Low Free T, Very High T, Extremely High SHBG LH & FSH

Hey guys,

I am a single 33 y/o male who has been battling with fatigue for years, plus other Low T related symptoms as follows:

  • fatigue
  • low mood/depression
  • no motivation
  • no libido
  • no morning wood or spontaneous erections, (i do not suffer from erectile dysfunction)
  • no desire to masturbate (have to force my self to watch porn, get aroused and masturbate).
  • could go without masturbating for 2 weeks before i realise this is not healthy and i need to get off.
  • below average sized testicles.
  • male pattern hair loss (I am not bold but from the age of 27 I have gradually thinned out on top and crown, forehead is receding)
  • I experienced irritability/anxiousness but this has reduced due to 100mg Zoloft ED (SSRI/antidepressant) implemented by GP August 2016.
  • I have always had low muscle mass for my height, skinny arms & legs despite weight training 4-5 days a week and good diet for 2-3 years. 5 Foot 10 and have always been around 68 - 72kg (150 - 158 pounds). Due to not exercising at all and perhaps the zoloft, I have risen to about 76kg at the start of 2018 with 30% BF. Currently I sit at 73kg after doing circuit training that utilises HIIT and functional training.
  • Despite people looking at me fully clothed and saying ‘you are so lean’ or ‘so skinny’, I have always had a high body fat %, around 20%, carried in the breast, lower abdomen, love handles, hips and thighs.
  • I have had gynecomastia since the age of 12/13. Recently seen a plastic surgeon who has confirmed breast tissue is present as well as fat - surgery to remove $6k.

I went to my GP regarding the above in march 2015 and requested blood tests + hormonal & Thyroid blood tests. Fasted morning blood test with the results and the laboratories suggested ranges are below. My GP referred me to an endocrinologist with the symptoms fatigue, low body muscle mass, male pattern hair loss, concerns with high Testosterone, SHBG, FSH & LH. Looking up the endo online he was a well regarded assoc professor etc however they sent me a letter prior to the appointment saying that I would be seen too by an endocrine registrar.

Appointment with endo August 2015: The endo registrar asked me a few questions like how much do you sleep, drugs/alcohol, what supplements do you taken, have you taken steroids, do you snore, what body type do your siblings and father have etc etc. Which my answers were protein powders, pre w/o’s, no to steroids/drugs/alcohol, no snoring, sleep 6-8 hours a night, and similar body shape to my brother and father. She didn’t know what to say or do and left the room to discuss with the assoc professor. They both came back, the assoc professor inspected by testicles, no abnormalities but did say they were below average in size. He said you look fit and healthy, which I then discussed my concerns about trying to put on muscle mass and the amount of body fat I had. He replied with ‘you are fine and not to look into those magazines with buff looking people as they are fake’. He recommend we get the bloods done again and review. Which I agreed. Her clinical notes back to my GP were as follows:

  • On appearance he looks extremely fit and healthy
  • similar body shape to siblings and parents
  • doesn’t drink alcohol
  • not on any medications (I wasn’t on the zoloft at this stage)
  • denies anabolic steroids
  • recent blood tests performed by yourself, supposedly looking for low testosterone, actually show a level of 42, with FSH 24, and LH of 11.
  • Thyroid function was normal.
  • he reports low libido but is able to achieve and maintain an erection.
  • Testicular examination reveals left testicle size of 12mls and right 10mls.
  • I note that the testosterone is slightly elevated at 42 and this could just be normal for the patient especially as he is young.
  • FSH is elevated at 24 and LH is 11.
  • I think this is likely normal however we will repeat these results.

I got a call back from the endo a week later saying that my results were all fine. When I asked him what my Test, LH and FSH were he gave the results to me. I didn’t ask for SHBG or calc free test which I now know I should have. I have since called the practice today requesting my full results and his assistant will ask the endo for permission to release them to me, I will update my results once I get them.

So thinking there was nothing wrong with my hormones I continued on with life and just put up with the symptoms until mid 2016 when I was sick of the low moods/irratability/fatigue/sexual effects. Thinking I was perhaps suffering from depression/anxiety, I went back to the GP ( a new one since my 1st GP passed away). He prescribed me with 50mg Zoloft daily. Went back 6 months later, said I had seen some improvement with the low moods, but the anxiety and fatigue is still there. He bumped it up to 100mg which I have been on since. It has improved the anxiety, I am sleeping better, however still always tired and have the low T symptoms. Went back to the GP last week and requested blood tests with the results below. My GP is not clued up on hormones and referred me to another endo, appointment coming up on the 8th of March. Seems well regarded and in his interests it lists male hormones/hypogonadism.

So, I am just trying to get some feed back from people who have experience with hormonal bloodwork results before my appointment. Mainly so I don’t walk into the appointment being so ‘naive’ and get turned around and pushed away.

I now understand that in regards to being a male, it is the free testosterone that gives us our characteristics not the total. The very high SHBG has all the Total testosterone bound to it, leaving low free/bio available testosterone which is evident in the most recent blood work (299 pmol/L). However, back in 2015 my free test was on the high range of 0.6 nmol/L with range of 0.2-0.6 with a note saying: the free testosterone calculation assumes a serum/plasma. I am confused about this. Also note the bloods were done by 2 different pathology laboratories which is why one of the results was in nmol/L.

If my Total Test is so high, why is my LH & FSH extremely high, shouldn’t the pituitary gland be receiving the message to stop resleasing LH & FSH and hence the testes will stop producing Testosterone?

Also, as a male, do I have any concerns with my Oestradiol being 143 pmol/L with range 40-200. Even though it is in the range, is it high for a 33 yo male??

I have also read that TSH should be closer to 1, even though at 3.2 it is in the range, and how is this treated.

What other information should I know before going into the appointment and other questions I should ask, no doubt he will send me off for another blood test to confirm the initial test.

Any comments/advice/help will be greatly appreciated, I’ll keep you all updated after my appointment.

03/2015 = 3.2 mIU/L - Range (0.5 - 4.0)
02/2018 = 3.2 mU/L - Range (0.5 - 5.0)

Free T4
03/2015 = 15 pmol/L - Range (10 - 25)
02/2018 = Not tested

Testosterone ( I am assuming this is total testosterone)
03/2018 = 42 nmol/L - Range (8.0 - 30.0)
08/2015 = 23
02/2018 = 30 nmol/L - Range (12.0 - 32.0)

03/2015 = 79 nmol/L - Range (10 - 45)
02/2018 = 98 nmol/L - Range (17 - 56)

Calc. Free Testosterone
03/2015 = 0.6 nmol/L - (600 pmol/L) - Range (0.20 - 0.60)
02/2018 = 299 pmol/L - (0.299 nmol/L) Range (260 - 740)

03/2015 = 11 IU/L - Range ( < 10)
08/2015 = 12
02/2018 = 15.6 U/L - Range (1.5 - 8.5)

03/2015 = 24 IU/L - Range ( < 12)
08/2015 = 17.9
02/2018 = 23.4 U/L - Range ( 1.5 - 12.4)

03/2015 = Not tested
02/2018 = 143 pmol/L - Range (40 - 200)

03/2015 = 310 mIU/L - Range (85 - 500)

Other tests including Gen Chem, Iron Studies, Lipids & HDL, CK, CRP, VIT D, B12/Folate, Haematology, ESR all came back sufficient and within normal ranges.

Is Zoloft the only thing you are taking? Meds increase SHBG. Finasteride, Benzos, Pain meds.

Yours jumped quite a bit. Are you doing keto or anything like that?

Thanks for your reply alphagunner, yes Zoloft is the only med I’m on.
It does jump a bit however it’s over a period of 3 years so I’m thinking the SHBG is steadily increasing naturally? For the 2015 blood test I was not on Zoloft.

Not doing Keto, just a normal balanced diet, with minimal sugars.

SHBG should only “increase naturally” as you age and have higher estrogen levels. But your 30. It shouldn’t be fluctuating that much. Id look into it more. See if you can drop the Zoloft. If not directly, it may be blocking pathways in your liver and causing it to be inflamed increases shbg

These SSRI’s can raise SHBG levels, don’t kid yourself there’s nothing natural about it.

Hi @systemlord, from my blood test back in 2015 prior to being on SSRI’s my SHBG was already elevated at 79nmol/L. Even though they may elevate SHBG levels, I don’t think they are the initial cause to my problem. Just waiting at the endo now. Hopefully he has answers.

So I had my endo appointment yesterday and I’m really happy with how thorough his examination was. He looked into the past and current blood tests and said there is something there that is obviously not quiet right.

We discussed the symptoms, and when they began, and what may have triggered them. In my early 20’s I had plenty of energy and my libido was fine. No case of mumps as an adult or a severe viral infection, so we are in the dark as to why my hormones have declined.

He took on board that I was never really able to gain muscle mass despite weight training and good diet. He asked when I went through puberty and when i stopped growing, which I believe puberty began when I was well into 13 years of age, almost 14, but not too sure when I stopped growing. Also in regards to facial hair, it is very patchy and it didn’t really start to grow until about mid 20’s, no hair on my chest or back. He measured my height and wingspan and found I was 2cm wider than I am taller. He examined my testicles and said they were below average in size, 10ml and 12ml. On average, testicles are around 20mls in size. He also noted the Gynecomastia since puberty. I believe he has some concerns that I may have Klinefelter Syndrome as all those signs point to it.
Looking it up, the only symptom I don’t think fits in with me is learning difficulties at school. I finished high school and graduated from university in a mathematial/science based degree. I didn’t have ADHD, however I do lack concentration which I believe hindered my results in high school. Looking back now, I think I could have performed a lot better if I tried/applied myself better.

He is open to TRT and we discussed how it can cause infertility issues down the track. He has sent me off to have a sperm count done. If it comes back that I have little to no sperm he will test for Klinefelter’s Syndrome. He didn’t discuss treatment options yet.

I will go in to give my semen sample early next week, await the results and see the endo again.

I realise this is a little old now but you’re bloods are incredibly similar to mine. How are you getting on now? Any breakthroughs?