Low SHBG

[Casey]

I am looking for advice about my current regimen. I’m 42 years old and have been on trt for one year. I’m on 200 mg per week of test cyp along with 1.5 mg arimidex per week. My latest blood test was a few weeks ago and my results were 841 total testosterone with 22 for estradiol. My SHBG is 15. I currently inject equally divided doses three times a week subcutaneously. I am wondering your thoughts. From what I’ve read I’d think my total testosterone would be much higher on that dosage.

 

[MarkM]

That's a pretty stiff does of testosterone each week along with a very high dose of arimidex. Arimidex at larger doses has many unwanted side effects over time. It's likely you would not need the arimidex if you lowered you testosterone consumption. You have very low SHBG so you are probably peeing out a lot of your testosterone.

Total Testosterone isn't what's important, it the Free Testosterone It's probably on the high side, which you want to a degree but you probably have high Free Estradiol too which you don't want. Most people with low SHBG like you have need smaller doses and more frequent injections for them to have success with TRT.

Have you considered daily injections? Smaller doses on a daily bases will likely raise you test and you could probably get rid of taking the arimidex because you are not going to have it spiking from the larger test injections. Is the estradiol test the Estradiol Sensitive, LC/MS/MS assay?

Do you have labs that you can post so we can see everything in it's entirety so we can see ranges and offer up more credible advice.

 

[Casey]

Labs

That's a pretty stiff does of testosterone each week along with a very high dose of arimidex. Arimidex at larger doses has many unwanted side effects over time. It's likely you would not need the arimidex if you lowered you testosterone consumption. You have very low SHBG so you are probably peeing out a lot of your testosterone.

Total Testosterone isn't what's important, it the Free Testosterone It's probably on the high side, which you want to a degree but you probably have high Free Estradiol. Most people with low SHBG like you have need smaller doses and more frequent injections for them to have success with TRT.

Have you considered daily injections? Smaller doses on a daily bases will likely raise you test and you could probably get rid of taking the arimidex because you are not going to have it spiking from the larger test injections. Is the estradiol test the Estradiol Sensitive, LC/MS/MS assay?

Do you have labs that you can post so we can see everything in it's entirety so we can see ranges and offer up more credible advice.

 

[Systemlord]

I also have low SHBG only 1 point higher than yours and I only respond well to TRT injecting 20mg EOD, any less and it feels as if I'm not even on TRT. I don't think three times a week is enough, it needs to be EOD or everyday. Your adrenal glands are overactive, which may be adrenal hyperplasia.

That large dosage of testosterone is likely why your RBC, hematocrit and hemoglobin are all high. Injecting smaller more frequent doses will fix it. Ferritin is low and is needed for thyroid hormone production, it could be an iron storage disorder.

No thyroid testing, you should be checking Free T3, Free T4, Reverse T3 and antibodies. Thyroid hormones can't be good with ferritin low.

 

[Casey]

So you’re only on about 80 mg per week? I feel good and have good libido, etc. I just thought my numbers don’t match up to the dosage I’m on.

 

[Systemlord]

So you're only on about 80 mg per week? I feel good and have good libido, etc. I just thought my numbers don't match up to the dosage I'm on.

That's correct, 20mg EOD and awaiting my AI prescription, low SHBG men struggle with controlling estrogen. Low SHBG men don't feel well in the high normal ranges do to an abundance of free hormones. You will feel better on smaller doses EOD or ED.

You need to target nothing above 600 ng/dL or you won't feel well.

 

[MarkM]

Looks like about half of a normal blood work up. No metabolic panel, no lipids, the estradiol test appears to be the wrong test. You need the Estradiol Ultrasensitive LC/MS/MS assay. The other test is for women and is not accurate for men. I do not see a Free Testosterone test and no thyroid panel.

Your iron and ferritin levels are dangerously low and this could be creating all kinds of issues for your thyroid. Are you donating blood? Your Hematocrit (HCT) and Hemoglobin (Hb) are both high, probably due to the large dose of testosterone you are taking.

Your DHEA-s is very high at 629. Are you supplementing DHEA in your protocol?

You probably need a change in our regimen/protocol but we really need to see the Free Testosterone and Estradiol Ultra-Sensitive numbers to point you in the right direction.

 

[Vince Carter]

I am looking for advice about my current regimen. I'm 42 years old and have been on trt for one year. I'm on 200 mg per week of test cyp along with 1.5 mg arimidex per week. My latest blood test was a few weeks ago and my results were 841 total testosterone with 22 for estradiol. My SHBG is 15. I currently inject equally divided doses three times a week subcutaneously. I am wondering your thoughts. From what I've read I'd think my total testosterone would be much higher on that dosage.

Remember that Total Test is all bound up and such that number really isn't useful, it's Free T that you need to be concerned about and work your dosing around. As other said Free T and Sensitive E2 LC/MS/MS...I'd also like to see if you can afford the test "Estradiol, Free". As stated by SystemLord your free hormones are going to be key here. We know low SHBG = high Free T, will also = high Free Estrogen, too. That will be the problem.

Though in your post here I don't doubt that you need that much Anastrozole with the dose of T and having your Sensensitive (which you didn't) E2 follow closely your SHBG is likely where the low SHBG needs to be in regards to E. You won't be able to tolerate very much E will probably need a sensitive <20 and like I said something in the range that mirrors SHBG.

 

[Vince]

I agree with the others, consider going to daily injections with a lower amount of testosterone. Get the right estradiol test for men and hopefully you can drop your AI.

 

[Gus80]

I also have low SHBG only 1 point higher than yours and I only respond well to TRT injecting 20mg EOD, any less and it feels as if I'm not even on TRT. I don't think three times a week is enough, it needs to be EOD or everyday. Your adrenal glands are overactive, which may be adrenal hyperplasia.

That large dosage of testosterone is likely why your RBC, hematocrit and hemoglobin are all high. Injecting smaller more frequent doses will fix it. Ferritin is low and is needed for thyroid hormone production, it could be an iron storage disorder.

No thyroid testing, you should be checking Free T3, Free T4, Reverse T3 and antibodies. Thyroid hormones can't be good with ferritin low.

How is your FT with 20mg EOD?

Do you inject EOD (1 week 4x and other 3x) or 3x/week?

 

[Systemlord]

How is your FT with 20mg EOD?

I'm on Jatenzo now @ 237 mg twice daily.

My Experience On Jatenzo (Oral TRT) Log

I wanted to start a thread detailing my personal experience with Jatenzo (oral TRT) which is remarkable in how quickly it has shown results when compared with injections. The first week on Jatenzo was very pleasant unlike my experience after dosing changes on injections, all with minimal swings...

www.excelmale.com

A new oral testosterone undecanoate therapy comes of age for the treatment of hypogonadal men

 

[Gus80]

I'm on Jatenzo now @ 237 mg twice daily.

My Experience On Jatenzo (Oral TRT) Log

I wanted to start a thread detailing my personal experience with Jatenzo (oral TRT) which is remarkable in how quickly it has shown results when compared with injections. The first week on Jatenzo was very pleasant unlike my experience after dosing changes on injections, all with minimal swings...

www.excelmale.com

A new oral testosterone undecanoate therapy comes of age for the treatment of hypogonadal men

As the half-life of oral testosterone is short, it might be an excellent option for people with Sleep Apnea, as it would be possible to calculate the 2nd dose so that testosterone was low enough at night to not disturb sleep. I read in another post of yours that you had 35% bf when you started trt, did you have apnea?

Did your bf decrease with injectable trt or only when you switched to oral?

 

[Systemlord]

I read in another post of yours that you had 35% bf when you started trt, did you have apnea?

No sleep apnea and zero fluid retention. Jatenzo also doesn’t affect hemoglobin and hematocrit as much as injections due to the shorter half-life.

Did your bf decrease with injectable trt or only when you switched to oral?

My bf only decreased on Jatenzo, that is after getting my vitamin D 30>. That’s when everything started to improving.

As the half-life of oral testosterone is short

Jatenzo has a 6 hour half-life. Steady states in 7 days.

 

[Gus80]

No sleep apnea and zero fluid retention. Jatenzo also doesn’t affect hemoglobin and hematocrit as much as injections due to the shorter half-life.

My bf only decreased on Jatenzo, that is after getting my vitamin D 30>. That’s when everything started to improving.

Jatenzo has a 6 hour half-life. Steady states in 7 days.

With injections, did you have retention and/or apnea?
Have you tested gel before?

It can be an excellent alternative for everyone with low shbg and sleep disorders, as it can follow a cycle more similar to the circadian cycle.

You must have researched safety from a liver point of view. What did you think about it?

 

[Systemlord]

injections, did you have retention and/or apnea?

No, but I never was able to ride out a protocol for long because I can’t tolerate cypionate or enanthate esters.

Hormones that are very steady cause me big problems, like crazy low blood pressure when sleeping causing me to wake up having difficulty breathing and swelling in right side abdomen with hot to the touch and strange sounds coming from the area.

I don’t absorb topicals at all.

You must have researched safety from a liver point of view. What did you think about it?

I have the clinical trial study and my Kaiser endo would never have agreed to prescribe Jatenzo without a through review by someone high up in Kaiser approving new drugs.

Some doctors are still hung up on old data and even with new data showing Jatenzo is reasonably safe, some doctors refuse to prescribe Jatenzo.

My liver enzymes have decreased while on Jatenzo.