High SHBG, low free T. TRT?

[savefoxes]

Testosterone Total - 1035 ng/dL (250-827)
SHBG - 76 nmol/L (10-50)
Free Testosterone = 13.2 ng/dl (9-29)
Estradiol 26 (20-30)

Everything else is normal.
I've had all symptoms of low T for the last 4 years.
I'm eating carbs and have tried everything to lower the SHBG and nothing worked.
Would TRT reduce the SHBG and increase the free T? If so, what dose should I start with and how many times a week? Would you recommend taking Winstrol or Anavar to lower the SHBG or first see if just the Testosterone will lower it?

 

[Cataceous]

I would not go on TRT with those numbers. Chances are you'll end up worse off as you disrupt a dozen or more other hormones. Don't fixate on SHBG. There's no evidence that modestly high levels are harmful. Contrary to popular belief, SHBG does not control free testosterone; forcing it down in isolation would have little effect

If you are determined to experience higher testosterone then a testosterone nasal gel can give you that with less disruption. Unlike conventional TRT, such treatments do not completely shut down the HPTA.

Your estradiol is a little low relative to testosterone. If this is not a mass spectrometry-based test then it would be worth checking with one of the so-called "sensitive" tests. Standard tests tend to give elevated results. If your level is even lower than suggested then it could be contributing to your issues.

 

[Systemlord]

Would TRT reduce the SHBG and increase the free T?

The majority of cases SHBG will be suppressed.

Free Testosterone = 13.2 ng/dl (9-29)

If the direct immunoassay method was used, then you need to go back and do it again using either the Equilibrium Dialysis or Ultrafiltration method.

 

[Systemlord]

I've had all symptoms of low T for the last 4 years.

No one can tell you with absolute certainty whether your symptoms are from low-T because numbers don't tell the whole story.

Your AR gene CAG repeats are an unknown factor.

The high SHBG is the elephant in the room.

Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men

Hypogonadism or Testosterone Deficiency (TD) in adult men as defined by low levels of serum testosterone accompanied by characteristic symptoms and/or signs as detailed further on can be found in long-recognized clinical entities such as Klinefelter syndrome, ...

www.ncbi.nlm.nih.gov

Unfortunately, no consensus has been reached regarding the lower TT threshold defining TD, and there are no generally accepted lower limits of normal TT [60]. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not.

Meanwhile the number of CAG (cytosine–adenine–guanine triplet) repeats in androgen receptor differs in men and influences the androgen receptor activity [61–64] (Figure 1). Hence testosterone sensitivity may vary in different individuals.

 

[savefoxes]

The majority of cases SHBG will be suppressed.

If the direct immunoassay method was used, then you need to go back and do it again using either the Equilibrium Dialysis or Ultrafiltration method.

It's calculated. My total T is usually around 800 so 1000 was probably the peak. And my SHBG fluctuates between 65-80. Could my total T be inflated by high SHBG? I have 0 libido, 0 morning erections and my dick works only once a week.

 

[FunkOdyssey]

It's calculated. My total T is usually around 800 so 1000 was probably the peak. And my SHBG fluctuates between 65-80. Could my total T be inflated by high SHBG? I have 0 libido, 0 morning erections and my dick works only once a week.

In my opinion, Total T is too heavily confounded by SHBG to be useful when SHBG is uncommonly high or low. I would pay more attention to equilibrium dialysis free T as an accurate reflection of your T production.

 

[Systemlord]

Could my total T be inflated by high SHBG?

That's how it works. When I was diagnosed with low-T, my Total T was 91 ng/dL (3.2 nmol/L) and Free T below range, SHBG 11.

 

[savefoxes]

That's how it works. When I was diagnosed with low-T, my Total T was 91 ng/dL (3.2 nmol/L) and Free T below range, SHBG 11.

so my free T could be even lower? Or the calculated amount is correct?

 

[Systemlord]

so my free T could be even lower? Or the calculated amount is correct?

Why TruT™

Free testosterone calculator by FPT. Improved accuracy of free T calculations.

tru-t.org

The Endocrine Society position

Current methods for measuring free testosterone (fT) are technically challenging and not accurate. The widely used direct immunoassay and tracer analog techniques for measuring fT have been shown to be inaccurate. Equilibrium dialysis, the reference method against which other methods are compared, is labor-intensive and cumbersome, and therefore has had limited clinical adoption. Recently, Endocrine Society’s Expert Panel acknowledged the experimental problems in fT measurements and concluded that "...the calculation of free testosterone is the most useful estimate of free testosterone in plasma..." For this reason they advocate for indirect "calculator" based methods, where free testosterone can be computed from the total testosterone, SHBG, and albumin concentrations.

However, we have demonstrated that even the calculated fT values derived from the prevailing equations, based on linear law-of-mass action models or empiric equations, differ systematically from free testosterone measured by equilibrium dialysis by as much as 40%.

 

[sammmy]

The TruT online calculator does not show low free testosterone but nobody guarantees it is actually correct in cases of high SHBG (except its creators):

 

[savefoxes]

The TruT online calculator does not show low free testosterone but nobody guarantees it is actually correct in cases of high SHBG (except its creators):

according to this calculator my free T would still be fine with the SHBG level over 200

 

[Systemlord]

And now you understand the complexities of Free T testing and why some doctors ignore it altogether. Almost always, when there is high Total T and high SHBG, there will be problems and how much is very individual.

Dr. Saya has said when SHBG gets in the 40's, it starts to affect the Free T negatively.

 

[FunkOdyssey]

according to this calculator my free T would still be fine with the SHBG level over 200

If free T by equilibrium dialysis is true, the ironically named TruT calculation method is somehow less accurate than the old school calculations. In my case, Vermeulen is only off by a few ng/dL -- TruT is off by a whopping 10 ng/dL. I can only assume it was named TruT rather than after its creator because no one wanted to put their name on it.

 

[arseniol]

I can only assume it was named TruT rather than after its creator because no one wanted to put their name on it.

lolol

Do you have a specific condition which makes the TruT and equilibrium dialysis so different?

 

[bixt]

The novel FDA registered TruT algorithm

So anything FDA endorsed regarding hormones should be a warning sign not to trust it. They hate hormone therapy and make it hard to obtain, look at the current war on compounding pharmacies and hormones.

The conspiracy theorist in me says that the TruT calc is a plot to mislead people.

 

[FunkOdyssey]

lolol

Do you have a specific condition which makes the TruT and equilibrium dialysis so different?

I have a high SHBG in the 50's.

 

[arseniol]

I have a high SHBG in the 50's.

then you trust more equilibrium dialysis than any computed FT?

 

[arseniol]

So anything FDA endorsed regarding hormones should be a warning sign not to trust it. They hate hormone therapy and make it hard to obtain, look at the current war on compounding pharmacies and hormones.

The conspiracy theorist in me says that the TruT calc is a plot to mislead people.

for me, the main issue is that this algorithm is still a black box, which doesn't seem yet validated by the medical community.

ppi'd also like to see if there are some tools to compute the Zakharov free t which seems to provide pretty reliable results.

 

[FunkOdyssey]

then you trust more equilibrium dialysis than any computed FT?

Yes, although it remains an open question whether different reference ranges between equilibrium dialysis offered by different labs are due to a difference in the values generated by those tests or a difference in the samples used to generate the range. I use Quest which is as mainstream as it gets, so the results of many men are available to me for accurate comparison. Whenever you see equilibrium dialysis free T results with a ref range of 35-155 pg/ml, that's Quest you're looking at.

 

[Jerajera]

In my personal experience, the TruT calculator is completely off. I've posted the numbers somewhere and it wasn't even close. I've also seen very similar numbers between the Direct and Equilibrium Dialysis methods, despite everyone saying the Direct method is garbage