Help me understand SHBG levels and injection protocols

[autiger]

Main question: Can someone give me some guidelines on what constitutes a low, ideal, and high SHBG level?

After reading many threads on SHBG, posters refer to low and high levels but I need some guidance on what is considered low and high. Labcorp cites 16.5-55.9 nmol/L as the standard range. One website cited 20-30 nmol/L as ideal (couldn't add link because of my low post count). If anyone can provide numbers and/or links providing additional detail so I can understand what is low, ideal, and high that would be appreciated greatly.

Secondary question: What would the optimal subcutaneous TRT injection frequency be for a person with a SHBG level of 45.9 nmol/L?

I read a lengthy thread ("Subcutaneous Adminstration of Testosterone" pg. 1&2) from 2013 that included Dr. Crisler and Dr. Saya discussing injection frequency based on SHBG (couldn't add link because of my low post count). At that time, Dr. Crisler suggested once a week subq injections for men with high SHBG. Dr. Saya was not sure he agreed.

Additional Details:
I started TRT 5 months ago after going to 5 different medical specialists from different fields concerning severe fatigue and confusion. I was barely functioning in all aspects of life. I was diagnosed with Chronic Fatigue Syndrome (CFS) - which has no treatment. I shared the details with my primary care physician during a routine physical and he decided to test my testosterone - something no one else had even considered. My bioavailable testosterone was 38.1 ng/dL (normal range 40.0-250.0 ng/dL). Testosterone injections immediately and significantly improved my CFS symptoms and now they are essentially gone. Dr. Hart essentially gave me back my life when all the specialists were unhelpful. Dr. Hart does not specialize in TRT but has been extremely open and supportive to learn with me and adjust things as we go. This forum has been an incredible resource in that learning.

I am currently on 50 mg testosterone cypionate 2X/week (Tues/Sat) and HCG 500 IU 3X/week (Tues/Thur/Sat) and .5 mg anastrozole 2X/week (Wed/Sun).

Even with the biweekly injections and anastrozole, my estradiol levels are high 74.4 pg/mL on the most recent sensitive test (standard 8.0-35.0 pg/mL). I am retaining a lot of water, have sensitive nipples, and have some ED problems as a result. My total testosterone was 1064 ng/dL (standard 348-1197 ng/dL) and my bioavailable testosterone was 227.7 (standard 40-250 ng/dL). This blood draw was 48 hours after my Tuesday injection of testosterone and HCG but before my Thursday injection of HCG.

I am considering more frequent injections (3X/week) to reduce the estradiol without increasing the anastrozole. However, I don't know if my SHBG level of 45.9 nmol/L (normal range 40.0-250.0 nmol/L) would be a concern. My bioavailable testosterone has always been low in relation to my total testosterone - a function of higher SHBG (% of bioavailable testosterone/total testosterone: 2/17/16 - 7.3%, 5/23/16 - 14.1%, 7/25/16 - 12.5%, and 11/17/16 - 21.4%). Dr. Crisler's comments back in 2013 about less frequent injections for men with high SHBG give me pause. But I'm not even sure if my SHBG level 45.9 is what he considers high.

 

[Vince Carter]

45.9 is indeed rather high, which as you see will have free T problems because so much will be bound up. You're indeed on a minimal dose of Cyp, 100mg a week (total) is a typical start dose. You should be able to do well on E3.5D injections but you're going to need more Cyp, probably on the order of 120-140mg to bring around Free T, and don't test @ 48hrs, always test right before your next injection.
You may need Anastrozole...don't fret that. Some of us need it in a proper protocol achieving the numbers desired; FT/TT.

 

[1Draw]

I am considering more frequent injections (3X/week) to reduce the estradiol without increasing the anastrozole. However, I don't know if my SHBG level of 45.9 nmol/L (normal range 40.0-250.0 ng/dL) would be a concern. My bioavailable testosterone has always been low in relation to my total testosterone - a function of higher SHBG (% of bioavailable testosterone/total testosterone: 2/17/16 - 7.3%, 5/23/16 - 14.1%, 7/25/16 - 12.5%, and 11/17/16 - 21.4%). Dr. Crisler's comments back in 2013 about less frequent injections for men with high SHBG give me pause. But I'm not even sure if my SHBG level 45.9 is what he considers high.[/QUOTE]

autiger can you clarify the ranges above? You are listing SHBG test results as nmol/l which is what LabCorp uses but the ranges are in ng/dl. Something is amiss. LabCorp ranges for SHBG in nmol/L is 19.3 - 76.4.

 

[autiger]

I am considering more frequent injections (3X/week) to reduce the estradiol without increasing the anastrozole. However, I don't know if my SHBG level of 45.9 nmol/L (normal range 40.0-250.0 ng/dL) would be a concern. My bioavailable testosterone has always been low in relation to my total testosterone - a function of higher SHBG (% of bioavailable testosterone/total testosterone: 2/17/16 - 7.3%, 5/23/16 - 14.1%, 7/25/16 - 12.5%, and 11/17/16 - 21.4%). Dr. Crisler's comments back in 2013 about less frequent injections for men with high SHBG give me pause. But I'm not even sure if my SHBG level 45.9 is what he considers high.

autiger can you clarify the ranges above? You are listing SHBG test results as nmol/l which is what LabCorp uses but the ranges are in ng/dl. Something is amiss. LabCorp ranges for SHBG in nmol/L is 19.3 - 76.4.

Good catch there 1Draw. I miscopied the units on the range. My SHBG was 45.9 nmol/L and the standard range with correct units is 16.5-55.9 nmol/L. I have edited the original message with the correction. Thanks!

 

[autiger]

45.9 is indeed rather high, which as you see will have free T problems because so much will be bound up. You're indeed on a minimal dose of Cyp, 100mg a week (total) is a typical start dose. You should be able to do well on E3.5D injections but you're going to need more Cyp, probably on the order of 120-140mg to bring around Free T, and don't test @ 48hrs, always test right before your next injection.
You may need Anastrozole...don't fret that. Some of us need it in a proper protocol achieving the numbers desired; FT/TT.

Vince, do you think going to 3X/week is a good choice to reduce the e2 even considering my high SHBG levels or sticking with 2X/week is a better option and just increase the anastrozole?

Just a point of clarification. The reason the blood draw was at 48 hours was the next HCG shot was that morning and I didn't want it to skew the results. Perhaps that was a bad choice. I am considering the moving to 2X/week on the HCG if I stick with 2X/week testosterone injections based on how common that protocol is. Then I would be following Nelson's protocol, which is attractive, and that would allow me to do the next blood draw 3.5 days after an injection.

Vince, your post suggests you are taking anastrozole. If you don't mind sharing, how much do you take and on what schedule. I have been taking .5 mg 24 hours after each shot. That timing was based on some posts I read on Excelmale. Is that timing optimal or is there a better option?

Finally, if I stick with the 2X week injection protocol, how much would you suggest inscreasing the anastrozole from .5 mg (2X/week) to bring my e2 levels into an acceptable range? (I can increase in .25 mg increments.) Currently my e2 levels are 74.4 pg/mL on the sensitive test. The unpleasant side effects I listed need to go but I don't want to increase the anastrozole so high that I tank my estradiol levels and create a whole different set of problems.

Sorry for so many questions. I am learning as fast as I can. This place has been such a helpful resource since I started 5 months ago. I have been reading regularly since that time, but I finally took the plunge with this first post.

 

[Vince Carter]

Id probably break up the anastrozole through the week instead of twice. It has about a 50hr half life and I take .25mg EOD. My E2 reads were in the 60/70/80s prior, I have not yet retested.