Low Free T

[Seth]

I just had a blood test and although my total T OK, my free T is low and I'm feeling it.
My SHBG is high which appears to be keeping my free T in the low range.
What can cause this and what can I do about it?

Report	Result	Ref. Range	Units		Status	Lab
TESTOSTERONE	645	300-720	NG/DL		Final	CPL
SEX HORM BIND GLOBULIN	86.2	19.3-76.4	NMOL/L	HIGH	Final	CPL
CALC FREE TESTOSTERONE	69.4	47.0-244.0	PG/ML		Final	CPL

 

[FunkOdyssey]

My SHBG is high which appears to be keeping my free T in the low range.
What can cause this and what can I do about it?

High levels of SHBG may be related to:

• Liver disease.
• Hyperthyroidism.
• Eating disorders.
• In females, using estrogen in medicine, such as: Hormone replacement therapy. Birth control pills.
• In males, reduced production of sex hormones.

Your high SHBG is not "keeping your free T low". Assuming you don't have liver disease, hyperthyroidism, and are not eating a strict keto diet, your SHBG is most likely high BECAUSE your free T is low. Why is your free T low? Because you aren't producing enough testosterone. Ignore the Total T -- it doesn't tell you anything important about your testosterone status and is falsely elevated here by your SHBG.

What can you do about it? If you have any lifestyle factors that would suppress testosterone production, you can start by fixing those (sleep apnea, obesity, alcohol, opiates, etc). If you've already eliminated anything that could be suppressing your T production, then this sad value of 69 pg/mL is the best you're going to do. In that case, assuming you also suffer from symptoms of hypogonadism, it is TRT time.

 

[sammmy]

What is your current diet and exercise? What body fat?

Weren't you on some form of TRT 2 years ago? Why did you stop?

 

[Seth]

High levels of SHBG may be related to:

• Liver disease.
• Hyperthyroidism.
• Eating disorders.
• In females, using estrogen in medicine, such as: Hormone replacement therapy. Birth control pills.
• In males, reduced production of sex hormones.

Your high SHBG is not "keeping your free T low". Assuming you don't have liver disease, hyperthyroidism, and are not eating a strict keto diet, your SHBG is most likely high BECAUSE your free T is low. Why is your free T low? Because you aren't producing enough testosterone. Ignore the Total T -- it doesn't tell you anything important about your testosterone status and is falsely elevated here by your SHBG.

What can you do about it? If you have any lifestyle factors that would suppress testosterone production, you can start by fixing those (sleep apnea, obesity, alcohol, opiates, etc). If you've already eliminated anything that could be suppressing your T production, then this sad value of 69 pg/mL is the best you're going to do. In that case, assuming you also suffer from symptoms of hypogonadism, it is TRT time.

Thanks for your reply. I'm injecting .15 ML of T weekly. I was taking .4ML but my doctor had be reduce it as my Total T was 1372, which was too high in his opinion. At that time, my free T was 182 and my SHBG was 84.4

I don't have any of those other medical or lifestyle conditions you mentioned. I exercise 5 to 6 days a week and take daily cialis. About a year ago, I was put on blood pressure and cholesterol medication. This is when I first noticed the changes. Low energy, depression, low libido, loss of morning wood and soft erections when I can get them. My doctor said these medications wouldn't have any effect on this. Maybe it's just a coincidence. But I feel like I did before I ever started taking TRT.

 

[sammmy]

Your doctor pretends he knows more than he actually does. Blood pressure meds and statins DO affect sexuality.

 

[Seth]

What is your current diet and exercise? What body fat?

Weren't you on some form of TRT 2 years ago? Why did you stop?

Diet hasn't been the best over the past year. Not on a Keto diet or anything like that. I'm about 5 pounds overweight which is all around my middle. I'm 5'10. 145 lbs.
I've been on TRT for years but have reduced the amount due to my doctors advice. See my reply to FunkOdyssey

 

[sammmy]

ChatGPT (Bing Copilot) gives summary that is much different from your doctor:

Blood pressure medications can indeed have an impact on sexual health. Here are some key points:

1. **Erectile Dysfunction (ED)**: Erectile dysfunction is a common side effect of blood pressure medications¹. Over time, high blood pressure damages the lining of blood vessels and causes arteries to harden and narrow, a condition known as atherosclerosis. This condition limits blood flow, which means that less blood flows to the penis, making it difficult for some men to get and keep erections².

2. **Decreased Sexual Drive**: Blood pressure medicines can also decrease sexual drive or make it more difficult to reach orgasm¹.

3. **Effect on Women**: High blood pressure can reduce blood flow to the vagina and might lower levels of nitric oxide, which helps smooth muscles relax. This may cause lowered sex drive or arousal, difficulty having an orgasm, and vaginal dryness².

4. **Medication Types**: Three types of blood-pressure medications — diuretics (or “water pills”), beta-blockers, and alpha-blockers — have been found to have the highest incidence of sexual side effects³.

If you or someone else is experiencing these side effects, it's important to discuss them with a healthcare provider. They can help find a solution, which may involve changing medications or dosages². Remember, you should never change or stop taking prescribed medication without consulting your healthcare provider.

Please note that this information is a general overview and may not apply to everyone. Always consult with a healthcare provider for personal medical advice.

Source: Conversation with Bing, 2/5/2024
(1) Can blood pressure medications interfere with my sex drive?. Can blood pressure medications interfere with my sex drive? - Harvard Health.
(2) High blood pressure and sex: Overcome the challenges. High blood pressure and sex: Overcome the challenges.
(3) Prescription Medications Can Cause Sexual Dysfunction - AARP. Prescription Medications Can Cause Sexual Dysfunction.
(4) High blood pressure: Effect on males' sexual health - Medical News Today. High blood pressure: Effect on males' sexual health.

 

[sammmy]

Bing Copilot on statins' effect on sexuality:

Statins, which are medications commonly used to lower cholesterol, can indeed have an impact on sexual health. Here are some key points:

1. **Erectile Dysfunction (ED)**: Statins may potentially improve ED, as high cholesterol is a critical risk factor for ED¹². High cholesterol contributes to ED by causing the build-up of fatty plaques in the arteries that service the penis¹. However, the relationship between statins and ED is not straightforward and more research is needed².

2. **Testosterone Levels**: One study found that statins may reduce testosterone levels¹. Testosterone is the primary male sex hormone, and it's necessary for an erection to be achieved².

3. **Sexual Pleasure**: Some studies suggest that statins could cause changes in sexual pleasure³. As the cholesterol count went down, the quality of sex did too³.

4. **Sex Drive**: Sexual problems, such as a lack of sex drive, are a reported side effect of statins⁵.

If you or someone else is experiencing these side effects, it's important to discuss them with a healthcare provider. They can help find a solution, which may involve changing medications or dosages². Remember, you should never change or stop taking prescribed medication without consulting your healthcare provider.

Please note that this information is a general overview and may not apply to everyone. Always consult with a healthcare provider for personal medical advice.

Source: Conversation with Bing, 2/5/2024
(1) Statins and Erectile Dysfunction (ED) - Verywell Health. Do Statin Drugs Cause Erectile Dysfunction?.
(2) Do Statins Cause Erectile Dysfunction? - Healthline. Do Statins Cause Erectile Dysfunction?.
(3) 5 Ways Cholesterol Can Affect Your Sex Life | HowStuffWorks. 5 Ways Cholesterol Can Affect Your Sex Life.
(4) Statins and sex drive - BHF - British Heart Foundation. Could statins be the reason for my lack of libido?.
(5) Prescription Medications Can Cause Sexual Dysfunction - AARP. Prescription Medications Can Cause Sexual Dysfunction.

 

[Systemlord]

My SHBG is high which appears to be keeping my free T in the low range.

LH and testicular response to stimulation is the main driver of testosterone production.

This has been discussed extensively on EM for sometime now.

20 year-old full hormone panel. Thoughts?

Hi all, I am 20 y/o and had all of my hormones checked recently. My endocrinologist basically said my labs are confusing af. I just thought I’d post them here to see what you guys think. Many things are out of wack but it’s weird because some are high and others are low. Let me know if you...

www.excelmale.com

Total Testosterone LC/MS: 1,238 H (250-1100) high
Free Testosterone Equilibrium Dialysis: 195.6 H (35-155) high
LH: 5.4 (1.5-9.3)
FSH: 5.3 (1.6-8)
SHBG: 65 H (10-50) high

 

[Seth]

Bing Copilot on statins' effect on sexuality:

Statins, which are medications commonly used to lower cholesterol, can indeed have an impact on sexual health. Here are some key points:

1. **Erectile Dysfunction (ED)**: Statins may potentially improve ED, as high cholesterol is a critical risk factor for ED¹². High cholesterol contributes to ED by causing the build-up of fatty plaques in the arteries that service the penis¹. However, the relationship between statins and ED is not straightforward and more research is needed².

2. **Testosterone Levels**: One study found that statins may reduce testosterone levels¹. Testosterone is the primary male sex hormone, and it's necessary for an erection to be achieved².

3. **Sexual Pleasure**: Some studies suggest that statins could cause changes in sexual pleasure³. As the cholesterol count went down, the quality of sex did too³.

4. **Sex Drive**: Sexual problems, such as a lack of sex drive, are a reported side effect of statins⁵.

If you or someone else is experiencing these side effects, it's important to discuss them with a healthcare provider. They can help find a solution, which may involve changing medications or dosages². Remember, you should never change or stop taking prescribed medication without consulting your healthcare provider.

Please note that this information is a general overview and may not apply to everyone. Always consult with a healthcare provider for personal medical advice.

Source: Conversation with Bing, 2/5/2024
(1) Statins and Erectile Dysfunction (ED) - Verywell Health. Do Statin Drugs Cause Erectile Dysfunction?.
(2) Do Statins Cause Erectile Dysfunction? - Healthline. Do Statins Cause Erectile Dysfunction?.
(3) 5 Ways Cholesterol Can Affect Your Sex Life | HowStuffWorks. 5 Ways Cholesterol Can Affect Your Sex Life.
(4) Statins and sex drive - BHF - British Heart Foundation. Could statins be the reason for my lack of libido?.
(5) Prescription Medications Can Cause Sexual Dysfunction - AARP. Prescription Medications Can Cause Sexual Dysfunction.

Thank you. I will read up on the links you provided. From what I can tell, all of this started after I started taking these medications, so it definitely seems to be related.

 

[sammmy]

How long have you been on TRT and what benefits do you experience from it?

Did you have low normal free testosterone before TRT?

Were you put on blood pressure and cholesterol meds after you started TRT?

 

[FunkOdyssey]

Thanks for your reply. I'm injecting .15 ML of T weekly. I was taking .4ML but my doctor had be reduce it as my Total T was 1372, which was too high in his opinion. At that time, my free T was 182 and my SHBG was 84.4

Is that 200 mg/ml testosterone cypionate you are injecting .15 ml of? Do I understand correctly that your protocol is 30 mg a week?? WTF! Your doctor has chemically castrated you with this severely underdosed joke of a protocol that probably leaves you worse off than if you were completely off TRT.

You need to find a new doctor that understands testosterone and TRT better. The total T is going to be driven to high values on TRT if/when your SHBG is that high, and that is no cause for alarm, because the SHBG-bound T is basically inert. You adjust dose based on free T and symptoms, NOT total T. Total T is just a number on a piece of paper.

Your free T on your old protocol was starting to barely enter the range where most men would expect relief of symptoms on TRT. If a dose adjustment was going to be made, in most cases the direction would have been up, not down, from your previous 80 mg week.

Good grief, please find a new doctor ASAP.

 

[Seth]

How long have you been on TRT and what benefits do you experience from it?

Did you have low normal free testosterone before TRT?

Were you put on blood pressure and cholesterol meds after you started TRT?

I've been on TRT about 8 years. I don't remember exactly what my testosterone was before TRT. I was having the common signs of low T at the time. After started TRT, along with Cialis and HGC, my symptoms improved greatly. More energy, sense of well being, muscle gain from exercise, libido and erections were great. I started blood pressure and cholesterol meds about a year ago.

 

[Seth]

Is that 200 mg/ml testosterone cypionate you are injecting .15 ml of? Do I understand correctly that your protocol is 30 mg a week?? WTF! Your doctor has chemically castrated you with this severely underdosed joke of a protocol that probably leaves you worse off than if you were completely off TRT.

You need to find a new doctor that understands testosterone and TRT better. The total T is going to be driven to high values on TRT if/when your SHBG is that high, and that is no cause for alarm, because the SHBG-bound T is basically inert. You adjust dose based on free T and symptoms, NOT total T. Total T is just a number on a piece of paper.

Your free T on your old protocol was starting to barely enter the range where most men would expect relief of symptoms on TRT. If a dose adjustment was going to be made, in most cases the direction would have been up, not down, from your previous 80 mg week.

Good grief, please find a new doctor ASAP.

Yes. 200 mg/ml testosterone cypionate. Using a 1 ml syringe, I draw it up to .15 ml line, which seems like a tiny amount. My doctor was concerned about my total T being high, so he had me cut it down to this new dose. He said my SHBG would drop with the reduced total T, thus freeing up from of the free T, but that isn't what has happened. Years ago when I first started TRT, I had a different doctor. At that time, I was up to injecting .4 ML twice a week and my total T was above 1600. He didn't seem concerned about that as my free T was in the high, normal range. I felt good on that dosage. My new doctor says having high total T can cause health problems. But I agree with you. at this point, I don't feel like I'm getting any benefit out of TRT. BTW, I also take a 500 IU injection of HCG twice a week.

 

[Vince]

The Interplay between Magnesium and Testosterone in Modulating Physical Function in Men

The role of nutritional status as key factor of successful aging is very well recognized. Among the different mechanisms by which nutrients may exert their beneficial effects is the modulation of the hormonal anabolic milieu, which is significantly reduced with aging. Undernutrition and anabolic...

www.hindawi.com

 

[Seth]

The Interplay between Magnesium and Testosterone in Modulating Physical Function in Men

The role of nutritional status as key factor of successful aging is very well recognized. Among the different mechanisms by which nutrients may exert their beneficial effects is the modulation of the hormonal anabolic milieu, which is significantly reduced with aging. Undernutrition and anabolic...

www.hindawi.com

Thanks. Might consider supplementing with this. I take a multi vitamin daily, but it only contains 75mg of magnesium

 

[FunkOdyssey]

Years ago when I first started TRT, I had a different doctor. At that time, I was up to injecting .4 ML twice a week and my total T was above 1600. He didn't seem concerned about that as my free T was in the high, normal range. I felt good on that dosage. My new doctor says having high total T can cause health problems.

Yeah, I think your old doctor knew what they were doing with TRT, and the current one doesn't.

 

[Vince]

Thanks. Might consider supplementing with this. I take a multi vitamin daily, but it only contains 75mg of magnesium

1 Mineral for Everything: Magnesium

Anyone else find that after just supplementing with magnesium their blood pressure is maintained as well as taking bp prescription meds?

www.excelmale.com

 

[Systemlord]

My new doctor says having high total T can cause health problems.

Ask your doctor to prove it, show you a randomized placebo controlled study supporting his claim.

I assure you , he will be unable to do so!

 

[RickB]

"My (calculated) free T is low. It is low because of my high SHBG."

This is circular logic. Calculated free T is based solely on total T vs SHBG.

Even if you believe in the methodology, blaming SHBG for low calculated free T is like blaming flames for a fire.