Blood Work - 10 Weeks Off Clomid

[txcajun]

Hey guys,

I had Nelson look over my blood work a few months ago. I was retested last Friday, all my levels. My doctor told me nothing to be concerned about, but wanted to discuss during my physical next week. I noticed a few things were different, and elevated slightly, so I was concerned. Do y'all think it's anything to be worried about? Again, I'm 36yo, male, 6'4", 252 lbs, 18% BF, non-smoker, workout 4x a week for 2hrs, drug-free, no medications, no steroids, no TRT, track my macros. The only medical issues I've had over the past 5 years IBS-C and stomach ulcers, but nothing too serious. My last colonoscopy, endoscopy, and CT scan was summer of 2013. Had a bunch of tests to rule out stomach/digestive issues. Thanks!

Here's results:

 

[MarkM]

Hi txcajun, welcome to the forum!

Your RBC, Hemoglobin, and Hematocrit are on the high side for someone not on TRT or on AAS. Do you live at a high altitude? How is your sleep? Do you have sleep apnea?

You have extremely high SHBG (Sex Hormone Binding Globulin) at 84.5. Your Total T at 871 is not bad in just looking at the number itself, but it being bound up by that large amount of SHBG leaving you little Free T. Your Free T is below mid range and is only accounting for 1.15% of your Total T. Most men have Free T levels at 2% to 3%%. Your bioavailable testosterone is only sitting at 28%. If your SHBG wasn't so high and was within a normal range you would probably be fine.

Your TSH, while, within range, is too high. Your Free T4 is a little on the low side and should be close to 1.7 and your Free T3 is not optimal either and should be at 3.8. Although they too are within range they are indicating there could be a thyroid issue. I would have a full thyroid panel work up to include the following: TSH, Free T3, Free T4, Reverse T3, and both Thyroid antibodies (TPOab and TgAB). An under performing thyroid will give you low T symptoms.

It appears that the Estradiol test is the wrong one just based off the range. You labs don't specifically state which test was used. I am betting it was the Roche ECLIA methodology which is the test for women. Men need the Estradiol Sensitive LC/MS/MS assay. Because it is more sensitive it an properly estimate the lower estradiol levels in men.

Once again, welcome to ExcelMale.

 

[txcajun]

Thanks Mark! I do not, live in Texas, and possible sleep apnea. I've never had a sleep study, but my wife says I snore a lot at night. I'll ask my doctor to order those tests. He's direct primary care, so shouldn't be an issue. Curious, is there a way to get SHBG back into normal range?

 

[MarkM]

SHBG is one of those "it is what it is". TRT doses at higher levels can help bring it down a little bit but nor a terrific amount. Someone like you, if going on TRT would best benefit by one large injection per week so that you get enough testosterone to compensate for the high SHBG and increase your Free T. It is the Free T you want to increase and it is that small fraction of your Total T that does all the heavy lifting. In order to raise your Free T, you may see your Total T raise to supra-physiological levels considerably higher than the top of the range, but in the case of high SHBG, that should not be a concern because most of it is bound up. You will need a doctor that understands that.

 

[txcajun]

Thanks for all that, Mark. I did have Thyroid AB done October 10, 2017 of last year, and my thyroid levels were the same, so not sure...

 

[txcajun]

Do any supplements actually lower SHBG? I was reading Boron, DIM, I3C, and all this stuff. I'm skeptical of supplement claims. I'd be happy if I could get it down in the 50s, but that's a significant reduction from my current level.

I guess I'm curious if I should take supplements to help thyroid, if any, and would that indirectly affect other stuff (SHBG, Free T)? Maybe I should focus on the SHBG, and find ways to lower that specifically? Testosterone injections don't seem to be the answer since it affects fertility, and my wife wants to try for another child.

 

[MarkM]

DIM and I3C have the ability to lower E2 a little bit but have not heard they decrease SHBG.

I have read that some have had success, to some degree, in lowering SHBG with Stinging Nettle, Boron, Magnesium, and Tongkat Ali LJ100. I can not confirm the validity to those claims. Stinging Nettle seems to be more reliable than the others based on what I've read but it is not going to bring yours down to the 50's from close to 85.

SHBG is created in the liver and I have read that Milk Thistle, being very good for the liver, can reduce SHBG. Like above, I can not confirm.

If any of these help, my bet is that it won't help reduce SHBG significantly.

 

[txcajun]

so what is the root cause of high/elevated SHBG? Anything to worry about or research further as it pertains to my overall health? Seems like if I could lower SHBG it would improve Free T since it would no longer be bound up.

 

[MarkM]

Some people just have naturally high SHBG and some have naturally low SHBG. Just like some have naturally low testosterone and some have naturally high levels. Nothing to worry about because there is little you can do to change it. High SHBG is probably better than having low SHBG.

 

[Systemlord]

Sleep apnea is likely, especially with the mention of snoring and the elevated CBC labs.

There are some things that can raise SHBG, alcohol and medications. SHBG is made in the liver, as the liver is stressed SHBG increase. SHBG is difficult to manipulate expect excess androgens or excess testosterone.

The plan of attack is moderate to large infrequent doses of testosterone once or twice weekly will most likely see SHBG decrease and free testosterone increase. If thyroid problems are present, one can expect mediocre results or a worsening of symptoms.

Strange your doctor went as far as to test the thyroid and missed an important test, Reverse T3 could have explained elevated TSH, Reverse T3 can block Free T3 at the receptors negating excellent Free T3 levels. In other words all that Free T3 is floating by the T3 receptors not doing anything or very little.

 

[txmx]

I tried many of the supplements to reduce high SHBG and had no good result with any of them. SHBG seems to find its own level.

 

[txcajun]

I'll get the Reverse T3 test done this week. Anything else I should test for?

 

[txcajun]

so the main reason for doing all of this is due to how I feel lately... I've been very "foggy" in the head, sort of the feeling someone would get coming off a caffeine high. I experience sweaty faint spells from time to time, if I don't have the right balance of food. I have noticed that if I eat carbs without fats or protein, I have some sort of blood sugar crash or spike, whatever you want to call it, about 30 minutes later. I watch what I eat, and county my macros, so not sure what's going on. I do suffer from IBS-C, so I suppose that could be it, or maybe it's something more? Takes a lot to wake up, and I just feel tired a lot. I just had a baby girl and we're building a custom home, so maybe it's stress. Just trying to pinpoint the issue(s).

 

[MarkM]

I'll get the Reverse T3 test done this week. Anything else I should test for?

Since we talked about the thyroid, I would have iron and ferritin tested. If these levels are low you will have a hard time in getting your thyroid right. Your ferritin needs to be a minimum of 80 for the thyroid to perform properly.

 

[MarkM]

If your thyroid is not functioning well it can give you the symptoms you are mentioning and make you feel tired all the time. If you have IBS then you likely have a gut imbalance which makes absorbing iron difficult which in turn hurts your thyroid function. They say our gut is like a second brain.

 

[txcajun]

Thanks for all the helpful information. May I ask what your occupation/background is? You're very knowledgable, and appreciate all the help, really do! I forwarded all your suggestions to my doctor, and will see if I can get tests run this week at CPL.

 

[MarkM]

You're welcome for the help. My background is as senior executive in the logistics area. I'm not as knowledgeable as you give me credit for. I've just been on testosterone replacement therapy (TRT) for over 13 years and am going through the learning curve just like you are.

 

[MarkM]

When you have your Reverse T3 tested you want it to be below 15. You will want your Free T3 to Reverse T3 ratio (FT3:RT3) to be greater than 20. Example, say your Free T3 is 3.2 and your Reverse T3 comes in at 25. Using the ratio FT3:RT3 (3.2:25) will give you a ratio of 12.8 which will be considerably too low. Your doctor will want to prescribe you a medication that will increase Free T3 and reduce the reverse T3.

The Free T3 in your body is similar to the Free T. Both of these hormones do all the heavy lifting even though they are a small fraction of the total.

 

[txcajun]

Nice! I'm in software, so no medical background. My wife is biomedical science, so she's been helping some, too. I'll see if I can get tests ordered this week. I'll post results here! Thanks again!

 

[lowe2sucks]

Spoiler: how to lower shbg

If you have elevated SHBG, talk to your doctor of course. But here are some additional ideas to help you lower your levels naturally. Again, remember that overly elevated levels will rob you of free testosterone potentially:

1. Correct Any Medical Issues. Step #1 should be to correct any medical issue - see the above - that has lead to excessively high SHBG. Getting to the root cause is always a good idea!

2. Protein. Animals studies have shown that increasing protein intake can lower SHBG. [13]

3. Fish Oil. Omega-3's can help with inflammation, depression, mood and cardiovascular outcomes according to some experts, so why not with free testosterone as well? (CAUTION: There is a recent study showing fish oil increases prostate cancer risk though.)

4. Vitamin D. According to one large study on men, the higher the Vitamin D, the higher the testosterone. And the good news does not stop there: the higher the Vitamin D, the lower the SHBG according to this same study. [11]

5. Dietary Fat. One (small) study on six men found that if the men ate a higher fat diet, > 100 grams fat/day, their SHBG dropped. This may seem like a good thing, but remember that high fat diets are used by researchers to induce insulin resistance. [9] A smiliar study echoed the same result and suggested that fiber may play a role as well. [10]

6. Stinging Nettle. Stinging Nettle is a proven SHBG lowerer and it does so by affecting the liver. I cover this in much more detail in my link on Free Testosterone.

7. HRT (Testosterone Therapy). I consider HRT to be a natural treatment option, assuming that testosterone is kept within physiological ranges. And exogenous testosterone will generally lower SHBG (along with many other benefits).

8. DHEA. DHEA can lower SHBG as shown in a couple of studies. [15] Anecdotally, one of our forum posters heard from his doctor that low DHEA can lead to elevated SHBG. [17] Interestingly, this doctor did not recommend supplemental DHEA but rather to lower stress. However, some of the adrenal fatigue docs treat their patients with this hormone when one is deficient. That said, DHEA supplementation is tricky and some of it will always convert to estradiol. It is somewhat of a crapshoot knowning whether the DHEA will turn properly into testosterone or estradiol. DHEA can also lower cortisol, which is not always desireable in every case. Adding to the confusion is the fact that some practitioners give 10 mg to their male patients when needed and still others 50 mg. So dosage can be vague and controversial.

Spoiler: how to lower shbg and raise free testosterone

Let me give you 10 Natural Ways to Lower SHBG and Raise Free Testosterone:
1) Testosterone and Lowering Estradiol. On this page, I'll show some ways to uniquely raise free testosterone levels. However, the most straightforward way to raise free testosterone levels is by raising total testosterone levels. In general, as you raise total testosterone, free testosterone tends to rise with it. I have already created a page with 40+ Ways to Raise Testosterone Naturally. Again, though, on this page we'll look at some ways to raise your percentage of free testosterone (out of total testosterone).
Similarly, if you can lower your estradiol levels, you can generally get a boost in total and free testosterone. Research shows that normal aging as well as an increase in adipose - that's a nice way of saying fat - tissue leads to ever increasing levels of the estrogens. And here's the key: increasing estrogen leads to increasing SHBG, which will lower your free testosterone as a percentage of your total. Please read the important link on How to Control Estrogen.
2) Protein-to-Carbohydrate Ratio. The protein/carbohydrate ratio has an interesting effect on free testosterone and SHBG. Several studies have shown that increasing carbs versus protein boosts total testosterone. However, before you start pounding granola bars, one study found that increasing the protein/carb ratio not only increased total testosterone but also SHBG. [4] This means that free testosterone may not have been increased significantly because of SHBG's opposing effects. (Increasing the protein to carbohydrate ratio also increased cortisol, a fact I cover elsewhere on this site.)
3) DHEA. Researchers examined untrained young and middle males and found that giving them 50 mg of DHEA daily raised their free testosterone significantly. They also noted that normally HIIT substantially lowers testosterone, but with the DHEA no such decrease in free testosterone at least occurred. [7] There are warnings out there that DHEA can increase estradiol disproportionately, but I have seen no actual research evidence of this. The real concern with DHEA is more brain-related. Ray Peat, in particular, has noted:
"One study has found that the only hormone abnormality in a groupt of Alzheimers patients' brains was an excess of DHEA. In cell culture, DHEA can cause changes in glial cells resembling those seen in the aging brain. These observations suggest that DHEA should be used with caution. Supplements of pregnenolone and thyroid seem to be the safest way to optimize DHEA production." In spite of this, DHEA seems to be widely used in the alternative and anti-aging communities. Do your own research and talk to your doc is all I can say.
CAUTION: Low SHBG men should not lower their SHBG further. See my page on The Risks and Causes of Low SHBG for more information.

4) Medications and Alcohol. If you have high SHBG and low free testosterone, one of the first checks you should do is looking at any prescriptions that you have: many medications can effect SHBG. Remember that SHBG is made in the liver and most medications effect the liver. Common drugs that often raise SHBG are sedatives, antihypertensiaves, tranquilizers as well as alcohol.
5) Stinging Nettle. Another way to lower SHBG is through an herb called Stinging Nettle. Stringing Nettle is widely prescribed in Europe for BPH (Benign Prostate Hypertrophy). Several studies have documented Stinging Nettle's SHBG-lowering powers [2] and, so far, Stinging Nettle has an excellent safety profile. However, its side effect profile is worth mentioning: Stinging Nettle also blocks the action of the enzyme that converts testosterone to DHT. Some would argue that this is good since DHT is associated with things like hair loss and prostate problems. However, sometimes, in sensitive individuals, side effects include erectile dysfuntion and a decreased amount of semen. Plus, DHT is a critical androgen for males and very important to libido and so Stinging Nettle is questionable in my opinion because of it. I should point out that there are no studies, as far as I know, that actually show Stinging Nettle increasing free testosterone: more research needs to be done.
6) Tongkat Ali (LJ 100). One study of a specific extract (LJ 100) of Tongkat Ali found that "SHBG decreased 66%, and the Free Testosterone Index escalated 73%." [9][10] I have seen claims that LJ100 is the only extract that it standardized for a high percentage of eurypeptides, the ingredient responsible for the above. CAUTION: Tongkat Ali can raise IGF-1 and should be monitored in those 40+ in my opinion: you do not want to be too high in this hormone, as it is associated with prostate and other cancers. (Being too low has been identified with increased cancer risk.)
7) Boron. This supplement produced a significant drop in SHBG in a recent study, which lead to a 28% increase and 39% drop in free testosterone and total estradiol, respectively. [6] This is a nice change in the testosterone-to-estradiol and should help a guy feel significantly better. See my link on Boron and Testosterone for more details.

8) Insulin Resistance. Insulin resistance will lower your SHBG [1] and, therefore, in the short term probably raise free testosterone. So let's all get insulin resistant and live happily ever after, right? Wrong! Insulin resistance is a death warrant. (Read this link on Metabolic Syndrome for more details.)
9) Sugar and Corn Syrup. These bad boys can lower SHBG. Unfortunately, these can lead to insulin resistance, inflammation, advanced glycation end products and many other nasty things. How does it do all this? Researchers have discovered that sugar will also lower SHBG, because it increases fat synthesis in the liver, which in turn shuts off the gene involved in SHBG synthesis. Bottom line: stay away from sugar and corn syrup even though in the short term they may raise your free testosterone.
10) Vitamin D. Vitamin D was found in a 2009 study of about 2,300 adult males to lower SHBG and increase both free and total testosterone. [3]
11) Magnesium. Research shows that magnesium can bind to SHBG and give a man a little higher bioavailable and free testosterone. I doubt this is a big effect, but it's cheap and easy to try. See my page on Testosterone and Magnesium for more details.

source: http://www.peaktestosterone.com/Free_Testosterone_SHBG.aspx http://www.peaktestosterone.com/High_SHBG.aspx