T Nation

Not Responding to TRT, Low SHBG

Hey guys , i have been long time lurker on these boards, i am 21 year old male and i was diagnosed with primary hypogonadism aobut 3 months ago since my test levels were very low (200 ng dl) and i have all the symptoms of low T.

Before having this diagnose i was tested for thyroids, adrenals, reproductive hormones and i had an HCG test done (my urologist put me on 5000 IU pregnyl for two weeks and then saw that there was no response) also he stated that my testicles were smaller than they should be. So i was put on TRT (sustanon)

Before starting TRT the blood tests showed that i have very low SHBG ( it was 7 from range of 10-70) and my LH was also in the upper high side. Now I have been on TRT for more than 2 months and i feel no improvement at all.

Firstly i began with 125 mg sustanon each week but i didnt experience anything positive from libido, mood, energy perspective in the first several weeks. So i made another test and saw that my T level was very high ( 1500 ) and my E2 was 121. Then i bought arimidex and started taking it at 1 mg a week but that drove it too low, so my doctor adviced me to lower the sustanon and adex doses and now i am taking 100 mg sustanon every 10 days and about 0.5 mg adex divided in those 10 days.

I read that a lot of young men with low shbg are TRT non responders. I am also balding and have a receding hairline from about two years and gyno from puberty like many of them say. The only positive thing that i noticed was muscle mass increase, but without any strength energy or whatsoever increase, only a little bit more fuller.

I wanted to ask those who have struggled with this problem did they see a muscle mass increase when starting the therapy but without other positives, also has anyone tried to increase their SHBG with supplements, diet or anything else ? I have read in some sites that caffeine, soy isoflavones, beta sitosterol, green tea as well as tamoxifen increase SHBG , has anyone ever had success with these ?

Also i have had a glucose tolerance test and it turned out normal so i am not insulin resistant and my thyroids have been checked with ultrasound and the bloods are also fine, so maybe my low SHBG is genetic.

I have low SHBG at 12.
Have seen others with lower, and TRT is very hard on guys with this condition.
Google “low shbg and trt” and you will find a lot of threads discussing the matter.

WRT increasing SHBG, I have tried with t3/t4 and iodine but it hasn’t worked.

WHAT HAS WORKED:

  1. Because you have very low SHBG, your body will dump test quickly to Free T and e2.
    To combat this, you need to use much smaller doses of test.
    I suggest daily IM injections at about 6-9mg per day.

I also found that test prop works better than cyp, but since you are using sustanon I would
stay with that.

There are a few discussions on T-Nation on a few threads below:

https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/anyone_feel_worse_with_higher_t_managed_e2

https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/trt_started_4_weeks_ago

Sounds like one should be checking FT and dosing for high normal. FT may be quite high.

One thing that is odd, TT and FT would be the same if there was no SHBG. So something is odd there. Perhaps your liver is not able to effectively clear T+SHBG from your blood. That leads to checking liver function via AST/ALT and your labs are in another thread.

SHBG is made in the liver and levels typically go up with higher E2. That response may be defective. Higher T levels reduce SHBG. So your assumed high FT may be opposing any increase of SHBG driven by higher E2 levels.

You still feel off … could be E2 or other medical issue.

Actually yesterday i stumbled upon an article saying that fatty liver disease can be the cause of low SHBG, so i am definitely getting my liver checked soon and for the E2 i am trying to keep it under control with anastrozole so i dont think its the problem. I hope i could find test propionate from somewhere, since in my country they only offer sustanon and nebido for trt :frowning:

Sustanon has prop in it.
KSman is correct in that FT needs to be controlled, and its accomplished by using low daily doses.
Stick with the sustanon, just get your free T into range. It may only require a total T of 300 to do so.

I’ve spent a lot of time trying to figure out what causes my low SHBG.
NAFLD is suspect but my ALT is 22 and AST is 26.
My TSH # points to possible Hypothyroid at 2.01, but I have attempted to use Iodine per the thyroid
sticky and it made me feel horrible as did t4/t3 and just t3 alone.

I’ve found a protocol that works for me (daily small doses of prop 12.5mg and 9mg aromasin EOD), but
KS, if you have other ideas I’d love to hear them.

I think sometimes blood tests for NAFLD can not be relied upon and i have read that its best to have an ultrasound done or something similar to confirm whether u have it or not.

As for the sustanon , it comes in ampules and each one is 1 ml so if i use a fraction of it every day and throw the other away its a big waste of money and my doc has said that once the ampule is open and used i can not store it for next day use.

What type of syringe are you using to inject ?
I use 1ml 1/2" 29g insulin syringes. I load 25mg and shoot half one day and half the next.
After the first use, I swab the needle with a sterile alcohol pad, put the cap back on, and
store it in the plastic sleeve it came in. The next day, I swab the needle again (along with my skin
at the injection site) then inject. This gets me two uses of the syringe.

You could also purchase syringes with removable needles.
That way you could draw the entire 1ml into the syringe and then just
replace the needle for each injection. That way the entire 1ml goes into
the syringe at once and remains sterile as long as you replace the needle each day,
and you don’t have a dull needle for injection after a couple days.

I have done that for years as well. No problems. Just do not see the point of going through more syringes. With 1mg vials, you can load two 50iu insulin syringes. See the protocol for injections sticky for more info. But can you get a small insulin syringe with a 12mm needle into the vial?

Maybe i will try injecting sustanon every day, but it will be hard to inject an exact amount as 1 ml has 250 mg , so i will have to inject 0.5 or smthg like that which is hard. I will try with injecting 0.1 ml every day and see how it goes. Approximately after how many days would i possibly notice any change if it works ?

Since its RX I’ll assume it’s Sustanon 100.
So you have a mix of short and long esters. The longer ones will hang on for up to two weeks.

If 125mg per week was putting you at 1500, you should be able to get by on 50mg per week.
I’d use that amount divided into daily doses until you feel better. You will also need to reduce
the amount of Adex you are taking by half.

You should try to get insulin syringes, it will make the dosing my precise and it’s painless.

Yes, insulin needles are perfect for small doses. See that sticky for loading tips. Some products may load slower than others.

PKNY,

In theory, what you suggest does not seem to make sense.

If daily injections of testosterone at 6-9mg did anything to alleviate the symptoms of low SHBG (including excess conversion to E2 and DHT) then other daily dose forms of testosterone should work, including Androgel, Axiron, Andromen, Androderm, Testim and Striant.

The whole point of topical T administration is that only 5-7mg are delivered per day and at a steady rate. Yet, these do not help those with SHBG.

While excess DHT from 5-AR in the skin might explain the failure, the existence of Striant negates that theory. Striant attaches to the gum and delivers T through gum membrane, bypassing the large stores of 5-AR.

As for me, I have suffered from the low SHBG and low T situation since I was 14 years old and am still looking for a way to allow my SHBG to increase. It has been 16 years… and no dice.

Diabetes or metabolic syndrome can cause low SHBG, so get checked for that.

As for T dosage, with your low SHBG you need to be on MUCH lower doses of T. A testosterone level of 600 ng/dL would already put your bioavailable testosterone close to the top of the range, so obviously a level > 1,500 ng/dL is too much and can make you feel bad. High doses of testosterone can also drive your SHBG even lower, whcih is not a good thing.

Man, that was so my case.

A higher level of FT, combined with my low SHBG, made me feel like dog shit.

I’m attacking the problem thusly:

  1. Dialed in diet and exercise plan. T alone wasn’t getting it, time to go old school and sweat.
  2. I am confident when I lose the gut (aka metabolic syndrome), many of my other factors will just simply disappear.
  3. I’ve shed a bunch of weight this year, and already see the change. I’ve tapered by BP meds down 50% and still have great numbers.
  4. Also, as the gut goes down, hopefully the SBHG will increase, allowing me to up my T dose.

Of course, consistent lab work and monitoring will be required.

Good luck to you.

James,
What is your SHBG level ? What have you tried as a work around, and or to raise SHBG ?
Do you have metabolic syndrome, diabetes, pre diabetes etc ?

I’ve never tried straint, but I did spend a year on Androgel with marginal at best results.
BTW, topicals have varying degrees of absorption, and my levels were all over the map
when I used Androgel.

I do daily shots of T, 12.5mg but I use T-prop, not enth or cyp. I’ve used both, and test suspension.
Prop works for me, and my theory is that it’s very short half life expresses its effects fast enough
to get into my cells, but not so fast as in the case of suspension and Androgel (where it’s eliminated
too quickly to having any meaningful effect). Cyp and Enth were both busts for me as they take too long
to express effects using small daily injections. By the time the longer ester is stripped, your total and free
are building to levels that negate the good effects of trt. In comes prop. which give a slightly delayed
release, and a clearance that’s fast enough to avoid high free and total T that
made me feel crappy.

So this is my theory. It isn’t hardened scientific method fact. But, I struggled mightily for years with trt, and this protocol worked for me. I share it here in the hopes of helping others in the same boat.

PKNY,

My SHBG ranges from 9 -13 nmol/L. Fasting insulin and glucose are normal. I recently had a 3 hour oral glucose tolerance test (OGTT) to further rule out metabolic syndrome or diabetes. Both insulin and glucose remained low. It did, however, reveal hypoglycemia. Near the 1.5 hour mark, my glucose dropped into the 50s. I have been experiencing reactive hypoglycemia for years, and this test confirmed the disease. However, the results do not seem to suggest a classical case of metabolic syndrome or diabetes. (Do they?)

As a low SHBG work around, I have attempted to boost T3 with Cytomel at doses from 12.5 - 25 mcg per day divided into two doses. I have no blood labs to confirm an effect on SHBG, but after a 6 month trial, I am assured that this does not make me feel any differently. Further, the 25 mcg dose led to sporadic heart arrhythmia and occasional temperatures of 99 degrees F . Boosting T3 was not unwarranted in my case, because my TSH fluctuates between 1.8 and 5.8 and RT3 is in the 300s. Still, I’m left with no clear path.

I would be willing to try testosterone propionate, but I suspect it will be hard to convince an endocrinologist to prescribe it if my request is based on anecdotal reports that I’ve heard on the Internet.

How do you administer the T-propionate? IM? SQ?

I am currently using 25 mg doses of TC subcutaneously in the glute.

More importantly, do you have any reasoning behind why your SHBG is low? All of the more modern literature suggests that low SHBG is a predictor of a number of diseases, can by itself cause metabolic syndrome, is linked to higher mortality rates, and that SHBG is a key player in the action of androgens and is required to bring T into certain cells and/or to activate the androgen receptor.

James,
Damn bro…I was thinking you may be on the other side of metabolic syndrome with High BG and
insulin resistance. Never thought about it as a problem involving hypoglycemia.

Low SHBG causes are a real puzzle to me. Like you, I have been trying to figure out the cause, and
work around for years. I too tried T3 Cytomel, and it didn’t do anything for me either.
In my case I believe metabolic syndrome is at work, yet I’ve only had a problem with symptoms matching
that for the last few years. The effects of low SHBG have been with me my entire life.

The only thing that has ever made me feel the effects of test is Prop, and I stumbled on it accidentally.
Being on TRT for a # of years, I found that I could grow physically on Test Cyp albiet slowly,
but I didn’t get any of the good feelings associated with it. I did more than a few blast and cruise cycles,
and in one a cpl years ago I tried a blend of Tprop, masteron prop and Tren Prop. I was also
using 500mg per week of Cyp and this crazy libido hit me. Crazy like when I was a teenager
(I’m 44 now). After some research I thought it was the Masteron, (I knew it was the Tren from prior experience).
I bought some Masteron and it did nothing for me in terms of good feelings, libido or erection strength.
I felt like I hit another dead end. A month or so later I started researching Test prop.
If you google it, you’ll find many reports of high libido, great outlook and erection quality.
A few weeks later, I procured my Prop and I’ve never looked back.

I hear ya on asking for Prop based on what some guy told you on the internet, but I’ve come across a few guys here
that were able to talk their docs into RXing it for them. Personally I get mine from the dark side, but that’s
the only way I could get it. It sounds like you have been through the ringer, give prop a try, it could help.

PNKY,

Can you explain how you administer the TP? Is it IM or SQ?

I don’t think I could handle daily IM injections. Too much damage to muscle tissue.

I do IM daily.
I switch from one delt to the other each day.
I use 29g slin pins, I know they do some muscle damage but I’ve never noticed scar tissue
building at all. The daily shot is more a pain than the actual injection.

They very small volume (12.5mg) also seems to keep any inflammation non existent.
I used to inject 25mg EOD, but the larger volume seemed to take longer than two days to
be absorbed, and the injection site would swell a little, I think it was due to the volume.
Plus, the smaller amount leaves less T to spill over into E2 due to low SHBG, and mimics the
natural cycle of T release the body.

I tried the propionate.

Does not work.