T Nation

Starting TRT - Mid Range Total T and Free T, Low E2

Hi Folks,

About to start TRT after initial blood work showed the following:

Total T - 22 nmol/l (10.3 - 29.5)
Free T - 349 pmol/l (175 - 700)
Free T3 - 4.6 pmol/l (3.5 - 6.5)
Free T4 16.4 pmol/l (9 - 23)
TSH 1.51 mU/l (0.2 - 4)
Cortisol AM - 285 nmol/l (120 - 620)
SHBG - 52 nmol/l (6 - 65)
Estradiol - 43 pmol/l (<200)
DHEAS - 8.9 umol/l (<14)

There are other results like lipid and glucose and they are “best iv seen” according to TRT doctor as I do intermittent fasting, eat low carb/keto, lift 3X a week and maintain 11-13% bodyfat and a good amount of muscle.

The Total T and possibly free T readings are higher then normal due to running high amounts of clomid (100mg for 2 weeks, then 50mg for 4 weeks) with blood work taken 4 weeks after last dose of 50mg clomid. I used clomid after advice from a friend to help boost natural levels, I guess it kinda worked but i felt like crap/pissed off all the time and still had low libido. I had Total T tested in the past by family doctor after complaining of libido, mood, energy issues and was always in the 10-12 nmol/l range which was low but not low enough for him to justify TRT. Now seeing a clinic and they are willing to start me on a trial after i told them total T high due to clomid and usually its low. They have given me 100mg/week to be injected 50mg every 3.5 days. Its only been 2 weeks and I haven’t noticed much but am hopeful for positive results. Do you think my protocol is adequate given my labs? I hear that low SHBG requires frequent injection but does my level mean multiple injections a week or possibly just one? Wondering if my low E2 is cause of low libido and if 100mg/week is enough to bring it up to a good range without overshooting.

Your feedback is appreciated.

I’ve heard of multiple studies showing intermittent fasting, low carb diets will raise SHBG, this may very well be why SHBG is elevated. Clomid raises SHBG, this is why you felt little difference.

Your dosage is low for a guy with high SHBG, having higher SHBG mean you will need more androgens to increase Free T to the optimal level.

It will take 6 weeks for the Test to build up in your system before becoming stable at 6 weeks, testosterone is a hormone, not a party drug where the effect is instant and can be a slow process which has more to do with AR CAG repeat lengths ~ receptor sensitivity.

TRT is under prescribed and a lot of men suffering out there do to lack of knowledge and frightened doctors who are by nature wary of TRT. There are no doctors in sick care (or state healthcare) who specializes in TRT, those that do are more than likely private, looks like you found one.

An every 3.5 day protocol should be optimal, however you will more than likely need a dosage increase. Free T needs to be high normal or preferably higher. If you want to lower estrogen, inject more frequent smaller doses.

There are some high SHBG guys injecting daily and doing very well.

I’ll look into those studies, I only started that way of eating a few years ago however my libido, mood and energy were issues years before that so wondering if I’v always had higher SHBG. Is there a way to lower SHBG so lower amounts of TRT would be more effective? Were those studies based on also eating a calorie deficit while IF and keto? I have had better energy since doing it and usually eat around maintenance (2500 calories).

I’m not overly worried about E2 and actually want it to go up a big since its on the low side. I have blood work scheduled to be done at 8 weeks since starting but will ask if I can do it at 6 weeks in order to make any adjustments sooner.

Men who have high SHBG, the only thing you can do is throw more androgens at SHBG to lower it and increase Free T. Beyond excess androgens, not much else effects SHBG by a large margin.

If intermittent fasting, keto/low carb could raise SHBG perhaps eating more frequently with more carbs could lower it? its something I can try after another round of blood tests post TRT (to see where Total T, free T and SHBG are) and see if it makes a difference. Say it works and my free T is raised dramatically without raising my total testosterone, I can technically lower my dose and keep 2X a week injections if SHBG is lowered significantly as long as I feel good. I am thinking less is more when it comes to amount of drugs someone is taking.

Got Some new labs of blood Drawn May 31 (3 weeks after start of treatment) 24 hours after
injection of 0.5ml @ 100mg/ml and here are the results:

Total T - 18.6 nmol/l (10.3 - 29.5)
Free T - 742 pmol/l (175 - 700)
Free T3 - 5.8 pmol/l (3.5 - 6.5)
Free T4 20.2 pmol/l (9 - 23)
TSH 1.34 mU/l (0.2 - 4)
Cortisol AM - 359 nmol/l (120 - 620)
SHBG - 8 nmol/l (6 - 65)
Estradiol - 81 pmol/l (<200)

Looks like despite my Total T going down my free T more then doubled! This is due to my SHBG dropping like crazy im guessing. Estradiol is also now in the ideal range. I had a feeling I’d have good results because even though its only been 3 weeks I have started feeling an increase in libido and energy, nothing crazy but definitely an improvement from baseline. My question is since my free T is high already am i going to notice any further improvements in libido and energy or am I maxed out? How did my SHBG decrease so much? Should I be doing every other day injections now or stay the course? Is my dosage good as my total T did go down from baseline with blood drawn at the peak?

I don’t understand why SHBG decreased so much, don’t normally see this much of a decrease. You went from SHBG being high normal to super low. Retest it and see if it’s an error.

You’re holding onto your T just fine with that super low SHBG, you may be able to get SHBG higher if you hit it with smaller daily doses. It work well for me, SHBG went 16->22 when going from once/twice weekly dosing to daily dosing.

Getting insulin lower could help increase SHBG.

I know SHBG was originally high because I had 2 tests done a few weeks apart before starting TRT and they showed low 50s, I’m wondering if this was a lab error because it does seem odd that it would drop that low. My insulin is very low, it was on my pre TRT blood tests (30 on a 35-140 Scale) due to my low carb/IF lifestyle. Either way if Free T is high even if Total T is mid range and SHBG is low and my symptoms keep improving is this not an ideal case? I’m happy with 2X week injections and don’t want to do daily unless I really need to.