T Nation

Low T, Low SHBG. Recommendations?

29 year old male suffering from low libido, fatigue, lack of motivation, etc. I also have been gaining weight the last couple of years and currently have a BMI of 29-30. I am around 6 feet tall and about 215 pounds with estimated BF % of 24-25 percent. Normal facial hair with some recently turning gray. I carry most of my fat around my midsection. I have a recent history of some anxiety since these other symptoms have started as well. I used to be very active and play many sports but recently haven’t been as active due to my job, lack of motivation, and significant joint pain. Diet fluctuates and is usually relatively healthy but not always. My liver enzymes have also crept up with my weight and was diagnosed with a mild fatty liver via ultrasound about 2 years ago. Other than that I have been healthy and the only medications I have taken are Xanax for anxiety and protonix for an ulcer.

Due to my increasing symptoms I went to get my thyroid and T levels checked

             I originally went to see an endocrinologist and here are my results from june 2018
	Total T: 182 (139-771)
	Free T:  8.1 (5.1-41.5)
	LH 4.4 (1.7-8.6)
	FSH 3.7 (1.5-12.4)
	Prolactin 11.9 (2.1-17.7)
	Thyroid Peroxidase AB: 10 (STD range 40)
	Free T 4:  .84 (.71-1.85)
	Free T 3: 3.47 (2.5-3.9)
	TSH 2.14 (.45-5.33)
	SHBG:  13 (11-56)

Original Endocinolosit did not want to prescribe any TRT at this time. He stated that due to I did not need supplementation due to my low SHBG.

Symptoms continued on and I followed up with a men’s health clinic 2 weeks ago. He only drew two labs at original consultation
Total T: 107
PSA: 0

His recommendations at this time were to start HCG and an estrogen blocker. I do plan on having kids and fertility was in the thought process at this time.

What are your opinions on this route? Anyone have success stories? I was also curious as I have been having significant joint problems and pain recently; Has anyone had significant improvement of this with normalization of hormones? I have heard some good things and some bad things about this route but from my understanding other than some suppression of FSH and LH that could be resolved once stopped side effects of this should be minimal.

If this does not work would you recommend starting T replacement with HCG and estrogen blockers: what doses should I look at being started at?

Benzodiazepines lower testosterone, taper off that Xanax under your doctors supervision. I was also a benzodiazepine user and these medications damage the pituitary gland which secretes luteinizing hormone that stimulates the testicles to produce testosterone.

Your previous doctors statement about testosterone being lower is alright do to lower SHBG is without merit. Studies show levels below 440 ng/dL is associated with cardiovascular disease, so your previous doctors lack of action is troubling.

You may struggle with TRT do to low SHBG, low SHBG men can have a hell of a time trying to control our free hormones, something low SHBG men have a ton of in the form of free testosterone and free estrogen. Being overweight doesn’t help your case and as a matter of fact it will increase your estrogen as aromatase enzymes live in fat tissue, the enzymes responsible for conversion of testosterone into estrogen.

If you decide on TRT in the near future I would recommend (daily dosing/EOD minimum) against large and frequent injections, otherwise free hormones will be difficult to control.

Lower SHBG men tend to do much better on more frequent dosing, while my SHBG isn’t as low as yours, I do pretty good on an 20mg EOD protocol, if the dose is any larger, Free T, estrogen and Free E2 are out of control.

You won’t find anybody on HCG monotherapy as you cannot always optimize testosterone, anastrozole can’t affect estrogen produced inside the testicles forcing you to lower your HCG dose to lower estrogen, therefore having to decrease your testosterone levels.

There are lots of men on TRT and having babies, adding HCG and especially FSH injections to your TRT protocol works well to increase sperm production.

Look, man. You’re 29, you’re taking benzos, you have an ulcer, you’re gaining weight, you have a fatty liver - you can’t say “other than that I’ve been healthy.” You are unhealthy, by virtually every metric. Take three months. Drop the Xanax, stick to a healthy diet, exercise regularly. If your symptoms are still there despite all that effort, you may have a legitimate problem.
But you’re asking for permission to fuck around with your endocrine system while admitting that you’re not exercising or even trying to. You have options that don’t involve being on TRT for life, especially at your age.

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This is good advice^.

Tough love. He’s 100% correct. When you get older this shit causes permanent damage after years of abuse. You really don’t want to be on trt for life if it’s avoidable.

Getting of benzos is hell. But at your age it’s more than doable. I got off opiates at your age. I was fine. It’s much harder after 35 or 40… way harder.

Find a detox if your addicted. I would first drop as low as I can go, then I’d find a rehab and get clean. Otherwise it will be hard… drug addiction is no joke. You need professional help. Don’t try to do it on your own will power alone.

There’s a saying “a normal user of drugs or alcohol doesn’t think or tak about stopping their usage , they jsut do it and life goes on”. I’m not that guy. I’ll talk and think and talk some more .

Treat the the crud of your problems not the symptoms . Good luck

I take Xanax periodically maybe one too two pills per month at a dose of .25 mg for anxiety. I have to believe at that frequency and dose its very highly unlikely to be effecting my testosterone that significantly. Ulcer was when I was in grad school from the stress. I take the protonix prophylactically to prevent another from occurring. I mentioned in the post I have had joint problems. Each time I try and get back in the gym the joints flare up and makes that difficult. I have put forth effort in the gym but old knee injuries from football are my main problem and make it difficult to sustain any kind of regimen.

When I had the testosterone reading of 186 I was about 205 pounds and had been exercising more than I am now.

I know that @flappinit was pretty direct in his post, but as others have already stated he’s right. You have other options. The fatty liver should be top priority right now, as you’re looking at diabetes in your future if you don’t handle up on that. Clean up your diet for a few months brother. And I mean CLEAN it up. Drop as many carbs as you can. Bring protein up to around 180g per day, try to keep carbs at less than 80g per day, and then make up the rest of you calories in healthy fats (omega 3 supps, salmon, etc). Set a caloric intake total of around 10-15% deficit. Once you have the diet on lock down for a few months, start putting light exercise back in the mix. You don’t have to go balls to the wall here. Keep it light and shoot for rep ranges at around 10-12 for 3-5 sets.

Take it slow and run this like a marathon brother. Get lean and then re assess from there.

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