Interpreting Bloodwork - ED & Low Libido

Hi all:

Over labor day my libido crashed to zero. This coincided with ED. A week later I had a barebones hormone test done - Estradiol 37 pg/ml, Prolactin 11.3 ng/ml, Testosterone 724 ng/dl, and SHBG 60.5 nmol/L. I started trying different Test/libido supplements over the next several weeks. I did experience varying degrees of improvement, but it was always fleeting. Finally, I went to an endocrinologist last week. I got some more bloodwork done.

Total testosterone 735 ng/dL
Free testosterone 104 pg/ml
TSH 2.53 uIU.mL
Free T4 0.83 ng/dL
Thyroid Perox AutoAb < 40
DHEA Sulfate 219 ug / dL
Cortisol AM 16.4 ug/dL
Prolactin 7.3 ng/mL
DHT 49 ng/dL
Estradiol 53 pg/mL
FSH 7.9 miU/mL
LH 6.2 mIU/mL.

The endo said that my estradiol level was just above normal which is likely caused by the high SHBG result from the test that I ordered. She had no endocrine cause for my symptoms. I find this hard to believe given my symptoms. Additional context…after the libido crash I started hitting the weights, doing HIIT and taking creatine. I feel strong, and I’m sleeping better than I have in awhile. Lastly, I took finasteride for almost a decade. It did impact my libido and EQ, but it was never debilitating. I stopped taking it about 5 years ago, but the side effects persisted. Again, it wasn’t debilitating until recently when both lack of libido and ED hit hard. I’m not sure if I have a light form of PFS. Regardless, I would sincerely appreciate alternative hypotheses to that of the endocrinologist.

You have low-T, the Total T is a carrier molecule that transports testosterone throughout the body preventing you from clearing out testosterone to quickly by deactivating it (Total T) while a small percentage is active (Free T).

Your Free T is 11 ng/dL and Free T percentage = 1.49 %, 2-3 percent being considered normal. The reason your Free T is subpar is the elevation in SHBG binding up more of the active T therefore lowering the amount of Free T.

Don’t expect your endocrinologist to understand.

Your endocrinologist clearly doesn’t understand sex hormones. The reason for high SHBG can be many different things, starvation (cutting), diet, medications and/or something going on in the liver since that’s where SHBG is produced.

Estrogen does have a “minimal impact” on SHBG levels, but nothing like what your endocrinologist is suggesting.

Thanks so much for the reply.

What do you suggest I do to remedy my symptoms?

More testosterone, TRT may be the only thing that can suppress the high SHBG allowing the Free T to increase.

You could try boron to lower SHBG, but don’t get your hopes up.

You’re fine, save for this. It’s binding up your test. However, I don’t think adding more test to overcome it would be the first course. You can lower it with supplements and diet first to see if you feel better with more FT (guessing you will)

Thanks Swoops. What diet helps lower shbg? Also, once I reduce it will my estradiol come down?

Thanks. I tried boron, but I felt pain in and around my thyroid, so I stopped.

Proviron? Or no?

I haven’t tried that. It increases dht levels, right? My dht reading didn’t seem to bad, but maybe that would help. What’s been your experience with it?

Nobody tests for DHT here in the UK, pretty unhelpful really

Do you get morning woods?

No, I don’t. Is that a bad sign?

A lack of erections is a red flag regarding a man’s health status, it is usually a sign of future vascular issues.

Yo dude sorry to hear about you libido/Ed issues.
What is your diet like, surplus or deficit?
PDE5 inhibitors working?

Eating a calorie surplus can reduce SHBG as well as increasing T.

Your levels aren’t that bad but as others have said your high SHBG is the issue for you.

TRT might be a good option for you but is certainly not the only option and it’s one that also need proper consideration as there’s no guarantee you won’t have these issues while on TRT. Low self esteem, porn addiction, issues at work, issues with relationships, body dysmorphic disorder, general depression and even just a decent amount of stress can cause ED and libido issues that affect morning erections too. Just confirm that none of these things are affecting you before thinking about altering your hormones.

TRT is a great tool but remember this is a TRT forum where some people are passionate and even evangelical about its benefits. With decent natural levels like yours don’t jump the gun but work on getting that SHBG down and reduce stress etc first.

I really appreciate the sentiment and your post regarding my situation madagascarspirit.

I’m 45. I’m 6’2" and weigh 210lbs. Yes, viagra does work for me most of the time, but I don’t have any urge to use it. After the libido crash, I started eating a Mediterranean diet - lots of leafy greens, blueberries bananas, salmon, eggs and whole grains in moderation. I’m not struggling with any of those other issues, thankfully. I’m happily married with kids and employed, so I don’t think stress is the issue.

In the past, whenever I started hitting the gym and taking creatine, my libido and EQ would improve. This time I’m not responding the same way.

If you haven’t been using fin for 5 years and you only get issues now, I highly doubt its from fin. I have similar free t levels to yours. My test is 700ng/dl and shbg hovering around 47-55 and i have the same symptoms as you except the libido part. No morning wood and ed. before this happened, gym would also have a positive effect on my libido and eq. Gonna hop on test this december. For now i just ice my balls and ingest a lot of magnesium and boron to increase free t as much as possible.

Did you tried proviron ?

No i haven’t but i was thinking about it

You’re probably right. My only reservation is that I did experience the immediate reduction in libido and EQ upon using which persisted during use and after stopping. I probably should have stopped, but it wasn’t debilitating. I was young, dumb and too vain sadly. I would love to hear how you do. I hope it works out! I’m thinking about trying Androsterone.

Have you tried it? Did you have similar symptoms or bloodwork? How did you respond to proviron?