First labs: High SHBG, lowish FT and E2

[everythingbagel]

Hello, 30 year-old male, difficulty with muscle building (despite strict surplus/protein diet). Difficulty with focus and sleep. No problem with erection frequency/quality but I have lost a lot of sensation over the years, difficult to orgasm. Frequent joint pains. Plan to have children in 3-4 years.

Labs:
Testosterone Total: 714 ng/dL (264 - 916)
Free Testosterone(Direct): 12.7 pg/mL (8.7 - 25.1)
Dihydrotestosterone: 58 ng/dL (30-85)
DHEA-Sulfate: 346.2 ug/dL (138.5 - 475.2)
Luteinizing Hormone(LH): 3.6 mIU/mL (1.7 - 8.6)
Prolactin: 10.8 ng/mL (4.0 - 15.2)
Insulin-Like Growth Factor 1: 159 ng/mL (98 - 282)
Estradiol, Sensitive: 17.0 pg/mL (8.0 - 35.0)
Sex Horm Binding Glob: 67.7 High nmol/L (16.5 - 55.9)

So I have a lowish FT due to my high SHBG. My E2 is also pretty low and from what I’ve read it could be contributing to the joint pain and decreased erection sensitivity. Not interested in stinging nettle root to decrease SHBG (not a heavy drinker but currently abstaining from alcohol to see if that helps). A few questions:

It seems that I would benefit from a modest increase in FT and E2. Since I want to remain fertile can I try DHEA for this? I know most people don’t advocate monotherapy with DHEA because it increases E2 but maybe this would be a good option for me if I’m ok with some E2 increases. I've also read that DHEA decreases SHBG. I understand that my DHEA is in the normal range but I want to try to get it to ~500.

-or-

Since my DHEA is already in the normal range should I just start HCG monotherapy instead to produce more T and E? Clomid wouldn't work due to its tendency to increase SHBG.
Thanks for the help

 

[everythingbagel]

Here are my thyroid labs as well:

TSH 3.060 uIU/mL (0.450 - 4.500)
T4,Free(Direct) 1.19 ng/dL (0.82 - 1.77)
Triiodothyronine (T3), Free 3.1 pg/mL (2.0 - 4.4)

 

[Systemlord]

Given your high SHBG, you would be forced to take a huge dose of HCG just to raise testosterone high enough, this is a bad idea. Controlling estrogen will be difficult with the amount of HCG you would need, I don't think it would ever be enough.

TSH is no good, test Reverse T3 and antibodies. High Reverse T3 and antibodies could explain high TSH.

Optimal vs Normal Thyroid Levels for All Lab Tests & Ages

 

[Vince Carter]

There's no direct way to manipulate SHBG, up or down. I concur though that Thyroid could get some help and thus could help you feel better.

TSH
Free T3
Free T4
Reverse T3
Antibodies

would be the big 5, your three there are informative but incomplete. Reverse T3 could tell if T3 is pooling or not making it in to the cells.

 

[YBWV]

Hi. I believe your plan to take DHEA to increase E2 and potentially get a modest increase in FT by lowering SHBG is a good idea and well worth trying; it certainly worked for me.

In my 30's my (natural) Labs were similar to those you have posted with the same net result; my decent level of TT was confounded by too high SHBG.

I had mid-range DHEAS and found that 25mg per day (cheap o.t.c. product) quickly took me well above range. Reducing the dose to 12.5mg daily has kept me around top of the range.
I was initially concerned that the DHEA might be suppressive, and thereby lower TT, but was prepared to "sacrifice" a small amount of TT. In the event there has been no noticeable suppression (subjectively or by Labs) and I have been supplementing with it for 20+ years.

As an aside I also had mid-range DHT and have found that exogenously increasing it to top of range, and keeping it there, has worked well. Where I live (Morocco) Proviron is available o.t.c. I gather that it's not licenced in the US.

Using DHEA and Proviron concurrently has, for me, increased FT and E2 which has allowed me to grow muscle (near impossible before, particularly in the upper body) and has not compromised my fertility.

Before embarking on any regime that may modulate E2 and DHT it is important to get a baseline PSA and thereafter to pay attention to prostate health.

Best of luck if you do try the DHEA and I hope you post the outcome as will be interested to see how you get on!

 

[everythingbagel]

Thanks everyone! My plan is to improve thyroid and add DHEA slowly (starting with 5-10 mg). Will repeat labs in 6 weeks. After that my plan is to consider HCG monotherapy and possibly add a low dose aromatase inhibitor if E2 becomes a problem. I'm weary about clomid or TRT because I'd rather not increase my SHBG any more. It also just makes more sense to me to increase upstream substrates and enzyme activity (DHEA being upstream substrate, HCG and aromatase being enzymes), before jumping in and supplementing downstream products (ie testosterone). I will update everyone here.