Very high T and SHBG

[RyanW]

Was on Sertraline at the time these labs but have since gone off successfully so far.
My primary complaint is fatigue, exhaustion and lack of desire to do anything including fun including sex.

I am not taking any supplements and eat a healthy diet, overall very healthy.

Testosterone: 1995 ng/dL (0.320-1100)
Free Testosterone: 133.7 (35.0-155.0)
SHBG: 146 nmol/L (10-50)
Prolactin: 17.4 ng/ml (Not listed)
THS: 3.871 ilU.L (0.320-5.550)
Estradoil: 50pg/ml (Not listed) BUT flagged as “High”
DHEA: 217 us.dL (Not listed)
FSH: 7.4miU/ml (Not listed)
LH: 8.3mIU/ml (Not listed)
T3F 2.79 (2.3-4.2)
T4F 1.40 (.50 -2.50)
T3, reverse 22 (8 - 25)

Liver, Kidney and CBC normal
Testicular ultrasound negative, BetaHtcgtm negative,

HERE IS MY ENDOCRINOLOGIST'S FINDINGS She had nothing to say about my thyroid or sertaline being a problem
As we reviewed today:
->your total testosterone is elevated but this is because SHBG (sex hormone binding globulin) the carrier protein for testosterone is elevated (in fact the free testosterone is normal)
_ _
->other hormone testing is also normal with the exception of estradiol being slightly elevated = which is likely the culprit for the elevated SHBG testing
_ _
->in terms of the etiology for the slightly elevated estradiol=your testicular ultrasound and HCG testing is normal so this is not coming from the testicles per se. I recommend a CT scan of the adrenal glands to verify that there is no abnormality in the adrenal glands (which is another source of estradiol precursors so can potentially cause elevated estradiol). In the end if all the additional testing is normal, then by diagnosis of exclusion the elevated estradiol is coming from increased extraglandular aromatase activity. That said, for a few years I will recommend your primary care doctor continue to assess your hormone levels periodically
_ _
->unfortunately this doesn't explain why you are felling unwell which is why you sought medical attention in the first place, I recommend some 8-9 am fasting blood work (additional testing to rule out contributing factors that could be implicated in your fatigue symptoms)
_ _
->I recommend you have a sleep study to rule out potential sleep apnea,
She ordered cortisol, Kidney function B12 and Vit D also ordered a CT of my adrenals and brainstem.

 

[Vince Carter]

I think that if those numbers, which by all accounts are pretty outrageous as far as the TT and SHBG, are not supported or validated with prior testing or is this the first time you've gotten a lab test?

 

[Vince]

What trt protocol are you on? I also would investigate your thyroid panel, looks like there should be some improvement there. I'll let more experience thyriod members comment on your thyroid panel.

 

[RyanW]

I think that if those numbers, which by all accounts are pretty outrageous as far as the TT and SHBG, are not supported or validated with prior testing or is this the first time you've gotten a lab test?

I know my T was >1500 the first time they tested it, but haven't tested SHBG more than once.

 

[RyanW]

What trt protocol are you on? I also would investigate your thyroid panel, looks like there should be some improvement there. I'll let more experience thyriod members comment on your thyroid panel.

I'm not taking any trt at all.

 

[Systemlord]

Most experienced doctors would first notice SHBG to explain why testosterone is so high, your pituitary gland is cranking out LH to get testosterone high enough to free up some free T which is in vein as it will never be able to compete with that SHBG level. Your free T makes no sense, it should be abysmal (0.885 %).

This is the sort of thing is seen in those who take finasteride which are some of the worst case of PFS, you previously stated you only were on Zoloft and had stopped. It's troubling that your doctor isn't connecting the dots, SSRIs are known to raise SHBG and lower testosterone, in your case it may only be affecting SHBG.

Closely monitor SHBG in about 40 days and see if it starts to drop.

http://blog.zrtlab.com/shbg-modulator-01

 

[RyanW]

Most experienced doctors would first notice SHBG to explain why testosterone is so high, your pituitary gland is cranking out LH to get testosterone high enough to free up some free T which is in vein as it will never be able to compete with that SHBG level. Your free T makes no sense, it should be abysmal (0.885 %).

This is the sort of thing is seen in those who take finasteride which are some of the worst case of PFS, you previously stated you only were on Zoloft and had stopped. It's troubling that your doctor isn't connecting the dots, SSRIs are known to raise SHBG and lower testosterone, in your case it may only be affecting SHBG.

Closely monitor SHBG in about 40 days and see if it starts to drop.

http://blog.zrtlab.com/shbg-modulator-01

Both my primary and endocrinologist are quite adamant zoloft has nothing to do with it, they are going to re-order the T and SBGH in a few months, which by then maybe I'll see a drop?

My energy also sucks, so I suspect my thyroid is bad but since it doesn't flag in yellow they don't even look at the number.