end of normal
How reliable is the free testosterone test?
Also I would love any other suggestions on what may be causing my symptoms to persists I would really love to regain my libido and just overall enjoyment in life

The Free T isn’t very accurate which is one of the reason why doctors rely on the Total T value, while I don’t think your Free T is dramatically different from what’s shown, the problem is Enclomiphene Citrate is still an estrogen receptor antagonist which blocks estrogen within the brain which is where libido resides and the last time I check you need estrogen for libido.

Enclomiphene Citrate also can still be detected in the urine 6 weeks after the last pill, so I think your levels would be lower the more time passes.

You may be unable to perceive any benefit because of the anti-estrogen blocking properties within the brain and the water weight could be related to the medicine. This is something I would expect from someone on clomid, perfect labs and no benefit.

I believe TRT is the only way you will ever feel good again because your thyroid treatment increased your SHBG making your Free T situation worse. You also say months after stopping AAS you crashed hard, it may be that your body no longer runs well at normal testosterone levels.

Also once on trt i know that we shouldn’t treat symptoms with numbers but what should i aim for on my TT and free t and what kind of frequency dosage do you think would work best

Thanks for the response systemlord that makes perfect sense. I think i might have a hard time getting a doc to prescribe Testosterone with my current levels. I guess UG test is the way to go for now.

Well you have high SHBG, so 140mg once or 60mg twice weekly should do nicely starting out.

Many healthcare providers are hesitate to initiate men on TRT due to the belief that these treatments increase the risk of cardiovascular (CV) events.

You are going to need a private doctor, private doctors are more into treating the symptoms. The guidelines are dated and the bar is set is too low to qualify for TRT unless you have the hormones of an 85 year old man (below reference range).

Each of us with experience symptoms of a testosterone deficiency at different levels, yet we are all treated exactly the same because diagnosing a testosterone deficiency is problematic.

I wonder if your doctor is testing for Free T3 and Reverse T3 when optimizing your thyroid, I don’t see any other tests other than TSH.

I’d start at 150mg (75mg twice a week) w/ no AI or anything else. My numbers were somewhat similar to yours pre-TRT and I ended up at 200mg but starting at 150mg is a good place to start. You can adjust from there. Expect to more feel great the first 8ish weeks. Don’t change anything during that time or base anything off of the first 8 weeks.