T Nation

Sky High SHBG, Low Free Test. Should I Try TRT?

Hey all - first time poster here. Got my lab results, and wondering if I should try TRT. Here’s my background info:

I’ve been on antidepressants since my early 20s, and I think it may have messed up my brain and my hormones. Always been moody and anxious etc. Started having brain fog, lack of energy, low libido the past 5 years or so.

I’ve actually been working for 3 or 4 years now to dial in my lifestyle and my mindset, and I’m working on getting off of the A/D’s, but when you’ve been on them this long, it’s a slow process.

As far as lifestyle, I eat low carb/Keto, because I’ve found that it really helps with my depression and anxiety, and I basically plan to eat this way for life. Used to drink a lot of alcohol and smoke a lot of weed. Quit both completely about 8 months ago. Drink a lot of coffee.

Work a desk job, but try to hit the gym a couple of times a week to get some activity. Not doing a “program” or anything. Just doing some basic lifting and time on the treadmill so that I’m not completely sedentary.

Always been skinny. 38 y/o, 5’9", 150 lbs. Terrible time gaining muscle. It’s gotten even worse in recent years. No problem growing a beard, and I shave every few days. Hardly any armpit hair or chest hair though; not sure if that means anything.

So anyway, decided to get my T tested recently at a specialty clinic in town. SHBG is sky high, which I’ve read can come from a low carb diet? Total T is normal. Free T is low because of the SHBG.

The clinic is recommending TRT. They weren’t pushy about it at all, but I know that they have a business to run.

I’m somewhat hesitant to start on something that’s a lifetime commitment if it’s unneccessary.

But with that being said, if TRT were to give me the benefits that I read about some guys getting, with the sense of well being, less depression/anxiety, high energy, high libido, easier muscle gain etc, I’d be totally down for it.

Here are my lab results. Any feedback? Should I go the TRT route? If so, recommendations on protocol? I’m in the US, by the way.

Welcome to the forum. First, I just want to say that Keto/Low carb increases SHBG. As well as some medications, alcohol and overconsumption of coffee. First priority is stopping these.

You probably genetically have higher SHBG, 40-50 range, and the keto and meds are pushing you into the 80 range.

I am between 37-55 usually 50 , but when I started lisinopril, I went up to 70. Back down now though. If you have any questions, let me know.

I started about where you were, with high SHBG, low free test, I felt like shit.

I am not saying to jump on TRT, but it did help me, if you end up with no other options.

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It seems your liver is causing all your problems and is why LH is high, LH is a pituitary hormone that stimulates the testicles to produce testosterone and is high in response to high SHBG produced in the liver.

SHBG scanaveges sex hormones and when elevated handcuffs free hormones, in your case Free T is negatively affected, A/D tend to increase SHBG so if you haven’t spends months off these A/D’s, then I would do so first to see if you can get SHBG to decrease.

Then again if you want optimal testosterone at 40, naturally that just isn’t usually possible. You may have needed these A/D’s do to the high SHBG to deal with a low hormone state, the question is which came first, the chicken or the egg.

These A/D’s can be hard on the liver, what are the A/D’s your currently taking?

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Fuck it your almost 40. You have a job, have tried to fix your health, the environment isn’t helping. The fda doesn’t give a damn. Big pharma doesn’t have our back. Our PCP cannot help us becusse they treat symptoms. Technology is constantly radiating us. Pollution. God the list goes on and on. Fix one thing and something else probably needs to be fixed.

It’s an uphill battle for the stubborn.

This is why I said Foook it. Let’s do this and get optimized and kick some ass.

Yes I have not seen anyone get off the Anti depressant and report back with lower shbg. This medicine is totally screwing men up left and right.

Usually once SHBG increases, it doesn’t come down much at all.

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So bad. They do not even put this on the labels of prescriptions.

It should be stated “this will make your labido dissapear,hormones crash, and your fudged for life”.

Your prolactin is unusually high. There are a number of studies that link high prolactin to increased ED and decreased libido.

It also looks like they didn’t run a CBC which is odd.

You self reported stress at 9? I would test cortisol and find out if it is out of whack because of your stress level.

You also self reported a LOT of coffee/caffeine … you will find studies in both directions of being good or bad. Personally, I am in the bad camp because it also can effect Cortisol.

@systemlord

Taking 50mg Zoloft (Depression/Anxiety) and .5mg Haldol (OCD). The fucked up thing is that after having been on them for years, I’ve made much bigger strides in my mental health by cleaning up my diet and learning some better coping strategy by working with a great therapist. The A/D’s honestly were just a band-aid.

@enackers Right? Like if I had had any idea what these meds could do, I never would have taken them even for a day. Shit is toxic as hell.

@traveling-man They didn’t test CBC because I had just recently had routine blood work at my family doctor, and they tested it then. All of the items tested were normal. Here’s a screenshot. Assume this is what you’re referring to, since they called it a CBC…

Yeah, stress is high (job + baby at home) and caffeine consumption is high. Sleep isn’t great either with the baby. I was already thinking that I should cut out caffeine. Your feedback pretty much seals the deal for me.

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I have taken Lexapro for 15 years now. There have been a few clinical studies which support SSRI’s causal relationship to increased ED and decreased libido. No studies or sources contradict the link between sexual issues and antidepressants. SSRI’s are empirically linked to sexual dysfunction through trials but the cause is unknown.
SSRI’s are believed to have an affect on an unknown number of mechanisms leading to sexual dysfunction but there is no clear understanding as to why.
I’ve met a few men on SSRI’s who have high SHBG so I wonder if that is not a factor.
I myself eventually began suffering the sexual consequences of taking an SSRI after 10 years. It is definitely a reason why I got on Testosterone. One NCBI study I read showed that the effects of sexual dysfunction were usually permanent after long term SSRI use. This is disheartening…but Testosterone has helped me…I even get morning wood sometimes…haven’t had that in 5 years!

My numbers were almost the same as yours but my TT and FT was lower and my SHBG was at around 57. My choice to take Testosterone and an SSRI was a risk to reward based decision. Testosterone treatment has not been an easy process, neither was getting on Lexapro. These are personal decisions for everyone. For me it was well worth it though I would be lying if I told you dialing in my numbers wasn’t rough.

I won’t be able to get off my Lexapro or Testosterone because of my conditions. I know the risks and difficulties and am doing it regardless.

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Yes, that is what I was asking about … but there are usually a few other tests that fall under the CBC “umbrella” but I guess is not included … such as AST, and ASL liver markers, as well as other blood chemistry such as HDL and such. Systemlord mentioned liver issues and I was curious about the labs.

PS: I gave up all caffeine from coffee; most of the caffeine from soft drinks; but still get caffeine through dark chocolate. I did this in Sept 2013 because I could only see negatives in the caffeine levels I was taking.

I also eliminated 85% of my sugar intake. Did this help? Don’t know. But it doesn’t effect me to have given it up and I continue doing it to this day.

Just kind of using this thread as my log now.

Injected 150mg T-Cyp for week 1. No HCG/Danazol/AI. First week was awful. Started off with anxiety, which faded after a few days. Days 5 and 6 I felt super irritable and exhausted.

Splitting the dose from here on out and doing E3.5D. Aiming for no further modifications to the protocol from here so that I can stabilize. Doctor isn’t planning on more labs until 12 weeks, so plenty of time still.

Injected 75mg this morning (Week 2). Feel the best that I’ve felt in months. High energy and a sense of calm and well being.

Noticing my libido starting to come back the last few days (even in the midst of the “dip” on days 5/6 of the first week). Didn’t expect it so soon. Fucked my wife every night for the past 3 nights. Typically, I’m too tired for anything more than once a week. And I usually only last about 5-10 minutes. Been going more like 30 minutes.

Hoping things just continue to improve from here!

Shit guys. Into week 3 and I was just starting to feel better. Woke up this morning feeling as bad or worse than before the T. Feel like hell. I know this is a sign that my body’s natural T production is shutting down.

What should I expect from here? How long before I start to feel better again?

Systemlord is a bit of a expert on the high SHBG thing, so read his stuff!!!
You splitting the dose would not be his recomedation…i have high SHBG also…118!!!
From what i understand ( thanks to people like systemlord) high SHBG is weekly injections on higher dosis…another person here does pellets, and another one does cyp 200mg every week.
anyhow, all i can tell you is to be patient to see what works best, finding the sweet spot does take time and bloodwork. I screwed around on my own cause of the lack of help, and everytime i felt a litlle crappy then i would chance something WRONG i know now.
Please try to find the other topics regarding High SHBG, and read them…plenty of info!!!

When you started TRT you have injectable T and natural T and now you only have injectable T, this is a time when the half life is building up in your system and by week 6 you should start feeling better if levels are in the therapeutic ranges. If not then another course correction is needed and another 6 weeks until levels are stable again.

It will take 6-12 months to see big changes so don’t expect miracles right away.

o, and another thing, get your other shit together, stop these ssri’s as fast as you can, use weed to help with the withdrawl symptons, its better to smoke some grass then those ssri’s.
get some 5 htp, eat clean, fruit veggies no or a minimal of sugars, buy nothing that comes in a box, carton or what ever contains any kind of e numbers, chemicals…you know, shit that doesn’t bellong in our body…eat less meat, replace this for nuts, fresh fish, beans tofu,
drink water instead of coffee and soda’s…and offcourse no alcohol.
i know easy said then done, but you only have one body, so try to treat this like you’ve just bought a brand new Ferrari.

Yeah, I’m actually fairly well dialed in lifestyle wise except for the SSRIs.

I have one beer maybe once a week. Diet is mostly meat/veggies. No sugars. No soda or anything.

Started lifting weights at the gym around the time that I started TRT.

Definitely planning to get off of the SSRIs as fast as I safely can.

Look, i should be the last to tell you what to do, cause i’m currently back on pain meds again…a necassery evil for now sinds i have to finish the house we bought, but those SSRIs
damn, they put me on years back when i first came with the same complaints i still have…
I now know what the problem is, but those meds…Holly shit, i used them for 8 months and i just didn’t feel anything anymore, you could kill somebody next to me and i wouldn’t gave a fuck. My wife told me to stop and i threw everything in the garbage the same day, best thing i did, with you allready used to weed…it works for every withdrawl, just make it your goal and start reading all the bad stuff about this shit…these are the worst meds on the planet…you can do it if you really want, so you just need to take the next step, good luck.

@systemlord is right about waiting it out until week 6. Probably you will need a small increase in dose, but no point in rushing. Some guys jump the gun on the dose adjustments and end up on too high of a dose, which can be as bad as too low depending on what you want. I would say though that meat avoidance is not actually a healthy diet for most, there are a lot of micronutrients and minerals that you need that come from meat and do not come from plant sources. And tofu should banned as toxic warfare against men. Anyway, 5-HTP you need to be super careful with if you are on an SSRI, as the SSRI blocks re-uptake to prolong the life of Serotonin in your brain and 5-HTP accelerates Serotonin production. And if you don’t have glaucoma or cancer, leave the weed alone, it’s not doing you any health favours.

I wish i could agree with everything you said, but the fact is that meat isn’t just meat…its full of hormones and antibiotics before they reach your plate, so to cut some out of a daily diet is not gonna do you harm, there is enough other foods that provides you with the things your body needs. I did a full bloodpanel in february and all my vitamines were checked, well like every other bloodpanel i see everywhere online…only vit D short. and in february i didn’t ate meat for a year. next part…and maybe i got this wrong, but i quited painmeds cold Turkey for 9 months and i used a botlle of 5htp and offcourse a few crumbs of weed before i went to sleep, the 5htp was probably not neccesary, but just in the hope to boost your mental health…the FEW crumbs…trust me, weed does less harm then ibuprofen, and when your experiencing withdrawl then the most importent thing is sleep. The doc told me to get in to a program before i quited the opiods and benzo’s, and i needed to take other meds to fight the withdrawl…it took me 2 months and all the symptons went away…quiting the weed is easy, quiting meds isn’t.
The tofu…i know, its all GMO, but in that case, we cant eat anything we buy anymore, cause its all covered with pesticides, GMO, hormones, but thats another discussion that i’m fully aware off, our whole life is surounded by chemicals and shit…we eat, drink, wash, brush, deoderants and parfums, clothing…you name it and its chemical, and besides that, look at how the world is trapped in there smartphones…i’m one of the few in this world that doesn’t own a cellphone. but all we can do is try to keep this intake as low as possible and i try to keep wifi and all that smart shit out of my house.