T Nation

Which Protocol for a High SHBG Guy?

This week I am going to see a TRT specialist in London, he’s very forward thinking in relation to TRT. I am of course a little anxious, since I don’t feel terrible, though I am not doing great either…

My symptoms are mainly from being poisoned by the antibiotic Cipro, but here is a quick list anyway:

  • Brain fog (intermittent)
  • Skin thinning/dryness
  • Low libido/ED
  • Lack of sensitivity (linked to ED)
  • Tough to loose abdominal fat (even though I am skinny)
  • Mild anxiety
  • Clicking/popping joints (though no pain specifically)

I wouldn’t say I have depression or low energy though, but i definitely have more aches and pains since Cipro poisoning.

Here are my labs:


ALBUMIN - 48 g/L (35 - 52)

Iron Metabolism

Iron - 95 μg/dL ( 65 - 170 )

Ferritine - 83 ng/mL ( 20 - 250 )

Thyroid Hormones

Reverse T3 - 0.26 ng/mL (0,09-0,35 ng/ml)


DEHYDROEPIANDROSTERONE-S - 8,20 μmol/L ( 2,17 - 15,2 )

CRP (C- REACTIVE PROTEIN) - 1,10 mg/L ( < 5 )


TSH (Tirotropin) - 1,23 mU/L ( 0.3 - 4.2 )

FREE THYROXINE (FT4) - 0,93 ng/dL ( 0.61-1.12 ng/dL)

TOTAL T3 (Thriyodotironine) - 0,8 μg/L ( 0.7 - 2 )

Sex hormones

17-BETA ESTRADIOL - 19 pg/mL ( < 60 )

Testosterone - 4,54 ng/mL ( 0,65 - 8,00 )

FREE TESTOSTERONE - 12,5 pg/mL ( 8,3 - 40,1 )

PROLACTIN - 4 μg/L ( 3 - 14,7 )

SEX HORMON BINDING GLOBULIN (SHBG) - 50,3 nmol/L ( 10 - 57 )


TOTAL PSA - 0.45 ( < 4 )
Free PSA - 0.16


Ac. anti Tiroglobulina - 20,4 UI/mL ( < 60 )

Ac. anti Peroxidasa (TPO)/Microsomales - 0.4 UI/mL ( <9 )

My latest labs came back recently and are a lot lower:

Sex Hormones

Testosterone - 3,66 ng/mL [ 2,6 - 10 ]

17 beta Estradiol - < 15 pg/mL

C Reactive Protein - 1,00 mg/L [ < 5 ]

It’s worth nothing, 10 years ago I had my testosterone tested (when I had no problems) and I was sitting at 680 total T. No symptoms at all, good sexually, etc.

What type of protocol generally be best for someone with higher SHBG like mine? A lot of my symptoms seem to stem from low E2 and free T.

I would see what your doc suggests. Based on what you’ve posted here I would guess at around 150-180mg / week given you have a high SHBG (you’ll need more total T to get Free T optimal). If he starts you really high then you might want to think about breaking up the injections to 2 or more a week to keep aromatase activity in check.

Another option would be to run 100mg-120mg / week for 12 weeks or so and see if your SHBG comes down some. Then re-assess from there.

I would start with 150mg/week and re-evaluate in six to eight weeks.

Your RT3 to T3 ratio (albeit you didn’t test free T3) looks like you could be hypothyroid. If that’s the case even the perfect trt protocol won’t make you feel ideal. It’s possible trt could even make you feel worse. If I were you I’d look into a good thyroid specialist and get that looked at.

Sorry, I should have included those in my latest labs here:

TSH - 0,66 mU/L [
Free T3 - 3.3 ng/L ( 2.1 - 4.4 )
Total T3 - 1.0 ug/L ( 0.7 - 2 )


Cortisol - 12.56 ug/dL ( 5 - 23 )

I believe my rt3 is elevated due to Cipro (antibiotic) poisoning and the damage it done to my body, tendons, etc.

I am hoping TRT improves thyroid function further due to it increasing iodine uptake and T4/T3 conversion.

Curiously, in what way would TRT make me worse? I have considered this as well btw, but keen to get some input.

TRT won’t make it worse. but you won’t get full benefit if the thyroid is off. If anything, the increased T will help you heal and recover. The E2 is low, because the Total T is low. When the T comes up, the E2 will come up and your joints should stop clicking. The free T will be trickier as long as the SHBG is elevated, but studies show a correlation between low T and elevated SHBG. It should hopefully come down over time with sufficient t levels.

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I think the doctor mentioned doing smaller dosages of TRT + HCG. But because I have a varicocele, I already have impaired testosterone production as per the labs. HCG should be beneficial for increasing E2 though (hopefully).

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I saw an explanation from Dr Mariano on why TRT can exasperate hypothyroidism (better at first but gradually becoming worse). I don’t remember enough of it to cite the exact reasoning but I’ll look for it when I get free later on. Regardless anyone that is also hypothyroid is going to never feel ideal until they deal with thyroid so dialing in trt felling-wise would be hard to do.

@dextermorgan, what are your thoughts on labs above in relation to thyroid? From what I can see my free t3 looks good, above mid range.

Reverse t3 is usually caused by inflammation or other factors related to the body being under stress. Because Cipro causes mitochondrial death, I believe my body is ramping out thyroid production to offset this and potentially help recover the damage done. T3 directly stimulates the mitochondrial ATP.

I’ve read that fixing sex hormones takes the weight off thyroid and helps improve conversion between T4-T3, as well as various other benefits. So I’m hoping this improves my situation, if it does not then only solution is going to be adding in low dose T3 as well.

Here’s what to read about thyroid and interpretation of your lab results