Chronically high SHBG and low free test (not on trt yet )

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I am hoping someone can shed some light on my current situation:

40 year old male, 5'10, 180 lbs

Symptoms: Low energy, zero libido, poor recovery from exercise, fatigue

Lifestyle: Don't drink, don't smoke, eat 40% carbs, 30% fat and 30% protein and 3000-4000 calories a day depending on energy expenditure on given day. Lift weights 3 times a week, cardio approx 8 hours a week. Sleep hygiene is good and no sleep apnea.

After having low T symptoms for the last 2 years and always getting good total T numbers around 20 nmol/l (ref 10-35) I went to the states (live in canada) to pay for a free testosterone test. Results were:

Total test : 596 ng/dl (ref 250-897)

Free test: 45.8 pg/ml (ref 46-224)

SHBG: 67 (ref 10-50 nmol/l)

I spent the next 4 weeks trying the following: Boron 9mg a day, increase carbs and calories, reduce exersize, stinging nettle root. I retested and had the exact same results

All other blood markers are normal (TSH, T3 and T4, lipid, liver, LH and FSH, A1C)

The only other issue is I for some reason have high BP, and was just diagnosed with WPW, waiting on cardiologist referral. I should be the poster boy for low bp

I have a trt clinic ready to script me as I know that exogenous test will lower SHBG, but want to make sure I have not missed anything. I have spoken to one doc who says technically she cannot script me as Canada only looks at total, and one doc at the trt clinic that says it's the answer.

Any ideas ?
 
Defy Medical TRT clinic doctor

Golfboy307

Active Member
Agreed. Not much will change SHBG other than Test treatment. I was similar to you, with SHBG in the 50's. Now I am around 30 after 8 years on TRT. Made a huge difference in quality of life for me.

What is WPW?
 

readalot

Member
I am hoping someone can shed some light on my current situation:

40 year old male, 5'10, 180 lbs

Symptoms: Low energy, zero libido, poor recovery from exercise, fatigue

Lifestyle: Don't drink, don't smoke, eat 40% carbs, 30% fat and 30% protein and 3000-4000 calories a day depending on energy expenditure on given day. Lift weights 3 times a week, cardio approx 8 hours a week. Sleep hygiene is good and no sleep apnea.

After having low T symptoms for the last 2 years and always getting good total T numbers around 20 nmol/l (ref 10-35) I went to the states (live in canada) to pay for a free testosterone test. Results were:

Total test : 596 ng/dl (ref 250-897)

Free test: 45.8 pg/ml (ref 46-224)

SHBG: 67 (ref 10-50 nmol/l)

I spent the next 4 weeks trying the following: Boron 9mg a day, increase carbs and calories, reduce exersize, stinging nettle root. I retested and had the exact same results

All other blood markers are normal (TSH, T3 and T4, lipid, liver, LH and FSH, A1C)

The only other issue is I for some reason have high BP, and was just diagnosed with WPW, waiting on cardiologist referral. I should be the poster boy for low bp

I have a trt clinic ready to script me as I know that exogenous test will lower SHBG, but want to make sure I have not missed anything. I have spoken to one doc who says technically she cannot script me as Canada only looks at total, and one doc at the trt clinic that says it's the answer.

Any ideas ?
Good thread for your to review so I don’t have to type it all again:




 
Agreed. Not much will change SHBG other than Test treatment. I was similar to you, with SHBG in the 50's. Now I am around 30 after 8 years on TRT. Made a huge difference in quality of life for me.

What is WPW?
Wolff Parkinson White, its a genetic heart defect that creates an extra electrical loop in your heart. Waiting to see cardiologist before jumping on trt, one thing at a time. What is your protocol? Did you also have doctors telling you it's all in your head and free testosterone doesn't matter ?
 

Gladiator

Member
Good thread for your to review so I don’t have to type it all again:




Don’t share t nation dribble
I called them out on a lie on Instagram and they blocked me. They aren’t anything but steroid abuse advocates
 

Golfboy307

Active Member
I have been fortunate in that a relatively simple TRT regimen has helped me immensely. I inject Test Cyp 3X week, 40mg for a total of 120mg/week. Keeps me in the 800-900 range and solid levels of Free T, E2 etc. No AI's etc.

Credit to my GP as he was the first to recognize that my Free T was below range, even though total was around 400 (at age 46). I came with physical symptoms: ED, fatigue, mild hypertension. So, no fortunately he didn't dismiss me. He could only offer Androgel which I chose not to start. Did my research with this site and Peak T, and found an awesome doctor in my area who was affiliated with Body Logic. He is on his own now, but he is an MD that focuses on longevity, overall health, and hormones. I still see my GP and he is impressed with the improvement in my health.

Definitely make sure you don't have any cardiac issues first. Not sure is TRT would affect that syndrome you have, but worth discussing. Quality of life is very important even if there are small risks.
 
I have been fortunate in that a relatively simple TRT regimen has helped me immensely. I inject Test Cyp 3X week, 40mg for a total of 120mg/week. Keeps me in the 800-900 range and solid levels of Free T, E2 etc. No AI's etc.

Credit to my GP as he was the first to recognize that my Free T was below range, even though total was around 400 (at age 46). I came with physical symptoms: ED, fatigue, mild hypertension. So, no fortunately he didn't dismiss me. He could only offer Androgel which I chose not to start. Did my research with this site and Peak T, and found an awesome doctor in my area who was affiliated with Body Logic. He is on his own now, but he is an MD that focuses on longevity, overall health, and hormones. I still see my GP and he is impressed with the improvement in my health.

Definitely make sure you don't have any cardiac issues first. Not sure is TRT would affect that syndrome you have, but worth discussing. Quality of life is very important even if there are small risks.
Awesome man, great to hear. Has your Hypertension come down since starting ? How long until you noticed symptom relief ?
 

Golfboy307

Active Member
My hypertension has remained the same really while on TRT. Despite me being a runner and a careful eater, my BP without meds is usually around 140/90. With meds I am under 120/80. 30 mg Lisinopril does the trick with no sides for me.

When I started TRT, I was on a once weekly shot. Symptom relief came in spurts. I would say after 1-2 months I really noticed improvements in EQ, libido, strength, confidence. It was erratic until I altered my protocol to where I am now injecting 3X per week. That eliminated all of the peaks and valleys.
 
I am hoping someone can shed some light on my current situation:

40 year old male, 5'10, 180 lbs

Symptoms: Low energy, zero libido, poor recovery from exercise, fatigue

Lifestyle: Don't drink, don't smoke, eat 40% carbs, 30% fat and 30% protein and 3000-4000 calories a day depending on energy expenditure on given day. Lift weights 3 times a week, cardio approx 8 hours a week. Sleep hygiene is good and no sleep apnea.

After having low T symptoms for the last 2 years and always getting good total T numbers around 20 nmol/l (ref 10-35) I went to the states (live in canada) to pay for a free testosterone test. Results were:

Total test : 596 ng/dl (ref 250-897)

Free test: 45.8 pg/ml (ref 46-224)

SHBG: 67 (ref 10-50 nmol/l)

I spent the next 4 weeks trying the following: Boron 9mg a day, increase carbs and calories, reduce exersize, stinging nettle root. I retested and had the exact same results

All other blood markers are normal (TSH, T3 and T4, lipid, liver, LH and FSH, A1C)

The only other issue is I for some reason have high BP, and was just diagnosed with WPW, waiting on cardiologist referral. I should be the poster boy for low bp

I have a trt clinic ready to script me as I know that exogenous test will lower SHBG, but want to make sure I have not missed anything. I have spoken to one doc who says technically she cannot script me as Canada only looks at total, and one doc at the trt clinic that says it's the answer.

Any ideas ?
readalot referred you to a thread on this topic that I started a few weeks ago. There is very helpful feedback on that thread, but I don't know yet if there is a clear great solution for guys like us.

You can see I am in a somewhat similar situation with normal T, higher range SHBG, and lower range Free T most of the time. My PSA of 1.7 is also on the higher end, but still within range. I don't know yet, but, in my case, I feel like my body is producing more SHBG in response to a higher PSA, like my hypothalmus is trying to protect my body and slow prostate growth by reducing effective androgen exposure to my prostate. Maybe that's wrong, not sure.

A few times my Free T labs look ok-ish, but my symptoms persist and they are not psychological for sure. I am not ready to do TRT. At this point, for me, TRT seems like an extreme way to lower SHBG and increase Free T - I am not sure if it would even alleviate my symptoms and I worry it would cause other problems. But I am curious to find out if consistent increased Free T would make me feel back to my normal self again.

Nettle and boron didn't do anything for me in terms of increasing Free T and lowering SHBG. I am going to try out enclomiphine next, 12.5mg twice a week, although it might raise my SHBG, but hopefully not much since my dose is low. I know a lot of people don't respond to enclomiphine but figured I would try it, as it seems there is little downside and maybe I'll be one of those who does respond well.

After that I am going to try some Natesto.

I wish there were a clear cut answer besides TRT for people in our category. It's frustrating because we are healthy and our bodies are producing enough testosterone, maybe just not using as much as they used to even though it's available. I haven't found the answer yet, but I am going to keep searching.

Given how important this is, I am surprised solutions fixing the source problem weren't all figured out 10 or 20 years ago. I am surprised there wasn't a Manhattan Project already for men's hormones as they age, but I guess it's complicated. Hopefully they figure it out soon. There is certainly interest and money from many men willing to pay for a solution.
 

Cataceous

Super Moderator
...
I wish there were a clear cut answer besides TRT for people in our category. It's frustrating because we are healthy and our bodies are producing enough testosterone, maybe just not using as much as they used to even though it's available. ...
If your free testosterone is low then you are not producing enough testosterone, period. This is basically independent of SHBG. High SHBG just means you have extra storage space for testosterone, driving up total testosterone. But for the most part it is free testosterone doing the useful things in your body—not the total testosterone sitting in storage.
 
If your free testosterone is low then you are not producing enough testosterone, period. This is basically independent of SHBG. High SHBG just means you have extra storage space for testosterone, driving up total testosterone. But for the most part it is free testosterone doing the useful things in your body—not the total testosterone sitting in storage.
That's a very good point, thank you.

Instead of saying this:
"It's frustrating because we are healthy and our bodies are producing enough testosterone, maybe just not using as much as they used to even though it's available."

I could have put it this way:
"It's frustrating because we are generally healthy and our bodies are capable of producing solid amounts of Total T (for example in the 600-800 range), but for some reason our body's Free T target is set lower.
 

Cataceous

Super Moderator
...
I could have put it this way:
"It's frustrating because we are generally healthy and our bodies are capable of producing solid amounts of Total T (for example in the 600-800 range), but for some reason our body's Free T target is set lower.
That's still somewhat missing the point. Total testosterone doesn't matter. Let me illustrate: You have a big tub of water and you are allowed to use only the overflow from that to water your lawn when there's a drought. Does the size of the tub have much bearing on how much water you can give your lawn? No, because on average your outflow is controlled by your inflow. If you're limited to transferring water into the tub with an eyedropper then your lawn is going to die. Having a big tub of water does not imply a good production rate. Because you can't drain the tank at will it doesn't much matter how much is in there. Your results are dependent on your production rate, not on your storage capacity.

The free testosterone set point is indeed the issue in secondary hypogonadism—and sure, it's frustrating to know that your testicles probably could produce enough testosterone for your needs if given the right signals. We have various imperfect tools for making those signals: enclomiphene, kisspeptin, gonadorelin, and hCG.
 
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