New to TRT. Low SHBG, High rT3/TSH

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mrhat75

New Member
I'm with Defy and have been on TRT and HCG for about 2.5 months. I have my follow up with Nurse Jill in about a month, but wanted to get some more opinions on my bloodwork as the low SHBG is very concerning. I also live in one of the few states without LabCorp and will be traveling in a couple weeks and will be able to use DiscountedLabs.....so I kind of want to take that opportunity to get a few more labs on the cheap and make the picture clearer.

January 12.5mg EOD Clomid and Cabergoline labs. Prolactin had been high in the past but has been fine as of the last several labs so no more caber. Pituitary MRI came back normal last summer.

http://imgur.com/a/qKHHX

Didn't feel any better after several months despite lab values so switched to 80mg twice a week subq cypionate and 40iu twice a week hcg + some anastrozole. Labs were 3 days after injection in the morning recently.

http://imgur.com/a/ixd54

Follow up with Defy isn't for another month so I want to get other's opinions though I know I'm in great hands. A few points:

6'1" 215 and 26 years old. I lift and have started running more. My main concern is libido. Lack thereof. I do notice nocturnal erections when I wake in the middle of the night, but morning wood is only a few days a week, and absolutely zero spontaneous erections. Same prior to taking anything, on clomid, and now. I remember what it was like being 17, that is what I'm chasing and I'm not even close. I have packed on about 5lbs and have put on quite a bit of strength in the 2.5 months on TRT, that is about the only difference. Might've had a libido spike around week 4-5, but that is relative to having none.

Testosterone is fairly high on trough. I was at 320ng/dl before any meds, but my body kicks it into high gear when LH rises. I question whether I need test and should maybe go back to serms or try hcg mono.

Iron really improved after I started supplementation (notice the differences). I take iron, iodine, selenium, vitamin d, and fish oil daily.

Thyroid is a problem. TSH has always been > 2. I did iodine replenishment for a while and that spiked it, but even after all of that and daily iodine + selenium supplementation, it is the same. I have never had hypothyroid symptoms and my body temperatures are good at 97.7F waking and 98.6 mid afternoon. All of my labs look good except for rT3. rT3 to fT3 ratio is not good (14.2, should be > 20). This is a problem. Oh and I had TPO Antibodies tested previously and they came back negative.

I did have one cortisol test ever and it was at the tip top of the range shortly after waking; right where it should have been.

E2 is not the proper assay. I'm going to get the Quest LC/MS/MS. Could have E2 issues, but SHBG seems like a much bigger issue.

LOW SHBG. This is the main point of my post. I know high test will lower it a bit, but if you go back to my clomid labs, the TT/FT ratio was still way off so I suspect this has been a problem for a long time, and potentially is the reason I had low T in the first place. A few points on this

a. I know glucose isn't the same as an insulin test. I have zero family history of type 2 diabetes. Insulin is the most potent hormone to SHBG so I'm going to a low carb paleo diet to be safe. Should probably get this tested.

b. Thyroid could be a reason for low SHBG too. I might ask about temporary T3 supplementation to improve rT3.

c. I ordered Dr Wilson's adrenal fatigue book. Would correspond to the rT3 issue. Do you think I need more adrenal bloodwork ie a 4x day cortisol saliva test?

d. I want to cut down to 190lbs or so. I know this hurts thyroid and other hormones in the short term, but is beneficial in the long term. I will not go too drastic and will follow Leigh Peele's refeeding advice. Still will hurt hormones, I don't see a way around this. T3 supplementation during the cut could help.

e. I think my liver function is good, but am not 100% sure on how to interpret those results. I've stopped drinking as of late and will continue to not drink much if at all. I ordered berberine, slo niacin, and milk thistle to help with liver/insulin as suggested in the peaktestosterone post on curing low shbg.

f. I've been told I'm not a snorer so I don't suspect sleep apnea. I do wake up for a minute once or twice a night on average though. Maybe a sleep study? I usually have 2 nights a week where I have trouble falling asleep. I'm working on improving this drastically. Not stressed in life otherwise. No chronic illnesses or anything like that. Good sleep and I wake up fine. Only real sleep issue is falling asleep sometimes as previously stated.

g. I've read ED or EOD injections can be beneficial for people with low SHBG. But I don't think I'm going to change up the injection protocol until my appointment.

h. While I do have the family genes for it. I started balding really quickly and noticeably by 22. Never took meds or anything, I just shave it and look good. I suspect things started going downhill for my testosterone in my early 20s, but don't recall for sure, but it coincides. Wouldn't low SHBG lead to higher DHT (I haven't read a lot on DHT, nor have had it tested)? I'm just curious to see if this adds anything to the picture.

Long winded post I know, but I want to try to cover every base that I can. I've been reading about everything I've been able to find. I think that it would be a good idea to test h1ac, ferritin, and tibc. Not sure if adrenals need further looking into because I read a post by Vettester Chris stating that adrenal and iron issues would usually have a much lower fT4 and mine was quite high.

Looking forward to the responses!
 
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Defy Medical TRT clinic doctor

CoastWatcher

Moderator
Your lab values did not post since members have to have a minimum number of posts before attachments can be made (spammers are a constant battle). Can you copy and paste them?
 
SHBG will settle where it wants to and you'll have to deal with whatever level that is...you can't raise it, or lower it....And stayoff the PeakT forum..."cure low SHBG"...that's a huge crock of stuff you step in on accident, that forum is one of the worst places for support.
 

mrhat75

New Member
Originally posted these urls:

January 12.5mg EOD Clomid and Cabergoline labs. Prolactin had been high in the past but has been fine as of the last several labs so no more caber. Pituitary MRI came back normal last summer.

http://imgur.com/a/qKHHX

Didn't feel any better after several months despite lab values so switched to 80mg twice a week subq cypionate and 40iu twice a week hcg + some anastrozole. Labs were 3 days after injection in the morning recently.

http://imgur.com/a/ixd54

Edit: I dug up some old labs and had HgbA1C test 4.8% (4.2 - 6.0) on 7/14/16.

I also calculated all TT to FT ratios that I've had. I wish I would've tested SHBG previously though. So perhaps it isn't that big of a problem when looking at ratio?

6/22/16 (no meds) - 380ng/dl vs 8ng/dl = 2.1%
10/19/16 (no meds) - 323nd/dl vs 12.3ng/dl = 3.2%
Jan 17 (Clomid) - 1148ng/dl vs 29.03ng/dl = 2.5%
Jun 17 (TRT/HCG) - 1077ng/dl vs 27.45ng/dl = 2.5%
 

CoastWatcher

Moderator
Estradiol appears to have been measured with the incorrect test given the language accompanying the results. Which means it's an unreliable result. Has this been an issue for you in the past, particularly with Clomid where e2 has to be carefully - and regularly - monitored?
 

mrhat75

New Member
Estradiol appears to have been measured with the incorrect test given the language accompanying the results. Which means it's an unreliable result. Has this been an issue for you in the past, particularly with Clomid where e2 has to be carefully - and regularly - monitored?

Yeah I will get another test before this appointment. SHBG and rT3 still are issues regardless of E2 (although it plays some part with SHBG). Any ideas on what else to look at for those, based on the rest of my labs?
 

Vettester Chris

Super Moderator
As you've gathered, RT3 can be problematic when FT3 doesn't/can't reach the cells. However, it can also happen when other issues are present, being illness, stress, injury, etc., most things where the body is signalling it needs to conserve energy.

With that said, YES, cortisol and iron/ferritin are probably the first two (2) key areas to look at first. YES, a more comprehensive adrenal panel would be desired for this. Go with the 4x Saliva kit, and try to see if you can get it with a DHEA test so that we can do a correlation analysis. I don't see iron serum or ferritin?

Please, when you get these, just type out the total summary of the labs, plus try to list an updated thyroid panel with RT3, FT3, FT4 and TSH. I only saw a TgAb antibody result on the first link, we also need TPO antibody. Again, just list them all once complete, with reference ranges, it will make commenting much, much easier. Thanks
 

mrhat75

New Member
1. I talked to the lab and was told that E2 was in fact the LC/MS/MS assay. 1077ng/dl TT and 33pg/mL E2 does not come close to the 14-20 recommended ratio. On .8mg/wk, EOD anastrozole. Think I should cut that in half or quit altogether? I'd need E2 at like 60 though....or cut the T dose. Really having erection/libido/orgasm problems.....thank god for PDE5 inhibitors for now (at 26, yay)

2. I've had thyroid all done this year:

TSH - 2.6 (0.4 - 4.0)
fT3 - 3.7 (2.3 - 5.0)
fT4 - 1.6 (0.6 - 1.8)
rT3 - 26 (8 - 25)
Thyroglobulin AB - < 1 (<=1)
TPO AB - 0.0 (0.0 - 6.8)

Oral body temps have been 97.7F waking and 98.6F mid afternoon for the past year.

3. I ordered the 4x saliva Cortisol before reading about DHEA

Morning DHEA-S last fall, prior to Clomid or TRT + HCG - 468 (80 - 560)
Morning DHEA-S June 2017 on TRT + HCG - 362 (80 - 560)

AM Cortisol blood last fall, prior to Clomid or TRT + HCG - 19.3 (6.0 - 19.4)
4x Cortisol saliva July 2017:

8:15am: 12.8ng/mL (3.7 - 9.5) HIGH
1:15pm: 2.1 (1.2 - 3.0)
6:15pm: 1.3 (0.6 - 1.9)
11:15pm: 0.8 (0.4 - 1.0)

Also read Dr. Wilson's Adrenal Fatigue book and took his test. Did not show adrenal fatigue, for what that is worth.

4. I'm scheduled to test Leptin, Insulin, Total Iron (again), TIBC, and Ferritin next week so I should have those results about a week from now.

I don't expect insulin problems based on HgbA1C and glucose, but good to be sure. I do have a history of PSMF dieting, so idk if that ****ed Leptin up and it never recovered. Doubtful that that alone would give me all of these problems.
 
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Please include a CBC with those tests you listed in #4 above, there can be some indicators there about your blood cells that with the iron/Ferritin/TIBC can be used together to see if you're iron deficient anemic.
 

mrhat75

New Member
By the way, would there really be any use in testing C Reactive Protein at this point or would it be a bit redundant?

Switching to an anti inflammatory diet is something that needs to be done regardless.
 

CoastWatcher

Moderator
By the way, would there really be any use in testing C Reactive Protein at this point or would it be a bit redundant?

Switching to an anti inflammatory diet is something that needs to be done regardless.

I test CRP on an annual basis because it's a marker for many issues I am at risk for due to family history and previously diagnosed issues. It's probably a good idea to get a baseline so you know where you stand, but it's not something that strikes me as mandatory.
 

ERO

Member
1. I talked to the lab and was told that E2 was in fact the LC/MS/MS assay. 1077ng/dl TT and 33pg/mL E2 does not come close to the 14-20 recommended ratio. On .8mg/wk, EOD anastrozole. Think I should cut that in half or quit altogether? I'd need E2 at like 60 though....or cut the T dose. Really having erection/libido/orgasm problems.....thank god for PDE5 inhibitors for now (at 26, yay)

2. I've had thyroid all done this year:

TSH - 2.6 (0.4 - 4.0)
fT3 - 3.7 (2.3 - 5.0)
fT4 - 1.6 (0.6 - 1.8)
rT3 - 26 (8 - 25)
Thyroglobulin AB - < 1 (<=1)
TPO AB - 0.0 (0.0 - 6.8)

Oral body temps have been 97.7F waking and 98.6F mid afternoon for the past year.

3. I ordered the 4x saliva Cortisol before reading about DHEA

Morning DHEA-S last fall, prior to Clomid or TRT + HCG - 468 (80 - 560)
Morning DHEA-S June 2017 on TRT + HCG - 362 (80 - 560)

AM Cortisol blood last fall, prior to Clomid or TRT + HCG - 19.3 (6.0 - 19.4)
4x Cortisol saliva July 2017:

8:15am: 12.8ng/mL (3.7 - 9.5) HIGH
1:15pm: 2.1 (1.2 - 3.0)
6:15pm: 1.3 (0.6 - 1.9)
11:15pm: 0.8 (0.4 - 1.0)

Also read Dr. Wilson's Adrenal Fatigue book and took his test. Did not show adrenal fatigue, for what that is worth.

4. I'm scheduled to test Leptin, Insulin, Total Iron (again), TIBC, and Ferritin next week so I should have those results about a week from now.

I don't expect insulin problems based on HgbA1C and glucose, but good to be sure. I do have a history of PSMF dieting, so idk if that ****ed Leptin up and it never recovered. Doubtful that that alone would give me all of these problems.

I would cut the dose of AI in half and test E2 again in 4 weeks with the Sensitive Assay.
 
What I'm learining about Iron and what I see is your numbers other than Ferritin look very middle of the road, I believe folks are saying Ferritin needs to be >100 or about 150 so you may consider some sort of daily supplement. have you been donating blood that your ferritin is reduced here?
 
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