T Nation

New to TRT, Lab Results & Protocol Advice

My family dr is admittedly not too familiar with TRT beyond prescribing shots. However he’s open to my doing research and figuring out what works best for me.

I am a 35 year old guy I suffered for a number of years before addressing the issue. Low libido, no energy depression etc.

My test levels were right at the bottom of the scale… however they were within the scale so other docs figured it was ok…

Anyway I was started about 2.5 months ago on 50mg Test-E every 3rd day.
I’ve noticed a bit better libido but nothing spectacular and no changes to energy or mood…
I’ve spoken with a family friend in his late 50s who said the difference for him was mind blowing like being 20 again.

I just recently found out the correct labs to order and did them yesterday. Which would have been at the very end of 3 days right before I took next shot.

I’d like to get on HCG as well as I’ve heard it can help with energy and mood as well as keeping the boys in shape.
Looking for recommendations for protocol is my T doseage high enough should I add HCG and if so at what dose?

Looking forward to some feedback thanks guys

SHBG 12.7 nmol/L
LH 0.1 iu/L
Free test 390 pmol/L
Total test 12.7 nmol/L
Bio avail Test 9.1 nmol/L
estradiol 79 pmol/L
FSH 0.2 iu/l

Your low SHBG is going to make TRT difficult, some low SHBG guys feel little to no benefit from TRT. SHBG is the foundation for adrogen activity, if this SHBG reading was before you started TRT, it will likely decrease further. Things that can lower SHBG is being overweight, excess testosterone and insulin resistance. This is why you must inject smaller doses everyday, the larger the dosage the lower the SHBG.

Thank you for responding, I am definitely not overweight at 6’ 1" and 190
My most recent test that had SHBG prior to starting trt was back in 2014, and showed 14.9 back then so not much different than it is now.

I guess this could be a possible reason for not noticing anything yet.

So you’re saying to split dose even more?, down to daily shots? is there anything else that can be done? workarounds.

Man I don’t want to panic but there’s a lot riding on this working out.

Nonetheless I appreciate the response.

Heres complete lab from 2014 to give a picture prior to TRT… can you see why I was miserable for years…

Testosterone 7.8 8.4-28.8 nmol/L
Testosterone Free Calculated 250 170-630 pmol/L
Testosterone Bioavailable Calculated 5.9 4.7-15.0 nmol/L
Sex Hormone Binding Globulin 14.9 10.0-70.0 nmol/L
When assessing testosterone status,
testosterone and SHBG should be tested on
the same specimen.

Forgot to mention some just have genetically low SHBG, you need smaller shots to allow SHBG to rise some, larger shots will always suppress SHBG some. The higher the SHBG the more it will decrease once TRT is started. My SHBG before TRT was above the threshold of what is considered low, once I started TRT is decrease to the upper teens from the mid 20’s. When I first started TRT I was on 200mg every 3 weeks, this drove up E2 and greatly suppressed SHBG. You need smallee injections every day for TRT to be effective, you might lag for sometime to come and may never fully experience TRT the way your 50+ year old friend did. I’m sure it won’t be long before they have a drug that increases and decreases SHBG. You’re going to need 27 gauge half inch insulin syringes so that you don’t end up running out of your testosterone before your prescription is ready to be refilled, any larger syringe and you waste medicine. There’s always a dead space that exists within the needle, medicine that never gets injected, so you can imagine what using larger needles larger waste.

Thanks for the info. as depressing as it is. I’ve been using 1ml 25g 5/8 needles injecting into my deltoid as I haven’t got any fat there, no problem hitting muscle.
Will pick up smaller ones.
Going to get in touch with HRT Specialist and have thyroid checked in detail as my previous thyroid labs were much like my testosterone ones… Within “Normal” range but right at the bottom.

Is there any benefit to adding HCG to this mess?

Also wondering if switching esters would make any difference with the SHBG?

It’s testosterone (androgen activity) is what suppress SHBG, not the esters.

So can you clarify for me why low SHBG is such a bad thing?
I’ve also read that it can potentially be increased a fair bit by a veggie protein heavy diet. As well as soy products.
A study showed up to a 30% increase over 12 weeks of consuming soy isolate.

I’m still planning on seeing a specialist as well as switching to every day shots for a while.

I still haven’t gotten an answer anywhere if my labs indicate a need for HCG or an AI

Any feedback really appreciated I’m kinda on my own with this and have to educate my doctor.


It’s not always a bad thing if I have anything to say about it from my personal experience. There’s a great variability in the stickiness of SHBG from person to person, some guys with high SHBG don’t have a lot of symptoms in the same range as some else to do that fact that their SHBG don’t rob them of all of their Free T as it does with another guy. You can imagine a guy with low SHBG in a similar situation where his SHBG draws in more T therefore less is excreted into his urine and his Free T is at a level to where he feels some symptom relief. Then you other variables like androgen receptor sensitivity, imagine a guy with SHBG that doesn’t have that much T sticking to it and his excreting most of it in his urine and also has low receptor sensitivity. Now you understand why your friend had such a mind blowing experience with TRT, his SHBG and androgen receptor sensitivity must have been ideal.

I said low SHBG would be difficult, not impossible. Low thyroid function can also lower SHBG. If the veggie protein heavy diet actually worked everyone would be doing it and doctors would swear by it. High soy intakes can also increase the risk for cancer, it has weak estrogen in it. Avoid soy like the plague!

Have a look. https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/