New member - 3 months of TRT and still feeling awful - LOW SHBG - Please help!

[teehee]

Hello! I am a new member of the forum. I recently discovered the website after seeing an interview with Nelson.

I am in my late 20s and got put on TRT due to secondary hypogonadism after a failed trial of clomid.

I have been on TRT once before. Last time, the first injections were great, but the doctor did not manage me properly and did MONTHLY injections. Eventually, the protocol broke down and stopped working when even after a brand new injection, I would actually get worse symptoms despite tight control of E2. Idk why this happened, maybe the large gaps in injections messed me up.

My current protocol is 20 mg Test cyp subq daily
250 IU HCG x3 week

My doctor put me on daily injections because of very low SHBG - 12.
Other labs: Total T about 312, Free T 15.

During the first month, we tried doing the cream, which got my level up to 450 and free T up to 26 (top of range), but I did not really feel better, despite the high Free T. My estrogen was well controlled (17) and I had no E2 sides. He switched me to injections because he was not happy with my numbers.

I am currently trying my best to lower SHBG by exercising and adding berberine as I have heard many people on low SHBG struggle to feel better on TRT. I will take new labs soon, but clinically still feel bad.

Is there anything else I can do to try to get dialed into this treatment ?
Do you think it is my low SHBG that is preventing me from feeling better on treatment? I wonder if the first trial of TRT with large, spread out doses, lowered my SHBG and made TRT not work for me at all.

Thanks for reading, any advice is greatly appreciated.

 

[SilverSurfer]

You gave us a lot of information, but the critical things you forgot were; symptoms and what you mean by “don’t feel good”. If you can list your symptoms (ie...no morning wood, flat libido, no energy, etc...) and how exactly you’re feeling, and what other medications, drugs, alcohol usage, you are taking.

 

[Gman86]

140mg/ week might be too much for you. If I were you, I would stick to ED injections, lower dose down to 80mg/ week, drop HCG, drop the ai, and then just wait 4-6 weeks and see how you feel. You don’t even need to get labs done. Just use the start low and go slow method. If you don’t feel good on 80mg/ week, I would bump it up to 100mg, and do that for 4-6 weeks. And just continue this cycle until you feel symptoms resolve.

I only say to drop dose down to 80mg/ week because you had a free T at the top of the range while having a total T of 450. So clearly you don’t need a lot of T to get a healthy free T level.

But I would keep things simple when starting out. You’re most likely on way too high of a dose, for your body, imo, and the HCG and ai is most likely preventing you from feeling the benefits of TRT, again imo. You can always add HCG in later, but starting out, I would definitely see how you feel on testosterone alone first. I’m 33 now, and also started out in my late 20’s. 27 to be exact. The advice I just gave you is exactly the advice I would of gave myself if I was in your position, after learning everything I have over the past 6 years on HRT.

 

[Systemlord]

I also have low SHBG, 14 pre-TRT and 22 while on TRT and only do well on daily protocols. I didn't do well on SQ injections either, IM is way better for me.

The HCG increases estrogen and can cause mood and libido problems in some men and take away benefits of TRT. It is for this reason I always recommend starting TRT in isolation because otherwise you are lost wondering why you feel no better and the culprit may be the HCG.

If you had started TRT in isolation and added the HCG later and felt worse, well then you would know what is causing your problems.

TRT cannot work when there are thyroid problems which would see SHBG low.

Did you have a thyroid panel done checking TSH, Free T4, Free T3, Reverse T3 and antibodies?

 

[teehee]

TRT cannot work when there are thyroid problems which would see SHBG low.
How are you doing daily IM? As in needle gauge, length, injection sites. Sounds like a lot of potential scar tissue.
I've got 5/8 25 GNeedles and 1/2 30 G needles. I guess the 5/8 can be a shallow IM in certain spots.
What is the different you feel on IM? I may be willing to try daily IM if it can actually make me feel better.

Did you have a thyroid panel done checking TSH, Free T4, Free T3, Reverse T3 and antibodies?

Yes. TSH, T4, T3 all in range.

140mg/ week might be too much for you. If I were you, I would stick to ED injections, lower dose down to 80mg/ week, drop HCG, drop the ai, and then just wait 4-6 weeks and see how you feel. You don’t even need to get labs done. Just use the start low and go slow method. If you don’t feel good on 80mg/ week, I would bump it up to 100mg, and do that for 4-6 weeks. And just continue this cycle until you feel symptoms resolve.

I only say to drop dose down to 80mg/ week because you had a free T at the top of the range while having a total T of 450. So clearly you don’t need a lot of T to get a healthy free T level.

But I would keep things simple when starting out. You’re most likely on way too high of a dose, for your body, imo, and the HCG and ai is most likely preventing you from feeling the benefits of TRT, again imo. You can always add HCG in later, but starting out, I would definitely see how you feel on testosterone alone first. I’m 33 now, and also started out in my late 20’s. 27 to be exact. The advice I just gave you is exactly the advice I would of gave myself if I was in your position, after learning everything I have over the past 6 years on HRT.

Thanks for your advice.
I'll consider dropping the HCG and dose. Instead of 20/day I guess it'd be like 12/day. I think my doc put on a a high daily dose because of the low SHBG. He was worried about me hyper excreting and not having enough in the system.

 

[MarcoFL]

Yes. TSH, T4, T3 all in range.



Thanks for your advice.
I'll consider dropping the HCG and dose. Instead of 20/day I guess it'd be like 12/day. I think my doc put on a a high daily dose because of the low SHBG. He was worried about me hyper excreting and not having enough in the system.

what are your actual thyroid numbers?

 

[teehee]

what are your actual thyroid numbers?

 

[SilverSurfer]

Hormones might not be your issue.

 

[Systemlord]

View attachment 7907

There isn't anything that jumps out at me that suggests a problem, 95% of people with normal thyroid function have a TSH <1.5, T4 is about mid-range which is ideal, T3 uptake is good and Free T4 is also good.

In the future you really want to test the active thyroid hormone Free T3 and Reverse T3, these must be balanced for you to function normally. Sometimes we see people with normal TSH and good Free T4 and abnormally low Free T3 an/or high Reverse T3 do to conversion problems.

 

[teehee]

Issues on TRT continue to get worse. My penis has "shrunk". Not permanently, but my flaccid penis has a lot less blood flow than it usually does and feels colder. I'm so lost as to what I could be doing wrong and what is causing this. Freaking out

 

[Systemlord]

Issues on TRT continue to get worse. My penis has "shrunk". Not permanently, but my flaccid penis has a lot less blood flow than it usually does and feels colder. I'm so lost as to what I could be doing wrong and what is causing this. Freaking out

Haven't really known many low SHBG guys to be doing well on TRT+HCG.

 

[Gman86]

Yes. TSH, T4, T3 all in range.



Thanks for your advice.
I'll consider dropping the HCG and dose. Instead of 20/day I guess it'd be like 12/day. I think my doc put on a a high daily dose because of the low SHBG. He was worried about me hyper excreting and not having enough in the system.

That’s definitely a valid thought, and he’s spot on about you hyper excreting. But his solution is all wrong. The solution is not to just give a higher dose. The solution is to increase frequency to ideally daily injections. But EOD injections should hopefully be just fine.

 

[Gman86]

View attachment 7907

Ya even after getting these labs done you still don’t know if you have a thyroid problem or not. Imo, I would say the chances are pretty good that you don’t, but without free T3 and RT3, you still don’t know whether your thyroid is functioning properly or not.

 

[Vince Carter]

Ya even after getting these labs done you still don’t know if you have a thyroid problem or not. Imo, I would say the chances are pretty good that you don’t, but without free T3 and RT3, you still don’t know whether your thyroid is functioning properly or not.

Totally concur with needing FT3 and RT3.

Too, you @teehee, should consider adding a test, "Estradiol, Free", use this along with the Ultra Sensitive LC/MS/MS testing for E2. This is the only test you should be using, not the Roche ECLIA which is a test for females. Estrogen management can be difficult and a challenge, will make of break you; low SHBG

 

[SilverSurfer]

Issues on TRT continue to get worse. My penis has "shrunk". Not permanently, but my flaccid penis has a lot less blood flow than it usually does and feels colder. I'm so lost as to what I could be doing wrong and what is causing this. Freaking out

My penis got larger on TRT both flaccid and erect. If I use a tiny bit too much AI my dick shrinks and gets ED. Stimulants and SSRIs can also do this. Are you taking any other meds, drugs, supplements?

 

[teehee]

I have another question, if someone can please give their thoughts. Not sure if this issue is related to E2 sides or low SHBG or something else:

During my first every start with TRT, the doc gave me a large dose 100-200mg (I can't remember) right in the glute. I felt fantastic fairly quickly. Energy, anxiety, focus, mood, it all changed in that first 1-2 weeks. Sadly, he wasn't great at TRT protocols and spaced out my injection really far. My next one was about 4 weeks later, my T had crashed below baseline because of down-regulation and I felt bad again.

He gave me another injection. This time, within the first few days, I felt only awful. Energy, mood, libido, everything was at an all time low. I felt like he gave me an injection that sucked up all my Testosterone instead of adding to it. There was not up and down trough like the first time, this put me straight into the toilet. I quit TRT because my doctor didn't have any answers and didn't seem to understand how to run a proper protocol with this once in 3-4 week dosing. Sadly, I don't have E2 labs from that time.

Since then, I've struggled to get dialed in like that first injection and just trying to get to the bottom of things. I have a new TRT doctor but he's also lost as to why this works inconsistently for me.

My two theories are E2 sides or due to low SHBG (which I have documented on many labs). Just trying to figure out why that first injection worked so well and that second one, as well as after wards, have struggled to work.

 

[Systemlord]

He gave me another injection. This time, within the first few days, I felt only awful.

Your were shut down by then, usually takes 1-3 weeks to shut down the HPTA.

 

[teehee]

Your were shut down by then, usually takes 1-3 weeks to shut down the HPTA.

Right, but why did the second injection now help and actually make symptoms worse so quickly? Aromatization or low shbg are the only thoughts I have, its just such a fast crash to call it e2 issues alone

 

[Systemlord]

Right, but why did the second injection now help and actually make symptoms worse so quickly? Aromatization or low shbg are the only thoughts I have, its just such a fast crash to call it e2 issues alone

That large injection probably hammered your SHBG low, so by the time of your next injection SHBG was lower and your Free T must have been too high creating more Free T-->E2 conversion. I see if anything an increase in SHBG on TRT, I've seen my SHBG as high as 22 on daily injections, off TRT at the moment and it's never been measured lower.

My SHBG isn't as low as yours (15 at the moment), but low testosterone is causing obesity and insulin resistance which lowers my SHBG, TRT increases it. I have the opposite reaction to a lot of things, was on klonopin and it didn't cause low testosterone until I stop it.

Daily injections was the right call for you.

 

[Vince Carter]

Pondering the why's is kind of just futile though beacuse it's not going to be repeated though@Systemlord does a good job there.