Naturally High Test & Estradiol, Still Feel Awful

Hello. I’m 37 years old and have naturally high testosterone (usually over 1000 ng/dl) but still feel like shit in general. For the past 6 months or so I have been experiencing some strange symptoms (nipples have a dull surging ache at various times) so I went ahead and started monitoring my estradiol. It is high as well. I will post a year or so of blood work numbers for reference.

My questions are as follows… Why is my SHBG so high and can anything be done to lower it? Am I converting my testosterone to estrogen and if so what is causing this? My endo has me take 1mg Anastrozole whenever it gets bad. It almost instantly make the dull ache in my nipples go away. Is there anything else I can do to lower my estrogen besides taking that medication? Any ideas as to why I feel relatively shitty even though my testosterone is high? Thanks in advance for any help and insight. Oh I also have hypothyroidism and take meds for that if its of any significance.

Total testosterone: (Oct 2020) 1056 (Dec 2021) 955 (Feb 2022) 1035 (Aug 2022) 906

Free T: (Dec 2021) 122.2 pg/ml (Feb 2022) 158.8 pg/ml (Aug 2022) 103.3 pg/ml

Estradiol pg/ml: (Dec 2021) 31 (Feb 2022) 41 (Aug 2022) 40

SHBG nmol/l range 10-50: (Dec 2021) 49 (Feb 2022) 54 (Aug 2022) 52

How’s your libido?

Please provide reference ranges and clean up your units on the TT/fT/E2 tests.

Your E2 (estradiol) doesn’t appear high at all given your endogenous TT/fT levels.

Why would you want to lower it?

Bodyfat level? What is your waist to height ratio?

About 10 million other reasons.

Yes. It is called aromatization.

It is of significance.

Why 1 mg and not 0.0625 / 0.125 / 0.25 / 0.5 mg each time?


Maybe you eat a low carb diet. Maybe you are overtreating your hypothyroidism. Maybe you drink too much coffee. Maybe it’s your genes. What do you think you’ll gain if you lower your SHBG though? All you would accomplish is a reduction of total testosterone.

Maybe there’s something wrong with your diet, sleep, stress, exercise, mental health, microbiome, relationships, nutritional deficiencies, sun exposure, indoor environment, etc, etc, etc.


Libido is very healthy.

Total test unit is ng/dl and the range via quest is 250-1100
Free Test unit is pg/ml and the range is 35-155
Estradiol is pg/ml Range: < OR = 39

I was under the impression that high SHBG means that less of my testosterone is being utilized. Is that not correct?

I don’t know my exact body fat but I stay pretty lean (visible abs) all the time. I’m 6’ and have probably a 30-31 inch waist.

Is the aromatization just an inherent byproduct of having higher testosterone and is taking the Anastrozole to manage it a normal thing and safe long term?

As for the dosage of Anastrozole I believe 0.5 mg each time would be more applicable myself. I’m looking into getting a new Endo and will bring this up and adjust the dosage in the mean time.

Thank you. I really appreciate the help.

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Thyroid medications increase SHBG.

What are your TSH, Free T3 and Free T4 levels?

Genes and body fat influence how you aromatize.

Thanks for clarifying the ranges and units. Good job getting decent fT test through Quest (equiibrium dialysis).

More mythology IMO. Intelligent opinion and clinical data indicate HPTA controls free testosterone (fT) not total testosterone (TT) and SHBG+fT yields TT. Hence, if you waved a magic wand and lowered your SHBG your fT would stay the same and TT would drop. I tried this on myself by using medication (oxandrolone) that lowers SHBG. Some additional comments about this:

@FunkOdyssey also has a much better analogy called the “sponge” analogy (super learning tool) and also look up cataceous over at ExcelMale. He has been preaching about this for years.

Unfortunately the myth that lowering SHBG increases absolute fT has been repeated over and over. I will agree lowering SHBG increases relative percentage of fT (fT/TT) but that isn’t the important driver.

Long term unsure and if it was me I would use the minimum effective dose that would do the job. You may find you could use much less.

Congrats on the low BF.

My pleasure. To your health.


The conventional thinking is that higher SHBG reduces free testosterone and causes hypogonadal symptoms as a result. The Sponge Theory of SHBG suggests the conventional thinking is wrong: SHBG only influences total testosterone, and your body will regulate to its preferred level of free testosterone regardless of SHBG value. Regardless of what you believe about SHBG though, free testosterone isn’t your problem here, because your free testosterone values are high normal. You’re at the top of the range with what looks like Quest’s free testosterone by equilibrium dialysis and your Vermeulen calculated free T is between 16 and 18.5 ng/dL. Those are great values for a natural guy.

I think the folks here could offer better suggestions if you described in detail what you mean when you say that you “feel awful”.


I was under the impression that lower SHGB is optimal as it means more of the total and free T is available. Maybe I have this wrong?

Yes, I definitely have shitty sleep. I suppose that could be the whole issue as far as how I feel on a regular basis.

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This is incorrect, people with metabolic syndrome typically have low SHBG. My SHBG was low (11) pre-TRT and as I’ve improved my health, my SHBG has more than doubled. You even get a temporarily increase in SHBG after weight lifting sessions.

SHBG is thought to activate testosterone at the receptor level.

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I would suggest you pick up one of these:

The oura ring will help you troubleshoot your sleep and make connections between the lifestyle factors that influence sleep and the results. Since they added SpO2 tracking, the ring is also able to diagnose sleep apnea with what appears to be a reasonable degree of accuracy. If you have sleep apnea, treatment is likely to be life-changing.


I suggest a sleep study. I was always on the verge of a nap before getting my CPAP. I attributed my fatigue and fog to hormones but it turned out I was having 90 episodes and hour while sleeping. Get the study… thank me later.


Can you explain a bit more? How do you feel like shit?

This leads me to think that it is less likely your issue is with Testosterone. Possible but less likely.

On a TRT forum, everything looks like it is hormone related (by the people on here, including myself). I’d try to rule other things out. You mentioned sleep. Do you have lots of stress?


Supplements that may help - Boron, Tongkat Ali, maybe Stinging Nettle Root.

Wow. Thanks for this reply. Very interesting info.

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Diet, liver health, overtraining, genetics. Narrow it down.

Was prolactin checked?

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I take Anastrozole 1/2 to 3/4 mg per week week in and week out and have for years.
When I took 1mg/week my Total Testosterone was 1100 and my Estradiol was 8. Yes, 8.
I felt pretty crappy with an E2 of 8.
You sound as though you are really sensitive to E2, and convert T easily, as do I.
An older friend of mine took 0.25mg every 7 days for 4 weeks, and then 0.25mg every 6 days for 4 weeks, and then 0.25 every 5 days for 4 weeks, and for him, 0.25mg every 5 days for 4 weeks, and got the response he was looking for.
This worked for him, it might work for you too.