Hi guys! I’ve just had my bloodwork done and I’d like some advice. Some info about myself: I’m a 38 male, 78KG (172 pounds) and 1.86m (6’1").
I’ve been feeling a bit low mentally for 6-9 months now, not very motivated to do things and I feel tired more often than I’d like to. Libido is also low. I made a few changes to my lifestyle and that has worked somewhat, but I still don’t feel like I’m on top of my game. I’ve been training consistently 3 times a week for a couple of years now. I’ve also stopped drinking alcohol in December last year as it started to make me feel depressed. I’ve always had a healthy diet, but since January I’ve cut out almost all junk. I’ve lost 10 pounds of weight since then. It all helped, just not as much as I’d hope.
First congrats on dropping the booze. I did the same in September and it changed my life completely. Second, how is your sleep and your caloric input? Thirdly, how is your thyroid?
Your lifestyle changes should be reflected in your labs by now, so it does appear you should be a candidate for TRT. However, getting doc to prescribe TRT for younger guys, particularly borderline cases, is like the proverbial pulling of teeth. Painful!
Looking at your labs, the problem seems to be a combination of moderately low T production combined with high SHBG. yes, the SHBG is in range, but combined with the lowish total T, it’s pushing your more important Free T to just barely above the low end of the normal range. SHBG bound T does not pass through the blood-brain barrier where you need T to feel normal and have normal cognitive function. As for your E2, it’s low because your T is low. E2 is made from T.
Some people are genetically programmed to produce higher amounts of SHBG. I read once (but have since lost the source) that it’s about 15% of the population, so about 8% of men. The mechanism is that we (I am one of them) add extra sugar molecules to the SHBG glycoprotein and this increases the half life of the molecule. So, for every molecule of SHBG we produce, it has about double the binding capacity (due to about doubling the half life).
What can you do? I’ve researched this quite extensively, and there are some oral synthetic anabolic steroids that, taken in small doses can suppress SHBG production (e.g., stanozolol [Winstrol] and oxandrolone [Anavar]). I have experimented with them and they do work, but getting a doc to prescribe them off label is even more difficult than getting them to prescribe TRT.
You other option is TRT, which is the option I have pursued long term (7+ years). The strategy is simple, you find a dose of T-cyp (or T-eth) that will saturate the SHBG protein so that enough spills over to Free T to feel normal again. For me that dose is around 50-60mg every 3 days.
Thanks! Yes it made a huge difference. The joy of waking up refreshed and no hangovers.
My sleep is good. I sleep easily and without waking up a lot during the night. I’m on a small caloric deficit at the moment. About -400 calories.
My thyroid values are
TSH 2.03 mU/L (0.27 - 4.20)
LH 3.0 iU (1.7 -8.6)
FSH 2.5 iU (1.5 - 12.4)
Thanks for this, this is very interesting to read. It would completely explain the results and makes a lot of sense! Do you have any references to information about this condition? How did you find out? Did you conclude this by looking at the lab results or were there other tests that made you come to this diagnose?
I have lost the references for the genetic link and the mechanism. If I find them again I will post.
Regarding use of low dose oral synthetic steroids to suppress SHBG. I should point out that you need to combine this with TRT because these hormones are also suppressive of T production. There are others too beside the two I mentioned (stanozolol and oxandolone). There are some that promote use of danazol without TRT because it is less suppressive of T, but I have no experience with it.
Here’s a really good randomized, double-blind, placebo-controlled study of the use of oxandrolone in the treatment of HIV-associated weight loss in men. It’s available free Open Access from Pub Med. You need to go beyond the abstract to find the SHBG information. On the top right column of page 309 they discuss the suppressive effect of oxandolone on pituitary function (LH and FSH) and SHBG. In all groups (20, 40, and 80 mg/day) there was a dose-dependent decrease in SHBG. You should not too that the data presented in Table 3 shows there is also a dose-dependent increase in liver enzymes (toxicity).
My experience is that you need half of their lowest dose, which meand 10mg per dayfor an effective suppression of SHBG. Since your SHBG is lower than mine, I suspect you could get by with even less, perhaps 5mg per day. This will minimize the liver toxicity to a pretty much negligable effect. My experience with stnaozolol is that it’s about twice as effective as oxandorlane in suppressing SHBG, so you need half as much. After some experimenting (before I chose to abandon the treatment), I found that 2.5mg twice per day was my optimal dose.
Many thanks, your insights help a lot. I’ll talk to the doctor next week and see what they say. If that is a dead end I’ll probably need to find a solution myself.
Let your doctor know that with this estrogen level osteoporosis is guaranteed. Your estrogen is low because T is low. I’ll bet your LH is <3 which is common in men diagnosed with secondary hypogonadism.
The problem is finding a doc not afraid to prescribe TRT, some docs will just tell you everything is normal and would rather not be involved with TRT/steroids. The cause of high SHBG can be secondary hypogonadism.
I would run a thyroid and liver panel to be sure, if those check out you know it’s the low-T causing the high SHBG. TRT will decrease SHBG in most cases freeing up more free androgens.
If in the UK according to the British Society for Sexual Medicine guidelines you qualify for TRT with Free T >0.225 nmol/l.
