SHBG High

Hello,

I wounder if anyone can offer any advice, I am 46 years old and seem to have a lot of symptoms that relate to low testosterone, is there anything to worry about in my lab tests? I see SHBG levels are high is this something to be concerned about?

Albumin levels are 45 g/L, so total free test is looking like 0.245 nmol/L = 1.35 % and Bioavailable Testosterone is 5.99 nmol/L = 33.1 %.

Testosterone 18.10 nmol/L
Luteinizing Hormone 4.7 IU/L
DHEA-S 5.90 umol/L
Oestradiol 78 pmol/L
Sex Hormone Binding Globulin (SHBG) 62 nmol/L
Follicle stimulating hormone (FSH) 3.3 IU/L
Prolactin 134 mIU/L
Vitamin B12 123 pmol/L

thanks

sr101 said:

so total free test is looking like 0.245 nmol/L = 1.35 % and Bioavailable Testosterone is 5.99 nmol/L = 33.1 %.

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Your free testosterone is low. 2-3% free testosterone is normal. You’re just above the cut off level. The normal ranges are poorly established, and have nothing to do with quality of life.

Many experts argue that free testosterone in the bottom 25 percentile is a sign of hypogonadism.

sr101 said:

I see SHBG levels are high is this something to be concerned about?

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Androgens, testosterone suppresses SHBG, so it’s not uncommon to see high SHBG alongside low free testosterone. The first things that happens when a man goes on TRT is the SHBG goes down.

Thanks alot for your reply, I thought it was low and just above the cut off point so would explain why I am seeing many of the low T symptoms. I will ask the doctor to refer me to discuss this further.

sr101 said:

Thanks alot for your reply, I thought it was low and just above the cut off point so would explain why I am seeing many of the low T symptoms. I will ask the doctor to refer me to discuss this further.

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I wouldn’t expect much from your doctor or your medical system, sex hormones is a field of medicine many doctors just don’t understand.

Men have different types of androgen receptors and sensitivities at those receptors, different receptor density, as well as the abilities for tissues to respond.

Everyone has their own normal range, but doctors treat everyone exactly the same.

I fully expect your doctor to look at you like a deer in headlights if you try to explain any of this to him.

First post and questions. First I would like to thank the contributors and organizers of this forum--it has been a valuable resource educating me on the subject of mens health.
Now the questions posted here as I have similar questions as the OP.
Seventy four years old, 45 years weight training, and showing all the symptoms of low T to include ED, suppressed mood, low energy/motivation, and loss of lean body mass. Talked with my doctor, had some blood work done (used info on this forum to add to his labs list) and received the results yesterday. Total T is 586 but Free T is 5.3 (less than 1% of Total T), SHBG is 58, Albumin is 4.4, Hematocrit is 49 (I live at 6k ft elevation if that matters-it varies from 46 to 49), Estradiol (sensitive) is 23.6, and LH and FSH are high at 12.2 and 14.1 respectively (primary hypogonadism). At my next Dr's visit I intended to press to start a protocol of 80 mg Test E per week split into two 40 mg injections per week--however I expect him to suggest that due to my Total T of 586 he would recommend nothing--even though I have all the traditional low T symptoms. Do you think the protocol I am suggesting could push my Free T up into the 2-3% of Total T range?? Would it push my Total T too high?? I just want to feel better!!

@NewGuy1DB: Free testosterone as a percent of total is not useful information; ignore it. It's simply an indirect reflection of SHBG, with more SHBG allowing for more stored testosterone, adding to total testosterone. Your calculated free testosterone is 8.6 ng/dL. The normal range for healthy young men is about 7-23 ng/dL. Your level is borderline.

You probably have an advantage in having primary hypogonadism, which is less common than secondary. With primary you can start TRT with very low doses of exogenous testosterone and have less fear of causing HPTA disruption. Instead you let LH and FSH guide you as to the appropriate dose. When their levels are knocked back to midrange then your level of testosterone is consistent with what your body is asking for. I have talked with a few guys on various forums who have had success with this approach. I'd suggest starting with only 10-20 mg TE per week in divided doses — ideally three, but two may work. Wait a few months and then see where you stand. You're looking for LH of ~6 mIU/mL. If it's still higher then you increase the dose a little. If lower then you decrease the dose. As long as you don't push LH too low the exogenous testosterone you take will add to your own production.

NewGuy1DB said:

Hematocrit is 49

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You can expect to have a secondary erythrocytosis on TRT. Excessive blood donations can lead to low ferritin. A slight elevation in hematocrit may be beneficial.

Thanks for the reply and information guys.

Cataceous--I had assumed that when introducing exogenous testosterone that your own production would actually shut down. It would seem that if I keep the dosage low, drop the LH to the mid range, that supplemental test would simply add to my own production. Am I understanding that correctly?? Based on my labs it appears that my body is ramping up the request for test production (high LH) but I am unable to produce enough???

Systemlord--Reference my hematocrit count (49), that is the highest it has ever been--normally 46-47. I seem to remember, based on study abstracts from this site, that the cut off for concern is 52 and that TRT typically adds 1 or 2 points to your non-TRT number. Is that increase dose dependent--ie if I stick with the low dose as suggested by Cataceous might that provide less chance of going over the cut off?

Learning a lot here.

Thanks

NewGuy1DB said:

Systemlord--Reference my hematocrit count (49), that is the highest it has ever been--normally 46-47. I seem to remember, based on study abstracts from this site, that the cut off for concern is 52 and that TRT typically adds 1 or 2 points to your non-TRT number. Is that increase dose dependent--ie if I stick with the low dose as suggested by Cataceous might that provide less chance of going over the cut off?

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The cut off for hematocrit for TRT is <54%, even this number is arbitrary. Lab values over the limit doesn't always translate into being dangerous. Sometimes it is optimal and desirable.

With a secondary erythrocytosis there is an increase in blood volume which enlarges the vascular bed, decreases peripheral resistance and increases cardiac output. Therefore, in a secondary erythrocytosis optimal oxygen transport with increased blood volume occurs at a higher hematocrit value than with a normal blood volume. A moderate increase in hematocrit may be beneficial despite the increased viscosity.

There are over 80 million people that live higher than 2,500 meters and they develop a secondary erythrocytosis. Men in parts of Bolivia for instance have a normal range of HCT from 45-61%. These men are not at an increased risk of thrombotic events nor do they have to undergo phlebotomies to manage their hematocrit.

NewGuy1DB said:

...
Cataceous--I had assumed that when introducing exogenous testosterone that your own production would actually shut down. It would seem that if I keep the dosage low, drop the LH to the mid range, that supplemental test would simply add to my own production. Am I understanding that correctly?? Based on my labs it appears that my body is ramping up the request for test production (high LH) but I am unable to produce enough???
...

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That's the gist of it. Having experienced problems due to the suppression of LH/FSH/GnRH etc. I believe it is advantageous to keep that signaling active, which you can do using the described technique.

Ignore those who would downplay the potential risks of higher hematocrit. The concern is more about the long-term wear and tear on the vasculature from that added viscosity, not to mention the greater load on the heart. In fact there is evidence of increased cardiovascular risk from high-altitude living:

Further references here:

Cataceous said:

Ignore those who would downplay the potential risks of higher hematocrit.

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I'm going to go with Dr. Abraham Morgentaler on this one and not some forum guru (no offense) with zero clinical experience and no medical license. Dr. Abraham Morgentaler takes the position that in the absence of certain medical conditions thicker blood has not shown to be harmful.

The study you linked makes statements such as, "we hypothesized (in other words they don't know) that FMD would be impaired in Andeans with EE after accounting for shear stress and that FMD would improve after isovolemic hemodilution.

Results: A total of 38,201 deaths and 75,893 stroke-related hospital admissions were reported. High altitude populations (HAP) had lower stroke mortality in men [OR: 0.91 (0.88–0.95)] and women [OR: 0.83 (0.79–0.86)]. In addition, HAP had a significant lower risk of getting admitted to the hospital when compared with the low altitude group in men [OR: 0.55 (CI 95% 0.54–0.56)] and women [OR: 0.65 (CI 95% 0.64–0.66)].

Conclusion: This is the first epidemiological study that aims to elucidate the association between stroke and altitude using four different elevation ranges. Our findings suggest that living at higher elevations offers a reduction or the risk of dying due to stroke as well as a reduction in the probability of being admitted to the hospital. Nevertheless, this protective factor has a stronger effect between 2,000 and 3,500 m.

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Systemlord said:

I'm going to go with Dr. Abraham Morgentaler on this one ...

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Argument from authority will get you nowhere. Of course Dr. Saya is no slouch either and he advises caution.

Systemlord said:

...
The study you linked makes statements such as, "we hypothesized (in other words they don't know) that FMD would be impaired in Andeans with EE after accounting for shear stress and that FMD would improve after isovolemic hemodilution.
...

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If you'd read a little further you'd understand that the study then found evidence supporting that hypothesis.

Systemlord said:

There are over 80 million people that live higher than 2,500 meters and they develop a secondary erythrocytosis. Men in parts of Bolivia for instance have a normal range of HCT from 45-61%. These men are not at an increased risk of thrombotic events nor do they have to undergo phlebotomies to manage their hematocrit.

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I guess this thread got highjacked as the subject matter was high SHBG.

We discussed the hematocrit/altitude subject at length in the thread below. It is an oversimplification to say that people at high altitudes live in the same conditions as a man on TRT at sea level. TRT increases red blood cells AND blood volume. Higher altitude dwellers are exposed to lower atmospheric pressure on their vessels and do not necessarily have higher blood volumes. A man with high blood pressure and high hematocrit is a man with high cardiovascular risk at high altitudes and also at sea level. I agree that someone with a blood pressure of 125/75 and hematocrit of 55 has lower cardiovascular risks than someone with blood pressure of 150/90 and a hematocrit of 52. I always warn everyone to always consider more than one variable at a time (the same can be said about high or low estradiol in the presence of high or low T). Risk calculations always include more than one variable.

GREATER CHANGES IN HEMATOCRIT PREDICT MORE FREQUENT MAJOR ADVERSE CARDIAC EVENTS IN MEN INITIATED ON TESTOSTERONE THERAPY - A LARGE CLAIMS DATABASE ANALYSIS​

Examples:
Here are some formulas that can be used to calculate cardiovascular health risk:

• 10-year cardiovascular risk score
  This calculator uses the following math to predict the risk of heart attack, stroke, or death from cardiovascular disease over 10 years:
  • Risk_Factors: = (ln(Age) + 3.06117) + (ln(Total_cholesterol) + 1.12370) - (ln(HDL_cholesterol) + 0.93263) + (ln(Systolic_blood_pressure) + On_blood_pressure_medication) + Cigarette_smoker + Diabetes_present - 23.9802
  • Risk: = 100 * (1 - 0.88936)
• Cholesterol ratio
  This ratio is calculated by dividing total cholesterol by HDL cholesterol. A higher ratio indicates a higher risk of heart disease.
• eASCVD
  This score is calculated by combining total cholesterol, HDL cholesterol, triglycerides, and age into a composite lipid score.
• Reynolds Risk Score
  This score uses information about age, sex, blood pressure, and cholesterol levels. It also considers whether a parent has had a heart attack before age 60, which can indicate a genetic risk.
• Whole blood viscosity (WBV)
  WBV can be estimated at high shear rate (HSR) and low shear rate (LSR) using formulas that include hematocrit (HcT) and total protein (TP). The formula for WBV at HSR is (0.12 × HcT) + 0.17 (TP - 2.07). The formula for WBV at LSR is (1.89 × HcT) + 3.76 (TP - 78.42).
• 2018 Prevention Guidelines Tool CV Risk Calculator
  
  We do not (yet) have a formula including blood pressure and hematocrit.