Decoding SHBG and primary vs. secondary

I've been on TRT for nearly 9 months now. My initial labs, before starting, were as follows:

Initial labs (pre-trt):

Total T: 3.33 (2.8-8.0)
Free T: 6.1 (8.7-25.1)
SHBG:69 (16.5-55.9)
LH: 5.6 (1.7-8.6)
Estradiol sensitive: 19.6 (8-35)

Most recent labs (taken the morning before injection on an every 3.5 day schedule):

Total T: 1143 (246-916)
Free T: 32.3 (8.7-25.1)
SHBG:34.8 (16.5-55.9)
Estradiol sensitive: 27.3 (8-35)

Two questions - and forgive me if these are "newbie" questions...

1. With SHBG that high initially, is it possible that I could have been functioning fine and have had good total/free T numbers if they weren't being bound up via the high SHBG? Or is that not at all how that works?

2. With those numbers, and I know LH is the primary determining factor in primary vs. secondary, do I appear to be more primary than secondary? I remember the NP at Defy saying it was "not as clear as some cases", but if she had to guess, she'd go with primary.

I'm actually at a point where things are starting to even out and I'm feeling TONS better, but these questions have been floating around for a while, and I am just curious if maybe I could have/still could get away with

When I first started trt my LH was 13.2 range 1.7-8.6, it was easy to know that I was primary. Looks like your trt protocol has really done a nice job for your testosterone levels. I don't think there's anything you could have done to get good testosterone levels without trt.

Assuming those pre-TRT labs are ng/mL (333 ng/dL) together with SHBG of 69, most if not all your testosterone was bound and unavailable. You aren't the first to second guess if TRT was the right move and you certainly won't be the last, your testosterone was already low enough to causes serious life altering health problems down the road.

TRT not only increase your testosterone to youthful levels, but also took care of your SHBG problem and lowered it to an optimal level. You killed two birds with one stone.

I am sure one could be both primary and secondary.

Your LH is low, but even if you boost LH by taking HCG / clomid, your TT never gets very high.

One question I would have about being secondary, if you use HCG how long do you need to use it to see the maximum response from your testicles? It might be that it takes a while for the stimulation of HCG to increase natural production, you might even get some additional testicular growth over time.

DragonBits said:

I am sure one could be both primary and secondary.

Your LH is low, but even if you boost LH by taking HCG / clomid, your TT never gets very high.

One question I would have about being secondary, if you use HCG how long do you need to use it to see the maximum response from your testicles? It might be that it takes a while for the stimulation of HCG to increase natural production, you might even get some additional testicular growth over time.

Click to expand...

LOH (late onset hypogonadism) is usually considered primary/secondary as there is dysfunction at the testes and hypothalamus-pituitary.

Where do you get that his LH was low pre-trt.....5.6 (1.7-8.6)?

madman said:

LOH (late onset hypogonadism) is usually considered primary/secondary as there is dysfunction at the testes and hypothalamus-pituitary.

Where do you get that his LH was low pre-trt.....5.6 (1.7-8.6)?

Click to expand...

When I said low LH, I was using it as a general example and not referring to the OP.


(My LH is a little on the low side at 2.7, [no TRT], but when I raised LH to 9.2 using clomid for a couple of months, I did get a rise in TT, but it was from 350 ng/dl >448 ng/dl, significant but not enough, this is where I thought of being primary/secondary)

You make a good point, thanks for your feedback.

Systemlord said:

Assuming those pre-TRT labs are ng/mL (333 ng/dL) together with SHBG of 69, most if not all your testosterone was bound and unavailable. You aren't the first to second guess if TRT was the right move and you certainly won't be the last, your testosterone was already low enough to causes serious life altering health problems down the road.

TRT not only increase your testosterone to youthful levels, but also took care of your SHBG problem and lowered it to an optimal level. You killed two birds with one stone.

Click to expand...

Vince,

You're probably right. Overall, I think it has been a good choice to go the TRT route, if I could only figure out the estrogen issue. I'm 31, fit (12% or so bodyfat gaged by visible abs/muscle definition), yet my E2 has continually been the problem for the 9 months I've been on TRT.

I get to a point where I feel good -- dare I say great -- and then things slowly unravel. I'm with Defy and made adjustments twice at the 3-month consults and each time this has repeated itself.

Just pulled my E2 and Testosterone labs again because I've once again been falling down the road of fatigue, soft erections (and inability to maintain), very low sex drive, loss of motivation, anxiety, etc. and sure enough, E2 came back at 52 at trough on an every 3.5 day schedule.

Have a consult a week from now with Defy (they are SO busy), hope to get this thing figured out.

You're probably right. Overall, I think it has been a good choice to go the TRT route, if I could only figure out the estrogen issue. I'm 31, fit (12% or so bodyfat gaged by visible abs/muscle definition), yet my E2 has continually been the problem for the 9 months I've been on TRT.

I get to a point where I feel good -- dare I say great -- and then things slowly unravel. I'm with Defy and made adjustments twice at the 3-month consults and each time this has repeated itself.

Just pulled my E2 and Testosterone labs again because I've once again been falling down the road of fatigue, soft erections (and inability to maintain), very low sex drive, loss of motivation, anxiety, etc. and sure enough, E2 came back at 52 at trough on an every 3.5 day schedule.

Have a consult a week from now with Defy (they are SO busy), hope to get this thing figured out.

Vince said:

When I first started trt my LH was 13.2 range 1.7-8.6, it was easy to know that I was primary. Looks like your trt protocol has really done a nice job for your testosterone levels. I don't think there's anything you could have done to get good testosterone levels without trt.

Click to expand...

readyforchange said:

You're probably right. Overall, I think it has been a good choice to go the TRT route, if I could only figure out the estrogen issue. I'm 31, fit (12% or so bodyfat gaged by visible abs/muscle definition), yet my E2 has continually been the problem for the 9 months I've been on TRT.

I get to a point where I feel good -- dare I say great -- and then things slowly unravel. I'm with Defy and made adjustments twice at the 3-month consults and each time this has repeated itself.

Just pulled my E2 and Testosterone labs again because I've once again been falling down the road of fatigue, soft erections (and inability to maintain), very low sex drive, loss of motivation, anxiety, etc. and sure enough, E2 came back at 52 at trough on an every 3.5 day schedule.

Have a consult a week from now with Defy (they are SO busy), hope to get this thing figured out.

Click to expand...

This is exactly what happens to me. I know the feeling so well I now can head it off before my d-ick goes limp and start my AI at the first sign of trouble.

Systemlord said:

Assuming those pre-TRT labs are ng/mL (333 ng/dL) together with SHBG of 69, most if not all your testosterone was bound and unavailable. You aren't the first to second guess if TRT was the right move and you certainly won't be the last, your testosterone was already low enough to causes serious life altering health problems down the road.

TRT not only increase your testosterone to youthful levels, but also took care of your SHBG problem and lowered it to an optimal level. You killed two birds with one stone.

Click to expand...

For my own knowledge, usually peoples SHBG goes up a little after starting TRT correct? I guess for some it can lower it?

I know My PSA was 2.7 pre trt and now its 1.1 . Normally it goes up a little too after starting trt but in my case it went down to a healthier level for me.