Help Interpreting New Labs -- SHBG Increased?

[bkb33]

Hi all,

I just received updated bloodwork from one month into TRT. My protocol is: 2 clicks T-cream (200 mg/ml) ED applied trans-scrotally, 300 IU hCG 2X/week, and 25 mg Ibutamoren ED. Prior to beginning TRT, I was taking an AI (with the hCG and Ibutamoren), but I am longer doing so.

Here are the numbers, with comparisons to their previous counterparts:
Total T: increased from 1989 to 2338 (Ref 250-1100)
Free T: increased from 192.9 to 215.1 (Ref 35-155)
SHBG: increased from 110 to 114 (Ref 15.5-55.9)

• Keep in mind that the previous total was recorded while I was taking an AI (.25 Anastrozole 3X/week).

Estradiol: decreased from 51 to 50 (Ref <29)
Cholesterol: increased from 189 to 200 (Ref <200)
LDL: increased from 124 to 136 (Ref <100)
HDL: decreased from 51 to 49 (Ref 40-60)
DHEA-S: increased from 270 (in Oct. 18) to 1009 (Ref 139-475)

• I have been supplementing with 100 mg 2x/week.

IGF-1: decreased from 288 (in Oct. 18) to 193 (Ref 63-373)

• During this time, I experimented with reducing Ibutamoren from 25 mg/ED to 25 mg/EOD to see if I really needed this peptide, which probably explains the drop.

HGB: increased from 15.1 to 15.5 (Ref 14-18)
HCT: increased from 44 to 45.7 (Ref 42-52)

Overall, I feel amazing -- way better than before TRT! I have noticed marked improvements in libido and quality of life. I am surprised, though, to see that SHBG not only didn't drop, but in fact went up. My TT and FT, of course, continue to be quite high as a result. I should note that at the very start of my hormonal optimization journey (May 2018), my SHBG was 180.

Should the SHBG number be surprising? Should I be concerned about cholesterol, DHEA, or anything else on here? I would love to hear your thoughts!

 

[Sean Mosher]

I doubt there's any reason to have concern since it sounds like you're not having any issues, but just out of curiosity, how much DHEA are you taking daily?
And I can't imagine a need to be concerned about your SHBG, especially if you're dialed in which it sounds like you are (congrats on that by the way).

 

[Vince Carter]

A 4 point change in SHBG almost transparent, means nothing and certainly didn't impact your treatment in any appreciable way.

Very interested in seeing you report doing so well on the scrotum delivery method.

 

[Vince Carter]

Way too much DHEA use @ 100mg twice per week.

While you're on this delivery route are you pulling, I think you should be pulling, DHT, every time, and probably PSA, too.

 

[bkb33]

I doubt there's any reason to have concern since it sounds like you're not having any issues, but just out of curiosity, how much DHEA are you taking daily?
And I can't imagine a need to be concerned about your SHBG, especially if you're dialed in which it sounds like you are (congrats on that by the way).

Thank you for the reply! I am currently taking 100mg 2X/week. Per @Vince Carter's comment, I'm gathering that's way too much. What do you think would be a better dose?

 

[bkb33]

Way too much DHEA use @ 100mg twice per week.

While you're on this delivery route are you pulling, I think you should be pulling, DHT, every time, and probably PSA, too.

I am surprised DHT wasn't included. My Rx called for CMP-14, CBC, Lipid Panel, PSA, SHBG, Testosterone F/T, DHEA-S, TSH, Estradiol Sensitive (ultra), IGF, and HGBA1C. My PSA was 0.4 (Ref < 4.0), which was unchanged.

 

[bkb33]

A 4 point change in SHBG almost transparent, means nothing and certainly didn't impact your treatment in any appreciable way.

Very interested in seeing you report doing so well on the scrotum delivery method.

That's good to know. Doesn't SHBG usually decrease, though, with the introduction of exogenous testosterone? Should I be hoping it will go down? I've seen some mixed information about that.

 

[Sean Mosher]

I believe DHEA only has a 12 hour half life so I'm curious as to why your doctor would only have you take it twice per week.
A much smaller daily dose would be more appropriate IMO.
Looks like you had labs right after the last time you took a DHEA dose as well I'm assuming.

 

[bkb33]

I believe DHEA only has a 12 hour half life so I'm curious as to why your doctor would only have you take it twice per week.
A much smaller daily dose would be more appropriate IMO.
Looks like you had labs right after the last time you took a DHEA dose as well I'm assuming.

Yes, I would have taken this right before. I just happened to have 100mg on hand, so that's what I was taking. Maybe 25 mg/EOD would be more appropriate?

 

[Sean Mosher]

I personally take 25mg in the morning everyday but you're going to get a variety of opinions on DHEA, that's for sure.
If you're not symptomatic or having any problems whatsoever I'm hesitant to suggest changing anything...........it's just unusual in my own personal opinion to see DHEA dosed and recommended that way.
Talk with your doctor before doing anything tho.

 

[Vince Carter]

That's good to know. Doesn't SHBG usually decrease, though, with the introduction of exogenous testosterone? Should I be hoping it will go down? I've seen some mixed information about that.

It can be thru 1 large injection which is typically how you deal with high SHBG, this daily cream will be an unknown but so far you're showing that that's not quite true, so far.

 

[bkb33]

It can be thru 1 large injection which is typically how you deal with high SHBG, this daily cream will be an unknown but so far you're showing that that's not quite true, so far.

I will definitely keep you posted on my success with the delivery mechanism. Obviously it's early in my protocol, and I have nothing prior to compare it to, but so far it has been absolutely great. I love the convenience of it, too.

Edit: out of curiosity, do you think it would be worth it to discuss with my doctor potentially upping the dose and reducing its frequency (say, 4 clicks every 2 days)? I assume lower SHBG is better (to an extent), but not sure about that.

 

[bkb33]

I personally take 25mg in the morning everyday but you're going to get a variety of opinions on DHEA, that's for sure.
If you're not symptomatic or having any problems whatsoever I'm hesitant to suggest changing anything...........it's just unusual in my own personal opinion to see DHEA dosed and recommended that way.
Talk with your doctor before doing anything tho.

Will do! I wouldn't say I'm "symptomatic," but I also don't know if I'm "all the way optimized." Libido has gone from 0 to 6. I feel there could still be some room for improvement. I just know I feel way better than I did before the T was introduced.

 

[Sean Mosher]

I will definitely keep you posted on my success with the delivery mechanism. Obviously it's early in my protocol, and I have nothing prior to compare it to, but so far it has been absolutely great. I love the convenience of it, too.

Edit: out of curiosity, do you think it would be worth it to discuss with my doctor potentially upping the dose and reducing its frequency (say, 4 clicks every 2 days)? I assume lower SHBG is better (to an extent), but not sure about that.

Topicals are daily application so that wouldn't really be an option for you.
It seems to be working for you so if it ain't broke..........

 

[Vince Carter]

Agree with @Sean Mosher , topicals are a daily routine.

 

[bkb33]

Thank you, @Vince Carter & @Sean Mosher, for all your help. Truly appreciate it.

 

[Gman86]

So on an ai, your E2 was 51, and on no ai your E2 was 50? While at the same time your total testosterone increased? You would think that would be impossible. Do you have any idea how E2 could actually drop, while on no ai and total testosterone being higher?

Also I can’t believe your E2 is only 50, with a total over 2000. Do you think it’s because you’re on a testosterone cream? I’ve never seen E2 so low with a testosterone level even near that high.

 

[bkb33]

So on an ai, your E2 was 51, and on no ai your E2 was 50? While at the same time your total testosterone increased? You would think that would be impossible. Do you have any idea how E2 could actually drop, while on no ai and total testosterone being higher?

Also I can’t believe your E2 is only 50, with a total over 2000. Do you think it’s because you’re on a testosterone cream? I’ve never seen E2 so low with a testosterone level even near that high.

That is correct. I have no idea how it could drop -- I was curious about that, too. Maybe it is related to the cream.

E2 numbers over time:
July 2018: 61
- Protocol at the time was AI & HCG
Oct. 2018: 51
- Protocol at the time was AI (higher dose), HCG & Ibutamoren
Feb. 2019: 50
- Protocol is HCG, Ibutamoren, and T cream (no AI)

Do you think there's reason for concern?

 

[Sean Mosher]

I see no reason for concern.
Seems that form of T therapy seems to be the best for you.

 

[Gman86]

Ya I see no reason for concern as well. If you’re feeling great, that’s usually the best indicator that your body is functioning optimally. When your body is not happy, and not functioning the way it’s supposed to, it has many ways to let you know. So if you feel great, that’s your body’s way of telling you to not change a thing, imo.

So you were on HCG mono with an ai the first two labs, and then testosterone cream during the 3rd set of labs? So ya it can’t be due to the testosterone cream. Your E2 was very similar on HCG mono as well. So you had a total T of 1989 while on HCG mono??