New poster, longtime lurker. I haven’t seen a situation quite like mine in the other threads, so I thought I’d create my own. Thanks in advance for reading.
TL;DR: astronomical SHBG, very high total T, no sex drive whatsoever, hCG & AI haven’t worked, should I just add exogenous T?
I am 27, 6’2", 175 pounds, 10% BF, eat clean, and lift six times a week.
I sought out treatment in May due to low libido and found out I have high SHBG – really high.
Total T: 1148 (Ref 264-916)
Free T: 13.8 (Ref 9.3-26.5)
SHBG: 167.0 (Ref 16.5-55.9)
Estradiol: 43.2 (Ref 7.6-42.6)
IGF-1: 234 (Ref 63-373)
My doc started treatment with hCG and a light dose of anastrozole. Two months later, we tested again, seeing these numbers:
Total T: 1828 (Ref 250-1100)
Free T: 174 (Ref 35-155)
SHBG: 112 (Ref 10-50)
Estradiol: 61 (Ref < 29)
My doc felt lowering SHBG and E2 would fix my issues. Thus, he upped the anastrozole dose. He also added Ibutamoren to see if increasing IGF-1 would help. We saw these numbers in October:
Total T: 1989 (Ref 250-1100)
Free T: 193 (Ref 35-155)
SHBG: 110 (Ref 17-56)
Estradiol: 51 (Ref < 29)
IGF-1: 288 (Ref 63-373)
Since then, we have upped the anastrozole dose again (I am now at .5 three times a week) and upped Ibutamoren (now 25 mg/day). And since then, my libido has somehow gotten even worse. It has not gotten any better since starting treatment. I used to desire sex once every 1-2 weeks; now, I never desire it, and it feels like a burden trying to have sex.
I’ve read a ton of back and forth about AIs. Some doctors (like Nichols) say we should never use them, while others (like Crisler and Saya) say they’re appropriate in some cases. It seems to me that they’re most often appropriate for individuals who are overweight, which I’m not.
Nichols would say I should drop the A.I. and give my system exogenous testosterone, but my Total T is already quite high and free T is moderately high as well. Scratching my head.
My current thought is that I may:
- Decrease (but not entirely eliminate) my A.I. usage
- Start a low T dose (maybe 200mg cyp)
What do you all think?