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Low Bioavalable Testosterone, High SHBG (25Y/O)

So I recently got a hormone assay:

Test Result Reference Range
LH 3.6 mU/ml 1.5 - 9.3
FSH 2.7 mU/ml 1.0 - 18.0
Estradiol 36 pg/ml 12.0 - 41.0
SHBG 54 nmol/l 17.3 - 65.8
Total Test. 470 ng/dl 270 - 920
Bioavail. Test. (measured) 0.79 ng/ml 1.1 - 3.1
DHEA-S 359 ug/dl 34 - 569
TSH 3.19 uU/ml 0.2 - 5.0
Vitamin D (25-OH) 67 ng/ml

By assuming Albumin levels of 4.3 g/dl, BAT levels would calculate to 166 ng/dl and Free Testosterone would be at 7.06 ng/dl.

My lab doesn’t check for Free testosterone, so I got the Bioavailable Testosterone (BAT) levels checked instead. What instantly catches the eye is the low BAT level. Is this in any way relevant? My total testosterone levels also seem a bit low for my age.

I seem to have trouble keeping my bodyfat down. I find I am always tired during the day too. (That was even before I knew low Testosterone levels existed, so that’s probably not psychosomatic) I get instantly tired after eating. Seem to lose a lot of strength (muscle?) when cutting, can gain weight easily, have been a bit more emotional than usual during the last months, for no apparent reason

Quick infos about me: I am 25 years old and have never touched AAS, Prohormones or any Testosterone boosters.

Maybe someone more experienced in the field of endocrinology or the relevance of free and bioavailable testosterone levels can provide his opinion.

Thank you very much in advance


More about me according to the sticky:

  • Age: 25
  • Height: 190cm
  • Waist: 85cm
  • Weight: 97kg
  • Body and Facial Hair: Chest hair, could grow full beard, full hair on head
  • Where you carry Fat: Rather large fat depot at chest since puberty (Was a bit overweight back then, apparently pseudogynecomastia, no breast tissue! got it checked via ultrasound) which I cannot seem to get rid of, lot of fat on hips (love handles), almost no fat on arms
  • Health conditions: Often restless legs, apart from that none (history: none)
  • Rx and OTC drugs: No hair loss/prostate drugs, only multivitamin and Vit D3+K2
  • Diet: Maintenance at 3000-3500kcal, Bulk 4000kcal, Cut 2700kcal, Alcohol once a month, almost no sugar, Symptoms don’t change with diet. Currently cut with 25% carbs, 45% prot., 30% fat (Percent of calories)
  • Training/Workout: 1.5hrs Resistance Workout 3-5 times a week, essentially no cardio
  • Testes Ache: None/Never
  • Morning wood: Became noticeably less, a year ago I began to struggle to keep/get an erection, was partying more back then (Alcohol), not partying anymore; erection problem got better again, but it doesn’t seem as hard as it was before.
  • Bodyfat: 19% (via DEXA)
  • Bone Mineral Density (average): 1.27 g/cm^2 (1.18 - 1.36)
  • Spermiogram: 65 Mio/ml ( >= 15 Mio/ml), 71% WHO AB (>= 32%)

More Blood tests (Was a few weeks later):

Test Result Reference Range
Sodium 141 nmol/l 136 - 146
Chloride 103 nmol/l 95 - 110
Calcium 2.30 nmol/l 2.20 - 2.56
Iron 96 ug/dl 59 - 158
Erythrocytes 5.23 T/l 4.4 - 5.8
Hemoglobin 15.6 g/dl 13.5 - 18.0
Hematocrit 47 % 40 - 52
MCV 89 fl 78 - 98
MCH 29.7 pg 27.0 - 33.0
MCHC 33.5 g/dl 31.5 - 36.0
Leukocytes 3.5 G/l 4.0 - 10.0
Blood sugar 86 mg/dl 74 - 100
BUN 24 mg/dl 8 - 20
Urea 52 mg/dl 17 - 43
Creatinine 1.0 mg/dl 0.8 - 1.3
Uric Acid 6.1 mg/dl 3.6 - 7.2
Bilirubin 1.1 mg/dl < 1.2
HDL 49 mg/dl > 40
CHOL/HDL 3.3 < 5.0
LDL 100 mg/dl < 130
LDL/HDL 2.0 < 3.7
CRP 0.1 mg/dl 0.00 - 0.50

A doctor tested my hormones another time, but not as comprehensive: (Third blood test)

Test Result Reference Range
beta-HCG 0.0 mU/ml
Prolactin 7.8 ng/ml 4.0 - 15.2
LH 7.3 mU/ml 1.5 - 9.3
FSH 2.3 mU/ml 1.0 - 18.0
Testosterone (Total) 5.70 ng/ml 2.70 - 9.20

EDIT: Oral body temperature in the evening: 36.4°C (97.5°F)

Where are you located?

TSH should be close[r] to 1.0
Thyroid lab ranges are very useless.

Your problem could be from an iodine deficiency caused by not using iodized salt. Please evaluate overall thyroid function via oral body temperatures - see below. This is very important.

With such thyroid problems you can have weight/fat gain and low energy, mood/depression/libido problems, even if T levels were good.

TT is middle of range. Elevated SHBG is creating a lot of SHBT+T that lowers FT and inflates TT so that TT overstates your T status just as Bio-T confirms.

High E2 is causing liver to product higher levels of SHBG.

High E2 is suppressing LH/FSH. FSH=2.7 is probably more indicative of your LH status.

FT is low and then FT–>E2 is not high. E2=36 may be showing impaired E2 liver clearance. Some medications etc can contribute to that as well a a liver pathology might as well.

So we need more info.
Also post any other lab work + ranges.

Post your oral body temps [both times of day] and discuss your history of using iodized salt.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

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First of all, thank you very much for your reply!

Located in central Europe (Germany). I translated the blood tests and typed them here for your convenience.

Using iodized salt only sparingly, because I generally don’t salt that much. Didn’t use salt at all during youth, all I got was from Milk/Bread/Ham. I will check oral body temperature and report back asap. EDIT: See original post for evening oral body temperature

Please note that I posted some more info (and bloodwork!) as an edit in the original post.

EDIT2: Added spermiogram results in original post


You need to consider all of the points that I have made and we need body temperatures at times specified.

When you do lab work it is important to not be dehydrated, all the more for fasting lab work, drink water…

Your are training with some degree of thyroid issues and low T. That combination has a well established pattern of leading to elevated rT3 because of adrenal stress and adrenalin replacing natural energy and vitality. See these terms in the thyroid basics sticky: stress, adrenal fatigue, over training, rT3, fT3, iodine, selenium, Wilson’s Book.

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High SHBG is ruining your day by reducing FT, perhaps see if you can find out what’s causing your high SHBG. SHBG is made in the liver so it could be something you’re eating, like plant based diets will raise SHBG, excessive drinking will also increase it. Best advice is to detox that liver and see where you stand.

No need to get FT measured directly as it’s rather inaccurate and useless do to very short half life, calculate TT and SHBG using SHBG calculator. Labcorps bottom of the ranges for FT is 6.8 ng/dL so you’re right near the limit.

Free Testosterone 7.06 ng/dL = 1.5 %
Bioavailable 166 ng/dL = 35.2 %
SHBG calc. http://www.issam.ch/freetesto.htm

Checking body temperatures using a glass thermometer is better than any blood test for indicating a problem with free thyroid hormones, fT3 is directly correlated to body temperatures. If lower than 97.7 upon waking may indicate slight iodine deficiency which is solved by supplementing iodine and selenium or a moderate thyroid issue that requires intervention that iodine and selenium cannot solve alone.

You need to check temperatures upon waking before you get out of bed and mid afternoon (2pm) as temperatures start dropping in the evening. 97.5 suggests iodine deficiency, optimal morning temperatures is 97.7 and 98.6 mid afternoon.

These thyroid ranges rather useless, most progressive doctors begin treating the thyroid once TSH is beyond 2.5 uU/ml, top end ranges are too high. TSH elevates when hypothalamus detects low fT3 or low thyroid hormones.

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@KSman Perfect, I will look a bit more into stress, adrenal fatigue, thyroid in general, iodine/selenium
Concerning the liver clearance: I am not taking any medications. Should I get a (comprehensive) liver function panel? (AST, ALT) Will have to read a bit more into that.

Concerning the adrenal fatigue: There could be something to it. I noticed that my chance of getting a cold/sick seems greatly increased after an intense leg workout. Should I get bloodwork on cortisol?

@systemlord I thought so concerning the measurement of FT. This is why included the calculation in the original post. I am not following a plant based diet and have been drinking only very sparingly during the last year.

Measured my oral body temperatures (used a digital thermometer, no glass thermometer though; didn’t have a glass one, does that make a difference?)::
Immediately after waking up (still in bed): 96.44°F
2pm: 97.34°F

EDIT: I just read that a digital thermometer is apparently useless. Will get a glass thermometer and try again tomorrow then.

Should I get a saliva or serum based iodine test? Would that be enough to tell if I suffer from iodine deficiency?

If temperatures are unchanged no need to test iodine, temperatures will confirm if iodine deficient.

Okay, glass thermometer got me different temperatures:

Immediately after waking up: 97.0°F
40 min after waking up: 97.25°F
2pm: 98.3°F

Seems better. I don’t have cold hands/feet/nose under normal conditions and sweat rather easily with a jacket on and when walking quickly. Doesn’t seem to be hypothyroidism (if it is, it seems minimal). From what I understand, temperatures could be a bit higher, but seem ok? @systemlord @KSman

You have subclinical hypothyroidism, if you believe your temperatures are alright and do not supplement iodine and selenium you will permanently your damage thyroid over time.

That was just my wild, inexperienced guess - that’s why I posed it as a question again :slight_smile:

I’m open to any experienced opinion I can get. So I should definitely supplement both Iodine and Selenium?

This doesn’t explain the high E2 and high SHGB though, does it?


Morning: 97.2°F
2pm: 97.6°F