T Nation

Need KSMan's Help. 27 Y/O. Low Total T, Low SHBG, High FSH


#21

Fyi, you were told to do a sperm analysis because if you aren’t fertile right now there may not be much hope outside of en vitro. You appear to be primary so drugs like hcg and clomid probably aren’t going to have much effect. Hcg just mimics LH. You have plenty of LH so that won’t help. Clomid forces the pituitary to produce more fsh and lh and you have e plenty of both. Once again a dead end. Read the stickies bro… if you follow the trail it all points to trt.


#22

Yeah the semen. Urologist friday and endo in a few weeks should straighten my worries out. I wonder if I have something w aromatase going on coupled with my weight since my shbg is low. Or a adenoma. Idk


#23

You need to screen for diabetes with fasting glucose and A1C as low SHBG can be from that condition, but also not.

Sometimes high or low SHBG is not explainable.

With low SHBG, your %FT is increased and there is less SHBG+T and TT is reduced. So your T status will be higher than TT implies.

With FSH much higher than LH you should have your testes screened for testicular cancer - a young man’s disease. Your screening did not show this.

You have signs of primary hypogonadism, your testes are not working very well. Varicocele perhaps.

Thyroid problems are seen very often here. Most often thyroid labs are normal, but lab ranges are rather useless. Most often problems involve not using iodized salt or other sources of iodine. Families can be affected by not using salt or not using iodized salt.

Find 5,000iu, yes 5000, tiny oil filled Vit-D3 capsules. You body makes Vit-D3–>Vit-D25 that is essential for proper gene expression in your body. Vit-D3 RDA’s will prevent crooked bones in children but the RDA is absolutely inadequate and sub-optima.

Anyone else in your family affected by some of these issues?


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#24

Standard TRT recommendations:

  • many doctors will be contrary

  • self inject 50mg T twice a week, subq not IM, with #29 1/2" 0.5ml insulin syringe to get steady T levels.

  • To get near optimal E2-22pg/ml - 80 pmol/L take 0.5mg anastrozole at time of T injections. Adjust as need after subsequent E2 labs. Needs the steady T levels from above to work properly as a T competitive drug. Read the stickies and understand “anastrozole over-responder” issues.

  • Fertility: 250iu hCG subq EOD to replace lost LH


#25

Thanks for the insight. Hypothyroidism runs in the family on both sides. I researched that it can lower SHBG , my glucose reading wasn’t fasting so I will have to get that retested.
Since LH was normal and the urologist said that it was well within range, Ive read fsh would be raised from variocele , I am worried about fertility as I want a family some day, I need to get my T levels tested again as this was only once in the morning. My urologist is an asshole and is sending me to a endocrinologist andrology specialist. I will have to get semen analysis but Im alittle more optimistic than before since I had karyotype and y analysis done. I wasnt taking vitamins and fish oil before. Heres what Im taking nowas of this week.
Daily vitamin
Vitamin D 1000
Fish oil
Liver health detox complex
CoQ10
Beberine


#26

@KSman do you think that my high fSH might be different if I were to get it tested again? Ive read that it could be a sign of low sperm count but I did not find anything when I looked at low testosterone with normal LH values.


#28

You say there’s a history of hypothyroidism in the family, this would cause SHBG to be low. Thyroid meds increase SHBG. Make sure new doctor checks fT3, rT3, fT4 and antibodies. Body temperatures are the best indication of thyroid status, temps = fT3 result.


#30

That’s hypothyroidism, fT3 is expected to be well below midrange. Expect mediocre results if you decide to start TRT with hypothyroidism.


#32

A lot who come here have more than one issue, there are a lot who have hypothyroidism and a testosterone deficiency or some testicles dysfunction. You seem to fit all those categories.


#33

So I had a convo w Dr Turek on the phone who is one of the best urologists hs his own practice in CA and associated with Stanford University . He said there is only up a 13% chance max that I have a Y chromosome microdeletion w a 7.8% chance it is C deletion. He said my bilateral Varioceles are most likely he reason why I have 0 sperm also interestingly he said my testosterone isnt low , he said the testosterone that matters is right within range , could be tested for thyroid or insulin though. So I have to get a ycmd test and if that’s negative im gonna pursure the surgery… thoughts?


#34

Low SHBG guys tend to have plenty of free T and you are at the right percentage. However if you are hypothyroid that would explain low SHBG, and if thyroid meds are use it will raise SHBG and decrease free T and then you will have a low testosterone.

Most endos get thyroid and TRT wrong, don’t get your hopes up. Do research and make sure you check fT3, rT3, fT4 and antibodies, if any are dismissed by your doctor then it’s time for a new one. Better yet why don’t you order these labs so when you meet with the endo the conversation can be more productive and you don’t have to argue order what labs to order.


#35

Thoughts on the varicoceles?


#36

I posted I had grade 3 varicoceles on both sides… they removed 4 larger total and rest were snaller veins. My sperm was really low 0 first time and 1.0*10^6 retest sperm morphology etc was ok. The doctors I talk to say the varicoceles are the main reason , they say Ive had them since puberty. Retests continues pn everything to see jow succesful it was. It wasnt invasive… micro surgery, subingroinal.


#37

I posted I had grade 3 varicoceles on both sides… they removed 4 larger total and rest were snaller veins. My sperm was really low 0 first time and 1.0*10^6 retest sperm morphology etc was ok. The doctors I talk to say the varicoceles are the main reason , they say Ive had them since puberty. Retests continues pn everything to see jow succesful it was. It wasnt invasive… micro surgery, subingroinal…


#38

That’s awesome to hear bro. Glad the surgery is helping you. Do you have or plan to have any follow up bloodwork for tt and ft?


#39

Will know tomorrow


#40

Going to retest everything probably 6 -9-12 months out.


#41

I got my sperm retested twice before surgery which hopefully the surtwill help my count n my other hormones