Endo says SHBG doesn’t need to be tested. Need advice

mg707

New Member
This site has been a huge help to me on my TRT journey, so big thanks to Nelson and the other mods for running it and responding to posts!

I’m 48 YO and Ive been on TRT since 10/10/2018 after my 3rd bout of MDD and 2 blood tests that showed I was at 110 and 150 TT. Traditional ADs were not working and I tried them all. As an aside, they may be what crashed my TEST, but also could be MDD. No way to tell.

People mostly talk about physical benefits of TRT, but I will tell you that TRT, along with some other holistic treatments, has literally saved my life and I’ve never felt better mentally

My protocol has settled into injecting 40mg (0.2ML) of Test Cyp 2x per week, Wed evening and Sunday morning. So 80 mg per week total.

I have side effects of acne on shoulders, higher overall sebum production and water retention, but the pros way outweigh the cons

I’m getting treated by an Endocrinologist, who is one of the best around. However, I asked to get SHBG tested and he said that was unnecessary, only need TT, FT and Estradial (although I had to suggest this get tested originally so not sure that he does a lot of TRT).

Here are my most recent labs taken on a Thursday morning with my prior last injection being Sunday - so trough.

Total Test (serum) 555
Free Test direct - 17.6
T4 Free (thyroxine) - 1.47
TSH - 0.91
Estradiol - 29.9 (Roche ECLIA methodology)
PSA - 1.7

Should I insist that SHBG be done and if so, what is the logic for having it done, what can I learn?


I asked about HCG as well because I have some significant atrophy and he said he doesn’t prescribe that bc of adverse side effects. I do take an AI nor have I.

I know I probably need to switch doctors and get one that is more versed in current treatment standards based on all the above.

My goal is to reduce acne and water retention while maintaining my positive mental and physical benefits of TRT some I’m hesitant to tweak too much

Appreciate anyone that responds with some insights
 

ERO

Member
If you are feeling great as-is, then no big need to test. Its good to know SHBG as a reference sure, but if the protocol is working, don't break it.
 

Cataceous

Well-Known Member
As @ERO says, SHBG is good to have for reference. If it's low or high you might adjust your dosing pattern accordingly. SHBG is also used to get an estimate for free testosterone that is better than the standard direct test, though not as good as a high quality test such as equilibrium dialysis.

Adding hCG can be good, bad, or a mixed bag. It almost always reduces testicular atrophy. Sometimes it improves libido and well-being. In some cases it raises estradiol levels enough to throw things out of balance.

With twice-weekly injections you could be having peak serum testosterone around 50% above the trough value. That's about 800 ng/dL, which isn't high for TRT, but is well above average for natural men. This could be giving you the side effects. You could see if you like smoother levels better by injecting 22 mg EOD. This would put your level closer to the average value all the time, perhaps somewhat under 700 ng/dL.
 
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