T Nation

SHBG Through the Roof, ED in the Gutter

Alright amigos!
First, I am glad to have found this great community and I have been reading and learning quite a bit. And now I need some advice…
(side-by-side comparison image below)

Long story short…
l have been battling with the most frustrating spell of ED of my life. No morning wood. EVER. I can count on one hand how many times I have had a morning “visitor” in the past 4-5 months. I have said it before… This is HELL. Why? Because the libido and urge is there, but even a crazy dose of cialis ain’t enough to consistently perform beyond having a “soft erection” at best…

So… a little over a month ago, the labs revealed high SHBG (which had already been in the higher range of normal in the past) and high prolactin showing in my test results, so I got some caber and some proviron (and upped the test) to deal with these issues. As you will see below, the caber worked (too damn well) - and as a result, I am pulling back on the caber. The proviron, however - did not budge the needle, nor did the higher dose of test - when it came to the SHBG issue. I realize proviron only binds and would not necessarily drop the number.

BUT… My bedroom performance issues had only marginally improved for a brief period a couple weeks ago. And since relapsed…

With this current test result, I have no doubt that the SHBG is the big culprit.

And so you have the entire picture, let me bullet out what I know/don’t know (and likely reasons for the high SHBG):

  • Quick stats: I am 40 years old. 6’3" / 210lbs / 33" waist / no clue on BF% (I am not fat, not skinny, no bulging 6 pack either - probably in range of 14-17%)

  • Current gear: 210mg/week Test cyp (pinned daily)

  • Workout: 4 days a week (PPL/Full Body), and have been adding cardio to my regimen

  • Diet: Intermittent Fasting (20 hours per day)/Keto (helps with bullet point below)

  • As a child, I was given this wonderful gift called type 1 diabetes (I don’t recommend it - it ain’t as cool as you’d think)

  • Blood Glucose: Strictly controlled (avg BG range: 5-7) *on US measure = 80-125ish

  • Blood Pressure: Good - average 110/75 (thanks to cialis/amlodipine)

  • Meds (not supps): Lantus Insulin (24 units per day), Humalog Fast Acting Insulin (~10-15 units per day on average), Metformin (1000mg/day), cialis (20mg/day), Amlodipine (10mg/day)

  • Other health issues: November 2019 - kidney stones (blasted and passed)

  • Liver levels (as of May 2020) - all good

  • Kidney health (as of March 2020) - all good

  • Thyroid (as of June 2020) - all good

  • Lipids/Heart (as of March 2020) - all good

  • So… I am confident that the SHBG is NOT likely related to liver or thyroid problems

  • From research, it appears that elevated SHBG is one of the glorious special bonuses of being a Type 1 Diabetic (thanks Diabetes!)

    • In fact, there is an inverse relationship between how much insulin you take (for T1D) and the level of SHBG

    • In other words… lots of insulin shots = really fat with lower SHBG

Now the test results (the money shot):

So… What can I do about this SHBG issue?

  • I am already taking boron, vitamin D, and all the other usual suspects (before this test)…

  • Since it isn’t likely my liver/thyroid, there is no protocol option there…

  • I know large T levels can suppress SHBG but I really don’t want my TRT/cruise dose to go any higher if I don’t have to. In fact, I would prefer to titrate down from where I am…

  • Clearly proviron didn’t make much of an impact for me…

  • And while increased insulin lowers shbg…

    • I can’t take more insulin shots unless I want to deal with hypoglycemia and take a permanent vacation 6 feet under
    • Nor, do I wanna start binging on carbs and sugar just so I can take more insulin shots and live a hyperglycemic lifestyle of having feet amputated and being on dialysis down the road.

Do I just need to embrace some DHT compounds in my cruise/TRT?

These are the options I know of right now:

  • I do have a sh-t load of primobolan - it is DHT but I am not sure if that would suppress SHBG enough on its own
  • I also have a nice supply of Masteron P - again, if proviron didn’t make it work - would mast?
  • I was already considering going on HGH (2iu/day). Some research suggests that it can lower SHBG…
  • I have about 200 tablets of syn anavar (10mg) - I read a lot of evidence of 5mg of winny doing the trick - perhaps 10mg daily of var would be the way to go.
  • I clearly prefer using orals like this in blasts/cycles. But it appears that to solve this will require an ONGOING protocol

This is what I am now trying (but based on your feedback - I may adjust it)…

Starting today…

  • I am lowering my weekly Test down back to 175mg (25mg daily)
  • and adding 210mg/wk of Primo (30mg daily).
  • And, also starting today, for 4 weeks (just to kickstart things) I am gonna take 10mg daily of the var.
  • If I successfully reduce SHBG - I might free up more hormones and need an AI (have aromasin and adex on hand - just in case)
  • Considering I crushed prolactin - doesn’t mean it won’t come back in the current absence of caber - may need to take .25 E3D (was taking .5 EOD - which was WAY TOO MUCH)
  • I would re-test in about 4-6 weeks

Thoughts?
I know I put a lot of info here and I truly thank you all so much for any input and feedback.

It raised your free androgen index, which is what would be expected. Notice that your E2 went up as well. It takes a while before the SHBG comes around when it’s high, like maybe a year or so. I would have kept at or raised the proviron a little and maybe gone with less frequent test injections.

Good point. I realize things take time. The last 4-5 months of ED from hell have felt like forever! I guess my risk-reward ratio has since been skewed in the pursuit of solving this issue. LOL

Can you pull back to fewer shots, maybe 2x a week? Might help. Also eating more sugar or carbs, but don’t know how that squares with your diabetus

I could. And then I would probably need to really put an AI at play. The main reason I was pinning daily was because, in the past, my E2 levels were too high - and the daily pinning leveled them out without needing any AI.

But… I will HAPPILY take an AI over ED - if spreading pins made the difference.

As for sugar… Even on my one cheat day every 6 weeks - my blood sugar just goes like a crazy roller coaster.

Here is what it looks like for folks who have a working pancreas:

  • I eat a high carb/sugar meal
  • I estimate the amount of insulin I need and shoot up
  • I almost NEVER get it right
  • it is impossible because fast acting insulin works faster than most food will digest so you have to underestimate it to avoid a hypoglycemic event (very deadly)
  • Then… over a couple hours my BG goes to the moon
  • I react by shooting more insulin
  • It is not unusual that I overshoot it
  • So now my BG is tanking and headed toward dangerous hypo
  • Then I need to rush to get a bunch of sugar in my blood and drink a high-fructose drink (such as grape juice)
  • My BG comes back up and spikes again and I need to estimate another shot
  • And the cycle repeats

This is why most diabetics that don’t restrict carbs/sugars just live with REALLY HIGH BG. It is easier to live with highs than lows - until your kidneys give up.

I’m sorry to hear about what you are going through. Do you think your ED could be a result of the diabetes? I’m wondering about a vascular component.

Considering that high shbg is common in people with type 1 diabetes, it is most likely the Underlying culprit. I’m not convinced it is vascular because I have solid lipid levels and my BP is good. The only issue in that regard I can say is my resting HR is higher than I’d like it to be (average of 80-85).

OK, I understand all of that. What is your doctor’s thinking on this? I guess where I am going is I don’t think your free testosterone is low enough to be the cause. You could have an exam to evaluate blood penile flow, but if you’re convinced that is not the issue how about increasing your testosterone which will correspondingly increase your free testosterone? Get your free test above the high end of the range if you have to in order to overcome your elevated SHBG. I do that with guys all the time.

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As a last resort you could try “trimix”. You inject it at the base of the penis. It works well from what I’ve heard, haven’t tried it myself.

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I haven’t read all the responses but bottom line, IMO, forget about shbg. Take however much testosterone it takes to get your free T to the levels that help you and quit over thinking it. My shbg was 151. The good news is higher shbg guys seem to have less e2 issues, probably from lower free e2.

You’re trying way too much stuff and focusing on the wrong things. Quit making it complicated. It isn’t. Add more T. Increase free T. Profit.

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