Lab Results: High T, Low Free-T, Very High SHBG

Hi all,

Just wanted to get some views on my bloods and what the right next steps are - below I’ve given my stats, history and lab results which I just received. The main thing to note is the elevated SHBG levels and the low-ish free T levels, despite high/normal total T levels.

Specifically, I’m wondering if based on this information you think TRT is right for me (I was told in these circumstances it can be used to drive down SHBG levels and drive free T levels up, and so it might be recommended to me but they haven’t decided yet) or if some other treatment is appropriate, or if I should be doing further investigation?

I’m 23 y/o male, 5’11"/180 cm, 58 kg / 128 lbs (I’ve always been very slim), waist 28". Not very hairy; can’t grow a beard etc and fairly light body hair.

In terms of my health, I have a condition called POTS (relates to poor blood pressure regulation), digestive issues and food intolerances, and I have had anxiety as long as I can remember. I have Joint Hypermobility Syndrome / EDS, and (I think linked to this) I also have pelvic floor issues accompanied by a condition called ‘hard flaccid’, which other than its namesake, also causes issues such as poor erections / lack of morning wood, urgency to urinate, mild pelvic pain after sex, etc - which is all exacerbated by anxiety as well.

In terms of my symptoms, I have a poor libido, general lack of interest in a lot of things I used to love, poor motivation, terrible attention span, poor erections, rarely get morning wood / nocturnal erections and only occasionally get spontaneous erections - though as above I’m unsure to what extent that relates to my pelvic floor issues / ‘hard flaccid’ or T. But the labs suggest T is could be a factor. I’ve had these symptoms for up to 5 years now, with varying severity over that period.

In terms of diet, I eat a fairly simple diet due to my intolerances, mostly based around meat, nuts, veg, simple carbs - generally high in proteins and fats, with moderate carbs.

In terms of exercise, I swim twice a week, and most mornings I do 15 mins or so of exercise (stretches, sit ups, push-ups, etc.).

See lab work in the images. Would be very interested in any thoughts on what the problem is and any advice on solving it. Thanks very much!

You high SHBG and very low Free T would give anyone erectile issues, Total T is almost useless as it’s not bioavailable. You have to have healthy Free T to have motivation, libido and erections. If my Free T drops below high normal, I experience all low T symptoms.

TRT is the only treatment that will lower SHBG enough to matter, now you are challenged with located a doctor who isn’t an idiot. The majority are TRT ignorant as there are no doctors that specialize in TRT, most of them can be found in private anti-aging (think Sylvester Stallone) who optimize your health, something managed health care doesn’t do.

A good starting protocol would be 120mg weekly or 60mg twice weekly, NOT 200mg every 2 weeks which a lot of doctors sadly are still doing.

A note on fertility, TRT can make you infertile unless you come off TRT or FSH injections will increase sperm production.

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Thank you very much for your response - that’s a really valuable confirmation.

Thankfully I’m with a private practice specifically focused on testing and treatment for TRT, so hopefully the right treatment won’t be too difficult to obtain. What do you think of gels - are they a bad option, or does it not make much difference either way?

Gels are poorly absorbed a lot of men.

Muscular responses to testosterone replacement vary by administration route: a systematic review and meta-analysis.

Intramuscular TRT is more effective than transdermal formulations at increasing LBM and improving muscle strength in middle-aged and older men, particularly in the lower extremities.

That’s very useful to know, thanks.

Unfortunately I’ve just been told that the doctor’s recommendation was not to prescribe TRT because they didn’t think T levels were an issue in this case, since my free-T levels are still within normal range and so TRT would not make a difference. This is despite my very high SHBG levels.

Obviously from what I’ve read on here, people in my kind of situation should take TRT, but I don’t know how I can get this prescribed - as you mentioned, finding the right doctor is a challenge.

Does anyone have any advice for how I might do this in the UK? I was with Optimale for these tests (who I have heard very good things about), but they didn’t want to prescribe TRT to me.

Try Balance My Hormones. I had very similar numbers - high SHBG and free T around 0.34 and they took me on (Optimale also rejected me).

That’s really useful to know, thanks - I’ll check them out. Did you have to do further testing / consultations with them before they gave you treatment (despite already having been tested etc)? I could spend more money on tests / consultations if I have to but I’d obviously prefer not to if possible!

More importantly, since you had similar results to me, I’m interested - did TRT help you with your symptoms? Optimale thought it wouldn’t.

I think if your blood tests are comprehensive enough and recent enough they can use those - they should have been taken within three months from memory. You do a telephone consultation as it’s all remote then they’ll come up with a treatment plan. Sometimes a skype consultation is required with the doctor.

Can’t remember what the initial fees are but you only pay if they prescribe.

It’s been a rough ride to be honest. Started out on the wrong protocol (large weekly shots due to high SHBG). My body does not like large shots. Felt terrible first few weeks. I’m now on small EOD injections and I’m doing much better.

The really bad symptoms I was experiencing immediately prior to TRT have pretty much gone however I can’t say for sure that the TRT is responsible as I took a holistic approach and tried to improve my health in every way possible - diet, stress etc.

Positives I have noticed that are definitely related to TRT are increased strength in the gym, high libido at times and the occasional morning wood which is something I hadn’t had for as long as I can remember. I’m hoping this is a sign of good things to come as it’s still fairly early days - I started 4 months ago.

I still don’t have the boundless energy that people talk about or the sense of well being but I’m hoping that will come too.

That’s really useful information, thanks! I’m going to get in touch with them.

I just had a quick look through your thread and yeah it definitely looks like you’ve had quite a wild ride. I’m a similar person in that I metabolize very quickly, and my weight never changes no matter what I do, which might mean I have a similar reaction to T.

As you say 4 months is still quite early days. I’ve followed your thread, interested in seeing where your journey goes.

I’ll update this thread in a few weeks after I’ve (hopefully) got some TRT prescribed.

No worries. It’s a harder decision when levels are borderline, especially when multiple doctors tell you you don’t need it. My thought process was that I’ve got the symptoms and the doctors weren’t giving me any other ideas as to what could be the problem so I owed it to myself to try.

Still, not a decision to be taken lightly. I would say exhaust other avenues first. Maybe get a more complete thyroid panel done that includes free T3.

I’ll be getting comprehensive blood testing in a few weeks so will update my thread then.

Often doctors have no idea what normals levels are and instead defer to the reference ranges compiled from a sick obese population that is bathing in a sea of chemicals, processed foods and pesticides.

The experts say Free T below midrange is where symptoms begin, in my case symptoms begin the moment I dip below high normal…

I cant really give you advice but can share my experience on TRT starting with very high SHBG.

My pre TRT SHBG was 89 in August last year and by October after starting (150mg p/week split twice a week) it was down to a more reasonable 54.

I’v since upped dose to 200mg a week but no bloods yet.

My SHBG was 108!!!

29 yo male.

Thanks all for the very helpful responses, seems like TRT has helped quite a lot of you with bringing SHBG down. I’m arranging a consultation with Balance My Hormones - they’ll probably want another round of bloods. I’ll report back soon.

Perhaps try some Boron supplements to see if that improves the SHBG?

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No one here is going to agree with what I am about to write - some will even tell you that my post is “ridiculous”. So take that for what it is worth. I believe in hearing alternate opinions before making any big jumps. Plus I am the bastard child - the only one here using Testosterone pellets.

I wish the doctors would have suggested I take something to lower the SHBG FIRST .

Yes, take boron. Currently the best IMO is Immersions Fructo Borate Complex. As soon as I run out of my previous supply, that is what I will switch to because of the increased bioavailability and double the elemental boron as most supplements.

Consider experiments with either Proviron or Danazol BEFORE TRT. Danazol works for me and has lowered my SHBG 60%. Yes, it is possible that it will crash your natural Testosterone production, but it may not as you have relatively high T levels (798ng/dL).

Even if it does crash your T levels and doesn’t work as you had hoped, you were considering TRT anyway and in my experience, Testosterone ALONE does not bring down very high SHBG levels.

I wish I would have tried to reduce my SHBG through Danazol/Proviron before going to TRT. In your case, it is your FREE-T % that is causing your problems IMO – just as it was for me.

You are going to be told that your T-levels are “artificially high” due to your high SHBG. I don’t believe that. I think your SHBG is taking all of your T that you have.

A free opinion … take it for what it is worth.

Hi all,

Thanks so much for your suggestions so far - I’ve started taking boron.

I got my second set of test results back - interestingly, my T levels are about 50% higher; and my free T levels have increased by the same amount - the free T level is now over 0.6, which is apparently high. In fact, my dr suggested my T levels look like someone who’s been on TRT (which I haven’t) - which suggests to me that my problems might not relate to T at all. SHBG is slightly lower, but despite a high SHBG, my free T is still very high (in fact, I would be out of the reference range used for the previous test).

Just to note, this test was taken in the morning (previous one was in the afternoon), and I had been taking an average dose of boron (6mg/day) in the weeks leading up to the test - but the boron hasn’t changed my symptoms and dr. doesn’t think this is the cause of the changes; in his view it’s likely due to the time of day.

However, he was a bit alarmed by my thyroid hormones, being right at the top of the range for T3 and the bottom for T4 - he said this could be ‘subclinical’ hypothyroidism. From my symptoms, and these results, he thought there could be something autoimmune going on which could be causing the symptoms - especially as there was an elevated antibody count.

For some reason I haven’t got access to the full results yet, only some of them, but I’ve copied what I have got below. It might be that some of this stuff is out of the scope of what this forum can advise on, but very grateful for any thoughts, especially on the thyroid hormones. Thanks!