Odd blood results, not sure of what to make of it.. help?

Hey all, wanted to preface this as I was on TRT in 2022 following previous blood results showing low free T and high total T. I was on test cyp injection (125mg/week) and HCG 250iu EOD. I started losing hair so I got off. I ran clomid + HCG for a few months then stayed off everything for many months. In 2023 I had a highly stressful period of life (abnormally high). I lost a lot of weight towards November-december of last year. I wasn’'t lifting or dieting trying to lose weight. I went from 195 to 179 with no muscle. Since jan I have been back in the gym lifting heavy and I’ve gotten my BF levels to maybe 13% at a fairly lean build. I am 6’0 and 181lbs. I am dieting and getting about 0.8 * weight in protein from mostly meats/fish and some protein shakes. I also take lots of vitamins and I am an amateur boxer as well. Anyways, I had recent blood work done. I ran HMG and enclomiphene earlier this year to try to boost my test levels as I was having some ED. Anyways I don’t really want to be on TRT at the moment although I am not opposed to it eventually. But I just got a fairly extensive blood work panel done and am unsure on how to read it, maybe someone can help and can let me know. Would my only solution long term only be TRT? is there anything else I could maybe do? Also looking @ my TSH it maybe indicates hypothyroid, would Synthroid fix my test maybe if its a pituitary issue? I was told maybe I have a tumor on my pituitary maybe but I am gonna speak to an endocrine doc about this soon.

I will include the things that showed abnormal as well as hormonal results:
Creatinine:1.32 (probably creatine powder I am taking)
Alkaline phosphate:143
Free test:7.1 (low)
Total test:578
TSH:6.82 (high)
LH: 15.5 (high) * I ran some HCG a week or so before taking the test, would this influence my blood LH levels being this high?
ACTH plasma:3.5 (low)
Cortisol:4.9 (low)

How do I interpret these and is TRT the only option? Could I just do hcg/clomid? Any help appreciated!

This is not a long-term solution, most guys that start clomid go on TRT at some point. You have somewhat highish SHBG, so clomid will increase it keeping Free T lower.

This is indicating testicular failure or a pituitary tumor. A pituitary tumor could raise the stimulating hormones for TSH and LH and also lower cortisol.

Pretty much, unless of course, you do have a pituitary tumor and get it treated.

My endo had prescribed me corticosteroids in the past but I didn’t take them because of the side effects I saw online. If I took these because of adrenal insufficiencies would it fix my hormonal issues you think? Also is there any kind of other stuff besides TRT that I could take to lower my SHBG & say I do have a pituitary tumor, if I had that removed would my body go back to normal homeostasis? I mainly want to remain fertile, not lose my hair and not get more body hair but I also don’t want to experience low T symptoms like ED.

No, androgens lower SHBG, and in fact some men end up with high SHBG due to declining testosterone. One of the most common occurrences on TRT is decreasing SHBG compared to baseline.

Lowering SHBG doesn’t increase testosterone, LH and response to LH by the testicles is the only mechanism by which testosterone increases.

Lastly, hCG doesn’t increase LH, it suppresses it.

So would that make HCG to be a potential treatment as standalone?

Correct, if you can tolerate it. Remember, LH is pulsatile and hCG is not. The LH receptors were never meant to be stimulated in this manner.

What do you think about low dose test gel? I want something more hair friendly and not have to take finssteride…

Or maybe another suggestion?

Topical treatments for high SHBG is a no go. Topical treatments don’t affect SHBG much at all.

Topical treatments are not hair friendly. I wouldn’t even consider Finasteride!