T Nation

SHBG Pre / Post TRT


#1

Hi guys.

I’m 28 now. Grew up (late puberty) as a 6’3 145 moody lanky dude till 2012. Was 180ish last year when I first read these forums. Up to 195 before starting self doses of TRT 6 weeks ago. 205 now, and still not a touch of bodyfat. Kept my hair in the process. Nearly no body hair really. I guess I should be happy with that?

Well I have always felt depressed, morning wood has never been a thing for me, joints and skin becoming dry… Apathy, poor libido since forever, all my friends being like “hey I’ve masturbated 4 times today” when that would be my number of fap in a couple of months or more. So all of that describes me and when I learnt about low e2 it was quite enlightening to say the least. For a while I measured test only and it was high so why bother?

Actually I had more complete natty bloods in January & May this year :

  • total test 800+ ng/dl
  • Free test between 2-8 pg/ml
  • Estradiol 10 pg/ml or less
  • Shbg averaging a huge 100 nmol/l
  • Normal thyroid values/ratios, normal cbc cmp lipids albumin…

So clearly the culprit is shbg? If that makes sense to isolate it? Can we talk about hypogonadism here?

I’m also expecting my first TRT bloods next week. Full bloods ($$$…) this time with DHEA, DHT, IGF1 and all the aforementioned values. I’ve started at 140mg/week = 100mg e5d of test E. Huge strength increase when I stacked that dose with a mere 20mg Dbol. Total went from 1000 to 1125 in those few weeks. I can say I respond quite well to hormones…

Back to shbg - I think I’ve been trying every diet/macros/cycling out there in 4 years. Even if I wasn’t aware of any interaction between lifestyle/diet and hormones I can analyze now: whatever physical changes I’d experience the mental and sexual aspect wouldn’t be affected. Or if any changes, they wouldn’t last long.

I believe that lessening shbg means either more metabolism of the free T, or a negative feedback which means less T in the system so same low free T. So quickly back to step 0. Correct me if I’m wrong there? I remember reading about Bill Roberts saying caring about shbg is useless.

A very simple Q to sum it all up - is exogenous test the only option here? I mean am I losing my time if I’m still trying to modify shbg since the HPTA shall sense any variation and adapt?

Thanks for the help/insights here.


#2

Please read these stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Post all thyroid labs with numbers. “Normal” thyroid numbers are meaningless.

Do you get cold easily?
Have you been using iodized salt to support thyroid function?
We see a lot of cases with low-T where low thyroid function is also a problem and perhaps a cause.

You cannot directly manipulate SHBG. SHBG is made in the liver to scavenge hormones from the blood. So we are interested in anything that may affect the liver such as alcohol, Rx and OTC drugs, toxins etc.

Labs: - always need ranges
TT
FT
E2
LH/FSH
prolactin
CBC
hematocrit
AST/ALT
TSH
fT3
fT4 [please not T3, T4]

There is a genetic test for this: https://en.wikipedia.org/wiki/Klinefelter_syndrome
""“
Sometimes symptoms are more prominent and may include weaker muscles, greater height, poor coordination, less body hair, smaller genitals, breast growth, and less interest in sex.[
”""


#3

Thank you for the answer. I have to admit I could do a better formatting. So here we go

No, I absolutely never get cold. As a matter of fact I barely heat my place during the winter and do not use a very warm blanket - all ex-GF were freezing, I was okay.

about one tsp a day at times, which got me uncomfortably sweating so I still use it but more sparingly, salting every dinner.

I’m suspecting a hyperthyroid but if you tell me I’m wrong I’ll be totally open to insights. Your help is very well appreciated anyhow

bad news here. It means that all SHBG lowering/raising strategies are useless? That SHBG is only a marker and a response to a pre existing condition?

Also, I seldom drink, zero OTC drugs or recreational, I eat the minimal amount of processed foods etc. Most of my diet is fruits, nuts, leafy greens, meat, eggs, full fat dairy. 50% fat then carbs and proteins are roughly the same. Grew up eating pretty clean since the parents were against sugar and candies.

Labs:

TT - 806.5 ng/dl (348-1197 ng/dl)
FT - 8.5 pg/ml (9.3-26.5 pg/ml)
E2 - 10.1 pg/ml (7.6-42.6 pg/ml)
LH - 5.1 mIU/ml (1.7-8.6 miu/ml)
FSH - 8.0 mIU/ml (1.5-12.4 mIU/ml)
prolactin - never asked for it
CBC
WBC 6.1 x10^3/ul (3.4-10.8)
RBC 4.6 x10^6/ul (4.14-5.8)
hemoglobin 13.5 g/dl (12.6-17.7 g/dl)
MCV 88 fl (79-97 fl)
MCH 29.4 pg (26.6-33.0 pg)
MCHC 33.4 g/dl (31.5-35.7 g/dl)
RDW 13.8% (12.3-15.4%)
Platelets 263 x10^3/ul (150-379)
Neutro 2.9 x10^3/ul (1.4-7.0)
Lympho 2.8 x10^3/ul (0.7-3.1)
Mono 0.5 x10^3/ul (0.1-0.9)
Eo .2 x10^3/ul (0-0.4)
Baso .1 x10^3/ul (0-0.2)
hematocrit - 40.4% (37.5-51.0%)
AST - 34 iu/l (0-40 iu/l)
ALT - 41 iu/l (0-44 iu/l)
TSH - 1.92 uIU/ml (.45-4.5 uIU/ml)
fT3 - 2.7 pg/ml (2.0-4.4 pg/ml)
fT4 - 1.59 ng/dl (0.82-1.77 ng/dl)

Also
Cholesterol 277 mg/dl
Triglycerides 39 mg/dl
HDL 88 mg/dl
calculated VLDL 8 mg/dl
calculated LDL 181 mg/dl
albumin serum 4.6 g/dl (3.5-5.5 g/dl)
CO2 total 22 mmol/l (18-29)


#4

Your blood is thin beyond lower levels expected with TRT.
Any digestive issues or food sensitivities?

Skip prolactin, you have hypogonadism and problem is in the testes.
DHEA-S would rule in/out low DHEA limiting DHEA–>T inside your testes.

fT3 is what gets the job done and its clearly below mid-range.
Please post oral body temperatures as per the thyroid basics sticky.
Odd that fT3 is down and you feel overheated.
fT4 is quite above midrange suggesting that fT4–>fT3 is impeded. That is possible if ferritin, not tested, is low. Any sense that your diet could be low in iron?

Test DHEA-S, not DHEA.
Please also AM Cortisol, at 8AM please.

Is your life stressful or major stress events other than ex wives?

AST/ALT: Do you think that these could be elevated from training?

Please review my prior post and get into those stickies.


#5

Just to be clear - these are my pre TRT bloods. I got a full panel this morning, my first while on TRT, results soon. DHEA-S included. Will do the other tests within the upcoming weeks. Diet is rich in iron, supposedly. Unless red meat isn’t what it’s supposed to be :wink:

Ast/alt definitely influenced by training. I need to test cortisol yes. Just so you know I’m a pharmacist and we’ve been having those debates with my endo. Your different point of view is super interesting to me. I’m by no means an expert on all of these parameters. My endo is good and likes to debate but clearly seems to rely too much on what’s within range and what isn’t.

Anyways, TRT bloods later on this week. Pretty impatient.

also - digestive issues : since forever. Even as a kid. Lots of gas. Painful sensitivities to many, many foods. Meat and water has been a good experiment. I keep fruit/carbs strictly around workouts now. If not, I’m good for palpitations, headaches, or massive bloating.


#6

I Guess I should change the title of this now that I’ve been on 150mg of test E /wk for the last couple of months…

First on-cycle bloods while on that regimen of test E +accutane 80mg/wk +superdrol 10mg preWO so 4 days a week (which I’ve stopped this week) received this morning. I thought I wouldn’t need adex based on feels… my mistake here. Will do 1mg /wk to shoot for a better T/E ratio.

If no ranges, same as above (from LabCorp)

CBC
WBC 7.8
RBC 4.69
Hemoglobin 13.7 g/dl
Hematocrit 41.7%
MCV 89 fl
MCH 29.2 pg
MCHC 32.9 g/dl
RDW 13.5 %
Platelets 324
Neutro 42%
Lymph 44%
Monos 9%
Eos 4%
Basos 1%
couldn’t get my ferritin this time. Will do it soon enough.

CMP
Glucose 91 mg/dl (unchanged)
Bun 9 mg/dl (preTRT - higher protein diet - was 22) range 6-20
Creatinine 1.07 mg/dl (unchanged)
Bun/creatinine ratio 8 (8-19, was high preTRT)
CO2 21 mmol/l
electrolytes all in range
albumin/globulin ratio unchanged
Alkalin phosphatase 50 IU/L
AST 50 IU/L
ALT 61 IU/L

Lipid Panel
Total cholesterol 246 mg/dl
Trigs 42 mg/dl
HDL 44 mg/dl
VLDL calc 8 mg/dl
LDL calc194 mg/dl (would be 150 using the iranian method though)

on to the good stuff
Total T 1370 ng/dl range 348-1197
Free T (equilibrium ultrafiltration method) 61.65 ng/dl range 9-21
DHT 54 ng/dl range 30-85
DHEA-s 289.0 µg/dl range 138.5-475.2
e2 66.7 pg/ml (heh) range 7.6-42.6
PSA 1.2 ng/ml <4
IGF-1 177 ng/ml range 98-282

aaaand that dear SHBG
SHBG 15.9 nmol/l range 16.5-55.9

Considering my CBC/CMP/lipids, I see no reason to lower my TRT since I’m responding well and I like the gains at the gym + okay libido and energy. Nothing groundbreaking but to me it’s okay to be flying under the radar. Besides that and as I said I’ll take arimidex diligently, splitting 1mg over the week on the 2 days I inject and on 2 other days. This all is a very simple protocol and is very convenient for now.

What else should I be looking for?


#7

Blood is thin before and after TRT. Digestive issues. I am concerned about a GI bleed. Get an occult blood test. If positive, you need to work through food issues or other pathologies.

What do you think of my concerns re thyroid?

Check ferritin. If low, can impede T4–>T3.


#8

the thing is I’ve always viewed low-average hematocrit as positive, but I’m always open to questioning what I’ve been thinking. I will check ferritin for sure. When my diet is all about meat eggs and some non-cow cheese with carbs peri workout, digestive issues are non-existent. But indeed I’m sensitive to many things and I know that when I cheat I can brace myself. I’m viewing my endo next week, been taking good notes from your stickies and will explore with him (gotta say paying for all of these blood tests is quite a chore)


#9

My interest in this is from the observation that HTC increases with TRT and TRT can be indicated for low RBC. Some of the low deviations seen here are symptoms of GI blood loss. So that needs to be a consideration and then an occult blood test can rule that in/out and you proceed from there. The causes can be food oriented or more serious. An occult blood test is simple but shitty work that is typically done in one’s own home. I have seen it done as part of a DRE where things are already messy. I think that doctors avoid DRE’s because its rather unpleasant work.


#10

I think I know where the problem comes from. Just throwing out a theory at this point and this will need to be tested when my current cycle is done before next year.

I think TRT showed me that I’ve had it backwards. I wasn’t feeling like shit while being super lean thanks to/because of low T. I was low T and feeling like shit because of just not being fat enough. 10% or less scanned, that lean since forever. 5-6% using shitty calipers and bodpods. Definitely a form of anorexia at this point, though I can go all the way back to my teenage years since I’ve always been underfed with mostly veggies, grains and fat-free stuff (thanks to a single Mom who has had the same symptoms of low hormones since forever, by the way. but she grew up being very poor so I get that.)

Hence the low e2, high SHBG, high cholesterol, low free T3 and low free T4 while other parameters are normal. Looks like the solution might be easy to fix in the end - it should involve lots of foods rich in cholesterol. Will probably bump this post PCT.

Ferritin came back in 130s by the way. Optimal.


#11

Feeling better with arimidex?


#12

What is superdrol? Is that some kind of energy enhancer?


#13

Superdrol is a steroid but previously classified as a prohormone. I’m surprised nobody mentioned your lipis. Superdrol will wreak havoc on them and your lipid profile is not great.


#14

actually the high e2 was a false high because of tren Ace that I used for a week before stopping it only a few days before the test. I was 100% sure I ordered the ultrasensitive, I was wrong. I don’t use an AI now and feel better. There’s no way I’m aromatizing that much on 150 mg/wk, I’m super lean.

Superdrol was received after the test. I planned on using it after not liking the tren. I actually didn’t, it felt terrible. By that time I just decided to just run test for good, enough fooling around with drugs that do not aromatize. I also lowered the accutane. Will do more bloods in 2 weeks.

my theory on lipids is related to what is seen in Anorexia nervosa. To quote Weinbrenner et al. "severe loss of body fat and the resulting changes in thyroid hormones increased lipolysis and decreased endogenous cholesterol synthesis with resulting decrease in LDL removal” (downloaded the full paper)

Basically low calories = body fat is burnt (obv) = changes in thyroid hormones (study shows low free t3/fT4 with normal/optimal TSH) = no cholesterol catabolism = high TC and specifically high LDL.

So the issue is deeper than X or Y drug. I’ll just eat much more. Former 6’4 145lbs now around 210 learning he actually needs to eat more because of the lack of body fat. How ironic. Meanwhile I’ll up the test a little bit, even if I’m fully aware it’s not treating the cause of the problem. But I need to work my way up with a controlled fat gain.


#15

Just so you know as I will be looking forward to updating it and maybe help other people who are concerned over shbg. As I believe shbg/LDL/thyroid function/low test are only consequences of a lifestyle imbalance in most cases, I’ve decided to stop my mild blast and PCT off. Then I’ll work on fixing my problem with proper measures. I think there will be some more trial and error. One thing I learnt though using steroids - we are miles away from living decently healthy, and we are way too quick to treat symptoms instead of researching the deeper problem that causes said symptoms.

Thanking ksman and others who chimed in because that made me do a ton of research and made me much more capable of reading bloodworks proper. Which isn’t too useless, for a pharmacist :wink:


#16

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#17

why the bump? Since I’m here… I decided against the PCT at that time because I wanted the gym gains. I got them, I’m going off. Working on my diet makes me feel great again. I’ve had experience with clomid, nolva, ralox and adex and bloods that looked great (highest TSH on gear 1.7 this summer, lowest .9 last fall)

This forum is certainly one of the 2 sources that I value on the internet, the other being Ray Peat’s.

I shall bump this with bloods after 18 months on various drugs. I’m very positive about this. Weight is maintained and strength is a bit down - nothing that bugs me.


#18

I have a question for you! How did you get your SHBG from 100 to 15? I saw that you were taking AAS as well.


#19

Androgens lower it a ton

And I was doing keto and caloric reduction prior to AAS which both cause the SHBG to skyrocket. My diet is much higher in sugar now (the good kind, with lots of vitamins and minerals for a faster metabolism). This also keeps TSH low.


#20

Are you getting this sugar with natural fruits? I also saw that fructose turns off the gene that makes SHBG. Would be interested in what you are eating. Also, im assuming it was the AAS that dropped it so drastically.