why does exogenous T cause my already low SHBG to plummet further?

[Aki]

So as I mentioned in another thread, my endo prescribed sustanon-250 once every two weeks, with review after three shots (labs taken day before third shot). I am aware of the T-level fluctuation related issues with high-dose low-frequency injections (half-lives and all that) but my problem isn't quite that. (And as I mentioned in my other thread, I decided I'd go along with the endo's suggestion to start with to avoid ticking him off straight away.)

For context, I had previously been on a low dose of clomid for a long time, but it's been several months since I stopped taking it.

My first sustanon-250 shot was done around 12 days ago (Thursday, 24th January) so technically (as per endo's advice) the second one is due after two days (although I don't have any intention of getting it as prescribed). Here's why:

I took my first shot on Thursday morning (24 Jan), within a few hours I began to feel uneasy and by late evening on the same day I was feeling positively sick, both psychologically (irritable and depressed) as well as physically (as if I had a fever). This bad feeling persisted for quite a few days, although it lessened after a week had passed. Needless to say, I felt absolutely no benefit at all, only negative effects.

In retrospect, I'm sort of happy I stuck to the doctor's prescribed dosage, because I'm hoping the adverse reaction I had might help uncover some fundamental issue that if tackled properly would lead me to an effective treatment.

I had labs done last Thursday, exactly one week after the shot. Testosterone was 550 ng/dL. (Before taking the shot it was ~190 ng/dL) Estradiol was up to 45 pg/mL from 25 pg/mL, and SHBG is discussed below.


Here's my relationship with SHBG:

• I believe my SHBG value if I stay off all meds is below 20, probably mid- or late-teens.
• A low regular dose of clomid, such as 12.5 mg/day, long-term (along with nothing else) tends to bring my SHBG slowly up to 30. Stopping clomid causes a slow but steady drop of SHBG. Subjectively I feel okay-ish (but not particularly great) on clomid, although my T-levels stay in the ~500-600 ng/dL range.
• For a fairly short while, a very low dose of danazol (50 mg every other day) made me feeling as close to amazing as I'd felt in years; I started it while I'd been taking clomid for over a year, but over time (within about a month and a half), it caused me to crash. During this month and a half, SHBG dropped from the clomid-raised 30 to around 14, and I crashed all of a sudden; all the benefits I'd been feeling went away all of a sudden and I began to feel feverish and fatigued and depressed. (For context, this was a few years ago; I gave up everything for a while and then restarted clomid at 12.5 mg/day which I stuck to for one and a half or so years.)
• Ever since I gave up clomid several months, my SHBG has been falling approximately at the rate of 1.4-2 nmol/L per month, however after I took my sustanon-250 shot it was down to 17.6 nmol/L from 21 nmol/L the previous week; basically SHBG fell 3.4 nmol/L in one week due the sustanon-250 shot.

So is the SHBG going down my main issue? Am I a fast aromatiser of testosterone (and does that have to do with low SHBG, as I think)? And is every kind of testosterone going to cause this issue for me, in which case even a small but frequent dose of testosterone might not do any good?

Is this kind of thing most guys with secondary hypogonadism and low SHBG generally experience or is there something peculiar about my case?

 

[Vince Carter]

Typical response for a large dose of Test which a 250 shot of Sustanon is a lot, will push SHBG down. Clomid typically raises SHBG, and Estrogen.

Why Sustanon and not Cypionate? If you're SHBG is indeed <20 you'll never do well on a 250 shot every two weeks.

 

[Aki]

Typical response for a large dose of Test which a 250 shot of Sustanon is a lot, will push SHBG down. Clomid typically raises SHBG, and Estrogen.

Why Sustanon and not Cypionate? If you're SHBG is indeed <20 you'll never do well on a 250 shot every two weeks.

Thank you for the quick reply, Vince. Right now I need all the help I can get.

My SHBG indeed tends to be that low. In fact, the only time I've recorded my SHBG touching 30 is when I've been on clomid continuously for upto a year (out of the dozen or so times I've had SHBG tested, over the past many years).

To answer your other question, I live in small country in the middle east and I haven't been able to find an endo who doesn't automatically propose sustanon-250 straightaway - it's like a knee-jerk reaction. The endo I settled for at least listens to what I have to say (based on my research and conversations on forums like this) which is a step up.

I don't know if any other form of T is actually available where I live, but I will ask him about cypionate (planning to see him on Thursday).

The good thing is (1) I get to take the sustanon-250 ampules, so I could self-inject, and (2) sustanon 250 is fairly cheap, and (3) I believe I could get enough ampules so I could even inject a fraction of it and throw the rest (although I've read people split the dose).
But I need to know (if there's no alternative to sustanon-250) what is likely to be a good injection schedule for someone like me to try and how I could optimise it? And if I can get cypionate (or some other short half-life ester) what would be a good schedule to try?

Also, my estradiol is rising (probably because I burn through the T quickly?) Does it look like I'd need an AI?
The only other time I ever took testosterone (also sustanon-250, 3 times, once ever 3 weeks, prescribed by the first endo who took my lot-T complain seriously way back in 2012) my estradiol rose to over 60 pg/mL. Back then I didn't even know what SHBG was (and he never ordered labs for it).

Also how about proviron or something like that? As I said, I felt really good on a low dose of danazol (50 mg EOD) until it caused my SHBG to go way down; but lowering SHBG a known side effect (use?) of danazol. Are there alternatives I could ask for? (assuming available)

 

[Vince Carter]

I had thought you saying Sustenon that you were outside the US as it's not used here that I know of.
You need smaller injections. If you get Cypionate the typical guy would need to inject let's say 25mg EOD. Estrogen is the largest culprit, you may be particularly sensitive to it which is the hard part with low SHBG.

With that, we know that SHBG binds to E just like it binds to T. So, you will likely have a lot of Free Testosterone with your injections and like wise high amount of Free Estrogen to go with it.

Finding out what amount of E is too high, and too low, for YOU is the hard part as you can't be given a number. though I would advise you that you likely need less Estrogen per the lab test, than higher numbers. If you use the standard US stuff of E = 21-30 in this example, the E you may be looking for would be less than that perhaps 10.

 

[Systemlord]

Do to the Sustanon esters you could get away with an M/W/F or EOD protocol, the concept is the same as you will keep steadier levels and hopefully be able to keep estrogen from getting out of hand.

You are basically taking a sledgehammer to your already low SHBG, excess androgens is the protocol best suited for high SHBG men since excess androgens lowers SHBG. You are shooting yourself in the foot to all to keep your doctor happy while you suffer, you have to find another way.

I fully expect your situation to only get worse with each injection.

 

[Cataceous]

Testosterone enanthate is more common than T cypionate in many countries, and can be a good substitute if injections are fairly frequent. You can certainly take frequent small doses of Sustanon for similar results (eventually), but the long half life of the decanoate ester means that corrections/changes must be given a long time to work, on the order of months.

 

[Aki]

@Vince Carter So (assuming I might need to maintain a lower level of estrogen) does that mean that I would probably need an AI?

@Cataceous Thanks, I'll ask about the available options regarding esters

Do to the Sustanon esters you could get away with an M/W/F or EOD protocol, the concept is the same as you will keep steadier levels and hopefully be able to keep estrogen from getting out of hand.

You are basically taking a sledgehammer to your already low SHBG, excess androgens is the protocol best suited for high SHBG men since excess androgens lowers SHBG. You are shooting yourself in the foot to all to keep your doctor happy while you suffer, you have to find another way.


I fully expect your situation to only get worse with each injection.

Thanks.. I'm just trying to make the best of a bad situation (by which I mean the lack of options in my current circumstances).

As I said, I don't intend on taking another injection with this protocol(*); this is my "low-key" way of making my endo realise that it won't work, and suggest to him why it didn't work the first time either back in 2012 when a different doctor had prescribed it (because my current endo seemed to have no clue why it didn't work the first time) - all of this without sounding like a know-it-all. Honestly, he's probably like every other endo here in terms of his experience in the field of TRT, but like I said, he seems to be open-minded and he doesn't disregard my suggestions outright. Ultimately I do need a doctor to write me a prescription for testosterone, after all. And as I said, I get the ampules and I can do anything I want with them.

So if I have no other option than sustanon, and I try a thrice weekly protocol or every other day, what would be the a good dosage to start with? 50 mg?

------------------

(*) Even though originally I had intended to go through with three shots, because based on my first experience from 2012 I don't recall feeling sick like I did this time; that time I just didn't - subjectively - feel anything, good or bad.

 

[Cataceous]

...So if I have no other option than sustanon, and I try a thrice weekly protocol or every other day, what would be the a good dosage to start with? 50 mg?
...

Like cypionate and enanthate, Sustanon is also about 70% testosterone, so total dosing should be similar. Most guys start with a total of 100 mg per week, meaning 35-40 mg TIW is a reasonable starting point unless you have prior knowledge that you're an under- or over-responder. As I mentioned, the problem with Sustanon is having to go slowly. For stabilization one is usually advised to wait five half lives of the longest ester, which could be ten weeks in the case of decanoate.

 

[Aki]

Like cypionate and enanthate, Sustanon is also about 70% testosterone, so total dosing should be similar. Most guys start with a total of 100 mg per week, meaning 35-40 mg TIW is a reasonable starting point unless you have prior knowledge that you're an under- or over-responder. As I mentioned, the problem with Sustanon is having to go slowly. For stabilization one is usually advised to wait five half lives of the longest ester, which could be ten weeks in the case of decanoate.

Thanks.. besides injectable testosterone, I can think of oral and gel as alternatives (although again I don't know about their availability). Seems gel might be good (if I remember correctly, Dr. Crisler advocated its use in his Low T book, although I don't have it at hand). Are these good options for low SHBG guys?

 

[Cataceous]

Thanks.. besides injectable testosterone, I can think of oral and gel as alternatives (although again I don't know about their availability). Seems gel might be good (if I remember correctly, Dr. Crisler advocated its use in his Low T book, although I don't have it at hand). Are these good options for low SHBG guys?

I have yet to come across anyone using oral testosterone, so the most I can say about it is that it is rare. I think there's also a nasal formulation, about which I also know little. Some guys do really well on transdermal formulations, i.e. gels and creams. But there's no shortage of guys like me who try them and move on to injections after getting poor results. Whether they work well for guys with low SHBG depends on things like the absorption rate, the extent to which the skin acts like a reservoir, and the willingness of the patient to apply twice-daily, if needed, to achieve better results.

 

[Vince Carter]

Orals are very hard on the liver

 

[Aki]

@Cataceous and @Vince Carter thank you both for your insight and experience.

Just as I had decided, I didn't taken the second shot sustanon-250 shot, which was due three days ago as per the once shot per two weeks schedule.

I am going to the see the endo again and try to see if he can offer me some better option than sustanone-250 (i.e.cypionate or enanthanate) but if not possible I will just have to figure out how to divide doses.

One question: should I wait for my SHBG numbers to "normalise"; or should I just start on a low dose 3 days a week sort of protocol and see if it works? It is possible my normal SHBG values are mid-teens and the shot just accelerated the descent, but I can't say for sure. [As I mentioned, long-term clomid caused my SHBG to go up to 30, and the numbers were on their way down after I quit it for several months, albeit at a gentler rate compared to after the sustanon shot.]

 

[Cataceous]

I don't think it's necessary to wait for SHBG to normalize before starting a new treatment. You already have an earlier baseline, so now you're mainly interested in where the numbers end up after stabilizing on the new routine.

 

[Aki]

I don't think it's necessary to wait for SHBG to normalize before starting a new treatment. You already have an earlier baseline, so now you're mainly interested in where the numbers end up after stabilizing on the new routine.

Right.. so the main thing seems to be is to try to get a faster-acting testosterone so things can stabilise quicker.

I wonder if it would be possible to calculate/estimate what dose to take based on an initial dose that feels "just right"? Like say (for argument's sake) I find that 30mg every other day during the first week makes me feel awesome, should I cut back to a lower dose to compensate for the eventual build-up of the longer-lived esters in "steady state"? Theoretically it seems it should be possible based on what seems to be the right amount of testosterone initially (when one is mostly feeling the effect of the short-lived ester) to do a rough calculation and work out what dose to take so that in the long run one is getting the right amount of testosterone for them, but don't know if it is practically feasible (or if the simple exponential decay model is detailed enough to be useful).

 

[CROM]

When I started TRT my SHBG was about 12. I inject .2 every other day and now my SHBG is 6 nmol/L. My total test is 558 ng/dl and free T is 149 pg/ml (or 14.9 ng/dl).

Frequent but small dosages doesn’t seem to improve my SHBG. Maybe if I go lower than .2 it will improve. What sucks is I tend to get acne when SHBG is low.

 

[Cataceous]

Right.. so the main thing seems to be is to try to get a faster-acting testosterone so things can stabilise quicker.

I wonder if it would be possible to calculate/estimate what dose to take based on an initial dose that feels "just right"? Like say (for argument's sake) I find that 30mg every other day during the first week makes me feel awesome, should I cut back to a lower dose to compensate for the eventual build-up of the longer-lived esters in "steady state"? Theoretically it seems it should be possible based on what seems to be the right amount of testosterone initially (when one is mostly feeling the effect of the short-lived ester) to do a rough calculation and work out what dose to take so that in the long run one is getting the right amount of testosterone for them, but don't know if it is practically feasible (or if the simple exponential decay model is detailed enough to be useful).

I've wondered about things like this, but I'm not sure this particular scenario is practical because of the strong influence of hormones in flux—meaning that hormones going up or down are also part of the subjective experience. So you probably can't easily recreate it with a static protocol. That's why the best advice is to give any change six weeks+ to work before evaluating and making further changes. And when just starting TRT it can be months before all the effects are known .

 

[Aki]

When I started TRT my SHBG was about 12. I inject .2 every other day and now my SHBG is 6 nmol/L. My total test is 558 ng/dl and free T is 149 pg/ml (or 14.9 ng/dl).

Frequent but small dosages doesn’t seem to improve my SHBG. Maybe if I go lower than .2 it will improve. What sucks is I tend to get acne when SHBG is low.

OK, that SHBG value seems very low. How do you feel at your current dosage?

 

[Aki]

I've wondered about things like this, but I'm not sure this particular scenario is practical because of the strong influence of hormones in flux—meaning that hormones going up or down are also part of the subjective experience. So you probably can't easily recreate it with a static protocol. That's why the best advice is to give any change six weeks+ to work before evaluating and making further changes. And when just starting TRT it can be months before all the effects are known .

Right, but you would look for a good initial subjective response as well as the lab values of hormones that are indirectly influenced (estrogen, SHBG, etc.), wouldn't you?
For example - hypothetically - I might've stuck to my doctor's protocol of sustanon-250 every two weeks for three doses (which was the original plan), but going by my numbers (SHBG down from 21 to 17 in one week, estrogen shooting up) and the very bad subjective response I had, it clearly doesn't feel/look like a good protocol.

 

[Cataceous]

Right, but you would look for a good initial subjective response as well as the lab values of hormones that are indirectly influenced (estrogen, SHBG, etc.), wouldn't you?
...

There can be random and seemingly inexplicable ups and downs, especially in the early going. A quick hormonal snapshot may or may not provide some insight. If estradiol is high and you're having side effects then it's fairly clear-cut. But neurotransmitters may also contribute to the so-called "TRT honeymoon" period, and these cannot so easily be measured and manipulated .