T Nation

Overcoming Very High SHBG With More Testosterone?

Hey guys,

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.

Original bloods:
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:

  1. Decrease (but not entirely eliminate) my A.I. usage
  2. Start a low T dose (maybe 200mg cyp)

What do you all think?

I wouldn’t normally recommend a 200mg weekly protocol, but in your case that’s exactly what you need. Amazing that Free T was over the ranges when SHBG was 110, it means your SHBG isn’t very sticky and that’s a good thing in your case.

HCG can increase estrogen more than TRT alone. AI’s can’t affect estrogen produced inside the testicles which is what HCG does.

If you are having issues with estrogen, perhaps 100mg twice weekly is needed. Do without the AI and adjust dosage to increase/decrease estrogen, if that fails then an AI may be needed.

What was the HCG dosage?

Thanks for the response. I think that 200mg weekly protocol will indeed be my move. The high Free T number is baffling to me, given my SHBG and symptoms. I’ve been thinking, how the f*** do I have this much bioavailable testosterone and still have zero sex drive?

The HCG dosage has been 300 IU SQ three times weekly since I started. Fertility is a factor for me, for what it’s worth.

Do you think there’s a reason to continue Ibutamoren? It’s pretty costly, so if it’s not really an important factor, I’d rather drop it.

Also, any specific reason you’d recommend 100mg twice weekly over more frequent dosing? Nichols advocates for daily application of scrotal cream.

HCG doesn’t stimulate all hormonal pathways, it suppresses half of the testicles and typically doesn’t work in the place of TRT. If your estrogen wasn’t an issue, I would have recommended 200mg once weekly. Splitting the dosages up lowers estrogen.

I was on ipamorelin for a couple of months which didn’t work, my wallet is heavier now. You won’t find many men on creams, not when injections provides more muscle mass in the lower extremities versus tropicals.

CONCLUSIONS: Intramuscular TRT is more effective than transdermal formulations at increasing LBM and improving muscle strength in middle-aged and older men, particularly in the lower extremities.

Reviving this thread as I’m attempting to discern the dosage of cream I’m taking in layman’s terms.

I was prescribed 200 mg/ml topiclick cream (.25 per click). Thus, four clicks is 200 mg. I’ve been doing 2-3 clicks/day, every day, applied to the balls.

I know absorption rate differs from person to person, and from site to site, but I’m trying to gather how this translates to injectable dosage – for example, when guys say they’re on “250 mg T-cyp per week.”

I want to make sure I’m not taking some astronomical amount of T, like a steroid cycle. ANY insight you could offer would be amazing.

You may need a supraphysiological dose of T to overcome high SHBG, you shouldn’t be concerned with Total T as it’s bound to SHBG and therefore not bioavailable, Free T is the stuff that interacts with your receptors.

You can’t compare dosages between trandermals and injectable testosterone, one is 100% absorbed and the other is an unknown. One is attached to an ester and that other is not.

Man that’s awesome I’ve heard great things about this. Did you switch to Nichols? Allot of guys had issues with Injection for whatever reason and after using the cream for the boy, they say they finally feel good and no other meds needed.

I’m pretty sure If it says 1 click = .25 then 4 clicks is 1mg . You sure that’s not 25mg per click.

Interesting. I’m just hesitant to go too high because of all I’ve read online warning that going too high can impact longevity. I want to improve symptoms (and, so far, they have gotten better!) and get everything I can from TRT, but I don’t want to shorten my lifespan.

Edit: But it sounds like you think that concern might be overblown?

Thank you! I did not switch to Nichols, but I have spoken with him a few times before and have followed a lot of his information online – good stuff. It says:

“Each mL contains: Testosterone 200 mg in a Transdermal base
Each 1/4 turn dispenses: 0.25 mL”

So I’m pretty sure each click (1/4 turn) dispenses 50 mg.

Curious: why don’t you like that idea? Seems way more appealing to me than injections (and travel/transport is a lot easier). Only downside is needing to shave down there! Oh, and the cost – I’ve read that creams are more expensive.

I have insane SHBG levels, you but you have REALLY insane levels. I understand your cautious approach, and I wish you the best, but in my non-medical opinion, I’m not confident that 25mg EOD will help you.

I take 100mg (50 am, 50 pm), and like I said, your levels are higher than mine.

Ulta Wellness has a " [Estradiol, FSH, SHBG, Testosterone Free and Total]" panel for $129. FSH isn’t really needed, but is included in this pricing group. You should test after 30 days on Danazol. IF you do not decrease by HALF, you need to use the labs to motivate your doctor into an increased dose.

He might want to see a CBC blood test as well to see liver markers … it is $12.95 more.

If you REALLY want to know what is working, get the blood tests.

Best of luck.

PS: I didn’t know that 25mg Danazol Existed! I learned something new.

My stance on creams have changed now that I’m using it myself. It’s the best out there. It absorbs quickly and gets levels higher than what i can achieve with injections. All in man. I think you should try it if you have high shbg.

He would probably have to use WAAYYY to much gel to over come that SHBG.

The problem with creams and high SHBG is levels never stay elevated in a given 24 hour period, injections does keep levels elevated 24/7.

Cream not gel. Totally different. One can be put on the body anywhere the other goes directly on the scrotum. It’s way better imo and levels stay high when you dose twice daily @systemlord I haven’t seen anywhere they say otherwise. Would like to see anything that shows that.

My last blood was done 2 hours after dosing and I was super crazy high … shows it absorbs quickly.

Interesting. Although I dislike needling myself, I really think I would hate having to put cream on my nutsack every day.

Haha that’s what I thought. It’s really not that bad when you look at the benefits. It dries quick to.

I just like knowing my levels constantly go up with my dose and don’t have to wait a couple months to stabilize every time I make a change.

Not sure if you were directing that to me or another user, but I have been on cream since the start of TRT. I have not done injections.

I am using 4 clicks, 2 AM and 2 PM. Starting to feel amazing! We are using cream partially because it allows my doctor to prescribe this higher dose.

Awesome it’s aloha who I responded to.