I'm new to this forum and have questions about my situation

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Matt73

New Member
I'm a 53 year old man in good health. I've been using a compounded testosterone cream 20-25 mg per day for a couple of years due to low bioavailable T. In 2019, I was experiencing anxiety, insomnia, low energy and some chronic GI issues. Here was my blood work in 2019:
total T 528 ng/dl (250-1100)
free T 47.1 pg/ml (46-224)
bioavail. T 90.7 ng/dl (110-575)
SHBG 54 nmol/L (10-50)
DHT 65 ng/dl (16-79)
estradiol 22 pg/ml (<39)

Since then, I have done many things to improve my health (supplements, eradicating chronic infections, detoxification, the testosterone cream, etc). In the past 10 months, I also added intermittent fasting/low carb diet and strength training (I had already done lots of cardio training). This has lead to a 15 pound weight loss despite gains in strength and muscle; I am more fit now than I have been in at least 20 years. GI issues and energy levels are much improved/resolved. I still have some anxiety and insomnia, for which I use 5 mg of edible THC at night (legal in my state.) My overall goals now are optimizing my vitality and longevity/healthspan.

My recent blood work has me puzzled and I would love some help with a few questions. Here are labs from 9/22 (units and ranges are the same as above)

total T 848
free T 48.4
bioavail. T 110
SHBG 89
DHT 129
estradiol 18
TSH 6.08

I recently started 30 mg Armour thyroid to deal with the elevated TSH.

In addition to weighing in on my specific questions, I'd love any other comments anyone has:

1) Why is my SHBG so much higher than it was before? I don't think I am deficient on any important minerals as I take lots of supplements and my liver is in good shape.

2) Why is my DHT so much higher than it was before? Is that a problem? (I had already lost most of the hair on the top of my head by 2019, before I started T).

3) Would switching to taking more T cream fewer days per week be effective at lowering the SHBG and increasing the bioavailable T? Or would it be smart to switch to an injectable form of T and do it fewer days per week (I'd rather stick with cream but I am willing to do sub-cut. injections if it would be the best move)?

4) Any ideas/thoughts about lifestyle, supplement or medication interventions that would improve this picture?

Thanks so much for any helpful comments and suggestions!
 
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sammmy

Well-Known Member
SHBG elevates when you fast and eat less sugar - you are on low carb diet, do fasting, and cardio training.

Fatty liver, diabetes, obesity, eating lots of sugar are associated with low SHBG.
 

sammmy

Well-Known Member
In terms of your free T lab value (if it's measured with an accurate test like dialysis) and how you feel, it doesn't seem that the TRT did anything for you, except keeping your free T at low normal on the background of your elevated SHBG: you dealt with the GI issues, infections, low energy, and lost weight due to your other supplements and interventions.

If you want to increase your free T, you could increase your unusually low dose of transdermal T, to overpower the elevated SHBG. Not sure that will decrease SHBG but it will give you more free T which is your goal ultimately. However with higher transdermal T may come more side effects.
 

Systemlord

Member
I also added intermittent fasting/low carb diet
This is a cause for an elevation in SHBG and can suppress testosterone.

Low carb diets can cause thyroid problems.

I recently started 30 mg Armour thyroid to deal with the elevated TSH.
Thyroid medicine also increases SHBG.

Why is my DHT so much higher than it was before? Is that a problem? (I had already lost most of the hair
T creams increases DHT substantially and sometimes many times higher than normal.

High DHT usually isn't a problem but can cause ache in some men. High DHT can have an anti-estrogen effect.

High DHT can contribute to hair loss.

Would switching to taking more T cream fewer days per week be effective at lowering the SHBG and increasing the bioavailable T?
T cream has little to no affect on SHBG, injectable T has a strong suppressive effect on SHBG in most cases.
 
Last edited:

Matt73

New Member
In terms of your free T lab value (if it's measured with an accurate test like dialysis) and how you feel, it doesn't seem that the TRT did anything for you, except keeping your free T at low normal on the background of your elevated SHBG: you dealt with the GI issues, infections, low energy, and lost weight due to your other supplements and interventions.

If you want to increase your free T, you could increase your unusually low dose of transdermal T, to overpower the elevated SHBG. Not sure that will decrease SHBG but it will give you more free T which is your goal ultimately. However with higher transdermal T may come more side effects.
Thanks for your replies, Sammmy. What kinds of side effects would I expect with increased doses of transdermal T?
 

Matt73

New Member
This is a cause for an elevation in SHBG and can suppress testosterone.

Low carb diets can cause thyroid problems.


Thyroid medicine also increases SHBG.


T creams increases DHT substantially and sometimes many times higher than normal.

High DHT usually isn't a problem but can cause ache in some men. High DHT can have an anti-estrogen effect.

High DHT can contribute to hair loss.


T cream has little to no affect on SHBG, injectable T has a strong suppressive effect on SHBG in most cases.
Thanks for your replies Systemlord. It seems like the transdermal T isn't fixing my free T, and it may be leading to elevated DHT. The intermittent fasting/low carb diet has been a total game changer in terms of increasing my energy and improving my body composition, plus there's data for increasing longevity and healthspan, so I don't want to stop doing that. I am now wondering if I should try a different form of T delivery that would lead to lower SHBG and DHT levels. Any recommendations on the best form to try?
 

Systemlord

Member
What kinds of side effects would I expect with increased doses of transdermal T?
The most common side effects is acne. Transdermal T also produces the highest DHT levels and increases libido and sense of well-being.

Any recommendations on the best form to try?
Jatenzo @237 mg taken orally twice-daily. Jatenzo is in second place for producing highest DHT.

Jatenzo should supress SHBG by about 40%. If your insurance doesn't cover Jatenzo, then cypionate injections may be the best option.
 

Fortunate

Well-Known Member
@Matt73, besides making labs look better, what current symptoms are bothering you? How do you currently feel and in what way do you want to feel better?

It’s easy to get caught up in lab values, but the bottom line is whether or not your treatment is successfully addressing your symptoms.

Dr. John Crisler (RIP, my man) used to always start a conversation with: “How do you feel?”
 

Matt73

New Member
@Matt73, besides making labs look better, what current symptoms are bothering you? How do you currently feel and in what way do you want to feel better?

It’s easy to get caught up in lab values, but the bottom line is whether or not your treatment is successfully addressing your symptoms.

Dr. John Crisler (RIP, my man) used to always start a conversation with: “How do you feel?”
Thanks Fortunate. I appreciate the question and I agree this is the most important to focus on, not the numbers. The things I would still like to improve are insomnia and lingering anxiety/lack of confidence. I am not sure how much the T numbers affect these outcomes. Any thoughts on that question?
 

Systemlord

Member
I am not sure how much the T numbers affect these outcomes. Any thoughts on that question?
The Free T level determines the outcome of your treatment. The transdermal T was a bad choice for you since it doesn't affect the SHBG levels much at all and therefore Free T won't go up much.

The injections or Jatenzo would significantly suppress the SHBG allowing Free T to increase.
 
Last edited:

Cooper

Member
@Matt73, besides making labs look better, what current symptoms are bothering you? How do you currently feel and in what way do you want to feel better?

It’s easy to get caught up in lab values, but the bottom line is whether or not your treatment is successfully addressing your symptoms.

Dr. John Crisler (RIP, my man) used to always start a conversation with: “How do you feel?”
Totally agree! Don't worry so much about the numbers. From the description it sounds like he is doing great. Don't mess with success.
 
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