T Nation

Newbie Needing Starting Advice

Hi everybody! I will try to keep this as short as possible to give you an overview over my problems: I am 33 years old and have been experiencing sexual problems the past 2 years. My libido is pretty darn low and erectons als significantly weaker. I have been single and alone now for close to 3 years and it is getting pretty tiresome. I started collecting multiple blood tests over the past two years. At first I had no clue about all this hormone stuff and thus only went in for Total testosterone measurements. I took like 8 seperate blood test over 18months which revealed my Total testosterone to be like this:

5 times blood taken between 7-9 a.m. : Always came back consistently at around 550-600. Mostly around 580 (reference range 250-830 always).
2 times blood taken in the afternoon: Both times it came back at 350 (same reference range).
1 time it was taken at 6.30a.m. and that time it came back at 700 (250- 830).

I couldn’t believe that as I had very obvious and clear symptoms. On top of the sexual stuff I had lost like 30% in strength. I used to easily benchpress 180-190lbs. but the last two years have struggled to press above 150lbs.

I then started reading more and more stuff about testosterone and decided to take free testosterone as well. Last two blood tests had both total and free testosterone in it:

TT: 450 (250-830)
FT: 11 (10-40)

Then I remeasured but labs forgot measuring free testosterone:

TT: 727 (250-830)
SHBG 76 (15-89)
Free androgen index: 46%

last blood test:
TT: 562 (250-830)
SHBG 42 (15-89)
Free Testosterone: 2.11 (3.4 - 32.3) LOW
Estradiol: 47 (range <40) HIGH

So essentially it seems as if my free testosterone is pretty low , although my total Testosterone has always been pretty solid. I am 6’2/170lbs. so I am not overweight or anything. I live a healthy life, exercise , don’t smoke and rarely drink. I have rarely morning erections—and if so then very weak ones. I tried adjusting my diet and everything but didn’t notice much difference in symptoms. I had a grade 2 left side varicocele which I fixed once at the age of 22 and then at 30 again.

I am not into bodybuilding etc. and am overall happy with everything except my sexual problems. Is it normal to not have good morning erections at the age of 33? I actually have decided to give TRT a shot but am a little hesitant because my LH/FSH levels were always in the midrange of the reference range as well as my total testosterone so that I’m neither primary or secondy hypogonadal but unfortunately it does not translate into my symptoms.

I was thinking injecting 50mg testosterone enanthate twice a week along with 250IU HCG twice a week along with 0.5mg Anastazole (overall weekly 100mg testosterone and 500IU HCG). What do you guys think? Is this a reasonable regimen? I actually want to do that for 2-3 months, gain some confidence back in the bedroom and then go off, hoping that my “system” readjusts and decides to keep more of the produced testosterone unbound. I want to be ultra careful and cautious about everything in order to not mess arounnd with my HPTA too much. Still I’m scared about this, fearing to do permanent damage. Any advice would be much appreciated.

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To start getting bloods in the afternoon are mostly useless.

Something is causing your SHBG to climb, when this happens your TT goes up and FT goes down, just look at your TT in relation to SHBG, high SHBG = mid to high TT. Basically your FT is gobbled up by high SHBG inflating your TT numbers and unless you can find out why SHBG is bouncing around you will need TRT to restore balance.

However if you can find the element that it causing your SHBG to rise (stopping/starting medication) you can skip TRT altogether and restore control of your HPTA system. Start with your liver, what are you putting into it? I believe your liver to be causing the problems, if what you say is true about LH/FSH your HPTA system is fine and your liver is causing the problems.

Are you eating plant based diets on and off?

How far apart are these two blood tests?


I posted this under another thread. Meant to reply here but applies to all.

You need to check your thyroid function. TSH, free r3, free t4.

Thyroid disorder can affect shbg.

I forgot to mention that I tested my thyroid function also but it wasn’t the extended testing but only TSH and FT4 which were both in range. Next week I will get a complete thyroid panel.

My diet is pretty balanced. I tend to eat sweats more often than I should but nothing extreme…keep in mind I am 6’2/170lbs. so not overweight at all. To be honest I have tried different types of diets and found they mad little difference at all. If anything I feel a higher libido on a high fat/high protein but low carb type of diet.

Is it possible to take TRT (100mg weekly along with 500IU HCG) for two months and then get off with a PCT in hopes to rebalance the system so that it stays that way? To be honest I feel like I have tried a lot over the past two years but have not had any success. Could it be genetic alltogether?

If I understand you guys correctly…if I bring my SHBG down, my TT would also go way down , right? Wouldn’t that put me at the same point again?

Should I get anything else tested except a complete thyroid panel?

I don’t take any medication (rogaine foam aside). the last two lood tests were 1 week apart.

It’s nearly impossible to rebalance your liver on TRT, you have one system fighting the other here. According to all labs and the fact you say your LH and FSH are midrange your problem seems to be your liver, not your HPTA system. Lots of guys end up on TRT with perfect hormone levels only to be completely wrecked by high SHBG which is made in the liver, the liver end up being the bad guy and only way to balance it out is TRT. Injectable forms of T do a great job of suppressing SHBG in a way natural T can’t, and TRT can also ruin a guys already genetically low SHBG and make TRT much less effective.

It’s going to take a good doctor to recognise that your liver is ruining your FT by increasing your SHBG, in your case FT is what doctor should be looking at.

Thanks a lot for the input. The thing that is driving me desperate is that there really doesn’t seem to be much of a surefire way to decrease SHBG (TRT aside). I rarely drink alcohol. Last year I had all my internal organs checked out via sonography and the doctor said they were “picture perfect”. Maybe there is something very subtle, I don’t know. I will take an extended liver and thyroid panel next week but I am fairly certain they’ll come back ok.

What do you guys think…is a 2months 100mg/week testosterone along with 500IU/week HCG a real threat to my HPTA axis longterm? From everything I can gather it is pretty low dose and not much danger involved in it if followed by a sound PCT. What PCT would you guys advise after 8-12 months on above schedule ?

There’s no evidence one way or the other that you’ll damage your HPTA, there have been guys on TRT for more than 20 years with no long term damage. I’m not understanding why you think a PCT will somehow fix your liver, a PCT is an attempt to restore your HPTA which at this point doesn’t seem to be a problem. Your liver is the problem. Testing your thyroid is the next logical step since thyroid can also raise or lower SHBG.

No my point is this: As far as I have researched the subject online there does not seem to be a great explanation for why SHBG may be high or low. Sure, SHBG gets produced in the liver so it is rational to think that there may be some sort of problem but I think will be hard to detect. I’ll do a liver panel and thyroid panel next week and post the results but I don’t expect to uncover much. In fact I’ve had my liver sporadically tested every now and then and never encountered out of range numbers for the typical liver enzymes etc.—I’ll give it a shot regardless.

It would be great to find something causal in the liver or thyroid which would be fixable…we will see. I’ll keep you guys updated. Thanks for your replies.

Are you on any medication or have you ever taken medications?

Try a liver detox for high SHBG.

Hey guys! Happy new year to everyone.

Tomorrow I’m going to take a blood test. I’m planning on taking a liver profile as well as thyroid panel. Is there anything else I should take? Before taking any further measures I will post the results here but to be hones I do not expect anything from this test. I live healthily and don’t have any physical trouble other than what is stated below:

As for my current situation. I’m pretty much preparing on going on TRT starting in february. After declining sexual health over the past two years I feel like there is not much left to do. I’m a little bit bummed overall as I have mid to high range LH, midrange FSh, midrange TT (500s) but unfortunately high range SHBG and low range (Even below low range) free T. They symptoms of low T seem undeniable:

-zero libido
-no morning erections
-little night time erections
-dated to girls last year and those problems showed up in the bedroom
-my shaving frequency has gone down noticably from every 3 days to once every 7-10 days
-I have lost considerable strengths in the gym–the 18 year old version of me was able to benchpress easier than the 33 year old version. I have lost approximately 30% in strength.

Sexual issues:
I actually think that the main problem is the lack of libido…when I have a decent amount of libido (which happens once or twice per month! I do have good erections). However, I can easily go 7 days without any sexual activity without the slightest problem. During my 20s I could barely go a day without it. I know that we all age at some point , but this decline has been steep.
The last two years I tried a lot of different things to get things back in line but to no avail. I’ve spent numerous hours searching the net etc. I feel like I have made my due diligence. My father is a doc and I am about to finish medical school as well so I feel comfortable starting the TRT route on my own. I’m currently planning on starting the following protocol in february after my final exams:

1.Testosterone enanthate injections (SQ) twice weekly at 50mg. (overall 100mg per week)
2.Injection of HCG 250IU twice weekly for 500IU overall per week (SQ)
3.0.5mg of anastrazol once a week

My objectives are these:
1.I dont care much about muscles and stuff. I like my body shape and am happy in that regard. I work out 2-3 times a week but don’t plan on becoming buff etc.
2.My main objective is to get my libido back and regain my sexual confidence. After a couple of bad experiences a year ago I lost all confidence. The loniless has been weighing hard on me lately and I want to change this (been single for 3 years now).
3.I don’t think I was ever in the high FT range but throughout my 20s I was really happy with my sex life so I believe that getting into midrange FT will do the trick for me. Thus I want to start as low a dose as possible and work my way up from there (if necessary).

Is this a sound plan?

I will actually re-measure FT tomorrow as well. I have also gotten Vitamin D and Boron along with Mucua pruriens. I want to give these supplements one last try and retake labs in 5 weeks to see if there is any difference there. Like I said, I don’t expect much from it but view it as a last last try. Is there anything else I an experiment with? 12mg of iodine per day?

I’m currently on no medication. I took finasteride 10 years ago for 4months overall but stopped due to fear of longterm sides.

I have taken regaine foam the past 4 years.

Post Finasteride Syndrome. Have you looked into that?

Well I took it for 4 months, but that was approximately 10 years ago…so I had like 6-7 years good function after stopping finasteride…would make it extremely unlikely to be finasteride related today.

PFS is caused by gene expression being damaged I believe. I think its possible that you could have lasting effects.

There’s no hard fast rule that says Post Finasteride Syndrome will happen immediately after stopping the medication, sometimes the damage caused by Finasteride can take years to show the first symptoms if the damage was slight enough to not affect you in the beginning.

Your high SHBG could be ruining your day and wrecking your FT.

I hear you guys and I take it very seriously. That was also the reason why I came off finasteride pretty quickly, too many concerns about longterm health. However , just intuitively I do not believe it to be finasteride related. There were just too many years of strong function and great libido, sex and erections after finasteride imo. There is also no real telling whether anymore whether finasteride is the culprit or not so I guess its kinda moot.
SHBG is definitely a problem here. It just seems that other than a good TRT protocol there is no way of consistently raising FT and improving symptoms.

Might have already thrown this out there, but a liver detox might help you. There are different supplements you can take. Milk Thistle, TUDCA, CDG, NAC.

I just ordered cholin, inositol and methionin for a liver detox. I’ give it a try.

What is CDG?

Which would you suggest.

CDG is calcium D glucarate. I couldn’t tell you which one to do. I had used milk thistle for a long time but it never helped with my SHBG, but kept all my other enzymes low.

Probably better to do a self tailored liver detox.