High estradiol and SHBG 10wks into TRT (was high on enclomiphene too) - long winded post sorry.

[Sandz]

I was brought here after listening to Nelson on Dr. Lyons podcast, man what a story and journey!

48M, 5'6" 160lbs.

I lost 90lbs 25 years ago and have kept in shape ever since. I workout daily, love being in the gym, but never truly felt optimized. This last year or two I made it a goal to feel comfortable in my own skin and get into the best shape by 50, so I felt it was valuable to go check more labs than a typical provider did.

In the end, I tested with low free T multiple times, always under 4.0. My Total T was 350-450ish throughout my 40s. Wasnt educated enough to test other markers, but I am really trying to tune into my body these days.

I got on an enclomiphene, and came to realize less is more. I was on 12.5mg, but ended up dialing down to 6.25EOD. I never felt great, eye flutters, and I didn't see the benefit, so I stopped after terrible Gerd (perhaps not related but I think it was).

Total T on elnclo was btwn 900 and then 1000.
Free T was consistently hovering around 14
SHBG was consistently high at 63 then 50 - (50 even before starting anything)
Estradiol btwn 38-40 from btwn 8-15 without any treatments

Started TRT - subq 2x a week - .3cc so 120mgs a week about 10wks ago. Feeling better than elcno, biggest change so far is irritability and attitude. Less agitated, more focused day to day. Workouts a little better, feeling a touch stronger, slight.
Total T - over 1500
Free T - 17.3
SHBG - 67
Estradiol 60
Sensitive estradiol 53
DHEA 157 taking 25mg a day

So, bottom line, I don't need my T to be over 1500.
I an lowering my dose to 100mg a week, .25cc 2x a week subQ
Adding in Nettle root, extract and root 300mg/150mg
Adding in 3mg or 6mg Boron
Adding in calcium d-glucarate 500mg
Continuing to take Dim 300mg which I started with TRT

I want to take advantage of the T, so bound testosterone doesn't seem valuable. I am not terribly afraid of the E2, I don't feel gyno but I do feel like my sleep isn't good, and I am retaining water which is expected on T, its mild (1-2lb). Doc suggested small dose of AI, but I don't think I need to jump there just yet unless my case is cause for it. Also in the fall, I had a terrible bout with Gerd and I believe its from the T and E being elevated. I hope lowering my dose and adding in support naturally is the winner, but I don't often see people with both High E2 and SHBG although I am sure its been documented I just cant find a lot of scenarios like mine. I want to take the maximum benefit, I dont need to be at a certain number, if it lands at 800, so be it. I just want to get my E2 and SHBG in check.

Any other questions or advise, please let me know. Any input is appreciated. Ill keep searching the forum too, its a fantastic resource!

 

[FunkOdyssey]

So, bottom line, I don't need my T to be over 1500.
I an lowering my dose to 100mg a week

Actually, you might need your total T to be that high, or even higher, to have a decent free T with that high SHBG. You need to retest testosterone with a proper LC/MS method though so you can see where that actually sits.

Your high E2 is also similarly artificially inflated by your high SHBG. Your free E2 is probably in a decent place, just like your free T.

I would not be considering a dose reduction with a free T of 17 ng/dL. Again though, we aren't sure what your free T actually is here, because of the testosterone assay used. I would retest with a proper test that can read higher than 1500 ng/dL before making any changes.

Forget about doing anything to specifically try to reduce your SHBG, that is a distraction and a dead end. Your free T is what matters here for symptom resolution, and it directly reflects your dosage of testosterone. Want more free T? Increase the dose. Forget total T and forget SHBG.

 

[FunkOdyssey]

By the way, I am a fellow GERD sufferer and have seen this worsen with TRT depending on the form and dosage. The effects of androgens vs estrogen here are distinct: estradiol relaxes the lower esophageal sphincter to promote more reflux events, while androgens somehow make the reflux more damaging.

This may turn out to be a dose-limiting side effect for you as it has been at times for me. One thing I found helpful were higher frequency injections to reduce peak levels (EOD with long esters) and IM injections to reduce aromatization. A decent percentage of men see a higher T/E2 ratio with IM, and it may be worth experimenting to find out if you are one of them.

 

[Systemlord]

Workouts a little better, feeling a touch stronger, slight.

I would get the Free T higher, 20-25 or higher if you feel the added benefits and other parameters aren’t too far out of range.

No mention of hemoglobin and hematocrit levels.

Remember, a given hormone level on TRT doesn’t have the same effect as a natural level with the regulatory systems in place at the same level.

So you need a higher Free T level on TRT to achieve an equal effect as a natural level, as an example, a natural Free T of 17ng/dL, you would need a Free T level a little higher to achieve the same effect.

My Total T is currently 239 ng/dL and Free T 5.1 ng/dL and I could never feel half as good as I do now with this level on TRT.

 

[Sandz]

Actually, you might need your total T to be that high, or even higher, to have a decent free T with that high SHBG. You need to retest testosterone with a proper LC/MS method though so you can see where that actually sits.

Your high E2 is also similarly artificially inflated by your high SHBG. Your free E2 is probably in a decent place, just like your free T.

I would not be considering a dose reduction with a free T of 17 ng/dL. Again though, we aren't sure what your free T actually is here, because of the testosterone assay used. I would retest with a proper test that can read higher than 1500 ng/dL before making any changes.

Forget about doing anything to specifically try to reduce your SHBG, that is a distraction and a dead end. Your free T is what matters here for symptom resolution, and it directly reflects your dosage of testosterone. Want more free T? Increase the dose. Forget total T and forget SHBG.

Interesting thoughts. If I reduce total T, and my free T stays in similar range, wont my ratio be improved? And if that lowers my SHBG, wont I have less bound/more bioavailable T? I am feeling the estrogen, to your point on your additional comment, the Gerd is more prevalent and I feel that's the driver which is why, in total, I decided to go down to 100mgs a week vs 120. I feel that the saturation of Total T is at max, for me, so even with lower total I think the other numbers wont go down that much but hopefully E2 will....again its trial and error. Good food for though for sure!! Thank you!

 

[Sandz]

I would get the Free T higher, 20-25 or higher if you feel the added benefits and other parameters aren’t too far out of range.

No mention of hemoglobin and hematocrit levels.

Remember, a given hormone level on TRT doesn’t have the same effect as a natural level with the regulatory systems in place at the same level.

So you need a higher Free T level on TRT to achieve an equal effect as a natural level, as an example, a natural Free T of 17ng/dL, you would need a Free T level a little higher to achieve the same effect.

My Total T is currently 239 ng/dL and Free T 5.1 ng/dL and I could never feel half as good as I do now with this level on TRT.

Hemoglobin - 16.6, i think thats in range.
Hematocrit - 48.9 i think also in range.

I hear ya, its a theme. More free T, more bioavailable. I am trying, but I feel more T isn't the answer for me personally as its driving up my E2 and SHBG.

Man its tough, I am just one of those with hereditary high SHGB, always been since ive tested before and after therapy.