T Nation

Sketchy Diagnosis? Determining "Free" Estradiol?

I’ve gone through the process of getting a TRT prescription and have only done 1 injection so far. The doctor did a decent job walking me through certain things, but I was already well versed on most of it (Thanks T-Nation!)
The doctor explained that many of my symptoms may be due to low estrogen, which I hadn’t considered. How does one determine how much estradiol is bound by SHBG?

As for the diagnosis:
This was through a telemedicine clinic and the doctor tried to tell me that I have primary hypogonadism, which definitely shook my faith in him because I do not think my test results would imply that my issues are primary. For example:

Total T: 828 ng/dL (264-916)
Free T: 15.7 pg/mL (9.3-26.5)
Estradiol, Sensitive: 24.2 pg/ml (8.0-35.0)
SHBG: 71.9 nmol/L (16.5-55.9)
LH: 6.2mIU/mL (1.7-8.6)

I’ve made topics on my case before and am well versed on the SHBG/binding deal.

To me, that would be secondary - if there is an issue at all. It’s a shame that there are few people between what I view as overly liberal telemedicine clinics and overly conservative Endos/Uros.

You have neither primary or secondary hypogonadism, your problem is your liver in ruining your day be producing excess SHBG which is then binding up too much testosterone. Your pituitary gland is maxed out in how much LH it can produce to overcome the very high SHBG.

TRT is your only good option to tackle this SHBG problem which will likely increase as you age.

Btw your Free T while not the worst is far from optimal and most experts agree men with Free T at this level are expected to see good results on TRT. The optimal range for Free T is 20-26 pg/mL. You’ll need levels well above 1000 ng/dL to see benefits on TRT.

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@systemlord Agreed on the lack of hypogonadism…pretty reputable doctor too. I’ve encountered another one of his high SHBG patients and he said the same thing to him. Gotta make that money.

Thanks for the insight. It’s obviously not an easy decision to make.

Personally I would not take T if I were in your shoes. Your T production was actually great and you clearly do not have hypogonadism - either primary or secondary. You have high SHBG. Why? What prescriptions are you on? Why not try to lower it first? Magnesium Boron, more carbs in your diet, less fibre in your diet, and as a last resort prescription drugs. You have been done a great disservice here by simply giving you test and not determining the problem.

Zed, did you ever decide on what to do ? I also have my Trt supplies sitting here wondering. My numbers were 600 test, 18 free test, estradiol 30, LH of 8.2 and shbg of 66. For 3 weeks I have been running magnesium, boron, upped my vitamin d, and using a supp called test up which has a bunch of free test boosters. My sex drive has been thru the roof the last week and a half. I’ve also cut down on my training, Alcohol intake and getting more sleep. This has me in limbo even more on the fence about trt.

Hey @Sprinter528, I had injected one time (80mg Test cyp) and got a little turned off for a few reasons.

I’m 30 years old and being tethered to medication during international travel is a headache I don’t want to deal with. I also feel that the Doctor I spoke to was less than sincere in his appraisal of my situation and that really pushed me away from it. I’m trying to see an actual endocrinologist to determine the cause of my high SHBG.

With that being said, I felt pretty damn good for a few days after that first injection. There’s a part of me that thinks it was placebo because most guys don’t notice effects until weeks after starting, but I had a tremendous feeling of wellbeing for about 2 days following that injection. It was a good enough feeling that I’ve considered hopping on it if I’d feel like that all the time.

If I can find a doctor I trust and he recommends it, I’ll probably do it.

That is a valid point. Ask around and find a local practice specializing on hormone replacement/restoration. They are out there and many operate on a only referral/word of mouth basis.