T Nation

Low Free T, Low LH, High SHBG

Greetings from Finland

I’m a long time lurker here and have read the stickies over and over again through the years and searched this forum and countless others in a quest to find a reason and help for my symptoms.

Backround: 33 old male, 83 kg (183 lbs), 178 cm (5 ft 10), bodyfat below 20 %, have been lifting for 10 years and have gone through many bulk and cut cycles in an attempt to gain better body composition, so essentially yo yo dieting. No steroids ever.

Symptoms: Gyno since puberty around 11 – 12 years old (had surgery 2015), fatigue especially in the mornings, trouble focusing, “brain fog”, insomnia, depression, anxiety, almost absent libido in recent years, trouble keeping an erection. Less than optimal results from weight training -> mostly novice lifts after years of training even with an experienced coach. On a side note I have always had somewhat bad hyposmia, can only smell and recognize strong smells like garlic and gasoline. Normal puberty apart from gyno so I guess no Kallmans. Still the low LH makes me wonder…

Meds and diagnoses: Have taken escitalopram for around 2 years 2014-2016 (helped my anxiety, killed my remaining libido), had a sleep study done in 2015 and got diagnosed with mild obstructive sleep apnea that is treated with a mouth piece that was shown in control study to remove the apnea -> no noticeable effect on symptoms. Have taken many sleep meds for chronic insomnia, these have helped and I don’t have to take them every day, only when I can’t get to sleep. I try to take them only when needed. The ones I currently use are zolpidem, mirtazapine and doxepin all in very low doses.

Have had my testosterone levels checked many times because of the gyno and the other symptoms. My TT has varied from low normal to pretty good, how ever LH is always low and SHBG relatively high so free T has been borderline low on every occasion but never below the threshold. Have been told by several GPs this can’t be the source of my symptoms. Recently a functional doc diagnosed me with low t3 hypothyroidism, how ever I was eating keto at the time and was well within the range (labs below) so I was very skeptical of his diagnosis. I intend to take a new t3 blood test after consuming high carbs for a month or so.

Morning temps always around 36 C or 96,8 F. I use Iodised salt and take kelp as a supplement. Fingers are usually cold, have been eating more carbs and this seems to help some.

Chronic constipation. Have had it all my life and I take psyllium husks and magnesium oxide (1 g) every day to keep my bowels functioning. My cholesterol levels are always somewhat low and lately I have been contemplating that maybe these supplements are causing some absorption issues.

Bloodwork (all morning fasted samples):
13 Dec 2017:
TT 19.5 nmol/l (8 – 29)
fT 271 pmol/l (155 – 800)
SHBG 44 nmol/l (15 – 95)
LH 1.08 IU/l (1.5 – 9.3)
FSH 5,9 IU/l (1.4 – 18.1)

11 Nov 2017
CRP 0.5 mg/l (<3)
GT 18 U/l (<60)
ALAT 22 U/l (<50)
TSH 1.97 mU/l (0.4 – 4.0)
T4 free 17.2 pmol/l (10 – 21)
T3 free 4.1 pmol/l (3.5 – 6.5)
Cortisol 309 nmol/l (133 – 530)
DHEAS 11.67 umol/l (4.34 – 12.19)
B12 541 pmol/l (180 – 700)
Hcyst 7 (<10)
Chol 3.9 mmol/l (<5)
HDL 1.2 mmol/l (>1)
LDL 2.4 mmol/l (<3)
Trigly 0.8 (< 1.7)
Uraat 247
Ferritin 122 ug/l (20-250)
Fe 26 umol/l (9-34)
Transf 2.4 g/l (2.0-3.6)
Prealb 0.28 g/l (0.2-0.4)
D-1,25 127 pmol/l (48 – 190)
TFer – Ky 41 % (17 -52)

5 Oct 2017
TT 12.5 nmol/l (8 – 29)
fT 176 pmol/l (155 – 800)
SHBG 43 nmol/l (15 – 95)
E2 0.11 nmol/l (<0.15 for males)
LH 1.39 IU/l (1.5 – 9.3)

21 Mar 2013
TT 17,0 nmol/l (10 - 38)
LH 1,2 IU/l (2,5 - 7)
12 Jul 2013
TT 13,1 nmol/l (8,4-28,7)
fT 19,7 pmol/l (13,3 - 118,7)

3 Dec 2013 (no range given)
TT 20,3 nmol/l
fT 283 pmol/l
LH 2,4 U/l
FSH 6,0 U/l
SHBG 44 nmol/l

What I’ve gathered from all of this is I have borderline low free t due to high SHBG and always very low LH which would make me secondary. I have spend thousands of euros already out of pocket and am very frustrated with the medical community. So far I have not seen an endo since there’s only one in town in the private sector and he isn’t specialized in hypogonadism and I’m afraid it would be once again waste of money. We have a very good public healthcare system if you are clearly sick but with my current levels there is no hope for getting treatment as stated by many GPs already. Any advice would be much appreciated gentlemen. Am I missing something here or is this all in my head? Cheers.

Constipation is common to hypothyroidism and the cold fingers. You could be one of those guys who needs to be near the top of the TT range, just because you’re in range doesn’t mean you’re alright. Your low LH is a smoking gun that something is wrong, the problem is doctors in your country are robotic and fixate on labs numbers because they lack deductive reasoning.

You’re missing rT3, if rT3 is high it can block your fT3 making you hypothyroid. There’s also no way of knowing if you’re converting T4 to T3 properly, your thyroid labs aren’t enough to properly diagnose you. Doctors are cutting corners.

I went to my occupational healthcare practitioner (free) complaining about fatigue and brought up the testosterone blood work I had done. I had requested testosteron blood work before through them but it was not part of their services. To my surprise the doc was willing to consult a public health care endocrinologist. This was a couple weeks ago so I called them back to see if the endo had looked at my results and they just said they haven’t received any answer yet and they think I might be depressed. So I’m not really holding my breath here for a solution.

For the past month or so I have been doing linear programming style training squatting three times a week and really busting my ass in the gym and tried to maintain a slight caloric surplus and I actually think I’m feeling slightly better. I still wake up feeling fatigued as f*** but I have actually felt some libido for a while and my strength levels are better then ever. Still struggling to squat 110 kg for 5 reps so nothing to write home about.

I’m starting to second guess my self. Maybe I am depressed and that’s what f’ing up my hormones? I’m never going to go on SSRIs again but I’m contemplating trying some another type of anti depressant with less sexual side effects. Any ideas?

Finally got a call from the doc today. He had received an answer from the endo which went somewhere along the lines: “I don’t know why the LH is so low - but it’s not that low so nothing to worry about. You should check for hypothyroidism and prolactin and if ok nothing needs to be done. Oh and bugger him about possible steroid use while you’re at it.”

So the doc prescribed a thyroid panel (it’s always tsh and T4 here) and prolactin to be tested. Going to get them checked this week but I know both will come back fine as I have had thyroid checked recently and while not optimal is well in range. Few years ago had prolactin checked and was on the lower end of the range for males. Had low t back then already so no reason to expect results suggesting prolactinoma.

I’m really at the end of my road here - trying not to think about this shit but it’s hard especially as I’ve been having ED issues lately. I’m thinking about trying (this is stupid, I know) to increase my prolactin before the blood test. Logic being that maybe low LH with even marginally high prolactin could trigger a more thorough check up on the pituitary since low LH clearly isn’t enough. Only things that I know of to increase prolactin are ejaculation and possibly high dose D-aspartic acid, and possibly having a baby but I’m not that desperate just yet…

It sounds like they believe your hormone problems are caused by depression and seem hooked on that diagnosis and that you’ll only get better on SSRI’s, not TRT. What a joke!

Your consistently super low LH should be a red flag for your doctors, doctors in your country are pretty useless. You need to locate a doctor who truly specialises in hormone replacement.