T Nation

Low Free T Due to Normal TT but High SHBG & Albumin

Hi,
I have a problem for which seemingly no solution and not even an explanation exists: normal total testosterone, but low free & bioavailable testosterone due to high SHBG and Albumin.

My blood levels in short:

  1. Low normal total testosterone, high SHBG & Albumin , therefore low free & bioavailable testosterone, low free androgen index
  2. TSH sometimes high , sometimes normal. fT3 normal, but not optimal. fT4 low . No thyroid antibodies. Thyroid volume is low (right 7ml + left 3ml = 10ml), “harmless cysts”, sonography shows no signs of autoimmune thyroiditis.
  3. High progesterone (depending on the used reference range; mine seems too narrow)
  4. Low estradiol
  5. LH seems fine, FSH rather low
  6. Cortisol seems fine, only slightly high once
  7. Lipids are fine
  8. GPT slightly high only once
  9. Prolactin, IGF-1, STH seem fine
  10. Some values seem to correlate: especially SHBG and total testosterone. I had relatively high total testosterone once, but SHBG also climbed to about 140% . This was also the only time where my estradiol fell in the optimal range - it was twice as high as my usual levels. Also my fT3 was almost in the optimal range (upper third).

Free testosterone

  • Afaik it’s not 100% certain that the “free hormone hypothesis” (only free testosterone can be used) is true
  • For example, I also read that SHBG protects testosterone from being metabolized too early and that a slightly high SHBG is good. Or that the effects of total and free testosterone differ : total testosterone affects libido, drive, mood etc, but free testosterone is necessary for gaining muscle.
  • But there are also at least 2 studies* that show exactly that : androgen deficiency symptoms are possible when somebody has normal total testosterone, but low free testosterone
  • therefore I also think that free testosterone matters (even if SHBG protects testosterone etc)

Reference ranges:

  1. Free testosterone : 0.174-0.672 nmol/l or: >0,25 nmol/l or: >0,2 nmol/l
  2. Bioavailable testosterone : 3.68-15.3 nmol/l or: >4,37 nmol/l or: > 4,54 nmol/l
  3. Free Androgen Index : 35-150
Date Total T SHBG free T bioavailable T free androgen index
04/2016 15,97 nmol/l 41,8 nmol/l 0,23 nmol/l 6,31 nmol/l /
06/2017 20,2 nmol/l 49,6 nmol/l 0,26 nmol/l 7,18 nmol/l 40
05/2018 20,9 nmol/l 48,4 nmol/l 0,27 nmol/l 7,55 nmol/l 43
01/2019 26,5 nmol/l 65,0 nmol/l 0,29 nmol/l 7,85 nmol/l 40
01/2019 16,3 nmol/l 51,3 nmol/l 0,20 nmol/l 5,66 nmol/l 31

Estradiol

Reference range : 11-43 pg/ml

My values :

  • 2017: 18,5 pg/ml

  • 2018: 14,8 pg/ml

  • 2019: 28,7 pg/ml

  • 2019: 11,70 pg/ml

  • Afaik E2 should be between 20-30 pg/ml -> I only fell in this range once , when my total testosterone and SHBG were also high

  • My other values are rather low and the last one is at the lower limit

  • Average E2 for <29 yrs is about 25 pg/ml . Levels below 20 pg/ml have negative consequences for bones, levels below 12 pg/ml cause a 3 times higher death rate.

  • I think, my E2 was measured with the wrong method (not sensitive test), so my “true” E2 values could be even lower .

  • I think, these levels are low enough to cause their own symptoms (independent of low testosterone). Some of my symptoms that could be due to low E2: very dry skin, eyes, lips . Hot flashes. Cracking joints. Low libido.

  • In one study people who had normal total testosterone but low free testosterone also had low E2

  • Testosterone has a higher binding affinity to SHBG than E2 does. But could it be, that due to my high SHBG my free E2 is below the reference range?

  • The only way to raise E2 seems to be raising testosterone

Questions

  1. Do you think my levels of free & bioavailable testosterone and estradiol are a problem? I have some testosterone and estrogen deficiency symptoms (some are more intensive, some less).
  2. Assuming diet, sleep, exercise etc are good, is there even anything I could do about it, aside from proviron, TRT, ostarine or clomid?

*References:

  1. https://www.ncbi.nlm.nih.gov/pubmed/29235134
  2. https://www.ncbi.nlm.nih.gov/pubmed/26909800

Yes.

You could try a few things, VitD, Stinging Nettle, Fish Oil supplements. Increasing protein and fat, though visceral fat leads to insulin resistance, which lowers SHBG. Low DHEA has been linked to high SHBG, you could look into that.

Correct, you need TRT or not only are you susceptible to the diseases associated with low testosterone, but also low estrogen.

TRT has the ability to decrease SHBG like no other form of treatment, excess androgen lowers SHBG. Free androgen index is a useless test, no one uses it to guide decisions, not even doctors.

It’s one of those labs that needs to disappear and be forgotten.