T Nation

SHBG High, FT Low, E2 Non Detectable


Hello everybody,
Thank you a thousand times for the information on these boards! I’ve read all the stickies and learned so much.

I’m new here trying to find help for my brother. We live in Europe. In short, this is what has happened to him:

  • used Propecia for 4 months. Then he quit cold turkey because he was on a vacation and forgot to take the pills with him.
  • He had no symptoms what so ever while on the drugs. Only 4 days after quitting, he experienced a sort of derealization (seeing things differently, in 2D, a feeling as if your life is passing by but you’re not in it). Some describe it as brainfog. He became very afraid which ended in severe panic attacks.
  • Now, one year later, he is even worse:
  • severe panic attacks
  • extreme brain fog with derealization 24/7
  • depressed
  • no sexual symptoms like all the other guys with PFS (post Finasteride syndrome). Morning wood and libido is less though, but is nothing compaired to the mental problems.

What we have done so far:
Visit a psychiatrist (diagnosed him with derealization and panic disorder - took AD, made things worse), psychologist, regular visits to GP (says it’s all in his head, does not believe in pfs), mri (was fine), bloodwork at the endocrinologist (see attachment)

-age: 38
-height: 71 inch (1m79)
-waist: 34 inch (86cm)
-weight: 77kg
-describe body and facial hair: normal beard grow, a bit chest hair
-describe where you carry fat and how changed: not much visible bodyfat
-health conditions: before this all started, he was in great shape and health
-Rx drugs: Propecia (Finasteride) for MPB (4 months), stopped 24/12/2014

  • OTC drugs: Calcium, magnesium, Zinc and omega 3 (already told him to stop taking the Zinc)
    -describe diet: eats quite healthy, low carbs, a lot of vegetables and fruit, olive oil, fish and some meat. Zero alcohol, no sigarettes
    -describe training: My brother was quite sportive before this happened. He has an atletic body shape.
    -testes ache, ever, with a fever: Since stopping the Finasteride, now and then one testicle hurts, no varicoceles
    -how have morning wood and nocturnal erections changed: less frequent, but still occurring
  • Lab results: see attachment
  • About his thyroid: I think the results look fine, but his basal bodytemperature is 96.8 . (36 degrees Celcius)

Last week, we visited an endocrinologist and got the results of his bloodwork. The Dr. gave him Testim to try if this does something. He started with this yesterday. We are both very worried about trying new meds bc the Propecia was prescribed by his GP too. :frowning:

In the mean time, the Dr. wants to test his cortisol again, through a 24hr urine sample. Results are for the 3rd of february.

Now, with all your knowledge here … can you help us please?
I’ve read the E2 thread …

  • How to lift his bio-available T?
  • How to lower SHBG?
  • Are herbs the way to go or won’t that make a difference for him?
  • How to increase his E2? He has NO estrogene at the moment.

Thank you,


I really cannot read that lab report and it needs to be rotated. Try two pics of the page.

He will need TRT.

Please read these stickies:

  • advice for new guys
  • things that damage your hormones
  • thyroid basics

Thyroid: Things can go wrong if not getting iodine. Seems that you need to consume dairy to get iodine there. Iodized salt can be found. Some vitamins list iodine+selenium.

  • gets cold easily
  • outer eyebrows sparse?

If he has low thyroid function, which seems to be the case, then he probably will not absorb transdermal T. If so, then self injected T would be the best option. That may be hard to get there.

Estrogens raise SHBG, testosterone lowers SHBG. High normal bio-available T will help. As FT is increased, FT–>E2 will increase.

Sorry to hear about your brother. We have seen this type of thing before. It is a permanent change in gene expression [epigenetic] from the drug.


Here’s another try, hope you can see it now.
His temp in the mid-afternoon is 98,96. His lab results for thyroid are ok I guess? his eyebrows are fine, not thinned.

About the TRT: Do I understand it correctly that the only thing that can help him is Testosteron, transdermal or with injections? So, if the transdermal T gets absorbed, he should feel better? Does he need HCG then too?

I’ve read those stickies … but in the TRT-thread I read lots of things to lower E, while his E has to increase. Are there any drugs or herbs that can:

  • lower SHBG
  • elevate E2
  • elevate T

Thanks for your time!


OMG I did it again! Sorry! Third try …


That is better.

Thyroid ‘appears’ OK. But it is free hormones that get the job done.
But low body temperatures suggest that something is wrong.
We can assume that free thyroid hormones levels are low OR rT3 is blocking fT3
Please see references to rT3 and adrenal fatigue in the thyroid basics sticky.

IGF-1 indicates that growth hormone status is good.

If transdermals work, you are good. Otherwise it is injections.
If T levels are increased, LH/FSH–>zero and hCG can then preserve the testes if that is desired.
hCG often improves mood. It does not matter what T delivery system is used.

LH/FSH appear good, so testes may be the problem.
There is enough DHEA for DHEA–>T inside the testes.

Because fT is so low and he is very symptomatic, he should be on TRT to treat primary hypogonadism.
If he gets to high normal FT and TRT and E2 is managed, he may feel better but in this case, perhaps there will still be some deficits.


[quote]KSman wrote:
Thyroid ‘appears’ OK. But it is free hormones that get the job done.
But low body temperatures suggest that something is wrong.
We can assume that free thyroid hormones levels are low OR rT3 is blocking fT3[/quote]
His fT3 is in the lab report, it’s 5.4 with ranges 3.1-6.8. We have no values for rT3. Should we ask for it when he gets new bloodwork? I’ll ask my brother to temp again and we’ll do the iodine supplementing and see what that does with his body temperature. He does not consume diary since 2 years.

[quote] If transdermals work, you are good. Otherwise it is injections. [/quote] I suppose he needs a new bloodtest then? In what timeframe would you do this? When should he start feeling the effect of the transdermal? (if it absorpts)

Is this according to fertility? I’ll read some more on the HCG and discuss this with his endo.

[quote]LH/FSH appear good, so testes may be the problem.
There is enough DHEA for DHEA–>T inside the testes. [/quote]
Would it be a good idea to see an urologist? And let him do an ultrasound of his testes?

Thank you so much! I’ve seen many, many posts from you … you’re a lifesaver. Did you write the book yet? If so, where can we get it?


That is very difficult to read. Formatting lost in the migration?

Please open up your posts above as an edit and save. That will recover formatting.

With a thyroid problem, transdermal T may simply not work, then its self injections.

Lab report attachments lost, please repost, there is a upload icon in the editor, 7th symbol.

Urologists and endos as a group are rather poor at these things. See the finding a TRT doc sticky that is no longer a sticky :cry:

No dairy removes a source of Vit-D3. You can test Vit-D25 or have take 5,000iu Vit-D3.


I fixed the formatting and I 've found the non sticking stickies again, so I am reading, and reading. Thank you for all that info. The transdermal worries my brother bc it’s very sticky and he’s afraid when his children hug him.

He will ask for the injections at the dr. office. I think it’s best for him to ask for Hcg too, for his testes, but also bc it can improve his mood? No AI for him, is that correct?

I’ll keep on reading and ask questions here when needed. I’ll only bother you when I cannot find it in the stickies. Would you mind answering my questions above please? Only those about the timeframe of the bloodtest and the urologist visit, the rest I’ve found in the stickies. Oh, and did you write your book yet? :slightly_smiling:

Thanks again,


No book.

In UK and Europe, getting T injectables can be a problem because of stupid restrictions.

Yes, hCG improves mood. But doctors Rx drugs for depression for that. May not be an option and may not be covered by medical plans and might be something that you pay for out-of-pocked.

T enanthate [often referred to, incorrectly, as ethanate] would be a good choice there.



We went friday tot the endocrinologist and today to another Dr.
The first one suggested Nebido. That is one injection every three months. We chose another doctor bc we didn’t feel good with the consultation. He took no time for questions and if we did, he got very irritated.

The second one prescribed Androtardyl. He has treated other pfs-patients before and seemed to know what he was talking about. He wanted to inject twice a month. I convinced him to inject weekly. Does this sound like a good idea? Any advice on the injecting?

Thank you!


I forgot to mention the dosage.
The dr. wants him to inject 250mg/ml, divided in 4 times so each week 0,25 ml. This is 62,5 mg/ week. He said that he prefers to start low and see what this does for him. His numbers are low, but not under range.

I asked him for the Hcg. He said that it was not needed now, maybe once he will try to build off. He mentioned Pregnyl.

I also asked about SC versus IM. He said IM was necessary. I think I saw an article about the effectiveness of SC, but I can’t find it anymore. If anyone could point me in the right direction,that would be great.

For the injection: we chose 0,8x40 to fill the syringe, then 0,6x25 to inject in quadriceps. Is this ok?


Access to the stickies is now via links in the 2nd post of the first topic.
See ‘protocol for injections’

You can load and shoot #29 1/2" 0.5ml insulin syringes.
These are good for SC or IM injections. whichever is more comfortable.

SC and IM are both 100% absorbed. SC releases slower giving smoother levels.

Docs will say that SC will not absorb, then offer pellets!


Here’s an update about my brother:

  • Bloodwork after two weeks showed that the dose was still too low. T didn’t rise very much. Dr. said to inject 125mg of Androtardyl/week. So he did this 4 weeks.

  • He experienced testicle shrinking, so we added Hcg, dosed as in the sticky here (250 units EOD). He got severe panic-attacks on top of the usual anxiety. He was afraid to go further with the Hcg so stopped after 2 times.

  • After 3 weeks on the new dose, these are his new labresults:

  • As you can see, his T-levels are quite good. But his Oestradiol is still below range. How is this possible? It was below range from the beginning so we hoped that his mental problems would get better when E rose.

  • He still feels terrible, with severe anxiety and derealisation.

  • He wants to stop the TRT, so he would try that with Nolvadex, not Hcg. Does this sound like a good idea? When does he best start with the Nolvadex then? Is 20mg EOD ok for him?

  • He wants to stop bc he is so afraid of everything, and he doesn’t experience benefits from the TRT. The only thing he experiences is more energy, more power and feeling agitated. But this wasn’t his goal.

  • Is there something we can do to try and raise his E?

Thank you again,


Lauren, some of the side effects of antidepressants occur when free testosterone is low.

Also look into genetic testing to see which drugs might suit your brother better. It’s an emerging field, and it might help if some are poorly tolerated.


TSH looks good.
fT4 is well below mid-range
fT3 is 4.9 and midrange is 5.5

What are waking AND mid-afternoon body temperatures?
Any action on iodine?

Can you find some Vit-D3 supplements for 4000 - 6000iu per day?

Transdermal T would lead to more E2.

What was the time of day for the labs [Cortisol].

What is Oestron?

It may be that your brother will have problems with things that are actually helpful.

If you increased T dose to increase FT, there would be more FT–>E2.

As an experiment, it would be interesting to see if he reacted well to some transdermal E2 cream.


I ordered the iodine for him but he is afraid to take it. As he is afraid of everything. :frowning: I convinced him to start taking it today. His temperatures are still low.

He started 4days ago with vitD3 6000iu.

Testim is not an option, he has young children. The dr. Said it was dangerous for them, so … He switched to injections. On testim, his T and FT did not increase.

The E2 cream would be worth to try, but where do we get this? I should ask his dr. I suppose?

If he wants to stop with the TRT, how should he do this? He has Nolvadex, but is afraid to take it (bc of a rare eye-disease some men get from this). Is it possible to get off TRT with only Hcg? How should he do this? He injects 100mg/week Androtardyl. He will add hcg again, to make his testes ok again. When this has happened, can he stop the T and go further with the hcg alone?

I don’t want him to stop yet, would like to see some E2 first, but he is so negative about everything. He concludes already that TRT doesn’t help him.

Oestron = Estrone. https://en.m.wikipedia.org/wiki/Estrone
Don’t know why it has been tested.

Thanks again, Lauren.


Blood was drawn in the morning, so cortisol is way too low I suppose?


For AM cortisol, should be done at 8AM.


It was drawn at 8 AM …


That level seems a bit low. That can contribute to low energy, lethargy etc.

Please review the thyroid basics sticky and find and read these terms:

  • stress
  • adrenal fatigue
    Does any of that seem to apply to you?