Paradox TRT results, very low SHBG

[mairomaster]

I started TRT 4 weeks ago. I spent a few months doing a solid research to educate myself before starting. I went so several doctors and quickly realised that there is not a single doctor in my country who is even remotely familiar with TRT. So my only option was to self-medicate.

My symptoms were bad recovery after workouts, joint pain, low mood, lack of energy, lack of motivation, low libido. I've been having those for years. I ran many different blood tests in the span of several months. This is the last set of blood work, which I ran just before starting TRT (I did an extensive list of tests, I'm posting only the most relevant ones here not to get you bored):

Total T: 216 ng/dL (250 - 870)
Free T (lab calculated): 6.4 ng/dL (9 - 30) 2.96%
Estradiol: 22 pg/mL (11 - 44) No idea what type of test they use for E2
LH: 2.9 mIU/mL (0.57 - 12.1)
FSH: 3.1 mIU/mL (0.95 - 12)
SHBG: 12.8 nmol/L (13.5 - 71.4)
Prolactin: 19.7 ng/mL (3.5 - 20)

All the other tests I did were within range, those being:

Progesteron, TSH, FT3, FT4, Cortisol, DHEA-S
Vitamin D, B12, Folic Acid, Calcium, Magnesium, Phosphorus, Potassium, Sodium, Iron, TIBC, Ferritin, BUN
CBC, Blood sugar, HbA1c, Insulin, Cholesterol panel, Creatinine, eGFR, Liver panel
PSA, Homocysteine, CRP

The protocol I choose to start with was Test C 120 mg a week split in 3 (M, W, F) + hCG 1200 IU a week split in 3 (together with the testosterone). I decided to go on the safer side and start with this more conservative dose. I need hCG for fertility reasons. I choose 3 times a week as a good compromise between convenience and steady levels. I am doing subQ in the belly fat.

After 4 weeks I didn't feel any improvement really, nor side effects. I know it's kind of a short time, but I expected to at least feel something. I ran another set of blood work on Friday morning, before my Friday injection (exactly 48 hours after my last injection on Wednesday). Those were the results:

Total T: 245 ng/dL (250 - 870)
Free T (lab calculated): 7.3 ng/dL (9 - 30) 2.97%
Estradiol: 30 pg/mL (11 - 44) No idea what type of test they use for E2
LH: 0.6 mIU/mL (0.57 - 12.1)
FSH: 1.2 mIU/mL (0.95 - 12)
SHBG: 12.4 nmol/L (13.5 - 71.4)
Prolactin: 21.6 ng/mL (3.5 - 20)

What is shocking to me is that my levels barely moved - both Total T and Free T. On 120 mg a week I expected much bigger difference, especially with the Free T considering my low SHBG. Estradiol moved up considerably, but that might be mostly because of the hCG I guess.

Judging by my research and using different online steroid plotters, 4 weeks should be enough time with Test C to see significant blood level change. So I don't think situation will change too much even if I wait for another 4 weeks or whatever. Also I don't think ED protocol would have made that much of a difference to be honest.

My aim is to obviously improve my symptoms considerably. Also it will be nice to get my levels towards the upper normal range for health benefits / workout gains. My current plan is to try a significantly bigger does per week to see how much will that improve things. I am thinking of something in the order of 200 - 300 mg per week. I am slightly afraid not to run into bad side effects though. Currently I am in a pretty good health in terms of blood pressure, cholesterol levels, hematocrit levels, no signs of balding, etc. So I think I have some margin with this. I also plan to reduce my hCG to 900 IU per week to help a bit with Estradiol control.

Any advice will be appreciated! Thank you!

 

[Vince]

My two cents. Looks like the only change is in your LH and FSH. Makes me wonder if the testosterone you're injecting is real.

 

[Cataceous]

How confident are you in the testosterone cypionate? Your results would be more consistent with taking only the hCG.

Some guys do have problems with prolactin higher in range. It may or may not be high enough to suppress testosterone, but it can affect libido and sexual function.

 

[mairomaster]

Thanks for the replies guys.

@Vince I thought my testosterone should be legit, since it seems to be suppressing LH/FSH production, but I guess those can be suppressed by the hCG as well. Also they might also be suppressed if the testosterone content is lower than is written on the bottle.

I am using Beijing Pharmaceuticals Testosterone Cypionate 250mg/ml

I couldn't find many opinions about it on the web, but the website looks kinda legit and they also have code verification feature where you can enter the code from your vial and it says if the vial is genuine. Obviously that is not a 100% guarantee that it's a legit product.

@Cataceous From what I've read it doesn't really seem to me that my prolactin is high enough to cause major issues, certainly not that low level of testosterone. Also I don't have any problems with ED/sexual function, just lowish libido.

 

[Cataceous]

Normal males produce 3-9 mg of testosterone per day. You're nominally taking an average of 12 mg per day in addition to the hCG. Of course if your testosterone product is ok you still wouldn't be alone in reporting low serum testosterone relative to dose. But the potential reasons for these cases are not known. Maybe a very fast underlying metabolic clearance rate, but this is speculation. Low SHBG itself does suppress total testosterone to a degree, but not to the extent you're reporting.

 

[Wolverine]

Thanks for the replies guys.

@Vince I thought my testosterone should be legit, since it seems to be suppressing LH/FSH production, but I guess those can be suppressed by the hCG as well. Also they might also be suppressed if the testosterone content is lower than is written on the bottle.

I am using Beijing Pharmaceuticals Testosterone Cypionate 250mg/ml

Beijing Pharmaceuticals :: Testosterone Cypionate 250

beijingpharmaceuticals.com

I couldn't find many opinions about it on the web, but the website looks kinda legit and they also have code verification feature where you can enter the code from your vial and it says if the vial is genuine. Obviously that is not a 100% guarantee that it's a legit product.

@Cataceous From what I've read it doesn't really seem to me that my prolactin is high enough to cause major issues, certainly not that low level of testosterone. Also I don't have any problems with ED/sexual function, just lowish libido.

Did you get that from a US pharmacy? I've never heard of that. If not, get legit T cyp from a US pharmacy.

 

[mairomaster]

I can't get Test C from a US pharmacy because:

1. I live in Europe.
2. I don't have e prescription.
3. In Europe they don't really prescribe Test C/E normally, at least not in my country. Also Test C/E is not available in pharmacies around here, especially in vials.

About the prescription part, my endocrinologist suggested to prescribe me Sustanon (Omnadren in EU) 250 mg once every 3 weeks and I wished her a good day. The situation was even worse with other endocrinologists/urologists I went to.

 

[fifty]

Your stuff is fake.

 

[fifty]

I would rather take your endo’s sustanon prescription and inject 80mg per week instead of using your Chinese testosterone.

 

[madman]

Did you get that from a US pharmacy? I've never heard of that. If not, get legit T cyp from a US pharmacy.

He stated..... I went so several doctors and quickly realised that there is not a single doctor in my country who is even remotely familiar with TRT. So my only option was to self-medicate.

Than goes on to say.....After 4 weeks I didn't feel any improvement really, nor side effects.

He is using UGL gear and judging by his lab work it is most likely bunk!

 

[Vince]

Thanks for the replies guys.

@Vince I thought my testosterone should be legit, since it seems to be suppressing LH/FSH production, but I guess those can be suppressed by the hCG as well. Also they might also be suppressed if the testosterone content is lower than is written on the bottle.

I am using Beijing Pharmaceuticals Testosterone Cypionate 250mg/ml

Beijing Pharmaceuticals :: Testosterone Cypionate 250

beijingpharmaceuticals.com

I couldn't find many opinions about it on the web, but the website looks kinda legit and they also have code verification feature where you can enter the code from your vial and it says if the vial is genuine. Obviously that is not a 100% guarantee that it's a legit product.

@Cataceous From what I've read it doesn't really seem to me that my prolactin is high enough to cause major issues, certainly not that low level of testosterone. Also I don't have any problems with ED/sexual function, just lowish libido.

I wonder if you injected 500 IU of HCG every other day and then do labs. If the HCG is good maybe it will bring you in a good level of testosterone and increase your LH production?

2 questions about hcg mono

firstly, I know that sometimes hypogonadism has the same symptoms as thyroid and adrenals. My question is, if one takes hcg, and gets their levels to optimal, but still has no symptom improvement does that mean that 1-low t isnt their problem or 2-trt is the only way to relieve symptoms my...

www.excelmale.com

 

[Vince]

I believe Dr Ramasamy recommends 2000 IU of HCG once a week and if needed 2000 IU of HCG twice a week. For HCG mono.

 

[Cataceous]

...
1. I live in Europe.
2. I don't have e prescription.
3. In Europe they don't really prescribe Test C/E normally, at least not in my country. Also Test C/E is not available in pharmacies around here, especially in vials.
...

You might want to try a brand that's been independently tested by this site. I have heard of good results with the Pharmacom Labs brand, but get it from a reliable source, e.g. the manufacturer's website.

 

[mairomaster]

@Vince I've done a lot of research about hCG mono therapy and made the conclusion that in the general case it seems to be less effective than a standard TRT with arguably more side effects due to the super high dose of hCG required. I'm also not very sure how sustainable it is long term. As I said, currently I am using 1200 IU per week and it pretty much didn't do anything for my levels. I would imagine that I would indeed need a few thousand units per week if I want to achieve something on hCG only, and that of course assumes that I have secondary hypogonadism which is not guaranteed as well.

@Cataceous Thanks for the suggestion. I found this website myself actually earlier today and that is indeed my current plan at the moment.

 

[benaoao]

You must get SHBG back up. Your free T / total T ratio isn’t off so I’m positive that you’ll have everything going back up with SHBG.

it seems to me that Clomid is your best bet. Clomid shoots SHBG back up while having an anti estrogenic effect. This will drop prolactin, increase total and free levels of androgens because of the absence of negative feedbacks from excess free E2 (and free DHT, I bet). You will also have more LH&FSH obviously which you will benefit from in terms of fertility.

If you’re going to buy underground use reputable forums such as mesoRX instead of potential scams. You can easily find pharmaceutical test, Clomid and HCG on there. I would give Clomid a 1-2 months trial.

 

[Systemlord]

I started TRT 4 weeks ago.

Judging by my research and using different online steroid plotters, 4 weeks should be enough time with Test C to see significant blood level change.

Getting your levels elevated is one thing, your body responding to hormones is another, testosterone is not fast acting like drugs, it takes time to repair tissue and actually start feeling good.

Additional health problems may add time to until you start feeling good again. You do need a dosage increase though and probably haven't gotten your levels high enough to make a difference.

All the other tests I did were within range, those being:

Progesteron, TSH, FT3, FT4, Cortisol, DHEA-S

It's a mistake to think because TSH and thyroid hormones in range that there isn't a problem, seen countless examples over the years where there are thyroid problems with normal levels. There is thyroid disease with normal TSH and mid-high free thyroid hormones, in the early stages of thyroid disease TSH can be in range, but mid-high and Free T3 will climb to the high normal range.

 

[mairomaster]

@benaoao Do you have a source for this? I've haven't really seen anything about Clomid rising SHBG significantly. I don't think my T is low because of E2 negative feedback. My E2 was really low as well - as low as 15 pg/mL before starting the therapy. Also a good dose of HCG which is quite good at mimicking LH didn't do anything to raise my T, so I am not really sure if Clomid will lead to a significant change either. I am not happy to boost it from 200 to 400, I am more looking into 900 - 1000 range to have good athletic benefit as well apart from symptoms resolution. On top of that, I don't think Clomid is suitable for long term therapy due to declining efficiency over time and more importantly side effects. And as we know, a short term Clomid therapy doesn't cure hypogonadism.

 

[Vince]

@benaoao Do you have a source for this? I've haven't really seen anything about Clomid rising SHBG significantly. I don't think my T is low because of E2 negative feedback. My E2 was really low as well - as low as 15 pg/mL before starting the therapy. Also a good dose of HCG which is quite good at mimicking LH didn't do anything to raise my T, so I am not really sure if Clomid will lead to a significant change either. I am not happy to boost it from 200 to 400, I am more looking into 900 - 1000 range to have good athletic benefit as well apart from symptoms resolution. On top of that, I don't think Clomid is suitable for long term therapy due to declining efficiency over time and more importantly side effects. And as we know, a short term Clomid therapy doesn't cure hypogonadism.

A common thing to happen is for Clomid user's SHBG to rise while on Clomid.

Clomid while on TRT/HCG

This is not something that I am contemplating, but I am just interested in the mechanism. It is known that Clomid is ineffective while on TRT. Is this because the TRT shuts down the LH production in the pituitary? A common thing to happen is for Clomid user's SHBG to rise while on Clomid...

www.excelmale.com

The effect of clomiphene citrate (CG) on sex hormone binding globulin (SHBG) was studied in 10 oligozoospermic patients with varicocele and 6 normospermic men. ... The findings of this study indicated the CC causes an increase of SHBG concentration, which is probably related to the rise of E2 concentration.

National Center for Biotechnology Information › pub...
The effect of clomiphene citrate on sex hormone binding globulin in normospermic and ... - NCBI

 

[Nelson Vergel]

This clinic treats men in Bulgaria

Testosterone Replacement Therapy (TRT) Experts in the UK - Balance My Hormones

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[benaoao]

@benaoao Do you have a source for this? I've haven't really seen anything about Clomid rising SHBG significantly. I don't think my T is low because of E2 negative feedback. My E2 was really low as well - as low as 15 pg/mL before starting the therapy. Also a good dose of HCG which is quite good at mimicking LH didn't do anything to raise my T, so I am not really sure if Clomid will lead to a significant change either. I am not happy to boost it from 200 to 400, I am more looking into 900 - 1000 range to have good athletic benefit as well apart from symptoms resolution. On top of that, I don't think Clomid is suitable for long term therapy due to declining efficiency over time and more importantly side effects. And as we know, a short term Clomid therapy doesn't cure hypogonadism.

like I said, your SHBG must be brought back up. TRT and HCG fail to address this problem and will cause exaggerated metabolism of testosterone into its (excessively) androgenic metabolite DHT and estrogenic metabolite E2.

losing 10-15% bodyweight was also shown in androxal’s documents to dramatically increase SHBG. I guess this won’t apply if you’re already under 15% fat.