Low SHBG, high Free Testosterone, and normal Total Testosterone

[Mike007]

T dose: 160 mg weekly
Arimidex: 0.25 EOD
Age: 40 yrs

I had blood work done at Quest and Labcorp the same day, 1 hour apart. I do weekly shots. This blood work was done right before my next injection.

Quest Diagnostics (7 am)
Total T: 551 ng/dL [250-1100]
Free T: 172 pg/mL [35-155]----> HIGH

LabCorp (8 am)
Total T: 653 ng/dL [348-1197]
Free T: 17.9 pg/mL [6.8-21.5]
SHBG: 9.9 nmol/L [16.5-55.9]

1. Which lab should I trust?
2. Are my levels good?
3. Is DHEA 25 mg daily recommended? If yes, why is it recommended if you are already on TRT?

Thanks.

 

[Vettester Chris]

Mike, I've always gone by the Labcorp standards myself. Not saying there's anything bad or wrong with Quest, just each place has some variances in equipment, calibrations, etc.

IMO, your free test is in a good place. I think for TRT purposes, most men can sustain a pretty good program in the 15pg/ml to 20pg/ml area (again, based on Labcorp standards). As you can see in your case it doesn't take a lot of total serum to achieve this. I also have a very low SHBG level. Sometimes this can be an indicator of other issues like hypothyroidism or a metabolic conditon. Just cover the bases with your doctor to make sure there are no underlying issues being overlooked.

Lastly, DHEA is upstream, so testosterone treatment won't replenish this hormone. Many men with hypogonadism are also struggling with other hormonal deficiencies like DHEA, Pregnenolone, D3, and thyroid as noted earlier. IMO, a successful TRT protocol includes hormonal support top to bottom, where it's needed. If the adrenals are tanked and the thyroid is shot, achieving wellness is going to be a difficult task on testosterone alone.

 

[Mike007]

Mike, I've always gone by the Labcorp standards myself. Not saying there's anything bad or wrong with Quest, just each place has some variances in equipment, calibrations, etc.

IMO, your free test is in a good place. I think for TRT purposes, most men can sustain a pretty good program in the 15pg/ml to 20pg/ml area (again, based on Labcorp standards). As you can see in your case it doesn't take a lot of total serum to achieve this. I also have a very low SHBG level. Sometimes this can be an indicator of other issues like hypothyroidism or a metabolic conditon. Just cover the bases with your doctor to make sure there are no underlying issues being overlooked.

Lastly, DHEA is upstream, so testosterone treatment won't replenish this hormone. Many men with hypogonadism are also struggling with other hormonal deficiencies like DHEA, Pregnenolone, D3, and thyroid as noted earlier. IMO, a successful TRT protocol includes hormonal support top to bottom, where it's needed. If the adrenals are tanked and the thyroid is shot, achieving wellness is going to be a difficult task on testosterone alone.

Thanks for your reply Chris.
I also did the following tests through Labcorp
DHEA-Sulfate: 51 [102.6-416.3]
Cortisol AM: 8.8 [6.2-19.4]
Cortisol PM: 6.1 [2.3-11.9]

I also started taking Metformin a month after this blood test.
How are my Cortisol levels looking?
DHEA looks low. What kind of effect will I experience after supplementing with DHEA? How will I feel?

 

[Vettester Chris]

Mike, your adrenals look like they're pretty exhausted. If possible, I'd rather really see a full circadian profile on the cortisol with a 24 hour saliva test, which will also include a DHEA saliva test. Morning cortisol should be right at the top end of the range, then it should slowly progress to the lower end of the reference range(s) by the end of the day.

Talk with your physician about those labs, plus look at the different treatment options with DHEA, pregnenolone, and "if" needed some form of HC therapy or adrenal cortex supplement. If your morning cortisol is in the lower quartile with the 24 hour saliva test, I can almost assure you that your thyroid will also be facing some challenges, specifically with the distribution of T3 into the body and promotion of ATP. A full thyroid panel that includes Reverse T3 will tell you how that side looks.

The biggest obstacle you might have is making sure you have a physician in your camp that knows what to look for with this, or that will even acknowledge this. If your doctor simply dismisses your cortisol because "it's within range", you need to reach out another direction.

 

[Mike007]

Mike, your adrenals look like they're pretty exhausted. If possible, I'd rather really see a full circadian profile on the cortisol with a 24 hour saliva test, which will also include a DHEA saliva test. Morning cortisol should be right at the top end of the range, then it should slowly progress to the lower end of the reference range(s) by the end of the day.

Talk with your physician about those labs, plus look at the different treatment options with DHEA, pregnenolone, and "if" needed some form of HC therapy or adrenal cortex supplement. If your morning cortisol is in the lower quartile with the 24 hour saliva test, I can almost assure you that your thyroid will also be facing some challenges, specifically with the distribution of T3 into the body and promotion of ATP. A full thyroid panel that includes Reverse T3 will tell you how that side looks.

The biggest obstacle you might have is making sure you have a physician in your camp that knows what to look for with this, or that will even acknowledge this. If your doctor simply dismisses your cortisol because "it's within range", you need to reach out another direction.

Chris, thanks again.
I have heard that Testosterone therapy reduces cortisol. Is this true?
I also heard that taking prescription prednisone causes weight gain?
How would DHEA help?
What would be the signs for low cortisol?
How could you raise cortisol naturally without taking OTC supplements made from Bovine?
How have you managed to keep your cortisol in good range?

 

[tmckenzie]

I dont want to get this thread off topic, but I have levels like yours. I am curious about your sex drive. Mine is awful. I have read elsewhere that low sgbh will cause this. And take it from me, get that cortisol checked, I have empty sella and they did an atch stim test and confirmed I have secondary adrenal insufficiency. Replacing cortisol and thyroid and dhea has helped the way I feel and function tremendously, but no sex drive at all.

 

[Mike007]

My sex drive is great. I have no problem. Sex drive will go down if your estrogen is too low.

Last week, my AM cortisol level was 12. Range is [3-22] mcg/dL

My primary care doctor wouldn't prescribe cortisol. He says that it is within acceptable range. He said he can let me see an endocrinologist if I like.

TSH was 1.95. [0.4 - 4.50] mlU/L

What kind of doctor are you seeing that will prescribe all of that?

 

[tmckenzie]

You need more in depth testing to rule out cortisol issues. But that sounds like a good number. My estradiol at last check was good. I have and endocrinologist handling everything except the testosterone, he will not do it, even though he says I need it based on no pituitary and my low numbers? Defy does my trt. I have not had sex drive in several years? Been through a pile of drs for trt and none of them so far can figure it out. Being diabetic may be it, meds for fibromyalgia and rickets may be it. Kidney disease as well. So many factors. I hit 35 and fell apart.