Extremely high SHBG

[andrew1324]

Hello all, been lurking this community for a while and figured it's time to make my first post.

I'm a 25 yo male that has had type 1 diabetes since age 4 and am generally in good health otherwise. Earlier this year I began suspecting I had a low t issue, so went to my GP and had my free / total level tested, the results came back as follows :

Testosterone : 28.3 nmol/L (820 ng/dl)
Free Testosterone : 307 pmol/L (8.8 ng/dl)

I was not satisfied with the results and wanted to have my SHBG and estradiol checked.

Estradiol : 93 pmol/L (25.3 pg/ml)
SHBG : 90 nmol/l


I was then referred to an endocrinologist that did the following tests

(5H sleep before bloodwork)

TSH : 3.45 mIU/L
T4 Free : 17 pmol/L (1.32 ng/dl)
LH : 4.6 IU/L
FSH : 3 IU/L
Testosterone : 19.6 nmol/L (564.8 ng/dl)
Free Testosterone : 172 pmol/L (5 ng/dl) flagged low
Bioavailable Testosterone : 4.8 nmol/l (138.3 ng/dl)
Prolactin : 14 ug/L

The endocrinologist told me since I was in the normal range for LH and Bioavailable T that she did not feel comfortable putting me on TRT and would not do so, and I unfortunately would have to suffer through the symptoms.

I began taking supplements hoping to lower my SHBG, magnesium, zinc, vitamin d3, boron, stinging nettle. I went back and had my SHBG and Free T retested, my SHBG came back even higher at 105 nmol/L and Free T was at 250 pmol/L (7 ng/dl).

To say the least I'm pretty disappointed and not sure where to turn from here. I have an upcoming appointment with a TRT knowledgeable doc near me who also prescribes HCG.

Would beginning TRT benefit me with lowering SHBG or raising Free/Bio T to any great amount? Where do I go from here?

Thanks so much for all insight / replys.

 

[Vince Carter]

aministration of Test typically lowers SHBG to some degree, you'll have to see how that goes. It would be appropriate to have one injection of TCyp probably 120-140mg per week (in one injection) it's the one large injection that may help reduce SHBG. Typical high SHBG you'll have to use larger doses in one shot and run a higher Total Test in order to get your Free T to come up. Free T is the number to concentrate on for your dosing in the end, get that to the upper lab range.

It would be worthwhile to travel the path on Thyroid as your TSH is too high but your test were incomplete and if money allows you should run all five of these together:

TSH
Free T4
Free T3
Reverse T3
Antibodies

 

[andrew1324]

I will most definitely ask about those tests.

I suppose its also worth mentioning I'm an occasional cannabis user, as I believe it helps reduce diabetic complications. Is it likely that it's wreaking havoc on my endocrine system including high shbg and tsh? If so I will likely discontinue it altogether.

Thanks for the reply Vince

 

[Systemlord]

Vince Carter nailed it. Your doctor unfortunately is lacking in her understanding of male hormones and the consequences of high SHBG which when elevated binds up more and more of your bioavailable testosterone, so you are in effect low testosterone because most it isn't free.

Thyroid is terrible, failed to test Free T3, Reverse T3 and antibodies. You clearly have hypothyroidism if TSH has anything to say about it.

It amazes me how clueless doctors really are in relation to TRT, thyroid and male hormones!

Most of us pay out of pocket to get the care we deserve, too many doctors these days follow these lab ranges, it ends all conversations and further investigation.

 

[andrew1324]

Is it possible that upon fixing the low t issue my thyroid function would improve?

thanks

 

[Systemlord]

Is it possible that upon fixing the low t issue my thyroid function would improve?

thanks

In your case no, thyroid meds raise SHBG, yours is already out of control. Larges weekly doses of testosterone will lower SHBG, how much is individual. Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. Fatty liver disease itself usually causes no symptoms. But it raises your risk of developing liver inflammation or scarring.

 

[andrew1324]

I never planned on taking thyroid meds, was just wondering if the hypothyroidism could be linked to the high shbg and low free testosterone, and if it's possible thyroid function would normalize upon starting TRT or not. My liver and kidneys are still working at 100 percent according to my doc. I also have type 1 diabetes and am not overweight (5 ft 10, 175 lbs), you may be thinking of type 2 that causes non alcoholic fatty liver disease. Thanks for the replies, will update with a more thorough thyroid panel in the future

 

[Vince Carter]

People like to talk about Thyroid causing low T or Low T causing Thyroid and so on and so forth but I've yet to see one person that has corrected one by treating the other. I would actually treat the Thyroid, first, and see how you do, if you're thinking of doing one or the other.

 

[andrew1324]

Here are my lab results, any insight would be greatly appreciated.


https://imgur.com/a/VOU1eSp

Still waiting to follow up with the doc, long waiting list.

Would starting TRT and thyroid medication be my best option?

What would be the best form of treatment for my thyroid issues?

Thanks

 

[MarkM]

Are you on TRT at this time? It sounds like you are not but your hemoglobin and hematocrit are abnormally high if you are not on TRT. Your Testosterone looks fine but I do not see your Free Testosterone and that is the important one that is needed to be seen. That is the active testosterone that does all the work.

I do not see an SHBG on the lab work you just supplied. Do you know if the estradiol is with the proper test? I am guessing it was with the Roche ECLIA methodology which is incorrect. That is the test for women. The one you must have is the Estradiol Sensitive, LC/MS/MS assay.

Your thyroid panel is incomplete meaning that you did not have all the necessary test run. You are lacking the ATA and TPA Anti-body tests. You have plenty of Free T4 and Free T3 but your TSH is very high and over the range at 4.28. I might be wrong but the way I understand it is that your Free T3 is pooling because your Reverse T3 is interfering with it being able to do its job so the thyroid is saying make more. Your Reverse T3 at 32 is about twice as high as it should be and it should really be at 15 or below. Your Free T3:Reverse T3 Ratio should be great than 20 and you are sitting at 15.9.

You need someone who really understands the thyroid gland to treat you. I would get the thyroid working properly first first and foremost.

 

[MarkM]

I found the SHBG and Free Testosterone on the original post. SHBG is very high and your Free T is pretty low. You would benefit from TRT with an injection protocol on one weekly injection verse splitting the injections up across the week. The larger injection will drive the SHBG down and increase your Free T.

However, if I were you I would get help with the thyroid issue first.

 

[andrew1324]

No I'm not on TRT, my main problem is with free T, I have had my SHBG checked twice, it came back at 95 nmol/l, the 2nd time it came back at 105 nmol/l. Each time I've had my free testosterone checked its been on the low end of the lab ranges. My hemoglobin and hematocrit are usually within range. I was sleep deprived due to having to get the results done at 7 A.M., not sure if that makes any difference

I'm seeing a new doc and the first appointment I saw the nurse and she ordered the bloodwork. Showed her previous bloodwork results and she photocopied, I mentioned the antibodies tests and she said they run them sometimes but she wasn't going to that time for me, no idea why they didn't run free t either? Not sure if the proper e2 test was ordered, I posted my e2 results earlier in the thread. She also said maybe HCG alone could fix my free T issue? The next appointment I will see the actual doc and begin TRT if necessary.

I'm type 1 diabetic and not yet on the insulin pump, I was told the synthetic insulins (lantus and humalog) can effect SHBG and other globulins.

Would taking bioidentical t3 be the solution to the reverse t3 problem?

Thanks

 

[andrew1324]

Hey there,

I was recently given a prescription for 0.5cc (100mg/week) Test Enanthate and HCG 0.4cc 3x per week. Is this a good starting dose? I was thinking of starting at 120/week. What really confused me was the nurse and doctor seemed very uninformed about the importance of SHBG and free testosterone. The nurse said free testosterone is just the stuff "floating around". Either way I have follow up bloodwork to be done after the 4th injection to test for TT and E2 and a follow up appointment. I wasn't given any AI at this time.

My labs are posted above.

I also got my TSH down to 1.3 after beginning supplementing with selenium and iodized salt.

Thanks

 

[MarkM]

Your SHBG should come down a little bit when you start TRT but it is still going to be very high since your pre-TRT SHBG is 90 nmol/l. You are more than likely going to feel best on one large injection per week and I/m thinking a dose of about 120 mg. Doing blood work to test for Total T and E2 is really premature and is not going to tell you anything. You are just too close to starting therapy. You need to wait a minimum of 6 weeks for blood work, preferably 8 if you can wait. At that time you will have reached a steady state. Anything prior to that is not going to give you a true picture.

It is not unusual for doctors and nurse's to be uninformed. Free T is more important than Total T because it is the small fraction of your testosterone that does all the work. SHBG determines what type of TRT protocol you should be on. You need a dose large enough, a single dose, to compensate for the high SHBG and therefore provide you with a mid to high normal level of Free T.

 

[MarkM]

Would taking bioidentical t3 be the solution to the reverse t3 problem?

Thanks

I have high Reverse T3, just found out, and am reading the T3 has the ability to flush out the high Reverse T3.

Here is a good read...............https://www.restartmed.com/?s=reverse+t3

 

[Systemlord]

Hey there,

The nurse said free testosterone is just the stuff "floating around". Thanks

100mg weekly isn't going to be enough and is clear your working with incompetent doctors who are most likely struggling to understand how this game is played.

Excess androgens is what forces SHBG down and you will likely need supraphysical doses of testosterone in order to get enough Free T (bioavailable T) to your body, insurance companies have instructions for doctors to keep men under 800 ng/dL and that is bad for you.

Doctors freak out when they see a Total T over the ranges, since bioavailable T is more important that's what they should be paying attention to because all men have varying levels of SHBG and it affects bioavailable T differently in each man.

You may require a specialist outside of your insurance network who won't freak out and knows what's he's doing or not much else will change. The majority of doctors struggle with TRT and don't understand how the game is played, because there is no standard of care for TRT.

 

[andrew1324]

This doctors ideal range is between 800 and 1100 so hopefully wouldnt have a problem me running a slightly higher total test, he seems pretty understanding. What kind of dose would I need to force my free t up? Would my high SHBG prevent some aromatase from happening at such a high total test level?

My doc also advised me to take selenium for my thyroid, which I had already begun doing. He said possible prescription of natural desiccated thyroid is an option if my thyroid fails to improve, as it has both t3 and t4.

 

[Nelson Vergel]

Here is a good article

How to decrease SHBG and increase free testosterone

 

[Systemlord]

This doctors ideal range is between 800 and 1100 so hopefully wouldnt have a problem me running a slightly higher total test, he seems pretty understanding. What kind of dose would I need to force my free t up? Would my high SHBG prevent some aromatase from happening at such a high total test level?

My doc also advised me to take selenium for my thyroid, which I had already begun doing. He said possible prescription of natural desiccated thyroid is an option if my thyroid fails to improve, as it has both t3 and t4.

If liver is impaired and not clearing out excess estrogen, then you my have a problem and just would need estrogen management. I would recommend about 70mg twice weekly to get started.

 

[andrew1324]

If liver is impaired and not clearing out excess estrogen, then you my have a problem and just would need estrogen management. I would recommend about 70mg twice weekly to get started.

My liver function appears to be normal from my bloodwork results

https://imgur.com/a/VOU1eSp

Also my E2 came back quite low at only 12, the nurse told me I was bottomed out on E. Why do you recommend twice weekly instead of once per week? I thought the large once per week is what could possibly help lower the SHBG?