T Nation

High Total Test, Very High SHBG, High TSH

Help would be much appreciated - (Please excuse the long winded post)

42 years old. Height 6ft 5" Weight 15st11lb.
Weight/Exercise History:
Skinny as a child until 10years old. Then chubby till16. Then overweight from 16 - 21.
Started gym training properly at 22years old (19 stone to 16 stone very low fat).
Trained continuously from 22 - 37 (ridiculous amounts, i’m certain that I was heavily over training almost every day)

Colic as a child. Chronic migraines from about 10 years old until 13.
Very strange Thyroid issues from 20-22 years old. (Drinking vast quantities of water, unbelievable thirst - totally disrupted sleep, fight or flight feelings). Was fobbed off at the time by endocrinologist - “Post Viral Thryroiditis” he didn’t have a clue. Also terrible tonsil inflammation/soreness for 3 years.
This health scare prompted me to start gym training and try to take my health seriously.
I have had thirst issues twice since, bad enough to go to doctor, fobbed off again, no thyroid tests done. I have not notes relating to my original Thyroid condition as I was sent to a specialist, so my doctor has no record!
N.B. I have always suffered more than most with headaches and terrible hangovers.
Throughout my 20’s and 30’s I knew something was not right, but had no idea what it was, I have no faith in traditional doctors solving any issues.
At 37years old, all of a sudden, started getting chronic migraines again (4 days in bed etc). Also suffering mild hangover like headaches every day.
Went to doctor, sent me to brain specialist, MRI etc, lots of scans, all fine. Given a load of heavy duty pills to take (didn’t touch tem).
Wife went away and started researching gut health. Immediately cut out gluten - made a huge difference, daily hangover headache gone. Still getting migraines, until 6 months ago. Tried everything. Cut out milk (milk only, not butter) - not a single migraine since.
We have long concluded that i’m suffering from allergies caused by "Leaky Gut,"
Elder sister had, what seems to be the flip side, Endomitriosis and Crohns Disease.

Since getting Migraines, I noticed my gym performance deteriorate, not matter what effort I put in. Muscle mass reduced significantly plus fat gain. Again to doctor - my wife suspected thyroid. Doctor tested TSH at 2.5, therefore I was deemed fine.

Please note - oral temperature very low all day. Anything for 34 degrees to an absolute rare max of 36.5
Very difficult for me to lose fat and i’m always cold especially hands and feet.

As, I say, I was not happy (plus not convinced by local labs here in Jersey, Channel Islands).
Got a blood test done in London.
TSH 3.75 ml/UL 0.27-4.2
Free Thyroxine 16.3 pmol/L 12-22
T4 91.1 nmol/L 59-154
Free T3 5.06 pmol/L 3.1-6.8
Reverse T3 19 ng/dL 10-24
Thyroglobulin Antibody 10.6 IU/mL 0-115
Thyroid Peroxidase 9.45 IU/mL 0-34
B12 102.6 pmol/L 25.1-165
Folate 10.38 ug/L 2.91-50
Vitamin D 166 nmol/L 50-200
Inflammation Marker CRP 0.1 mg/L 0-5
Ferritin 263 ug/L 30-400
Magnesium 0.93 nmol/L 0.6-1
DHEA 6.39 umol/L 0.44-13.4
Follicle 4.92 IU/L 1.5-12.4
Luteinising Hormone 6.44 IU/L 1.7-8.6
Testosterone 26.3 nmol/L 7.6-31.4
Free-T (calculated) 0.282 0.3-1
THIS HAS BEEN CONFIRMED by an actual separate Free-T test recently
SHBG 90.5 - Endocrinologist chuckled and said he had never seen a value this high in anyone outside of women on the pill. 16-55
Free Androgen Index 29.06 Ratio 24-104
17-BETA Oestradiol 107 pmol/L 0-192

Went to Doctor with these results - he said I was in range. I said, I am 42 not 92, I have no libido and am always tired and cold.
Sent me to private endocrinologist.
Double checked results and then gave me 3 options.
1/ Test Gel
2/ HCG? stimulate my own production of test
3/ Nebido

I opted for Nebido and had 1st jab on Novemeber 22nd.
I gained 7lbs in first week and nipples super sensitive etc.

Have since read in a few places that I should be getting treated with Testosterone with a shorter Ester once a week - I am not Low T but very high SHBG.
I also tried asking Doc for an A.I. but he would not prescribe.
I have, so far not felt a single benefit on Nebido. Occasionaly I now have a half hearted morning erection.
N.B. until the last 3/4 years I have had no Libido issues, in fact quite the opposite.

I have an appointment with the Endo at 4om tomorrow and was wondering which at to go. He says my Thyroid is fine. I also mentioned my persistently low temp and inability to lose weight. He looked at me like I had two heads and told me that everyone has a different temperature!!

Any advice very much appreciated!!

One last thing - I wake up almost every day at 4am, no matter what I do and am wondering if there may also be an adrenal issue at play?

Many thanks in advance


Forgot to add.
Have since had liver blood tests - fine.
I have not really drunk alcohol for 14 years.
Do not smoke.

D3 10,000
Vit C
Magnesium spray
Pro biotics
Vit E
Multi B

Nettle root
Iodine and selenium
Liver health tablet

Waist: 34"
Height 6ft5"
Weight 221lb

Facial Hair: Patchy, not able to grow decent beard.
Body Hair: Average. Noticeable lack on underarms, body hair also very soft.

Body fat: Always on belly, hips and upper thighs.

No hair loss drugs or prostte drugs

Diet: very healthy. Have never starved myself. No milk, no wheat.

Training: have done a lot of weights and many many hours of cardio over the years. I often wonder if this has masked underlying health issues.

Morning erections non existent. Dramatic change from 5 years ago. No erections during the night, generally a lot less interested in sex. This area alerted me to the problem.

Eyebrows very thin. Outer eyebrows almost non existent.

Concerning your SHBG: Are you on or have you been on ANY medications?

You need to include lab ranges, each labs differs in its ranges and it’s impossible to know if any are midrange without ranges. Problem with Nebido is the slow acting esters and for someone with high SHBG you need larger doses with more punch to suppress SHBG. You are low T because all your T is unbound (inactive) do to high SHBG, your body isn’t seeing any of the T that’s locked up in SHBG. You T is high because your pituitary gland is attempting to compensate for high SHBG, it’s a battle that’s already lost.

As for TSH doctors usually wait until “disease status” meaning they wait for things to reach 100% bad before they do anything, some doctors are treating thyroid numbers above 2.5 bml/UL with good results. Cold hands and feet are thyroid related, thyroid hormones regulate metabolic rate (fat burning) and lower body temperatures indicate low thyroid hormones mainly the fT3 hormone. If rT3 is elevated it will block fT3 hormone.

The heart pounding and waking up early is your body adjusting to the restored metabolic rate that TRT has restored, but if thyroid function is still low it won’t last. Your doctor is a moron, all humans run at 98.6 degrees. How the hell does your doctor know if you are one of those who runs slightly colder? Is he guessing with your health? I’m sorry but that’s a lazy ass answer, a cop out! He’s probably fat and low T himself. You need to push for thyroid treatment as it will only get worse and you will have problems losing fat with those thyroid numbers. Thyroid numbers are very near the ranges where treatment is initiated, you are only at 75% bad. What’s the doctor waiting for?

No. No medications whatsoever.

Hi systemlord
I have sort of been through all this with both the doctor and the endocrinologist. They both have said I am within range - which in there eyes means you are fine. I had to push for a test jab, even though my free test is that of an average 70 year old added to the fact that the other physical changes are obvious (total lack of erections and libido and an obvious change in ability to weight train/retain muscle).

I have often wondered if my physical training over the years, has compensated for being hypothyroid?

Will include lab ranges shortly.

No you’re not fine, while your T levels are fine your SHBG is so high it’s binding up all your FT, that’s why you feel the way your feel. Doctors fixate too much of these pure statistical ranges, this is how you know the doctor your dealing with is mentally challenged and some doctors who don’t know one way or the other will still say you’re fine. TSH is also a problem, some doctors start treating when TSH reaches 2.5 ml/UL with good results. The majority of doctors are just plain stupid and aren’t capable of critical thinking, these doctors tend to be lazy minded. These are the ones who say you are fine when you are showing SHBG well above range.

SHBG is too damn high!

Have now edited first post to include ranges.

You’re 35 points over the range for SHBG, your doctor is a retard. I starting learning math in first grade, your doctor must have dropped out of pre-school. If your doctor understood the function of SHBG he would know that there’s clearly a problem. If you were to give those labs to a child they probably wouldn’t think much of it.

My biggest question - my appointment with he endocrinologist is tomorrow at 4pm.
Nebido thus far has not helped.
I am 7lbs heavier. Certain due to massive increase in eostrogen.
I would like to move to weekly injection with an estrogen inhibitor - not sure if he will go for it.
If not, should I just quit the nebido altogether?
Next injection due on 3rd Jan.

Also waking at 4am started long before first nebido jab and have had no heart palpitations.

Heart palpitations and racing heart rate is common to low T suffers, the body recognises low red blood cell production increasing your heart rate to compensate and to get oxygen to vital organs. It’s going to take awhile for your symptoms to be resolved. Gaining weight on TRT is normal even if E2 is normal or high, it will take many months for your body to reach balance. During this time your body will go through body comp changes as your body fat shifts around. Hows you appetite?

Appetite - no difference whatsoever.

Hi banjoplayer. There are two of us here with open threads, and both of us have high T and high SHBG as well. I doubt it will provide you with new information, but just FYI that others are suffering with it as well.

Your doctor’s “chuckle” about SHBG being high also indicates his lack of understanding about SHBG. It is more common than I ever realized; and there is still a great “unknown” as to why SHBG is so high (as in my case).

Please keep updating. :slight_smile:

Hi traveling man
I have just read your thread. Very interesting.
I note the lactose intolerance similarity.
I am almost certain that my problem has stemmed from leaky gut.
Note: I have read that the rogue particles go through the stomach lining and into the blood, this causes pressure on the liver to cleanse the blood which then increases SHBG production!

Also, I have periodically suffered from very dry mouth lips, no saliva creation. This seems to cause me to have nightmares that wake me up because mouth is so dry.

I will keep updating with any information that I come accross.

I am also considering going to a private clinic to balance my hormones. The clinic of Thierry Hertoghe in Belgium.

I will tag @ksman to see if he can shed any light on my situation.

User “hostile” made reference to leaky gut and I began reading about it.

I found an interesting article that explains the various testing methods.

I’m out of the country until mid January, which is when I hope to find one or more of the tests to take and either rule-out or demonstrate a new angle to follow.

Thanks for posting this. This was a new way to look at the leaky gut issue.

I didn’t post this as a symptom because 1) I never saw it as a symptom; and 2) it is not a regular occurrence. However, I keep water by the bed and have had this happen a dozen times or more that I can remember, but all spread over time.

I expect the results of my "ZRT Labs 49 Panel Urine Advanced Metabolites Home Test Kit: Advanced " sometime after Christmas. I’m interested to see if urine results matches blood results.

Thanks for posting and replying.

Had appointment with the endo on Friday evening. Spoke about water retention issue and obvious elevation in estrogen. He took blood for lab work and is quite happy to prescribe an AI.
I posed the scenario of a low total test guy and myself being put on nebido, said that nebido will only give me the total test I already had and the SHBG will then deactivate it, whereas the other guy will have a big increase in free test. He agreed with this. I suggested that I should be on 200mg of test ethanate per week. He said that was not a good idea due to the big spikes and lows?!?! He also said the object of the exercise was not to lower the SHBG??!! I was confused by this point. He then said that he would look at he blood test results and we could then look at a double dose of Nebido!!
Not sure if anyone has any thoughts on this?


That’s not a good sign, the odds of your doctor of scoring a 10/10 for TRT knowledge wasn’t a realistic one. Wait to see what he says when your SHBG starts dropping when you get your first set of labs. He should understand why SHBG needs to come down, that’s the whole point of going on TRT. Your T levels are fine but the SHBG is binding up all your T, lower SHBG and then your FT and TT will rise while SHBG goes down.

Lab results back. 5 weeks after nebido jab.
Total test 14!!!
Estrogen Normal Range.
I told the endo this would happen.
My free T is now much lower after starting Nebido.
I am now due in for a double jab on 3rd Jan.
Told endo I wanted an AI after my recent issues. He says that they could have been a one off so won’t prescribe at the moment.
I want one large jab of test per week coupled with an AI - maybe with Proviron.
Why is this so difficult to get?