Low SHBG and 13 Recent Lab Work

[TestAdvocate]

Hello Members:

Quick profile on me: 53 years old, 6'3" 227lbs, leanly muscled. Have always been active and athletic (basketball, weightlifting etc.). I wanted to look into TRT when my A1c reached 6.4 in December. My GP's theory was 15 years of high dosage statins caused my high A1c. I looked into TRT, in January of this year......my total T was about 470 and Free T was 11.4. The low Free T and my high A1c was reason enough for treatment, along with early symptom sings of LowT.....(mind fog, lethargic, decreased sex drive, energy dive by 9PM).

My proto

CBC With Differential/PlateletWBC 4.3 x10E3/uL 3.4 - 10.8 01
RBC 4.99 x10E6/uL 4.14 - 5.80 01
Hemoglobin 14.9 g/dL 12.6 - 17.7 01
Hematocrit 46.9 % 37.5 - 51.0 01
MCV 94 fL 79 - 97 01
MCH 29.9 pg 26.6 - 33.0 01
MCHC 31.8 g/dL 31.5 - 35.7 01
RDW 15.2 % 12.3 - 15.4 01
Platelets 348 x10E3/uL 150 - 379 01
Neutrophils 47 % 01
Lymphs 37 % 01
Monocytes 11 % 01
Eos 4 % 01
Basos 1 % 01
Neutrophils (Absolute) 2.0 x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 1.6 x10E3/uL 0.7 - 3.1 01
Monocytes(Absolute) 0.5 x10E3/uL 0.1 - 0.9 01
Eos (Absolute) 0.2 x10E3/uL 0.0 - 0.4 01
Baso (Absolute) 0.0 x10E3/uL 0.0 - 0.2 01
Immature Granulocytes 0 % 01
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 01
Comp. Metabolic Panel (14)
Glucose, Serum 87 mg/dL 65 - 99 01
BUN 12 mg/dL 6 - 24 01
Creatinine, Serum 1.14 mg/dL 0.76 - 1.27 01
eGFR If NonAfricn Am 73 mL/min/1.73 >59
eGFR If Africn Am 84 mL/min/1.73 >59
BUN/Creatinine Ratio 11 9 - 20
Sodium, Serum 138 mmol/L 134 - 144 01
Potassium, Serum 4.9 mmol/L 3.5 - 5.2 01
Chloride, Serum 99 mmol/L 97 - 108 01
Carbon Dioxide, Total 23 mmol/L 18 - 29 01
Calcium, Serum 8.8 mg/dL 8.7 - 10.2 01
Protein, Total, Serum 6.3 g/dL 6.0 - 8.5 01
Albumin, Serum 4.2 g/dL 3.5 - 5.5 01
Globulin, Total 2.1 g/dL 1.5 - 4.5
A/G Ratio 2.0 1.1 - 2.5
Bilirubin, Total 0.4 mg/dL 0.0 - 1.2 01
Alkaline Phosphatase, S 51 IU/L 39 - 117 01
AST (SGOT) 30 IU/L 0 - 40 01

ALT (SGPT) 46 High IU/L 0 - 44 01

Testosterone,Free and Total

Testosterone, Serum 520 ng/dL 348 - 1197 01
Comment:
Adult male reference interval is based on a population of lean males
up to 40 years old.
Free Testosterone(Direct) 23.8 pg/mL 7.2 - 24.0 02

Sex Hormone Binding Globulin 8.3 Low Verified by repeat analysis.
Reference Range: >49y: 19.3 - 76.4
Hemoglobin A1c 5.7 High
Increased risk for diabetes: 5.7 - 6.4
Diabetes: >6.4
Glycemic control for adults with diabetes: <7.0

Prostate Specific Ag, Serum 0.9 ng/mL 0.0 - 4.0 01


Estradiol, Sensitive 62.7 High pg/mL 8.0 - 35.0

 

[ERO]

Has TRT helped you feel better and/or lower your A1C? It looks like your total T is only 520 as well. You must be on a low dose of T.

I too have low SHBG, although my A1C is 5.4 and my fasting gluse is always in the 80s. Low SHBG for many of us makes for a far less than ideal TRT experience, unfortunately.

 

[TestAdvocate]

Has TRT helped you feel better and/or lower your A1C? It looks like your total T is only 520 as well. You must be on a low dose of T.

I too have low SHBG, although my A1C is 5.4 and my fasting gluse is always in the 80s. Low SHBG for many of us makes for a far less than ideal TRT experience, unfortunately.

My reason looking into TRT at the beginning of this year wasthat my A1c had reached 6.4 at my physical in December last year. My GP'stheory was that 15 years of high dosed statins had caused the pre-diabeteslevel on my A1c reading.

I decided to look into TRT to help with the blood sugarproblem. My total Test at baseline (Jan 2015) was around 470 and FreeTest at about 11.4 before therapy. I started therapy with Defy on March10th.

My 6 week labs at the end of April looked promising. My protocol was 80mg / week of Test Cyp, one injection each Tues, no AI and noHcG. After 6 weeks my total testosterone trough had increased to 570 (up from470) and my Free test reached 15.4 (up from 11.4). Hematocrit and Estradiolwere fine and in the mid normal range. My RN at Defy advised increasingmy weekly injection dosage to 120mg a week and no AI and no HcG.

My muscularity and bodyweight started increasing by week 7,when I started I was lean at about 217lbs, by week 12 closer to 230lbs. My anklesstarted swelling, I suspected estrogen was causing some water retention. Nelson forwarded(on ExcelMale) some nice research regarding some men's reaction totestosterone and the sensitivity to the hormone Aldosterone, which regulatessodium. The reaction can cause some water retention. This was the sameopionon of my RN at Defy. She explained that once this happens, the body usuallyresponds and this will simply go away in a few weeks. She was right, andit went away, however from curiosity I ordered updated lab work throughDiscounted Labs (good service by the way J)and had the TRT labs drawn.

The labs show that on week 13, even though we had increasedmy weekly dose from 80mg / week to 120mg / week my total T actually decreased alittle down to 520 (down from 570), however my Free had increased to anastonishing 23.8! I was very pleased to see this and thought this couldbe the reason for my increased muscle and lean body mass weight. (I'm beginningto look like Terrell Owens or something of that look). SHBG had not beenmeasured on my previous labs, so I don't know if I have always had low SHBG,however my I found out my SHBG is very low 8.3 on a scale of 19.3 to76.4. And now too my Estradiol (sensitive measured) has skyrocketed to 62.7(8.0 &#8211; 35.0). Up from 13.8 ECLIA methodology measured on April 28[SUP]th[/SUP]2015. (7.6 to 42.6).

I still do not feel any effects of the elevatedEstradiol. My A1c is down to 5.7 (it was 6.4 in Dec!). I love thehigh Free T measurement, I don't know what to think of the still relativelymodest 520 Total T.

Do you have any ideas? Should I be concerned with highEstradiol with no symptoms? Nipples are erect, but not sore or sensitive,no signs of oncoming gynecomastia or anything. Feet and ankles are notswelling anymore. I feel great, sex drive is good, sleep is good. Istill have energy crash by 9PM, don't know what to think of that. We havea three year old son, could be that!

I would be very forever grateful for your review andthoughts!

 

[ERO]

Cutting your weekly T dose in half and injecting twice a week may help your E2 to move down as well as giving you a more stable T level.

Many guys with low SHBG metabolize/excrete Testosterone very quickly so if your total T is 520 on your trough, it may have been like 900 or 1000 on your peak, which could explain your current E2 levels. If you do not feel any nipple soreness or other high E symptoms, I would go to twice a week dosing for 4-6 weeks and test again rather than start an AI now.

I am glad that you are feeling good and have a good sex drive. Many folks, including myself, that have low SHBG never get a really good sex drive and or a really good feeling overall from TRT.

 

[TestAdvocate]

Sorry my post has all the crazy notes on it......I'm not doing something correctly with the cut and paste.

Thanks for your response Ero........the lab work has me perplexed at the 13 week mark. Feeling great, body has recomped, added muscle lost about two notches on my belt and I was already lean to begin with. I'm literally feeling no effects from the high estrogen reading, and my Total T isn't that high, however the Free T is almost peaked. I definitely would prefer to stay off of the AI and let this go further, I absolutely hate injections, so adding more frequent injections will not be pleasant for me, but I'll certainly give it a try and see how it affects the numbers.

 

[ERO]

If you are not already doing so, I recommend injecting sub-Q with an insulin syringe. It is literally painless that way. I never liked the IM injections, but with sub-Q I could do it daily if needed.

Also, on the cut and paste, you can get rid of the formatting issues if you paste into Notepad (if you are using Windows) and then doing another cut and paste from Notepad to the forum.

Glad to hear how well this is working for you overall. That is very cool!

 

[CoastWatcher]

Sorry my post has all the crazy notes on it......I'm not doing something correctly with the cut and paste.

Thanks for your response Ero........the lab work has me perplexed at the 13 week mark. Feeling great, body has recomped, added muscle lost about two notches on my belt and I was already lean to begin with. I'm literally feeling no effects from the high estrogen reading, and my Total T isn't that high, however the Free T is almost peaked. I definitely would prefer to stay off of the AI and let this go further, I absolutely hate injections, so adding more frequent injections will not be pleasant for me, but I'll certainly give it a try and see how it affects the numbers.

Everything ERO wrote is true in my case. My SHBG is not as low as yours, but I was noticing a peak of 1035 and a trough of 723, and feeling it as well. My estradiol had climbed from 22 to 55 in 6 weeks; I felt that as well. Oddly, I was doing injections every three and one half days when this was noted.

I have now switched to daily injections of 15 mgs - it is a commitment, but nothing too bad. Five minutes in the morning routine. I feel great and will test in another week and a half. I may have achieved the same results with small, three times weekly shots, but I wanted to avoid an AI if at all possible so I went radical.

 

[TestAdvocate]

Just finished the consult with the RN at Defy on this. She thinks I'm a high metabolizer of Test, just as you guys have also theorized, thus the numbers. The thought now is to try two weekly injections at 80/mg each injection.......160mg / week. They prescribed anastrozole, she could tell I'm a minimizer, so she said I could hold off on the anastrozole until I see symptoms. She said they would like to get my trough total to at least 800 minimum, so they think increasing the dosage just a bit, going to twice weekly injections will stabilize the levels, and perhaps reduce E2 levels and perhaps bring up SHBG. Since I don't feel any negative effects from this at all, I'll try this protocol. Thanks so much Ero and Coastwatcher for your input on this. Curt

 

[Vince Carter]

My journey with low SHBG and advice to you is injections EOD. We typically need more MG's more frequently. You're on the right past with fast metabolizing theory, for instance, my ~72hr trough Total is in the low 800's, my 24hr post injection peak approaches 1500. It's a constant up and down ride but EOD injections keep you up and make the day-to-day ride a much smoother experience.
Defy and Dr Saya are pretty good with letting you use an AI on symptoms vs numbers on a test. I'm currently using only .15mg once per week.

 

[BuzzzardMarinePumper]

Just a note from my research and other not clinical but random studies my Testosterone levels dropped over a 4 mths period switching from IM to Sub-Q and I went back to IM ! All men are different and some men can do Sub-Q with no change ! It did have a lowering effect on ME !

 

[Nelson Vergel]

TestAdvocate

Your original posts are a mess in formatting and very difficult to read. Please edit your posts to clean all the HTML stuff.

I remind everyone that messy posts do not get many replies.