Advice/help for high shbg guy

[mw10200]

Any guys here with normal total t and high shbg (pre trt) that could give me some advice please?

Had blood tests done 4 time over the last year. Each time everything was right where it needed to be axcpet for my shbg. Total t has been 620-743. Shbg has been 56-75. Putting my free t between 9.1 and 10.5 ng/dl.

For free t ng/dl I've seen ranges from 4-21 and other labs outside of the US that were 9-30. So I'm having trouble figuring out if my symptoms are caused by my t levels or if it's something else.

I'm having a hard time because I feel like an outlier. Seems easy to know if trt is the right option if your total is low. Having the shbg issue is making me second guess my decision. I have already been approved through a clinic and have meds on hand, Just hesitant to start.

If I were going off symptoms alone I would have started treatment last year. But free t ranges are making me confused and wonder if I have a different issue.

Classic symptoms: lethargy, zero motivation, easily overwhelmed, anxious, depressed, no sex drive and moodiness/Irritability (the last one is the worst).

I got gyno during puberty and my estradiol has been on the very high end of the range each time I've had my blood drawn.

I'm 33yo 6'4" currently 195lb. About 18%bf. Was at a 6 pack for my first blood test but have been bulking for a while. Get 7-9 hours sleep every night. Take zinc, fish oil, zma, multi and d3. Tdee is 2900 and I make sure to get 1.1-1.3 grams of protein per lb of body weight. Fat intake is at 25% of my total and I shoot for healthy fats: avocados, almonds etc. Always at least at maintenance if not surplus calories for blood tests.

Any high shbg guys here that could give me some insight?

Is my free t considered low?

I'm extremely anxious to start trt. The 'lifelong commitment' idea scares the hell out of me. But at the same time I can't continue on feeling this way- most days I feel like a lazy, unmotivated PMSing blob.

TIA

 

[madman]

Any guys here with normal total t and high shbg (pre trt) that could give me some advice please?

Had blood tests done 4 time over the last year. Each time everything was right where it needed to be axcpet for my shbg. Total t has been 620-743. Shbg has been 56-75. Putting my free t between 9.1 and 10.5 ng/dl.

For free t ng/dl I've seen ranges from 4-21 and other labs outside of the US that were 9-30. So I'm having trouble figuring out if my symptoms are caused by my t levels or if it's something else.

I'm having a hard time because I feel like an outlier. Seems easy to know if trt is the right option if your total is low. Having the shbg issue is making me second guess my decision. I have already been approved through a clinic and have meds on hand, Just hesitant to start.

If I were going off symptoms alone I would have started treatment last year. But free t ranges are making me confused and wonder if I have a different issue.

Classic symptoms: lethargy, zero motivation, easily overwhelmed, anxious, depressed, no sex drive and moodiness/Irritability (the last one is the worst).

I got gyno during puberty and my estradiol has been on the very high end of the range each time I've had my blood drawn.

I'm 33yo 6'4" currently 195lb. About 18%bf. Was at a 6 pack for my first blood test but have been bulking for a while. Get 7-9 hours sleep every night. Take zinc, fish oil, zma, multi and d3. Tdee is 2900 and I make sure to get 1.1-1.3 grams of protein per lb of body weight. Fat intake is at 25% of my total and I shoot for healthy fats: avocados, almonds etc. Always at least at maintenance if not surplus calories for blood tests.

Any high shbg guys here that could give me some insight?

Is my free t considered low?

I'm extremely anxious to start trt. The 'lifelong commitment' idea scares the hell out of me. But at the same time I can't continue on feeling this way- most days I feel like a lazy, unmotivated PMSing blob.

TIA

Need a more thorough set of labs.

Keep in mind that dysfunction thyroid/adrenals can easily mimic low-t symptoms.

Yes, men with what would be considered normal/robust T levels can still have lowish/low FT due to highish/high SHBG.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

Even then it is critical to use the most accurate assays TT/estradiol (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

I would not rely upon inaccurate assays (direct immunoassay) let alone outdated calculated methods especially in cases of altered SHBG.

Good chance that depending on where your current TT/SHBG sits that you may very well have lowish/low FT but even then I would retest using the most accurate assays ED or UF especially seeing as you have high SHBG before jumping to any conclusion that your FT is truly lowish/low!

 

[mw10200]

Need a more thorough set of labs.

Keep in mind that dysfunction thyroid/adrenals can easily mimic low-t symptoms.

Yes, men with what would be considered normal/robust T levels can still have lowish/low FT due to highish/high SHBG.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

Even then it is critical to use the most accurate assays TT/estradiol (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration).

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

I would not rely upon inaccurate assays (direct immunoassay) let alone outdated calculated methods especially in cases of altered SHBG.

Good chance that depending on where your current TT/SHBG sits that you may very well have lowish/low FT but even then I would retest using the most accurate assays ED or UF especially seeing as you have high SHBG before jumping to any conclusion that your FT is truly lowish/low!

Thanks for the reply!

Had thyroid levels checked as well. Tsh was 1.3.
Total t and estradiol were used (LC/MS-MS).

2 of the four panels I had done were super thorough. Prolactin, psa, lh, fsh, progesterone, dhea, Prolactin etc.

Dhea, Prolactin and progesterone were all on the lower side but within range. Hematocrit was one the higher side (56) but my doc thought it was due to living at high altitude (11,000 ft.).

I am curious about adrenals. I don't know whether or not I had those tested. Cortisol came back good. But I don't know if that says anything. What would adrenals be? Maybe they were part of my tests.. not sure.

I had heard about the free tests you mentioned and I don't know where to find them.. 2 of the tests I had were for bioavailable/free+ weakly bound tests but I don't think they were Equilibrium Dialysis or Ultrafiltration.

Do you know if I can order the ED or UF off private MD labs?

I would love a more accurate free t test all I have right now are online calculators and I want to be thorough before starting anything.

 

[madman]

Thanks for the reply!

Had thyroid levels checked as well. Tsh was 1.3.
Total t and estradiol were used (LC/MS-MS).

2 of the four panels I had done were super thorough. Prolactin, psa, lh, fsh, progesterone, dhea, Prolactin etc.

Dhea, Prolactin and progesterone were all on the lower side but within range. Hematocrit was one the higher side (56) but my doc thought it was due to living at high altitude (11,000 ft.).

I am curious about adrenals. I don't know whether or not I had those tested. Cortisol came back good. But I don't know if that says anything. What would adrenals be? Maybe they were part of my tests.. not sure.

I had heard about the free tests you mentioned and I don't know where to find them.. 2 of the tests I had were for bioavailable/free+ weakly bound tests but I don't think they were Equilibrium Dialysis or Ultrafiltration.

Do you know if I can order the ED or UF off private MD labs?

I would love a more accurate free t test all I have right now are online calculators and I want to be thorough before starting anything.

A full thyroid panel includes much more than just TSH.

Hematocrit of 56 is very high and I would look into this as most would not recommend starting trt when hematocrit is >52%.

When using exogenous T RBCs/hemoglobin/hematocrit will increase within the 1st month and can take up to 9-12 months to reach peak levels.

T formulation, the dose of T, genetics (polymorphism of the AR), age all play a role in the impact a trt protocol will have on blood markers (RBCs/hemoglobin/hematocrit).

Other factors such as sleep apnea, smoking can have a negative impact on hematocrit.


*Men with significant erythrocytosis (hematocrit >52%), severe untreated obstructive sleep apnea, or untreated severe congestive heart failure should not be started on treatment with TTh without prior resolution of the co-morbid condition.


-Some authors recommend that TTh be discontinued if hematocrit is >54%, which may be reasonable while baseline hematocrit level >50% is a relative contraindication for starting testosterone therapy. However, these recommendations are based on assumptions – the clinical significance of a hematocrit >54% is unknown. The meta-analysis by FernandezBalsells [208] showed that, despite a higher incidence of elevated hematocrit, no clinical adverse effects were reported. Results of earlier studies (MEDLINE database search from 1966 to 2004) showed that, despite TTh-treated men being nearly four times as likely to have hematocrit >50% compared with placebo-treated men (OR ¼ 3.69, 95% CI, 1.82–7.51), the frequency of cardiovascular events, sleep apnea or death was not significantly different between the two groups. Hematocrit elevations were reported in 43.8% of patients administered intramuscular T enanthate injections and in 15.4% of patients administered transdermal T treatment [222]. The lack of increase in cardiovascular events with elevated hematocrit may be due to the fact that T acts as a vasodilator and has anti-atherosclerotic effects [223]. In addition, testosterone is able to decrease plasma concentrations of procoagulatory substances such as fibrinogen and PAI-1 as well as Factor XII [224] Isolated hematocrit elevations can be the result of insufficient fluid intake on a hot day. Only repeated measures of hematocrit >54% should be followed by concomitant administration of aspirin, bleeding, therapeutic phlebotomy, and/or discontinuation of TTh until hematocrit declines below 54%. After normalization of hematocrit levels, TTh can be continued with a reduced dosage

-Periodic hematological assessment is, however, indicated, i.e. before TTh, then 3–4 months and 12 months in the first year of treatment, and annually thereafter. Although it is not yet clear what upper limit of hematocrit level is clinically desirable, dose adjustments may be necessary to keep hematocrit below 52–54%




Adrenals- 4 point cortisol test.

Yes, you can purchase TT (LC/MS-MS)/FT (Equilibrium Dialysis or Ultrafiltration) through PMD.

Or better yet through Nelson's Discountedlabs.com


1. Total Testosterone (LC/MS- No Upper Limit) and Free Testosterone (Equilibrium Dialysis)

Total and Free Testosterone Test Panel plus Hematocrit

Lowest Cost Hematocrit, Total and Free Testosterone Test Panel for Men on TRT

www.discountedlabs.com

2. Total Testosterone (LC/MS- No Upper Limit) and Free Testosterone (Equilibrium Ultrafiltration)

Testosterone, Free (Equilibrium Dialysis) and Total, MS - Most Affordable and Accurate Test

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

 

[Systemlord]

Total t has been 620-743. Shbg has been 56-75. Putting my free t between 9.1 and 10.5 ng/dl.

For free t ng/dl I've seen ranges from 4-21 and other labs outside of the US that were 9-30. So I'm having trouble figuring out if my symptoms are caused by my t levels or if it's something else.

Is this a calculated Free T? If so remember the binding affinity for SHBG is thought to differ among individuals. I mean this nature we're talking about here and variables are expected.

Seeing your hematocrit is so high at 56%, sleep apnea can elevated the hematocrit.

 

[mw10200]

Thanks for that link on blood tests- definitely cheaper than what I'm paying now.

Sorry, the thyroid panel was tsh, t4, free t4, free t3 and t3 uptake. The only thing that was a little off was my t3 uptake % was on the high end. I think 1 point above range. My wife has been doing bloods for thyroid since she was a kid and said everything looked good. But I can attach a pic if it would help?

I just double checked the hematocrit and both tests were 50.3%. About 8 months apart. First test I was vaping and the second test was 5 months after quitting. But they were the exact same. No sleep apnea either. Only thing the doctor and I could come up with is living at high elevation but I'm definitely no expert.

I looked up my previous tests and the total t definitely said (LC/MS-MS) but it was unclear on free t. I'll definitely get it checked again and update once I have better numbers to go off

 

[Deleted member 16042]

I second Madman's urge for you to get Free T ultrafiltration or Equilibrium dialysis.

I have a different issue causing high SHBG, due to a co-morbidity outside of the range of normal TRT concerns. Last SHBG was 183. My total T was 1397 and free T direct 7.1.

The Free T Direct was nowhere near the TruT calculator so I got the Free T ultrafiltration test. It closely agreed with the TruT caclulation Free T: 32.96ng/dl Range 5.00-21.00. I lowered my dose slightly. New labs coming up soon.

My conclusion: I will no longer depend on the Testosterone Free Direct blood test... period

 

[Dicky]

Any guys here with normal total t and high shbg (pre trt) that could give me some advice please?

Had blood tests done 4 time over the last year. Each time everything was right where it needed to be axcpet for my shbg. Total t has been 620-743. Shbg has been 56-75. Putting my free t between 9.1 and 10.5 ng/dl.

My experience is a lot like yours. My total T levels were in the same range and my SHBG was in the 70's. My free was even lower than yours.

Your Free T levels are ones that men start to feel symptoms at. I know I did. The way my doctor dealt with this was to give me a higher dose of testosterone than typical. This boosted my total T up above the normal range. But the high SHBG leaves my free T just in the middle to upper level of the range.

I ended up feeling much better on TRT than before.

A good doctor will be mindful of the lab ranges of course. And a good doctor will treat you for resolution of your symptoms.

 

[Match]

Here too kind of a similar result.
TT 637, TF 8.9. SHBG 62. I don't do TRT. Should?

 

[Systemlord]

Here too kind of a similar result.
TT 637, TF 8.9. SHBG 62. I don't do TRT. Should?

Yes, if symptoms are present.

 

[ivkonst2017]

Total t has been 620-743. Shbg has been 56-75. Putting my free t between 9.1 and 10.5 ng/dl.

I had similar total t, shbg of 50 and free t of around 9 ng/dl according to the old school calculator.

TRT was lifechanging to me although I struggled a lot to dial in. But it was worthy. Now Im optimising thyroid as well.

 

[ivkonst2017]

Here too kind of a similar result.
TT 637, TF 8.9. SHBG 62. I don't do TRT. Should?

Depends whether you have enough symptoms of low t or not. For such values symptoms should be decisive. The question is not should you do TRT, but to what extend TRT can improve your life and is it worthy for you to bother.

 

[ivkonst2017]

A good doctor will be mindful of the lab ranges of course. And a good doctor will treat you for resolution of your symptoms.

Very often these two cannot happen together due to the absurdly low lab ranges nowadays.
The total t upper limit in my country is 800ng/dl which is insane.

 

[Deleted member 16042]

So your Free T is really 32.96 ng/dL and not 7.1 ng/dL??? That's nuts. Such a huge difference. You're on TRT right?

I was, yes.

And yes, I am on TRT.

 

[madman]

Is this a calculated Free T? If so remember the binding affinity for SHBG is thought to differ among individuals. I mean this nature we're talking about here and variables are expected.

Seeing your hematocrit is so high at 56%, sleep apnea can elevated the hematocrit.

Sure.....if you are one that falls under the 2% of Caucasians that genetically have one of the 2 SHBG polymorphisms which have been described to have to affect T: SHBG binding.

I am not buying into this stickier than others SHBG affecting FT levels drastically!

Again the only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

I would not rely upon the piss poor direct immunoassays which are known to be inaccurate let alone the older outdated cFTV when testing FT especially in cases of altered SHBG!

TruT Free Testosterone Calculator by FPT

Free testosterone calculator by FPT. Improved accuracy of free T calculations.

tru-t.org

TruT model: 98% of Caucasians (wild type SHBG)

*The current algorithm and the experimental data reported here were generated using wild-type SHBG which is present in nearly 98% of Caucasians. Genome-wide association studies have revealed several SHBG polymorphisms, two of which have been reported to affect testosterone binding to SHBG (28). Therefore, in the future, the algorithms may include a term for the SHBG genotype.


*Relation between Percent FT with Total Testosterone and SHBG. Intra-dimer complex allostery suggests that SHBG can regulate FT fraction over a wide range of total testosterone concentrations without getting saturated. Indeed, it was found that percent FT calculated using the new model changed very modestly over a wide range of total testosterone concentrations. In contrast, Vermeulen's equation suggests a negative relation between percent FT and total testosterone. Furthermore, as SHBG concentrations increase, percent FT calculated using our new model shows only a modest decline in contrast to the marked decline in percent FT calculated using Vermeulen's equation.

 

[madman]

Is this a calculated Free T? If so remember the binding affinity for SHBG is thought to differ among individuals. I mean this nature we're talking about here and variables are expected.

Seeing your hematocrit is so high at 56%, sleep apnea can elevated the hematocrit.

TruT Free Testosterone Calculator by FPT

Free testosterone calculator by FPT. Improved accuracy of free T calculations.

tru-t.org

The new dynamic model leads to the reconsideration of several dogmas related to testosterone's binding to SHBG and has important physiologic and clinical implications.

*First, the fraction of circulating testosterone that is free is substantially greater (2.9±0.4%) than has been generally assumed (% cFTV 1.5±0.4%).

*Second, percent FT is not significantly related to total testosterone over a wide range of total testosterone concentrations. However, the percent FT declines as SHBG concentrations increase, although it does not decline as precipitously as predicted by Vermeulen's model. Due to the allostery between the two binding sites, SHBG is able to regulate FT levels in a much larger dynamic range.


Key points:

EAM (cFTZ) SHBG: T binding

*Intra-dimer complex allostery suggests that SHBG can regulate FT fraction over a wide range of total testosterone concentrations without getting saturated.

*Indeed, it was found that percent FT calculated using the new model changed very modestly over a wide range of total testosterone concentrations.

*Due to the allostery between the two binding sites, SHBG is able to regulate FT levels in a much larger dynamic range.

 

[madman]

This is the part that goes over everyone's head:

*Intra-dimer complex allostery suggests that SHBG can regulate FT fraction over a wide range of total testosterone concentrations without getting saturated

*Due to the allostery between the two binding sites, SHBG is able to regulate FT levels in a much larger dynamic range.