T Nation

Testosterone Total 938 / Free 104

 A coworker of mine who was training for an Ironman Triathlon started feeling EXTREMELY FATIGUED and unmotivated. He got got some blood work done, and here are the results. I would appreciate some feedback ... as to what might be causing his SHBG to be so high ? His total T seems fantastic, but his SHBG seem to be cancelling it out.

 I myself (50yr, 5'7", 180lbs) started TRT because my SHBG was ridiculously high, and my Free T and Estradiol were low and I also had osteopenia and osteoporosis. (I'm all dialed in and feeling great now

 I kinda wonder if an environmental factor may be at play causing the high SHBG ? The only things the two of us have in common are ... we are both truck drivers, work nights .. 12hrs average, but can go to 14 - 16 hours sometimes. We are both also lifelong fitness freaks. He is into endurance/cardio. I'm into lifting.
 Any thoughts or suggestions would be greatly appreciated.

Testosterone total 938 H (302-903)
Testosterone free 103 L (47-244)
Testosterone % free 1.1 L (1.6-2.9)
DHEA-S 154 (80-560)
Ferritin 20 L (23-322)
Iron 174 H (50-160)
Estradiol 70 H (0-40)
SHBG 91 (13-110)
TSH .93 (.33-4.70)
FT3 3.1 (2.3-4.2)
FT4 .83 L (.89-1.76)
Vit D 29.8 L (30-100)

He is 40yrs old. Six feet tall. 14% body fat. He works nights (60+ hours a week) He works out religiously... mostly endurance stuff .. swim bike run. He sleeps perhaps 4-6 hours a day. He is currently NOT on any HRT/TRT.

Please pardon any spelling or punctuation errors, I just got home from a 15 hour night at work.


My understanding is there is very little that can be done about SHBG levels.

However, did you not notice those ferritin levels or Estradiol levels?

There are clear things that can be and should be done about that.


Secondary hypogonadism with high E2 as a factor, possibly liver mediated.
Suspected iodine deficiency.

High E2 is driving up SHBG then more SHBG+T inflates TT numbers.

Suspect that LH/FSH are depressed by elevated E2. But more may be wrong.

FT4=.083 is well below midrange. Has he stopped using iodized salt and become iodine deficient. If so, others in his house could have issues too. He can check his body temperatures as per the thyroid basics sticky.

Sea alt, Kosher salt and Himalayan Pink salt are ruin lives.

Need these labs:
AM cortisol
LH/FSH <-- must be before any TRT
occult blood test

DHEA-S is getting low, try 25mg

Did he mess with steroids or 5-alpha reductase inhibitor hair loss drugs?

Liver problems may be reducing clearance rates of E2 and SHBG+T. Can be a problem with the liver or Rx/OTC drugs that complete for the same liver enzyme pathways. List all drugs, Rx, OTC, supplements etc.

Direct him to the stickies:

  • advice for new guys
  • things that damage your hormones
  • finding a TRT doc

Low iron stores [ferritin] and elevated free iron suggests a long term low iron situation and recent iron rich meal or supplements. Iron can be low from GI bleed blood loss. So ask about changes to digestion. Occult blood test will be useful and CBC. Also need to know about older and new food sensitivities.

you or he take sleep aids or stay awake aids?

A good immediate intervention would be 0.5mg anastrozole per week in divided doses.

Please work all of the points above. He should also have his own thread here. Ping me at ‘KSman is here’ thread when you post here with more info.


KSMan, Thanks for the reply. I will talk with him and get him to join the site and have a look around … and hopefully start his own thread.