High SHBG

[Gman86]

Quest
Reference Range(s)
AdultMales 18-69yrs (pg/mL) 46.0-224.0
Testosterone, Free (18944)

Labcorp
20 to >59yrs (pg/mL) 6.6-26.5
144980: Testosterone, Free, Direct | LabCorp

For some reason I thought labcorp uses ng/dL. So ya this clearly shows that labs can be COMPLETELY different, even when using the same measurement.

 

[madman]

I would prefer the Equilibrium Dialysis over any.....yes most are using the direct immunoassay, the calculated Vermeulen method is online for free

Amazing post. Love learning new things like this. Would of probably never known about these differences if it wasn’t for you, so thanks madman for that.

So you’re right, labcorp does offer both the direct and calculated by Vermeulin Equation. But I don’t think anyone is getting the calculated. The reference range for direct is (6.8−21.5) for 40-49 year old men. This is roughly the reference range we see with labcorp. With the labcorp test done by Vermeulen Equation the reference range is
(30.3–183.2) for a 41-50 year old man. I’ve never seen someone have this reference range with their free T when using labcorp.

So even though labcorp offers the calculated free T by Vermeulin Equation, do you think anyone’s actually getting that version done? Seems like everyone’s getting the direct free T from labcorp. And you would probably recommend guys to switch over to the calculated free T test by Labcorp I would assume, correct?

Most are getting the Direct analog enzyme immunoassay (EIA) :
144980: Testosterone, Free, Direct | LabCorp



Instead of Equilibrium Dialysis which is considered the gold standard regading accuracy of Free Testosterone levels : 500726: Testosterone, Free, Mass Spectrometry... | LabCorp

 

[madman]

Again both methods have their flaws regarding measurement of Free Testosterone:

Calculated Free Testosterone (Vermuelen) method tends to overestimate and the direct analog immunoassay RIA (radio immunoassay) or EIA (enzyme immunoassay) tends to underestimate when compared against the gold standard EQUILIBRIUM DIALYSIS.

To obtain the most accurate value of ones Free Testosterone levels you would need to get the equilibrium dialysis:

500726: Testosterone, Free, Mass Spectrometry... | LabCorp


Or the equilibrium ultrafiltration:

070038: Testosterone, Free, Equilibrium Ultrafiltration... | LabCorp


Most importantly if you are always basing how you feel compared to lab work when looking at your free testosterone levels than in cases of men with low or high SHBG I would definitely be using equilibrium dialysis if you want to truly gauge how your FT levels are affected when adjusting trt protocol whether increasing/decreasing testosterone dose.

 

[BCD19800]

Hey all,

Just a quick update. After reading everyone’s posts to my thread I decided to have a consultation with Defy. My wife and I had a teleconferenc with Dr. Calkins. He seemed very knowledgeable and took his time to explain my labs and field our questions. He recommended I start taking 25 mg DHEA, 160 mg test per week and HCG. I agreed to the DHEA and testosterone but am holding off on the HCG. I’m done having children and would prefer to see how I do with testosterone mono therapy. Surprisingly, my labs for my defy consultation showed a drop in SHGB from the low 70s I posted originally on here to 61. That’s the lowest in 2 years. Anyhow, hoping to drop it more and get my free test at the top of the range. Dr. Calkin expects my total test to get around 1400 or so and did not seem concerned. I did my first shot subq on Saturday and will do my second tomorrow. I don’t feel any different yet obviously. Hope positive changes come in the new year.

 

[bkb33]

Hey all,

Just a quick update. After reading everyone’s posts to my thread I decided to have a consultation with Defy. My wife and I had a teleconferenc with Dr. Calkins. He seemed very knowledgeable and took his time to explain my labs and field our questions. He recommended I start taking 25 mg DHEA, 160 mg test per week and HCG. I agreed to the DHEA and testosterone but am holding off on the HCG. I’m done having children and would prefer to see how I do with testosterone mono therapy. Surprisingly, my labs for my defy consultation showed a drop in SHGB from the low 70s I posted originally on here to 61. That’s the lowest in 2 years. Anyhow, hoping to drop it more and get my free test at the top of the range. Dr. Calkin expects my total test to get around 1400 or so and did not seem concerned. I did my first shot subq on Saturday and will do my second tomorrow. I don’t feel any different yet obviously. Hope positive changes come in the new year.

Would you mind updating on your situation?

 

[Logan24]

Uhhh...well prior to starting TRT my SHBG was 75. I was placed on a every 3.5 day protocol. The theory was it would lower my SHBG.
And this whole, “high SHBG guys need one or two large doses” is not always correct.

It only lowered my SHBG down to about 65. Not a significant amount at all.

And...those larger doses coupled with hCG shot my E2 up to 75.

I then went to M-W-F protocol and lower doses and ditched the HCG. That lowered my E2 down to the high 30’s. My SHBG is still in the 60’s.

I am now doing EOD injections. Blood work will tell the story, but so far each time I moved to more frequent doses, my overall well-being has improved.

It gets kind of tiring to hear high SHBG guys always need one or two large doses and this will fixed your SHBG issues.

I know this is an old thread but I’m in a very similar boat as you with shbg of 70 and injecting e3.5 days. When you went to MWF did you keep your weekly dose the same or reduce it some? I’m contemplating the same move. Thought I would keep my dose the same for now so that I’m not changing too many variables at once.

 

[bkb33]

I know this is an old thread but I’m in a very similar boat as you with shbg of 70 and injecting e3.5 days. When you went to MWF did you keep your weekly dose the same or reduce it some? I’m contemplating the same move. Thought I would keep my dose the same for now so that I’m not changing too many variables at once.

I am in the same situation. SHBG over 100, injecting 100 mg E3.5 (total 200mg/week). But debating switching to 3X/week, as I am not feeling any better.

 

[fifty]

If you're going from 2x to 3x I would lower the dose ~10% if you want the same levels.

 

[RPellerin]

I am in the same situation. SHBG over 100, injecting 100 mg E3.5 (total 200mg/week). But debating switching to 3X/week, as I am not feeling any better.

I have been on TRT for 11 months, with SHBG ranging from 92 initially to 60's now.
-Waiting on blood results from Friday's draw.
At 75mg every 3.5 days 6 months, then 150mgs every 7 days for 3 months (each IM), I didn't feel much of a difference.
For the last 2 months I have been injecting 40mgs SQ EOD and I feel better; clearer mind, better gains.
I also inject 200ius of HCG EOD and take 25mgs DHEA every day.

 

[Gman86]

I have been on TRT for 11 months, with SHBG ranging from 92 initially to 60's now.
-Waiting on blood results from Friday's draw.
At 75mg every 3.5 days 6 months, then 150mgs every 7 days for 3 months (each IM), I didn't feel much of a difference.
For the last 2 months I have been injecting 40mgs SQ EOD and I feel better; clearer mind, better gains.
I also inject 200ius of HCG EOD and take 25mgs DHEA every day.

Were you taking the HCG and DHEA during your 150mg once per week and 75mg twice per week protocols too, or is the HCG and DHEA new additions?

 

[BigBamBoo]

I know this is an old thread but I’m in a very similar boat as you with shbg of 70 and injecting e3.5 days. When you went to MWF did you keep your weekly dose the same or reduce it some? I’m contemplating the same move. Thought I would keep my dose the same for now so that I’m not changing too many variables at once.

The doctor (Defy) actually INCREASED my overall weekly dose when moving me to M-W-F dosing.
I was on 160mg for the week on the every 3.5 days and went up to 180mg for the week on the M-W-F protocol.

 

[RPellerin]

Were you taking the HCG and DHEA during your 150mg once per week and 75mg twice per week protocols too, or is the HCG and DHEA new additions?

I have been on HCG since day one, and the DHEA was added about a month before I started the EOD injections.

 

[Logan24]

The doctor (Defy) actually INCREASED my overall weekly dose when moving me to M-W-F dosing.
I was on 160mg for the week on the every 3.5 days and went up to 180mg for the week on the M-W-F protocol.

Wow! Even with a higher weekly dose your e2 dropped from 75 to 30 by increasing frequency to MWF?

 

[BigBamBoo]

Yes, but not quite 30. Think it was 38. But it had a huge impact on my E2.

 

[Logan24]

Yes, but not quite 30. Think it was 38. But it had a huge impact on my E2.

That’s great! This gives me hope

 

[Logan24]

Yes, but not quite 30. Think it was 38. But it had a huge impact on my E2.

Do you mind me asking where your total and free t generally runs?

 

[BigBamBoo]

Do you mind me asking where your total and free t generally runs?

When I was on TRT, my last labs where:

TT 1134 (264-914 range)
FT 21.4 (6.8-21.5 range)
E2 39.4 (8-35 range)
SHBG 66.7 (16.5-55.9 range)

 

[Logan24]

When I was on TRT, my last labs where:

TT 1134 (264-914 range)
FT 21.4 (6.8-21.5 range)
E2 39.4 (8-35 range)
SHBG 66.7 (16.5-55.9 range)

Thanks brother! These are very similar to my labs except my free t is 13.7. I want to try raising that level but without elevating e2 any further. Hoping the switch to mwf will help. I’m only using 50mg e3.5 days though.

 

[BigBamBoo]

It should. As you can see it made a large difference for me. Totally counter to “conventional wisdom” for guys with high SHBG.

Good luck.

 

[apsjiml]

Anyone with elevated SHBG - there is genetic causes of this but also a common cause is iron overload Hemochromatosis. If it were me, I would be getting a full iron panel with ferritin and saturation. This is my issue as well and I have iron overload. Liver iron overload is associated with elevated SHBG concentration and moderate hypogonadotrophic hypogonadism in dysmetabolic men without genetic ... - PubMed - NCBI