Question about high SHBG and injection frequency.

[Kaliman911]

Hello all and thank you in advance. Little bit of history, I'm a 42yo male, 6'1”, 193lbs and 13% BF. Workout with heavy weights 5 times a week and cardio once per week. I'm on my 6th week of TRT recommended by my doctor for low energy and low libido, poor erections. The doctor found issues with my thyroid too and it is also being managed with Armour thyroid. My current protocol is 100mg of Test Cyp which I split on two doses every 3.5 days Sub Q. So 50mg per injection. I take 1.5 grains of Armour. I supplement with 10,000IU of vitamin D, 3g of fish oil, B12 and Curcumin. Now, my concern is that on my follow up lab results my SHBG level went from 29 to 53 (16.5-55.9 nmol/L), my total Test is at 768 (264-916 ng/dL) but my free T didn't move much from 14.3 to 14.6 (6.8-21.5 pg/mL). I am assuming the higher SHBG levels are binding to more free T than usual. Could the injection frequency have contributed to this? By the way, I am not on any AI nor HCG. My E2 came back at a 13.5 (7.6-42.6 pg/mL), but I think the lab messed up and didn't do the sensitive assay. So don't know for sure how my E2 is. I feel pretty good though.
should I do a single weekly injection of 100mg per week instead?
here is the rest of my lab results:
Total T 768 (264-916 ng/dL)
free T 14.6 (6.8-21.5 pg/mL)
Pregnenolone <10 ng/dL
SHBG 53.6 (16.5-55.9 nmol/L)
Estradiol 13.5 (7.6-42.6 pg/mL) probably not sensitive assay
TSH 1.36 (0.450-4.500 uIU/mL)
fT4 0.82 (0.82-1.77 ng/dL)
fT3 3.4 (2.0-4.4 pg/mL)
rT3 10.8 (9.2-24.1 ng/dL)
Vitamin D 71.2 (30.0-100.0 ng/mL)
Vitamin B12 488 (232-1245 pg/mL)
Prolactin 8.1 (4.0-15.2 ng/mL)
DHEA-S 73 (31-701 ng/dL)

Energy has improved a little and libido also, but not as much as I expected.

Thank you

 

[Vince Carter]

I would stay as you are another month, keep everything the same and then retest and at least verify the SHBG before making a change.

 

[Systemlord]

Once SHBG starts to get above 40 it starts to take over therefore affecting your FT, Also low thyroid function is associated with lower SHBG levels and now that your thyroid is improving SHBG has risen, you may have to play around with your Armour dosing. If your SHBG doesn't decrease on it's own you will need larger weekly injections to bring it down, high SHBG guys need large weekly injections to push it downwards.

Even if your E2 test isn't sensitive it's still too low, are you on an AI?

 

[Milad Zadeh]

I agree with Vince and at the same time you can also make sure it’s the sensitive assay.

 

[Milad Zadeh]

Prior to starting TRT my E2 was at 12.
As soon as I got on TRT And HCG it shot up to 55. I been taking an AI ever since. So perhaps if you start using HCG which you should be anyways it could improve E2 numbers.

 

[Kaliman911]

Right, the Estradiol test done was not the sensitive assay. I will have to re do it to get a better reading of E2. Currently, I am not on an AI, which that's why I was surprised to see a lower E2. Could it be the fact that I am injecting twice a week Sub Q? I have been thinking about HCG, but my doctor didn't want to start me on it. I have a vasectomy so fertility is not an issue. I am slightly concerned about testicular athrophy, but so far so good. No pain either.

 

[Kaliman911]

Thanks, Vince. Should I stay with the same injection frequency also? Or should I try IM once a week? I read a thread here about how that could help reduce SHBG.

 

[Vince Carter]

I want you to stay steady and reverify, I'm leary of making changes based on one test especially when from one test to another like you had there's a dramatic difference. But yes, if your SHBG remains 50 range or more typically what you have to do is run once per week but you have to run a much higher TT in order to get the FT to move even just a little bit, I think TT approaching 1100-1200.

 

[Vince]

I agree with Vince Carter I would increase my testosterone injection amount and really consider starting HCG.

 

[Kaliman911]

I agree with Vince Carter I would increase my testosterone injection amount and really consider starting HCG.

Ok, I'll talk to my doctor about it. Not sure how much she will increase it by. Hopefully she will help me out with the HCG, but I'm sure I'm gonna have to pay for it from my own pocket. I will continue my protocol, but I will see her in two days, so she might change things around. By the way, any advice on my Pregnenolone and DHEA levels? Are they ok?

thanks

 

[Vince]

Ok, I'll talk to my doctor about it. Not sure how much she will increase it by. Hopefully she will help me out with the HCG, but I'm sure I'm gonna have to pay for it from my own pocket. I will continue my protocol, but I will see her in two days, so she might change things around. By the way, any advice on my Pregnenolone and DHEA levels? Are they ok?

thanks

I pay $70 plus shipping for 11,000iu of HCG, your levels of DHEA are low. It may be better to add one thing at a time so you can feel if there's any (positive or negative) results.

 

[Vince Carter]

to DHEA/Preg I would not add variables at this time and I'm not really a believer in using either one of those. The Preg test is not accurate let alone very expensive, most no one runs this test, and DHEA if included needs to be started low @ 5-10mg to gauge tolerance as it can keep you up at night, increase Estrogens, and a few other things. Some guys like it and some it just complicates their therapy.

 

[Kaliman911]

Thank you guys for all the responses. I talked to my doctor today and she will increase my dose to 160mg per week divided in two doses every 3.5 days. No other changes. My E2 is low so will not add an AI. She still thinks I don't need HCG if feeling good and if I have no issues with my testis, which I don't. I have a vasectomy, so not concerned about fertility. She is willing to add HCG if I really need it. Therefore, I will be injecting 80mg every 3.5D and will try shallow IM to shoulders or thighs using a 27ga 5/8” needle. Next lab will be in 6 weeks. I'm thinking also to supplement with stinging nettle root to my regimen to see if it helps with the SHBG and free T. I think this would get me into the 1,000 range and hopefully bring the free T up. We'll see.

 

[OMI100]

FYI
"

Copyright John Crisler, DO 2017 This article may, in its entirety or in part, be reprinted and republished without permission, provided that credit is given to its author, with copyright notice and www.DrJohnCrisler.com clearly displayed as source.

 

[Kaliman911]

Thanks for the link. Great information. I agree that at some point it may be necessary. I will keep an eye on how I feel and the testicular athropy. In this article Dr Chrisler touches on how HCG may not be effective on everyone:
”Of note, the rest (about 80%) of the mass of the testicle consists of the Sertoli cells, whose task it is to produce sperm; in an immediate environment of high Testosterone concentration. This is also why HCG seems to have little benefit with respect to maintaining testicular size in some cases. THAT, and the fact every-body is different&#8230;why hormonal interventions must be individually customized.”

so an individually customized protocol is needed. I really want to minimize how many different things I want to be injecting. It seems my E2 is very well controlled without an AI. I like that. It may increase once I increase my dose, but I don't expect it to be much more. I still don't know how it will go with the need for HCG. We will see.

 

[Vince]

Print this and give it to your doctor.

The Use of HCG to Prevent / Reverse Testicular Shrinkage and Preserve Fertility​

https://www.excelmale.com/forum/sho...e-Testicular-Shrinkage-and-Preserve-Fertility

 

[Kaliman911]

Thanks for the info. I will bring it in for my next appointment.
I have another question, is shallow IM ok to do on thighs? I have 27ga 5/8” needles and injecting a volume of 0.4ml from a 1ml syringe. I have injected twice using shallow IM on shoulders and I like it better than sub Q, but I want to rotate on as many sites as possible. Thanks

 

[Vince]

Thanks for the info. I will bring it in for my next appointment.
I have another question, is shallow IM ok to do on thighs? I have 27ga 5/8” needles and injecting a volume of 0.4ml from a 1ml syringe. I have injected twice using shallow IM on shoulders and I like it better than sub Q, but I want to rotate on as many sites as possible. Thanks

I like rotating from shoulders and VG using shallow IM with a easy touch 29g 1/2" syringe but 27g 1/2" is good.

Best Injection site, no aspiration needed, avoids all nerves​

[SUB][SUP]
[/SUP][/SUB]https://www.excelmale.com/forum/sho...n-site-no-aspiration-needed-avoids-all-nerves[SUB][SUP]

[/SUP][/SUB]​

 

[CoastWatcher]

Thanks for the info. I will bring it in for my next appointment.
I have another question, is shallow IM ok to do on thighs? I have 27ga 5/8” needles and injecting a volume of 0.4ml from a 1ml syringe. I have injected twice using shallow IM on shoulders and I like it better than sub Q, but I want to rotate on as many sites as possible. Thanks

Using your thighs should present no problem.

 

[Vince]

Using your thighs should present no problem.

I know many men inject in the thighs, for whatever reason it does cause me pain after I inject. I believe there are a lot of nerves in the thigh area, so that's one reason why I try to avoid it. I did try it for a short time but was not happy with the results.