Testosterone Okay, Other Values Puzzling: Opinions, Please

[ClashCityRocker]

I am 51 years old, fit, and physically active. BMI is 19.3. Body fat is 9.8%.

Health is okay, but I am quite thin and the hardest of "hard gainers" in the gym. Sleep is rather poor (3-6 hours a night). Blood pressure is borderline high (134/80). I am going through a divorce and stressed about that.

I work as a phlebotomist in a men's health clinic that specializes in TRT. Curious about my own status, I had comprehensive lab work. I am not currently taking any exogenous T or T boosters.

Values for CMP, CBC, and U/A were all normal. LDL (159) and total cholesterol (235) were high, but that is a longstanding, probably genetic issue.

The hormone levels, however, puzzle me.

In range results:

Total Testosterone: 669 (ref. range 193 -- 740)
Calc. Free Testosterone 79.8 (ref. range 48.0 -- 250.0)
TSH: 1.45 (ref. range 0.270 -- 4.200)
Estradiol 18.1 (ref. range 11.3 -- 43.2)

Out of range results:

Free Testosterone: 1.2% (ref. range 1.3 -- 2.9)
SHBG: 77.1 (19.3 -- 76.4)
FSH 47.2 (ref. range 1.5 -- 12.4)
LH: 19.0 (ref. range 1.7 -- 8.6)

It seems I have good T but suboptimal bio-availability with the borderline low Free T and the borderline high SHBG. Is there anything I can do to improve that situation?

And what should I make of the high levels for FSH and LH?

Thank you for any feedback.

 

[Vince]

Your 51, I will assume you're done having kids? Because of your high shbg, it's causing low-free testosterone. Testosterone should lower it and of course increase your free testosterone. It's nice if you could add HCG into your protocol, keep your testicles. I would also supplement with magnesium, that will help your free T levels.

 

[ClashCityRocker]

Thank you, Vince. What type and dose of magnesium do you recommend?

 

[Vince]

Thank you, Vince. What type and dose of magnesium do you recommend?

I use source naturals magnesium malate. I take three tablets twice a day. Keeps my levels at a good range.

 

[Systemlord]

LH: 19.0 (ref. range 1.7 -- 8.6)

There are two scenarios where LH would be elevated, one is testicular failure and two is high SHBG.

If the latter, then the pituitary senses bioavailable T is low and attempts to increase the T by increasing the LH to stimulate the testicles.

Getting your T up should improve your sleep and correct a lot of other biomarkers including the blood pressure.

 

[Cataceous]

...Because of your high shbg, it's causing low-free testosterone. ...

There's no evidence for causality; the high SHBG is incidental. The issue is that his testosterone production is borderline.

There are two scenarios where LH would be elevated, one is testicular failure and two is high SHBG.
...

Correct on the first, wrong on the second. SHBG has little to do with this.

@ClashCityRocker: You do seem to be approaching primary hypogonadism. I would consider a trial with testosterone nasal gel. This is a less intrusive way of seeing if higher testosterone can ameliorate your symptoms.

 

[Systemlord]

Correct on the first, wrong on the second.

A properly functioning pituitary and if SHBG is high enough, then you can have high LH as I've seen it more than a couple of times on these forums.

 

[tareload]

Realistic TRT Recomp Progress

Yep, same dose of T

forums.t-nation.com

Characteristics of Secondary, Primary, and Compensated Hypogonadism in Aging Men: Evidence from the European Male Ageing Study

Classification of late onset hypogonadism into different categories including a novel diagnostic subgroup (compensated hypogonadism) may refine its diagnosis an

academic.oup.com

Compensated hypogonadism​

A relatively large number of men (9.5%) were identified as having compensated hypogonadism (3, 9). The frequency of this condition showed a clear increase with age (Fig. 1, inset) forming the largest LOH category (21.1%) in the 70- to 79-yr age group. Although smokers are overrepresented in compensated hypogonadism, there was no significant difference in total T, fT, or SHBG between smokers and nonsmokers in this group (data not shown). Excluding smokers from the analyses did not make any difference to the risk factor associations in any of the hypogonadal groups (Table 2). The explanation linking smoking with compensated hypogonadism remains unclear. Compensated hypogonadism was associated predominantly with physical symptoms. This is compatible with previous studies showing an inverse relationship between LH and muscle strength independent of T (10) and a lack of association between LH and libido (32). Although T levels in the compensated group remained above the thresholds for sexual symptoms, they may be insufficient to maintain previous levels of physical functions (33, 34). Given its wide normal range, it is possible that T had declined from previously high normal to current low normal levels in men with compensated hypogonadism. High LH may therefore be a biomarker for T decline within the reference range, indicating a readjustment of the HPT feedback set point in aging to compensate for deficiencies in testicular function and/or defective T feedback at the hypothalamic-pituitary level (35). A possible alternative explanation for the occurrence of physical symptoms in compensated hypogonadism may be the slightly lower mean fT in this group compared with eugonadal men (Table 1 and Fig. 2). However, after stratifying this group into those with low (<230 pmol/liter) or normal fT, low fT levels were not associated with increased symptoms (sexual or physical) after adjusting for age and other confounders (data not shown).

Compensated hypogonadism may be analogous to subclinical hypothyroidism (high TSH and normal thyroid hormone levels) (36) where it is accepted that most patients will go on to develop overt hypothyroidism and T4 replacement is indicated (37, 38). Our results suggest that elevated LH levels in compensated hypogonadism are not an isolated laboratory finding but significantly associated with physical symptoms. This lends support to the conclusion that it represents a genuine clinical subgroup of LOH. This condition may, therefore, be a forerunner of overt primary hypogonadism, being characterized by both elevated LH and higher age. Men with increased comorbidity and/or other as yet undefined factors may eventually progress from compensated to overt primary hypogonadism. The follow-up data in EMAS should provide verification to this hypothesized natural history of LOH.

The higher SHBG level in compensated hypogonadism could be an important proximal factor in the development of compensated hypogonadism and the higher E2 in the same group may be a potential mechanism. However, the present cross-sectional data cannot dissect out the complex but potentially important interrelationships, and more research on this aspect is warranted.

 

[Cataceous]

A properly functioning pituitary and if SHBG is high enough, then you can have high LH as I've seen it more than a couple of times on these forums.

Cite a mechanism. Or instead turn your causality around and consider that it's diminished free testosterone that's contributing to higher SHBG.

...
The higher SHBG level in compensated hypogonadism could be an important proximal factor in the development of compensated hypogonadism and the higher E2 in the same group may be a potential mechanism. However, the present cross-sectional data cannot dissect out the complex but potentially important interrelationships, and more research on this aspect is warranted.

The higher estradiol is interesting and would also contribute to higher SHBG. A possible mechanism is via the elevated LH. We already know that hCG acutely stimulates aromatization in Leydig cells. It seems likely that excessive LH has the same effect.

 

[Vince]

There's no evidence for causality; the high SHBG is incidental. The issue is that his testosterone production is borderline.

At 51, his levels should continue going down for the rest of his life. So I see no issue with him starting TRT. It should improve his free testosterone levels. Also lower his SHPG. Most men do so good on TRT. It's hard for me to discourage him.

It seems that the main issue is HCT. As you know, my first two years I donated blood every 8 weeks. After that my HCT stabilized, I've never had to donate blood again.

 

[Cataceous]

At 51, his levels should continue going down for the rest of his life. So I see no issue with him starting TRT. It should improve his free testosterone levels. Also lower his SHPG. Most men do so good on TRT. It's hard for me to discourage him.
...

If he responds well to nasal gel but doesn't care for that form of TRT then he could make the transition to a traditional method. When it's done right, guys with primary hypogonadism can tune conventional TRT such that HPTA function is maintained. I've seen at least a couple guys do that now. They slowly increase the dose until LH drops to normal. Unfortunately I doubt very many doctors are aware of this approach. If you get stuck on a typical protocol of 100+ mg TC per week then you end up fully suppressed.

 

[tareload]

If he responds well to nasal gel but doesn't care for that form of TRT then he could make the transition to a traditional method. When it's done right, guys with primary hypogonadism can tune conventional TRT such that HPTA function is maintained. I've seen at least a couple guys do that now. They slowly increase the dose until LH and FSH drop to normal. Unfortunately I doubt very many doctors are aware of this approach. If you get stuck on a typical protocol of 100+ mg TC per week then you end up fully suppressed.

You are typically way too sophisticated for a forum. Many guys don't want the right answer; a simple answer please that sounds pleasing. Did I mention simple?

This forum is very fortunate to have you dishing out sage information.

 

[Vince]

If he responds well to nasal gel but doesn't care for that form of TRT then he could make the transition to a traditional method. When it's done right, guys with primary hypogonadism can tune conventional TRT such that HPTA function is maintained. I've seen at least a couple guys do that now. They slowly increase the dose until LH and FSH drop to normal. Unfortunately I doubt very many doctors are aware of this approach. If you get stuck on a typical protocol of 100+ mg TC per week then you end up fully suppressed.

I'm also primary. Testosterone with HCG has serve me well. For me it's been a complete game changer. I can't imagine going around any longer with my brain fog. Sometimes I forget how bad it was and how TRT has completely changed my life.

 

[Systemlord]

Or instead turn your causality around and consider that it's diminished free testosterone that's contributing to higher SHBG.

I agree with this ^^, just not in every case.

 

[Systemlord]

Cite a mechanism.

Liver cirrhosis thus increasing SHBG, but not to the severity to where it would lower testosterone yet.

Scenario two would be a substance or compound increasing SHBG without affecting testosterone production.

 

[ClashCityRocker]

I appreciate the responses.

Reaction from PCP was of course that everything is fine, T-wise. Total T is normal (particularly for my age) and bioavailable is also normal.

Of course, "insurance normal" is not necessarily optimal from a wellness/functional standpoint.

I'm reluctant to embark on TRT just yet because of dependence and because some of my symptoms are undoubtedly exacerbated by the stress of the divorce. Moreover, I always look to natural/behavioral changes before long-term prescriptions, if there's reason to believe they could work.

I'll be investigating boron, Vitamin D, magnesium, zinc, Tongkat Ali, and ways to get better sleep. But I am scheduling a consultation with a doctor at the men's health practice where I work to get that perspective as well.

 

[Systemlord]

Reaction from PCP was of course that everything is fine, T-wise. Total T is normal (particularly for my age) and bioavailable is also normal.

Your PCP doesn't get paid to keep you healthy, he gets paid treat disease. If you want to optimize your state of health, then you'll have to foot the bill for that because your insurance company won't.

Also with differences in AR Gene CAG repeat lengths, with differing testosterone sensitivities in men, you can't have one number for everyone.

 

[Systemlord]

I'll be investigating boron, Vitamin D, magnesium, zinc, Tongkat Ali, and ways to get better sleep.

I tried and failed to build muscle on TRT with high T and then I found I had low vitamin D.

The vitamin D helped restore my sleep quality and muscle recovery.

Getting my vitamin D up has changed everything!

Vitamin D does soo much for brain, bone and muscle.

 

[Cataceous]

Liver cirrhosis thus increasing SHBG, but not to the severity to where it would lower testosterone yet.

Scenario two would be a substance or compound increasing SHBG without affecting testosterone production.

These don't address the request. You said "There are two scenarios where LH would be elevated, one is testicular failure and two is high SHBG." Cite the mechanism by which increasing SHBG results in higher LH. If you're going to claim that higher SHBG results in lower free testosterone then explain how total testosterone is held constant when the HPTA is regulating free hormones.

 

[Systemlord]

You said "There are two scenarios where LH would be elevated

I'm talking about high LH in cases of high SHBG other than testicular failure and secondary hypogonadism.

So by some other force increasing SHBG.

So I proposed a robust pituitary gland would increase LH high in order to get the Free T up in those two scenarios in my prior post.

If testosterone production remains the same as SHBG is increasing, you can't have the Free T unchanged.