T Nation

Lab Results: Very High SHBG and LH. High Test. Low % Free T

Male 30 years old
6’1’
31 inch waste
155 pounds (been about 148-155 since 16 years old)
Body/Facial hair: Average (can grow beard)
I don’t really carry any fat, very hard to put on weight

Health Conditions:
-Had my left testicle removed as a young child, the right one is and always has been very large as far as I can remember.
-Depression, anxiety, ADHD all coming on around age 18. None of these severe, but enough to seek therapy. Recently decided to get medication to help…
-Started taking 150mg of Welbutrin (snri) and 27mg Concerta about 5 months ago
-Acne (a bit more than average) age 15-17
-Erections/morning wood: never changed same as 10 years ago
-Started using tobacco in high school and picked up cigarettes in college (quitting now…on the patch)

Diet:
-Lots of carbs, Nuts, Salads, Veggies (broccoli, carrots), Veg/lentil soups. I eat “ok” generally, eating high carb/low nutritional value foods (trying to put on weight), with salads, veggies, and soups mixed in.
-Never have much of an appetite in the morning, except for coffee. If I’m eating within the first 3 hours of when I wake up it’s because I feel I should, not b/c I’m hungry.
-I drink alcohol 1-2 times every coupe weeks

Training:
-Last 4 months or so been lifting 3-4 times a week, 2 of those being heavy but not max low rep leg days (usually get just a little sore from these workouts) and the other days I usually just workout what I’m feeling staying in the low rep higher weight routine (again just trying to put on some mass)
In decided to go out and get some lab tests thinking maybe I could find a link to my depression, and adhd symptoms. I had also never done any hormone panel before and wanted to make sure things were normal with the lone teste and all, and here is what I found…

Lab Results (taken fasted at 11am back in December 2018):

Testosterone, Serum (Total)…1022ng/dL
% Free Testosterone…0.7%
Free Testosterone, S…72pg/mL (7.2ng/dL)
SHBG…113.1nmol/L
Albumin, Serum…4.7g/dL
Luteinizing Hormone…10.2mlU/mL
FSH…6.3mlU/ml
Prolocatin…6.9ng/mL
TSH…1.890uIU/ml

Glucose, Serum…85mg/dL
BUN…13mg/dL
Creatinine, Serum…0.88mg.dL
eGFR…115ml/min/1.73
BUN/Creatinine Ration…15
Sodium, Serum…142mmol/L
Potassium…4.1mmol/L
Chloride…102mmol/L
Carbon Dioxide, total…25mmol/L
Calcium…9.8mg/dL
Protein, total, serum…7g/dL
Globulin, total…2.2g/dL
Albumin/Globulin Ratio…2.2
Bilirubin, Total…0.7mg/dL
Alkaline Phosphatase…77IU/L
AST (SGOT)…23IU/L
ALT (SGPT)…23IU/L
Vitamin D, 25-Hydroxy…39.7ng/mL
Vitamin B12…558pg/mL
Methylmalonic acid, serum…101nmol/L

Cholesterol, Total …199mg/dL
Triglycerides…45mg/dL
HDL cholesterol…77mg/dL
VLDL cholesterol…9mg/dl
LDL cholesterol…113mg/dL
T.Chol/HDL Ratio…2.6 ratio

WBC…5.2x10E3/uL
RBC…4.77x10E6/uL
Hemoglobin…14.3g/dL
Hematocrit…41.1%
MCV…86fL
MCH…30pg
MCHC…34.8g/dL
RDW…13.7%
Platelets…206x10E3/ul
Neutrophils…55%
Lymphs…36%
Monocytes…7%
Eos…1%
Basos…1%
Neutrophils (absolute)…2.9x10E3/uL
Lymphs (absolute)…1.9x10E3/ul
Monocytes (absolute)…0.4x10E3/uL
Eos (absolute)…0.1x10E3/ul
Baso (absolute)…0.0x10E3
Immature Granulocytes…0%
Immature Grans (Absolute)…0.0x10E3/uL

The hormone tests were ordered from a Urologist, he told me my LH and SHBG were very high, but since my total testosterone was also high I’m in good shape. I mentioned that I thought my % free testosterone was pretty low and he said not a big deal because total was so high and also mentioned Clomid as a possible medical solution. The rest of the tests were ordered by a primary care physician, she said everything is within the normal range, and that was it.

My goal is to get off the medications, and be at my optimal health. I love weight lifting, rock climbing, pushing myself physically, running, backpacking, yoga, etc. and I want to do them all as best I can for as long as possible. Getting completely off tobacco and eating a cleaner diet are the obvious places to start. But need some advice on where to go from here other than the doc’s obligatory “you’re fine, you’re within the range we’ve deemed normal”

You need to run away from this doctor as he is sex hormone ignorant, clomid will increase SHBG further and run what little Free T you have into oblivion. There aren’t many doctors who know how to do TRT well, endocrinologist and urologist are typically the worst at TRT as this isn’t their area of expertise. An endocrinologist area of expertise is thyroid and diabetes, a urologist is into prostate, male reproductive health and procedures, typically neither specializes in TRT.

Your main problem is your liver is pumping out insane amounts of SHBG, total testosterone binds to SHBG and handcuffs your free testosterone. Total testosterone isn’t bioavailable and Free T is the unbound hormone that’s responsible for muscle growth and sex drive. Total testosterone bound to SHBG is useless to you, your body will never be able to use any of it.

Your pituitary gland detects your dire Free T situation and is attempting to compensate (higher LH) for what the SHBG is doing to your Free T, sadly unless medication (SSRIs) can explain why SHBG is high, you will need TRT for life short of a liver transplant.

I believe you were treated for depression and anxiety with Wellbutrin and Concerta when the cause is low free testosterone, very common thing to happen in mainstream medicine and hormone therapies elude them all and is lacking. You need to treat the very high SHBG with TRT and get off these drugs.

Hematocrit labs is on the lower end, the cause again is low free testosterone. You will need supraphysiological doses of testosterone in order to hammer SHBG downwards and increase Free T, something a sick car doctor may be unable to assist.

You need an private anti-aging doctor, Defy Medical is such a place that can help. Defy Medical is quite popular telemedicine clinic to which I’m also a very happy patient. Dr. Saya is the best and one look at your SHBG and without hesitation will know actually what to do.

Men with lower testosterone live shorter lives and men with high normal testosterone (Free T) live longer lives.

The denial of healthcare coverage by insurance companies is based on the requirements to meet specific testosterone threshold (under 300 ng/dL), representing a transparent desire on the part of the insurance companies to deny treatment and thereby reduce costs.

By “we’ve deemed normal”, he means the insurance companies. Doctors are puppets and insurance companies are dictating what these doctor are allow to do and when they can take action. Private doctors who don’t take insurance have their dignity in tact and don’t have to play by these rules of screwing the patient since you are the one footing the bill.

This is what I was thinking, and actually hoping for because though I’m just starting to learn about it, would rather be on TRT than these prescriptions. I’m still curious if there is something I can do to lower SHBG instead, since I read on here many people say you should exhaust all other options before going to TRT.

Wellbutrin actually works as a norepinephrine (rather than serotonin) re-uptake inhibitor. Not sure if that changes anything about what you are saying.

But either sounds like an appointment with a TRT specialist is needed. Appreciate your response.

Effect of cigarette smoking on levels of bioavailable testosterone in healthy men.

These data suggest that cigarette smoking has no significant effect on the biologically active fraction of testosterone, but may influence the levels of total and free testosterone through changes in the levels of SHBG.

I’ve never known anyone with SHBG so high to be able to lower enough to matter, you’re not just a little bit high here, you’re more than double the ranges and it may be genetic, therefore there’s no chance at lowering it. If it’s not genetic it may still be permanent do to scarring of the liver if that cause was from smoking.^^^^

You won’t fix it naturally, the liver does what it wants to and is almost impossible to manipulate SHBG.

You should look on these boards and see if other members who were on these meds also have high shbg. For some reason my minds telling me I have seen this several times. Where someone is on some sort of med for mood and they have high shbg. Maybe removing the medicine helps fix that issue. Just a thought.

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My pre TRT SHBG level was 89. (Also low free T and also similar in that i’ve always been slim and found it hard to put on any muscle.) A few months in (150mg a week and now 200mg per week.) and I was down to 54 with freeT back up to decent levels. I don’t understand the how’s and why’s but it can be done.

Might be a dumb question (bear with me I’m a total noob) but,is it pretty unlikely that my very high SHBG production from the liver could be a response to some other underlying (and possibly reversible) health problem such as a thyroid issue? I don’t want to get going on a TRT program and overlook some other serious medical condition that may have created my abnormal hormone numbers.

Listening to a podcast w/ Dr Peter Attia he lists 4 reasons for high SHGB
1.Insulin
2.Thyroid Hormone
3.Estrogen
4.Genetics

Edit: I think I’ve answered my own question with some research. (1) Insulin problem can be ruled out based on my lipid panel, (2) Thyroid can be ruled out based on TSH level of 1.9ulU/ml even though that’s slightly higher than ideal (3) Estrogen can’t be ruled out until I get me E1, E2, and E3 levels tested. Does this sound right?

My SHBG is high also (65) but not near as high as yours. I’m 2 weeks into TRT, injecting 160mg a week, no other drugs. I get my next labs in 4 weeks. I’ll let you know how that dose affects me and my numbers.

Best of luck

Another high SHBG guy here. Typically it hovers around 72. In my case SHBG shot up after thyroid treatment. I’m 10 weeks into TRT, initially at 160mg/wk and now 200mg/wk. I’m starting to feel really good. No labs yet but lots of positive changes. It’s worth it! Also recommend Defy.

i read shbg could sky rocket by being underweight or not eating enough. op is 6’155 and said he cant eat enough. isnt this the problem?

How long after starting at 160 did you jump to 200mg weekly?
Are you injecting subq?
How many times a week?

I’m doing 2x a week subq. I don’t think I’ve felt many affects just yet (except libido is increasing which is fantastic to feel for the first time in 2 years) but I am only 2 weeks in.

I’m not planning on changing my dosage until I see my first labs but was curious how folks on similar protocols and lab numbers were doing.

Hmmm, I’m also 6 foot and 150lbs/difficulty putting on weight. SHBG around 80. Is fast metabolism linked with high SHBG? makes sense as hyperthyroidism is linked with high SHBG.

How does defy work? Telemedicine? Basically they send you for labs and then prescribe a protocol based off your numbers without the need for dr’s visit? How much does that cost you? How much is your T? I feel like my doc is really high priced for my T, I pay them and they deal with the compounding pharmacy. Not to mention $350 for every lab & consultation session

I’m 5’11 170, SHBG 65, I workout 5 days a week and avg 18,000 steps a day at work, if I eat more then 27-2900 calories a day I start packing the weight on

I’ll look into this. But I wouldn’t say I’m underweight, since this is where I have always leveled out to. I was thinking about running a marathon this summer so did a ton of running and no weight lifting, dropped down to 143, which was surprising to see. I stopped and started lifting heavy legs twice a week and slugging high calorie protein shakes and am now 4 months later back around 155-160. Getting the calories down is always the hard part for me though.

If you had low thyroid hormones and needed treatment, thyroid medications would only increase SHBG. Estrogen can influence SHBG, but not to a large degree, it has a minimal effect. Once the liver is scarred, SHBG will remain high and isn’t reversible if that is why SHBG is elevated. If it’s genetic then there’s nothing you can do.

I have never known of a single case where SHBG was decrease by more than 15-20 nmol/L through dietary changes, guys start to see Free T affected negatively in the mid to high 40’s, you’re about three times that high.

I believe what happened is your genetics are set for higher SHBG and the years of smoking tobacco added to the severity of your problem. We don’t get many guys in here with SHBG nearing 100, I’ve even seen a guy at 246 and a Total T of 1998, insanely high LH and Free T is in the gutter. That guys screwed because he needs astronomically high Total T to ever have enough Free T without running into high hematocrit issues.

Your estrogen can be ruled out as the cause, even if your estrogen was elevated, it wouldn’t affect SHBG as much as you think.

Defy on average is $100-$150 per month pay as you go, you will have to get a physical before they can treat you, I got at a physical CVS minute clinic.

sorry mate but 6’ 150 is considered underweight or almost normal welght

Thanks, so what exactly does $150mo get you? phone or email consultation, and all T vials? Not additional labs I’m assuming or does it? Do they do hgh?

Absolutely everything, consults, labs and medicine. If you’re not on HCG, the cost will be lower.

Defy has every option available, hgh, peptides, you name it, they have it.

Even at the full 150mon. that is far cheaper than my doc. Sounds like from reading through some of your other posts you are more than satisfied with the Dr you deal with and his knowledge of sex hormone therapy, being able to adjust based on your changing results etc. Is that right?

Do you do hgh? If so is that included in the 150? No hcg for me (at least not for now, hopefully can stay that way) I’m taking it one thing at a time, want to get my TRT dialed in first, but my nutrition and exercise are on point. I would really love to take my physique up several notches