Posting for a friend considering treatment - high SHBG and all the symptoms

jessie02 · May 15, 2019

So a good friend of mine just had his labs done. He is experiencing all the classic symptoms, low libido, no morning erections at all, no energy, etc. His SHBG and Total T are through the roof so seems to be an issue with his high SHBG and no free T? Overall he's in good shape, good diet. How can he get his SHBG number's down? His doc is going to still treat him based on symptoms, but will an Rx for Testosterone just continue to elevate his SHBG? Here are the numbers:

Total T: 945 ng/dl (300-890)
SHBG:71 nmol/L (11-80) *some
Free T: 121 pg/ml (47-244)
T %free:1.3% (1.6-2.9)
Estradiol: 24

fifty · May 15, 2019

Rx for testosterone won’t help. T is on top of the upper range. Free T number is wrong. Why would he want to pay a grand to shut off his balls to have 30% more test?

Test or proviron or danazol will lower shbg...and shut him down.

Stop taking caffeine and sleep.

madman · May 16, 2019

jessie02 said:
So a good friend of mine just had his labs done. He is experiencing all the classic symptoms, low libido, no morning erections at all, no energy, etc. His SHBG and Total T are through the roof so seems to be an issue with his high SHBG and no free T? Overall he's in good shape, good diet. How can he get his SHBG number's down? His doc is going to still treat him based on symptoms, but will an Rx for Testosterone just continue to elevate his SHBG? Here are the numbers:

Total T: 945 ng/dl (300-890)
SHBG:71 nmol/L (11-80) *some
Free T: 121 pg/ml (47-244)
T %free:1.3% (1.6-2.9)
Estradiol: 24

Unfortunately regarding testing ones FT (free testosterone) most are using the direct analog-based free testosterone immunoassays which are inaccurate.

If anything you should be getting the equilibrium dialysis or better yet save yourself the money and use the Calculate free testosterone with TruT by FPT - Try the public free testosterone calculator at tru-t.org

Do you truly know your FT levels?

500726: Testosterone, Free, Mass Spectrometry... | LabCorp

Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences)

TEST: 500726
Test number copied

CPT: 84402; 84403

Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline (2018)

Testosterone Therapy in Men With Hypogonadism: An Endocrine Society * Clinical Practice Guideline

In men who have conditions that alter sex hormone–binding globulin (SHBG) (Table 2), or whose initial total testosterone concentrations are at or near the lower limit of the normal range (Fig. 1), clinicians should determine free testosterone concentrations either directly from equilibrium dialysis assays or by calculations that use total testosterone, SHBG, and albumin concentrations. Clinicians should not use direct analog-based free testosterone immunoassays, as they are inaccurate.

Ones SHBG levels definitely has a big impact on ones FT levels but it comes down to his overall TT level as although his SHBG is high (definitely not through the roof) most would think that his FT level would be low..... but because his TT level is so high 945 ng/dL than his FT would be close to the top of the reference range when using the TruT by FPT calculated Free Testosterone Try the public free testosterone calculator at tru-t.org

If we take his TT 945 ng/dL, SHBG 70 nmol/L and Albumin 4.3 g/dL (default) than his FT would be 29.12 ng/dL (near the top end of the reference range of 16-31 ng/dL)

If his TT levels were 600 ng/dL or less than you can clearly see that his FT level would be at the bottom of the reference range or low (examples below)

As you can see if his TT were 600 ng/dL, SHBG 70 nmol/L and Albumin 4.3 g/dL (default) than his FT would be 16.47 ng/dL (at the bottom of the reference range of 16-31 ng/dL)

As you can see if his TT were 500 ng/dL, SHBG 70 nmol/L and Albumin 4.3 g/dL (default) than his FT would be LOW 12.97 ng/dL (below the bottom of the reference range of 16-31 ng/dL)

Although you stated that he is experiencing symptoms which may be low-t related I would look into having thyroid tested (full panel) and adrenals as thyroid dysfunction can mimic low-t symptoms.