High estradiol and SHBG 10wks into TRT (was high on enclomiphene too) - long winded post sorry.

[Sandz]

I was brought here after listening to Nelson on Dr. Lyons podcast, man what a story and journey!

48M, 5'6" 160lbs.

I lost 90lbs 25 years ago and have kept in shape ever since. I workout daily, love being in the gym, but never truly felt optimized. This last year or two I made it a goal to feel comfortable in my own skin and get into the best shape by 50, so I felt it was valuable to go check more labs than a typical provider did.

In the end, I tested with low free T multiple times, always under 4.0. My Total T was 350-450ish throughout my 40s. Wasnt educated enough to test other markers, but I am really trying to tune into my body these days.

I got on an enclomiphene, and came to realize less is more. I was on 12.5mg, but ended up dialing down to 6.25EOD. I never felt great, eye flutters, and I didn't see the benefit, so I stopped after terrible Gerd (perhaps not related but I think it was).

Total T on elnclo was btwn 900 and then 1000.
Free T was consistently hovering around 14
SHBG was consistently high at 63 then 50 - (50 even before starting anything)
Estradiol btwn 38-40 from btwn 8-15 without any treatments

Started TRT - subq 2x a week - .3cc so 120mgs a week about 10wks ago. Feeling better than elcno, biggest change so far is irritability and attitude. Less agitated, more focused day to day. Workouts a little better, feeling a touch stronger, slight.
Total T - over 1500
Free T - 17.3
SHBG - 67
Estradiol 60
Sensitive estradiol 53
DHEA 157 taking 25mg a day

So, bottom line, I don't need my T to be over 1500.
I an lowering my dose to 100mg a week, .25cc 2x a week subQ
Adding in Nettle root, extract and root 300mg/150mg
Adding in 3mg or 6mg Boron
Adding in calcium d-glucarate 500mg
Continuing to take Dim 300mg which I started with TRT

I want to take advantage of the T, so bound testosterone doesn't seem valuable. I am not terribly afraid of the E2, I don't feel gyno but I do feel like my sleep isn't good, and I am retaining water which is expected on T, its mild (1-2lb). Doc suggested small dose of AI, but I don't think I need to jump there just yet unless my case is cause for it. Also in the fall, I had a terrible bout with Gerd and I believe its from the T and E being elevated. I hope lowering my dose and adding in support naturally is the winner, but I don't often see people with both High E2 and SHBG although I am sure its been documented I just cant find a lot of scenarios like mine. I want to take the maximum benefit, I dont need to be at a certain number, if it lands at 800, so be it. I just want to get my E2 and SHBG in check.

Any other questions or advise, please let me know. Any input is appreciated. Ill keep searching the forum too, its a fantastic resource!

 

[FunkOdyssey]

So, bottom line, I don't need my T to be over 1500.
I an lowering my dose to 100mg a week

Actually, you might need your total T to be that high, or even higher, to have a decent free T with that high SHBG. You need to retest testosterone with a proper LC/MS method though so you can see where that actually sits.

Your high E2 is also similarly artificially inflated by your high SHBG. Your free E2 is probably in a decent place, just like your free T.

I would not be considering a dose reduction with a free T of 17 ng/dL. Again though, we aren't sure what your free T actually is here, because of the testosterone assay used. I would retest with a proper test that can read higher than 1500 ng/dL before making any changes.

Forget about doing anything to specifically try to reduce your SHBG, that is a distraction and a dead end. Your free T is what matters here for symptom resolution, and it directly reflects your dosage of testosterone. Want more free T? Increase the dose. Forget total T and forget SHBG.

 

[FunkOdyssey]

By the way, I am a fellow GERD sufferer and have seen this worsen with TRT depending on the form and dosage. The effects of androgens vs estrogen here are distinct: estradiol relaxes the lower esophageal sphincter to promote more reflux events, while androgens somehow make the reflux more damaging.

This may turn out to be a dose-limiting side effect for you as it has been at times for me. One thing I found helpful were higher frequency injections to reduce peak levels (EOD with long esters) and IM injections to reduce aromatization. A decent percentage of men see a higher T/E2 ratio with IM, and it may be worth experimenting to find out if you are one of them.

 

[Systemlord]

Workouts a little better, feeling a touch stronger, slight.

I would get the Free T higher, 20-25 or higher if you feel the added benefits and other parameters aren’t too far out of range.

No mention of hemoglobin and hematocrit levels.

Remember, a given hormone level on TRT doesn’t have the same effect as a natural level with the regulatory systems in place at the same level.

So you need a higher Free T level on TRT to achieve an equal effect as a natural level, as an example, a natural Free T of 17ng/dL, you would need a Free T level a little higher to achieve the same effect.

My Total T is currently 239 ng/dL and Free T 5.1 ng/dL and I could never feel half as good as I do now with this level on TRT.

 

[Sandz]

Actually, you might need your total T to be that high, or even higher, to have a decent free T with that high SHBG. You need to retest testosterone with a proper LC/MS method though so you can see where that actually sits.

Your high E2 is also similarly artificially inflated by your high SHBG. Your free E2 is probably in a decent place, just like your free T.

I would not be considering a dose reduction with a free T of 17 ng/dL. Again though, we aren't sure what your free T actually is here, because of the testosterone assay used. I would retest with a proper test that can read higher than 1500 ng/dL before making any changes.

Forget about doing anything to specifically try to reduce your SHBG, that is a distraction and a dead end. Your free T is what matters here for symptom resolution, and it directly reflects your dosage of testosterone. Want more free T? Increase the dose. Forget total T and forget SHBG.

Interesting thoughts. If I reduce total T, and my free T stays in similar range, wont my ratio be improved? And if that lowers my SHBG, wont I have less bound/more bioavailable T? I am feeling the estrogen, to your point on your additional comment, the Gerd is more prevalent and I feel that's the driver which is why, in total, I decided to go down to 100mgs a week vs 120. I feel that the saturation of Total T is at max, for me, so even with lower total I think the other numbers wont go down that much but hopefully E2 will....again its trial and error. Good food for though for sure!! Thank you!

 

[Sandz]

I would get the Free T higher, 20-25 or higher if you feel the added benefits and other parameters aren’t too far out of range.

No mention of hemoglobin and hematocrit levels.

Remember, a given hormone level on TRT doesn’t have the same effect as a natural level with the regulatory systems in place at the same level.

So you need a higher Free T level on TRT to achieve an equal effect as a natural level, as an example, a natural Free T of 17ng/dL, you would need a Free T level a little higher to achieve the same effect.

My Total T is currently 239 ng/dL and Free T 5.1 ng/dL and I could never feel half as good as I do now with this level on TRT.

Hemoglobin - 16.6, i think thats in range.
Hematocrit - 48.9 i think also in range.

I hear ya, its a theme. More free T, more bioavailable. I am trying, but I feel more T isn't the answer for me personally as its driving up my E2 and SHBG.

Man its tough, I am just one of those with hereditary high SHGB, always been since ive tested before and after therapy.

 

[FunkOdyssey]

If I reduce total T, and my free T stays in similar range, wont my ratio be improved?

Your free T is going to drop proportionately to your dose reduction. What type of free testosterone test did you have performed? A calculated free T based on 1500 ng/dL total and 67 nmol/L SHBG would be 25 ng/dL free T. That's probably a more reliable number, and if that was the trough of a twice weekly injection then you probably do have room to reduce dose a bit and still have good levels, especially if you increase frequency to EOD.

Be sure to request the LC-MS method for total testosterone next time so you can see your actual result.

And if that lowers my SHBG, wont I have less bound/more bioavailable T?

Reducing your dose is unlikely to increase your SHBG - if anything, higher doses of androgens reduce SHBG. No, reducing your SHBG is not going to increase your free testosterone, that is a common misconception. The effect of reducing your SHBG, if you managed to do that in isolation of other variables, is to reduce your total testosterone level.

I am feeling the estrogen, to your point on your additional comment, the Gerd is more prevalent and I feel that's the driver which is why, in total, I decided to go down to 100mgs a week vs 120.

That's fair, but don't discount switching to IM as a way to reduce aromatization. When it works, it really works.

Man its tough, I am just one of those with hereditary high SHGB, always been since ive tested before and after therapy.

Low SHBG is alot worse. High SHBG is associated with better metabolic and overall health. If you can get over the shock value of the total testosterone numbers it's going to take for you to have a therapeutic level of free T, there are no downsides.

 

[Systemlord]

And if that lowers my SHBG, wont I have less bound/more bioavailable T?

No, SHBG has no influence on how much testosterone you’re producing in the testicles. SHBG is made in the liver. Luteinizing hormone and the response by the testicles and the adrenal glands determines how much Free T you’re producing.

Now androgens lower SHBG and estrogen increases SHBG, hormones balance other hormones. Dopamine restrains prolactin, so people with high prolactin tend to have lower dopamine.

When I overdose on vitamin C, my liver enzymes become elevated and my SHBG increases, along with my Total T. This has no influence on my testosterone production within the testicles and the adrenal glands.

I had Gerd like symptoms on TRT that had more to do with iron deficiency caused by the TRT. The daily and every other day protocols caused iron deficiency. Other delivery methods of TRT did not cause iron deficiency.

It wasn’t actually Gerd but it sure felt like it.