Single Digit SHBG - Poor Results on EOD Protocol

[Gabriel08]

Hey Guys! long time lurker first time poster. You guys are an amazing resource and I have learned so much from the forums.
I was hoping to get some insight into my numbers here as they are a little outside the norm I believe.
First off been on TRT since Sept of last year, initial TT was 161, follow up was 184. Unfortunately did not get E2 or SHBG at that time. was initially prescribed 100mg per week by my GP moving eventually to 150 per week. My SHBG at this time was a 12 so I decided to do .10 mg ED subQ, which brought my TT to 609, FT to 17.6 , SHGB @ 10 but E2 was @63.1!
My GP was not interested in prescribing an AI so I made the switch to DEFY about three months ago,
had my consultation with DR. Calkins and we settled on .25 EOD with .125 Anastrozole on injection days. So an average of 175mg per week.
Got my first set of labs back today and it has my TT@ 434, FT@ 17.3 E2@ 18.3 and SHBG@ 7.7
Now one would think with an SHBG of 7.7 my FT would be off the charts however this has never been the case and seems to track midrange with my TT. The Anastrozole has been great and puts E2 where I would expect with TT@ 434.
I haven't scheduled my next consultation yet but seems to me the next step would be to move to 200mg per week ED injections and hope that gets it moved on up some while keeping AI the same for now.
What do you guys think? Any similar Super low SHBG and low responders out there? Does moving to ED injections at a 200mg vs EOD at 175mg seem reasonable? And finally anyone have to go above 200mg to get TT toward the higher end of the range?

Thanks a lot guys!
P.S all ranges are standard Labcorp ranges I'm sure your all familiar with.

 

[CoastWatcher]

Welcome to Excelmale. Of course, you should do nothing prior to your Defy consultation. That discussion will be based on how you feel, the lab results you have shared with us, and your current protocol. Any changes you make prior,to the appoint,met with Defy will be like walking in the dark. Patience until you and Dr. Calkins confer.

i inject daily due to low SHBG - but not as low as you've posted. Obviously, a change is coming, but how do you feel? Unusual lab numbers, but what are you responding?

 

[Gabriel08]

Thanks for the reply Coastwatcher! I certainly value your opinion as I've been paying attention to your posts for some time now.
I certainly don't plan on making any changes to my protocol prior to my next consultation with Defy, they have been extremely helpful and give me the confidence that comes along with having a knowledgeable team on your side.
As with many low Shbg guys I really don't feel a huge difference on TRT. Yes there is a difference coming from very low levels but no pie in the sky stuff some guys talk about.
I workout four times a week and am an intermediate to advanced lifter so performance is very important to me and I notice the greatest changes from TRT in my progress in the gym which makes me happy.

 

[CoastWatcher]

Thanks for the reply Coastwatcher! I certainly value your opinion as I've been paying attention to your posts for some time now.
I certainly don't plan on making any changes to my protocol prior to my next consultation with Defy, they have been extremely helpful and give me the confidence that comes along with having a knowledgeable team on your side.
As with many low Shbg guys I really don't feel a huge difference on TRT. Yes there is a difference coming from very low levels but no pie in the sky stuff some guys talk about.
I workout four times a week and am an intermediate to advanced lifter so performance is very important to me and I notice the greatest changes from TRT in my progress in the gym which makes me happy.

You may have the record for lowest, noted SHBG here at EM. Not an honour you went looking for, I'm sure.

 

[ERO]

I have very low SHBG as well, although in my case I don't seem to eliminate Testosterone from my system super quickly as is the norm with low SHBG guys. In your case I would definitely ask Defy to try daily injections (use insulin syringes, they are pretty much painless) and also try a daily dab of Test Gel on your scrotum. Increased DHT may help you feel something from TRT. In my case it gave me some libido for 3 weeks when I had not had any for years. Since then the libido has been hit and miss, but that is better than flat lined at zero as it had been before.

 

[Vince Carter]

yes it appears that you're going to need to move on from EOD, I moved off EOD about a year ago for daily's and its been much better, I was using 28mg/D Cypionate. This is pretty typical for us daily if not EOD.

Defy will work with a dosing change outside of a regular consult if you just ask them for some guidance, has worked for me.

 

[Gabriel08]

Yeah I imagine Defy will recommend something around that dosage, still stumped why my free T is not higher, any one have any ideas on that one? Thanks for the heads up on Defy working outside of scheduled consults if a change is warranted. Do you just call them and request a lab order say around the 45 day mark or so?

I would like to get toward top of range as long as all health markers stay in line but now doubting if even 200mg per week would do it and doubt anyone would prescribe it. Anyway shouldn't get out ahead of myself here, just have to wait and see what my next change brings!

Thanks for the help!

 

[Vince Carter]

Ive got my nurses email and I request labs, at-will, and even discuss small matters with her like a dose change.

Yes I would say a key marker for low SHBG is very high FT but then you're not pulling much a of a TT, 609 is pretty lame for a TT. How long, how many hours post injection was your blood drawn?

 

[Re-Ride]

[ If the SHBG is low, a man's total testosterone level may look abnormally low even though his bioavailable testosterone level is well within the norm. ]

... Dr. Pallis. http://www.health.harvard.edu/mens-health/testing-your-testosterone-its-tricky

Let your treating physician Dr. Calkins interpret your numbers. The serum goal theory works for many folks around here but not all. There are those who dispute the validity of immuno assays and even LC/MS. When it comes to estimating free T whether calculated or "direct" good luck on that.

 

[Gabriel08]

Thanks Guys,

My original post may not have been clear but my last labs were TT 434 so quite low for a protocol of .25 EOD an average of 175mg per week. Blood draw was morning of injection but before my injection for a true trough reading.

I appreciate all the replies, my numbers are definitely strange making therapy a little trickier, however was able to get a consult for this Saturday so very pleased with that! We'll make a few changes I'm sure and I will report back on how it's going.