T Nation

Smoothest_criminal's Log: Low SHBG, High E2, High Free T

Hello there! Sorry for the long post, I’ll try to be thorough but concise as I can. New member, long time lurker. Any input would be amazing as I’ve run to the end of the road with doctors.

29yo Australian male. 6ft, 95kg. Generally healthy up until recently. History of asthma, hypermobility syndrome which is worsening over time, anxiety, depression and possibly borderline personality disorder. Barely ever drink alcohol, drink green tea most days.

I’m pescatarian, so eat some seafood dairy and eggs, but no meat or chicken. I eat healthy meals mostly, but do have a tendency to eat pizza, chocolate etc sometimes.

I have been knocked unconscious on at least 3 occasions during my teenage years.

I’ve always been on the chubbier side, never obesce, never lean, somewhat of a dad bod. Never been really strong. I’ve tried a few different workout approaches from bro splits, Jason blahas 5x5, and other similar ones. Generally stick to full body, compound lifts with some arm isolation too. Strongest I’ve ever been was squatting 110kg with a belt, bench pressing 92kg, overhead press 50kg. Not what you would consider beast mode. That was a few years ago, I’m far weaker now.

I’d had some blood tests over the years showing my test level was on the low side of the “normal” range (11 nmol/L). This hovered around that level each time I had it tested. It was always tested as part of overall blood work for other health problems but I never thought much about it as it was inside “normal”.

Eventually I had another blood test that showed I was hovering around the 11 nmol level for T. I queried the doctor about it and he tried to brush it off, but I told him I’ve read of many other people having the same symptoms as me with low “normal” T. He sent me off to an endo to see what the endo thinks.

Endo was good, had an open mind. He said although my levels were within the normal range, we could try trt and see if it helps. The symptoms I had at this stage were: low mood, low energy, low libido, anxiety, depression, low self esteem, low confidence, low motivation, easily irritated, emotional, etc.

So the plan was, try try for 6 weeks, if I feel better, stay on, if not, give up and try something else. It made me feel a lot better. I was on T enanthate 250mg per fortnight IM. I would feel great for the first week, then flat for the second. After 6 weeks I saw him again and although I don’t have the bloods on me, it was higher than before.

So I stayed on TRT for the next 6 months, switching to weekly doses of 125mg IM, and then trying sub cut 62.5mg twice a week. Out of all of those, the best for me was 125mg IM weekly. Wasn’t perfect as I would still feel flat the last 1 or 2 days, but was pretty good. I felt like Superman, was feeling happier, more confident, more energy, libido etc. ALL aspects of my life improved. Had some issues with what I think we’re too much e2 at times but it was far better than before trt. The highest my levels got were 18nmol.

Then after 6 months of trt I went on a 6 week cycle of HCG (under the endo’s instructions). 2500iu HCG twice a week. This made my balls bigger as the trt shrunk them a bit. I felt different on the HCG, more unstable and less resilient than the trt but I stuck with it as the Dr said that’s the best way of preserving fertility and jump starting my system back up.

Well, I had tests done at the end of the HCG cycle, and showed my sperm count was shot to hell (went from 250 million before trt to 3 million at end of HCG cycle). My T was down to 8.1 nmol. Something seriously went wrong with the plan to keep my fertility and natural T production. I was shocked, and devastated and scared.

So the endo then said to stop everything, wait 3 months to see if I rebound back up. I had a preliminary test done last week and showed my sperm is going back up (thank fuck). I also had some blood tests done through a different endo for a 2nd opinion. These were taken last week, about a month after stopping HCG. They are:

Haemoglobin 146 g/L (130-175)
HCT 0.43 (0.38-0.50)
MCV 86 fL
Neutrophils 2.1 /nL
Lymphocytes 1.7 /nL
Monocytes 0.3 /nL
Eosinophils 0.1 /nL
Basophils <0.1 /nL
Platelets 173 /nL

TSH. 2.3 mU/L (0.5-4.0)
Free t4 15.9 pmol/L

FSH 5 U/L (2-12)
LH 6 U/L (2-9)

I didn’t have oestradiol tested this time but recently had results of 52 and 39 in previous months (pmol/L)

Prolactin 352 mU/L (86-324)

Testosterone 14.2 nmol/L (12.0-31.9)

(Previous testosterone results were 8.1 on HCG and 18.6, 18.7 on trt. 11 before starting any trt. )

SHBG 20 nmol/L (15-48)

CRP <1 mg/L (<5)

Ser. Osmo 299 mmol/kg (275-300)

Sodium 146 mmol/L (135-145)
Potassium 5.1 mmol/L (3.5-5.5)
Chloride 104 mmol/L (95-110)
Urea 6.2 mmol/L (3.0-7.5)
Creatinine 95 umol/L (60-110)
eGFR >90 mL/min/1.73m2 (>89)
Bicarbonate 30 mmol/L (20-32)
Total bilirubin 6 umol/L (4-20)
ALP 52 U/L (35-110)
Gamma GT 17 U/L (5-50)
ALT 34 U/L (5-40)
Total protein 68 g/L (66-83)
Albumin 40 g/L (36-47)
Globulin 28 g/L (26-41)
Total calcium 2.43 mmol/L (2.15-2.55)
Corr. Calcium 2.43 mmol/L (2.15-2.55)
Phosphate 1.12 mmol/L (0.8-1.5)
Magnesium 0.89 mmol/L (0.7-1.05)

Testosterone 14.2 nmol/L (12.0-31.9)
SHBG 20 nmol/L (15-48)
Albumin 40 g/L (36-47)
Calculated FTe 392 pmol/L (260-740)

(taken the week before:
Testosterone 11.6 nmol/L (12.0-31.9)
SHBG 14 nmol/L (15-48)
Albumin 49 g/L (36-47)
Calculated FTe 311 pmol/L (260-740))

Cortisol 0810 Hrs 309 nmol/L

Growth hormone <0.1 ug/L
Growth hormone <0.3 mIU/L

IGF-1 Liaison 26 nmol/L (15-43)

I have no idea what most of that means. The endo I saw for a 2nd opinion said its all perfect and normal, which I find hard to believe. She ruled out issues with the pituitary. She basically said that my T is on the lower side of “normal” but that’s just how my body likes it. I argued a bit with her about the concept of normal and how I want to be optimal. She wasn’t having a bar of it! Looks like I’ll go back to the original endo who is more open minded, just spooked me seeing my sperm and T levels plummet during the HCG cycle.

I’m feeling absolutely dreadful these days since stopping all treatment. Worse libido since puberty, no surprise erections, no energy,always anxious, depressed, sensitive, easily irritated etc. FYI the second opinion endo blamed all my symptoms on “depression” and said repeatedly I do not have low t.

But… Thought I should come to the EXPERTS here and see what you guys think? Again sorry for the long post, I wanted to be thorough as this is so important to me and my happiness and wellbeing.


You have primary hypogonadism do to better than midrange LH and very low testosterone, testicles are responding poorly to good LH levels. Doctors in your country are braindead on such matters, some of the comments coming from your doctors is retarded! Freeze what sperm you have now, future fertility doesn’t look good.

Doctors here in the USA are concerned about fertility which is why they incorporate HCG together with a TRT protocol. However HCG can provide mood benefits to some guys, so even though your testicles are dying you may still benefit mood wise. You have yet to be put on a TRT protocol designed around you biomarkers, your TRT protocols are all wrong.

Your low SHBG dictates that you should be injecting smaller doses every other day or everyday because most of your testosterone ends up in the toilet within a 1-2 days, so once weekly is stupid. What these doctors are doing is cruel and none of them have any business prescribing testosterone, they simply don’t have any idea what they are doing!

Injecting larger doses once weekly produces larger testosterone peaks therefore also larger estrogen peaks, smaller injections EOD can lower estrogen levels do to smaller peaks. You really haven’t looked closely enough at your thyroid, labs for thyroid basically tell you nothing. Too many doctors fail to test Free T3 and Reverse T3, Free T3 is the only active thyroid hormones and it wasn’t tested.

You can check thyroid status by checking oral morning and afternoon body temperatures per thyroid sticky. Your need to inject 15-20mg EOD or 8-10mg everyday, incorporate HCG and a low dose AI if needed. This is the end game if you want to live an active healthy life.

Another note, the current state of health worldwide will lack understanding in anything related to male hormones, you need to educate yourself so you can vet your doctors and move on to the next one and not waste time with an uneducated one.

Thanks so much for your reply.

I find this stuff so complex and confusing. So my T is low as I suspected?

I’d be interested in thoughts on my HCG cycle protocol (2500iu twice a week) my endo said this is the best way, but when it ended up lowering my test and my sperm I was shattered, and he said that we should try an even higher dose in the future. My understanding is that that dose was way too high to begin with and could have damaged receptors… I mentioned that too him, that maybe smaller regular doses with testosterone could work better and he just brushed it off.

Does anyone have any recommendations for a doc in Australia that takes this stuff seriously? I’m in Tasmania and it doesn’t seem like there are any docs here who specialize in trt.

250iu hCG subq EOD is a replacement for normal LH function. Those high doses are stupid and harmful.

TRT should be T+hCG+AI
AI is aromatase inhibitor and almost always = anastrozole

Need normal ranges for AM Cortisol and fT4

Prolactin is high and we then suspect a prolactin secreting pituitary adinoma - that typically causes secondary hypogonadism.

TSH should be near 1.0, the lab ranges for thyroid levels are retarded and then doctors pronounce that all is well. You should also be using iodized salt in your kitchen.

Note “oral body temperature” below and post BOTH sets of temperatures.

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.

No starting protocol should have an AI especially at 100 mg test a week.

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Morning oral temperature was 36.1c (96.98f)

I just saw a 3rd opinion Dr who was very helpful!

My plan now is to wait until my sperm count goes back up, then freeze some sperm to be extra safe.

I will then begin IM Test E injections 125mg every 5 days.

Also prescribed a pill for me to take to prevent any hair loss (which was a nice extra little bonus).

He prescribed me HCG and said I could just take it when I feel I need to. He said I could take it regularly with my T, but I simply cannot afford that. So he said I can have a shot every couple of weeks or so and that should preserve testicular size but not likely to do anything for fertility.

He said eventually when I want to have kids I can come off the T, take HCG and wait for my levels to go back up.

My main concern here is fertility. He said its fine to do 1500iu of HCG, but I’m a bit worried. In Australia HCG comes in 1500iu containers, and it doesn’t store well, so I may as well do it all in one go.

Any thoughts?

Test schedule looks like a good place to start.

Take caution with the hair loss drugs, they can negate the benefits of TRT.

Many have been able to conceive while on TRT and hCG concurrently. Dosing is usually smaller and every other day.

Thanks for the reply. What do you mean “test schedule is a good place to start”?

I tried injecting once every 7 days and it was almost good enough, hence every 5 days now.

My issue is, the HCG only comes in 1500iu ampules and apparently doesn’t last too long after I mix it up, so that makes it hard to do 250iu every 2 days.

Hold on just a minute, if your doctor prescribed Propecia or Finasteride stop it immediately! Blocking DHT a natural hormone because you have a genetic defect is a good because? You will be trading hair loss for some type of other loss or negative. This is how drugs work, give and they take.

Google “Post Finasteride Syndrome”, I don’t understand why doctors keep prescribing this poison.

The Post-Finasteride Syndrome is a serious state of permanent sexual, mental, and physical side effects which do not resolve after quitting the drug, most often accompanied by an acquired form of secondary hypogonadism and post-drug loss of androgenic action, which remains highly resistant to hormonal treatments aimed at restoring Testosterone/DHT’s effects in the male body to pre-drug virility levels. It is also surmised by the few specialists in the medical field that a type of receptor or “brain damage” has occurred. As often seen with such damage, recovery is very slow or now questioned whether possible at all. Needless to say, men suffering from PFS are plagued with any physical, mental, and emotional symptoms that have led to long term depression, marital problems and divorce, and now several reports cases of suicide.

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I was referring to the every five day “schedule” and didn’t catch that it was not a start.

The hCG needs to be refrigerated. Can you keep it in a sterile vial?

Thanks mate, wow sounds like scary stuff! He prescribed me Finasteride 5mg (quarter of a tablet per day). I didn’t even ask about it, he just said it will prevent my hair loss if the trt makes me go bald, but also said it might stimulate my hair to grow back! I’ve got a bit of a receding hairline. I haven’t had time to research this drug yet but it sounds like it won’t be worth it. I’ll just go bald if it’s that nasty!

Yes, in the past I was doing every 7 days but feeling burned out at day 6ish. This time around I’ll try every 5 days.

HCG is where it gets tricky. In the past, with a different doc I cycled trt 6 months, then HCG 6 weeks (1500iu twice a week). This was “the best way of preserving fertility”. The HCG made me feel horrible, although it made my balls bigger, I felt worse than before starting trt. At the end of the 6 week HCG cycle I had bloods and sperm tests and saw my doc. Sperm had gone from 255million before trt to 3 million after HCG. Test had gone down from 18 to 8. So then the doc said basically, it hadn’t worked and to stop everything, wait 3 months for my sperm to rebound and regenerate and then go from there.

It’s almost been 3 months and my sperm is back up to about 44 million, so it’s getting better. I’ve seen a different doc now, who I believe is one of the leading trt docs in Australia. Once my sperm count gets higher I’ll freeze some as a back up insurance, then start the trt every 5 days.

I’m not sold on injecting 1500iu of HCG once a week every few weeks. I’m worried it will either be pointless, or be too high of a dose and screw me around. This is why I am interested in doing regular smaller doses, say 250iu twice a week.

In Australia, you can only get HCG in 1500iu amps. You have to mix the powder with the saline solution it comes with and inject immediately. I’m concerned that if I mix it, split it up into 6 sterile syringes (=250iu each) that it will result in me getting infected, or the HCG going bad.

Urgently hoping for some help interpreting my bloods as I have an appointment with doc tomorrow morning and want to be informed and prepared.

Updated test results posted below. I’ve been on trt for 6 weeks. Feeling better than previously in almost all aspects. My test results say otherwise. Seems like all results are worse than before trt. It makes me think that either the blood test was wrong, or my improved symptoms are all psychological. Not sure what to think, any help greatly appreciated.

Current protocol for the last 6 weeks:

62.5mg test enanthate IM every 3 days250iu HCG SQ every 3 days (day before T injection)

I had the blood test done Monday morning before HCG. Test was administered Saturday.

I’m sure some others will chime in pal, but I would say you are very low shbg so your test is getting used up and excreted real quick. E3d injections are no good for you, you need eod or even ed.

62.5mg E3D is pushing you to about 145mg every week. I think your dose is actually a little high which is probably why the Estradiol is up to 100 (very high conversion/aromatase rate). Free Test is not terrible but Total Test is a little low, so you may have low SHBG, but I would lower my dose to 50-55mg E3.5D and drop the HCG for 6 weeks and test again if I were you. I would push more for getting estradiol issue in hand (and NOT by introducing AIs just yet) before moving injections closer together because that may wind up compounding the issue. One thing at a time and a less is more approach.


The above comments are assuming that (hopefully) you are asking these questions because you still don’t feel that great (or not as great as you would like) and not chasing numbers here. If that is NOT the case, then how do you truly feel? You said you were feeling pretty good but you obviously have some concerns or you wouldn’t be posting now. If you feel great and your trend is getting better everyday, then don’t chase the numbers. Leave it be and wait another 6 weeks and check your bloods. If you feel like shit or start feeling like shit again after being better for a while then it’s time to talk tweaking.

Yes thanks bud, I’ll look into more frequent doses. Anyone know what the equivalent (or a good starting) dose would be if I was administering EOD?

Thanks for the reply!

Is there any way to raise SHBG?

Why do you advise no AI just yet? Wouldn’t that be an easy/simple solution?

I am feeling better than before trt, however I feel like there is definitely room for improvement. In the past I tried 125mg per week, and felt amazing for the first few days, then the effects wore off quickly, which is why this time I’m trying more frequent doses. Another option could be 125mg e5d. Thoughts? I did like that superman feeling you get from a big dose of T, however E2 was also an issue with that approach.

There is no way to raise SHBG, unless insulin resistance or fatty around the liver.

The AI should only be used if you are already showing symptoms of high E2. It should NOT be a preventative “chase the numbers” thing. The reason for this is that, once you have symptoms, you can judge the smallest dose possible to alleviate those symptoms slowly and steadily, without overshooting. If you go at it from a preventative standpoint, you run the risk of completely tanking E2, which I don’t know from experience, but I have read and heard that that is MUCH worse than high E2.

Again I will re-iterate my last edit. DON’T CHASE THE NUMBERS! If you are feeling great then there is no need to change anything unless the way you are feeling changes, ie…Symptomatic E2 issues, excessive aggressiveness, depression, anxiety…etc… Give it 6 more weeks and see if you are still steadily feeling better and better and then have the bloods ran again. you may be surprised. If something changes as mentioned above, THEN start considering some tweaks.

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It’s better to feel really good all the time, than to feel great for a day or two and then like shit for the rest of the week. That not only leads to instability, which will not only exasperate the problems, but will also drain you mentally. Not good…

Edit to add…This is my personal opinion based on my readings, so take this with a grain of salt, but I wouldn’t personally do any single injection more than 50mg. If you inject twice a week, then your maximum should be 100mg in that week. If your dose calls for 150mg, then I wouldn’t do two 75mg injections that week…instead, I would do three 50mg injections, or 21.5mg ED, or 42.8mg EOD…that sort of idea. My thinking behind this is that, as you have seen already, the higher any single dose is, the more of an E2 spike you get. Keeping to max 50mg per injection will keep your E2 aromatase rate in check…Also, as an added bonus, if you happen to accidentally nick a vein and you get some seepage of the oil into the bloodstream, the tight chest coughing fits and immediate headache will be minimal if the the dose is smaller…just my thoughts though…

Using your range of 125mg per week, I would personally make that 35mg EOD…