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Low Test, High LH, Low FSH - What to Do?

There are some less than optimal readings with my blood results that I got done. I am 35 and have always been fairly fit and played sports/gym. I have seen a doctor and he said that TRT is an option but I don’t know whether there is action I can take without going down that route. I have read that sometimes its enough just to take clomiphene (or similar).

My first set of tests were done in June 2017, outlined below.
I had other tests done at this time also, lipids etc that all seemed to be inline with ranges that may be relevant but will leave it with these for now.

Test 15.1 (10-35)
Free 245 (225-725)
FAI 33.6 (20-160)
SHBG 45 (10-50)
Prolactin 110mIU/L (<330)

The most recent set of bloodwork done outlined below.
Seems to be slight improvements in the above results but I got a more extensive set of bloods done which shows that LH, FSH, progesterone and Androstenedione seem to be out of whack? Not sure what that means and if things can be done to get them back inline and whether that will have an impact on my test readings which is still on the low side.

Test 16.8 nmol (8-28)
Free Test 317 pmol (243-571)
FAI 43 (38.7 - 91.7)
SHBH 39 nmol (18-54)

Oestradiol 89 pmol (28-156)
DHEAS 6.1 umol (2.41 - 11.6)
LH of 9 (2-9 range)
FSH of 4 (2-12 range)
Progesterone 0.9 (<0.6 range)

Prolactin 168 mIU/L (86-324)
Androstenedione 3.8 nmol (2.1-10.8)

I guess the bit of background that needs to be talked about is that I had elevated thyroid readings which have now corrected themselves through lifestyle changes. Also I know alcohol has a negative affect on test and I would have been drinking regularly and excessively over quite a number of years from early 2000s right up until circa 2016. Binge drinking fairly regularly. I think I put it down to this as the main reason along with stress, both of which I have tried to cut out a lot but I still drink on occassion (too much).

Are you having symptoms / issues that match up with low T or just saw that it was low on the blood test results?

Yes all the usual symptoms. Low thyroid has similar symptoms and I thought it was the reason but that’s cleared and I do feel better but still the symptoms persist.

Tired often, poor memory/cognitive function, lacking motivation/confidence/drive, anxiety, low libido, social skills greatly diminished (anxiety).

Here is the obstacle and the reason for suboptimal Free T, sadly there is not much you can do about it naturally, high SHBG is not reversible and will only increase as you age. A high LH value is attempting to stimulate the testicles in an attempt to increase Total T with the intent of increasing Free T, it will never be enough because LH is already maxed out at the top of the ranges.

The cause of elevated LH is high SHBG and the only thing can can suppress SHBG is excess androgens, it’s TRT or BUST.

This is why SHBG is elevated, the liver is scarred from excessive alcohol. SHBG will continue to increase as you age binding up more and more testosterone. You are attempting to bail water out of a sinking ship.

The testing methods being used are more than likely the direct immunoassay which have been shown to be inaccurate, so your Free T is likely lower. Direct immunoassay tends to overestimate Free T levels.

The Endocrine Society position

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Thanks for the reply.
As you can see from my results my SHBG has dropped from 45 to 39, a bit over 10%.
This has also shown an increase in Free T over the same period of approx 30%, which is not a small increase. So this seems, maybe, to be correcting itself, even though still not where it should be.

My understanding now based on your response is LH is trying hard to stimulate TT which if successful will drop SHBG due to the binding of TT which will increase FT. If that is correct then we can see this action improving from result 1 to result 2. Where does the FSH come into it?

My question is, how variable is this SHBG reading, does it usually never drop in people my age, with a full change around in lifestyle factors will this continue to improve etc?

As a comparison how often does TSH reading reduce from 5.5 to less than 2 with no interventions apart from lifestyle.

Im of the opinion that I can’t expect a total turnaround instantly based on past extended abuses on the body from work (lack of sleep due to getting up at 230am to work out before starting work at 5am, stress, consistently working >80hrs per week over 7 years - 4 weeks on 1 week off, poor diet etc) and play (too much partying when off for that 1 week, continued lack of sleep)

The TRT doctor I visited said its unlikely that this will continue to increase but I’m curious how accurate this statement is in the face of some improving symptoms. Just in the last 6 months I have felt a noticeable improvement but not full of course or else I wouldn’t be writing this. The functional doctor I am currently seeing has given me some supplements which improve “dream sleep” and I have noticed a steady increase in morning wood the last couple months.

I Rarely drink alcohol now, I can’t expect to burn the candle hard at both ends for years and expect it to correct overnight.

I have completed a liver function test 2 years ago which showed good liver function and that was two years ago. From my research ALT is the main marker for liver damage and this is well below ranges.
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In regards to the testing methods and results, yes it may be lower but it also may be higher, I guess the symptoms are the best basis to go off to judge this?

I don’t want to sound like I’m saying what you are saying is wrong, im just playing devils advocate to try improve my understanding.

SHBG was a fluctuation nothing more, biology doesn’t do linear. Tomorrow SHBG will be somewhere else. I hate it when any man needs TRT with such a robust HPTA, the liver is causing all the problems.

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What affects on my readings would using certain creams do:

Elocon Lotion ( mometasone furoate) is a topical (for the skin) steroid used to treat the inflammation and itching caused by a number of skin conditions such as allergic reactions, eczema, and psoriasis. Elocon Lotion is available in generic form.

and

Eleuphrat is classified as a high potency topical corticosteroid . Eleuphrat is used on the skin to relieve the redness, swelling, itching and discomfort of many skin problems such as: psoriasis (a stubborn skin disorder with raised, rough, reddened areas covered with dry, fine silvery scales)

I have been using these creams for many years due to psoriasis and would guess they must have some affect?

Even if it were the creams which I doubt, you can’t stop using the screams do to your skin issues. I wonder how TRT will affect your skin condition, TRT can cause skin conditions such as psoriasis.

TRT affects skin collagen, maybe there is a slim change TRT could improve your skin. TRT has been known to change people skin.