Does TRT reverse/improve sexual symptoms for most men with High Range SHBG / Lower Free T?

[ResearchIt]

They're alluding to this study showing that low free testosterone is associated with the negative symptoms, even with normal total testosterone. I don't believe they are implying a causal connection to SHBG.

Conclusions: Low cFT, even in the presence of normal TT, is associated with androgen deficiency-related symptoms. Normal cFT, despite low TT, is not associated with cognate symptoms; therefore, cFT levels should be assessed in men with suspected hypogonadal symptoms.​

I agree, it's the low Free T that causes the negative symptoms, but when normal Total T levels are present, I feel the urge to blame high SHBG. Really I should blame the hypothalamus or pituitary for it's new Free T target in me, right?

I am only 43 and my current Total T levels usually range between 600-800 with SHBG in the mid 50s. Obviously my body can produce testosterone, but for some reason doesn't want to make it as available as it was before.

I know it would just be speculation, but do you think I used to produce much more Total T (say 900-1200) and had high SHBG, or do you think my Total T has remained the same and my SHBG has increased over the last few years?

 

[tareload]

I am only 43 and my current Total T levels usually range between 600-800 with SHBG in the mid 50s. Obviously my body can produce testosterone, but for some reason doesn't want to make it as available as it was before.

Your fT estimate is 8-10 ng/dl. Are you concerned you have low fT?

In wondrous Tru-T land you'd be >=18 ng/dl:

See green bars above for that reference range.

 

[ResearchIt]

Your fT estimate is 8-10 ng/dl. Are you concerned you have low fT?


View attachment 21712




In wondrous Tru-T land you'd be >=18 ng/dl:
View attachment 21713

See green bars above for that reference range.

Yes I am concerned I have low Free T, but I am still investigating to see what has caused my symptoms of the last year and a half. Low Free T and high SHBG are my only lab values that are off which is why I feel like they are the cause of the changes I experienced.

I know this doesn't effect the calculation much, but my Albumin level is usually about 4.8.

Below are my last two labs using Equilibrium Dialysis for Free T. I have had 10+ other labs done but don't know the Free T method used for those labs. However, using the Tru T calculator on those 10+ labs, my Free T ranges from 13.5 to 24.6 with a median level of 18.4. It seems like I am low range Free T which is a range that covers the entire age range of adult men, 18-80+, not just men in my age range of 40-45.

What do you think about my Free T levels for someone who is age 43, healthy, no drugs, no alcohol, no porn, healthy relationship, fit, and started feeling some negative sexual symptoms starting about age 41.5?

Loss of morning erections, weaker nocturnal erections, sex still works fine, but not like before including fine but weaker erections, weaker orgasms, and a penis, scrotum, and balls that feel a bit shriveled and less prone for action - like what I thought they would be when I was 60 or 70 and not 43 lol.

Do you feel that lower Free T is likely the culprit? Or am I experiencing normal aging and am just overly observant and concerned about it?

Thank you in advance for your feedback! I really appreciate your expertise and help here.

May 2022

March 2022

 

[Cataceous]

I agree, it's the low Free T that causes the negative symptoms, but when normal Total T levels are present, I feel the urge to blame high SHBG. Really I should blame the hypothalamus or pituitary for it's new Free T target in me, right?
...

Yes. Think of the problem in terms of the production/flow rate. The rate is too low; the size of the SHBG reservoir doesn't much matter.

... However, using the Tru T calculator on those 10+ labs, my Free T ranges from 13.5 to 24.6 with a median level of 18.4. It seems like I am low range Free T which is a range that covers the entire age range of adult men, 18-80+, not just men in my age range of 40-45.

The range of 16-31 ng/dL for Tru-T is not a general population reference. It is a target therapeutic range as explained in this post.

"Based on the new data on the distribution of free testosterone levels in healthy men the target range of free testosterone has been determined to be 164 to 314 pg/ml (mean+/−1SD)"​

​

...
I know it would just be speculation, but do you think I used to produce much more Total T (say 900-1200) and had high SHBG, or do you think my Total T has remained the same and my SHBG has increased over the last few years?

I vote for a combination. Maybe you had above-average SHBG that increased some over time. Meanwhile your free testosterone set point declined a little. Both results are considered to be a normal function of aging.

 

[Dudley]

Really appreciating this thread and all the voices in it. Quick question to be sure I'm understanding something basic: what is the relevant target range that we want to get to in total T and in free T? Sounds like Cataceous and Researchit are suggesting a free T range that is significantly higher than the one that comes printed out when I get my lab results from Quest. Thanks for helping me understand what the free T range I should be shooting for really is.

 

[tareload]

Yes I am concerned I have low Free T, but I am still investigating to see what has caused my symptoms of the last year and a half. Low Free T and high SHBG are my only lab values that are off which is why I feel like they are the cause of the changes I experienced.

I know this doesn't effect the calculation much, but my Albumin level is usually about 4.8.

Below are my last two labs using Equilibrium Dialysis for Free T. I have had 10+ other labs done but don't know the Free T method used for those labs. However, using the Tru T calculator on those 10+ labs, my Free T ranges from 13.5 to 24.6 with a median level of 18.4. It seems like I am low range Free T which is a range that covers the entire age range of adult men, 18-80+, not just men in my age range of 40-45.

What do you think about my Free T levels for someone who is age 43, healthy, no drugs, no alcohol, no porn, healthy relationship, fit, and started feeling some negative sexual symptoms starting about age 41.5?

Loss of morning erections, weaker nocturnal erections, sex still works fine, but not like before including fine but weaker erections, weaker orgasms, and a penis, scrotum, and balls that feel a bit shriveled and less prone for action - like what I thought they would be when I was 60 or 70 and not 43 lol.

Do you feel that lower Free T is likely the culprit? Or am I experiencing normal aging and am just overly observant and concerned about it?

Thank you in advance for your feedback! I really appreciate your expertise and help here.

May 2022
View attachment 21714

March 2022
View attachment 21716

Try comparing your ED labs with Vermeulen cfTV and tru-T. What do you conclude about the comparisons? I don't see any lab work here with low fT. Thanks for sharing your data and I have no idea if raising your fT level would help your symptoms. But with a functional HPTA please let someone talk you into trying nasal gel before the injections if you really want to try it.

I was at half your levels of fT, similar position and jacking up fT didn't help my symptoms. But that was me. Good luck with your journey and thanks for sharing. Either Quest is doing their ED wrong or tru-T is way over. cfTV has been kicking butt here lately on the comparisons. Someone has some explaining to do.

 

[tareload]

Really appreciating this thread and all the voices in it. Quick question to be sure I'm understanding something basic: what is the relevant target range that we want to get to in total T and in free T? Sounds like Cataceous and Researchit are suggesting a free T range that is significantly higher than the one that comes printed out when I get my lab results from Quest. Thanks for helping me understand what the free T range I should be shooting for really is.

I shared the plot with ref ranges for major reference labs in US (first 4 bars). Here it is again:

Tru-T way over (>=40%) a large fraction of both Labcorp and Quest LC/MS-MS+ED measurements that I have come across and also in the peer reviewed literature. Plenty of discussion and comparisons on here. Vermeulen typically 0 to 20% higher than fT with ED. Make your own conclusions. I will stick with fT ref range of 5 to 25 ng/dl (ARUP, they seem like a decent pick) till I read the standardization work is complete. Maybe then we will know if tru-T truly is superior or inferior to cfTV. Currently something is very very wrong in the wonderful world of fT.

 

[tareload]

So you guys don't feel too bad with average or modest fT levels...

"Unachievable" Male Body Image?

Goes back to my bias that T levels on their own aren’t much of the story. A few bottles of cypionate and you still have no chance one-on-one: Ok sorry @carlbm. I’m done.

forums.t-nation.com

I gotta find this fella's SHBG.

 

[ResearchIt]

I appreciate the feedback - it's very helpful in my process of trying to identify the cause of my symptoms, which maybe are just due to natural aging and probably not a hormone deficiency. Nice reminder that we have higher testosterone than a gorilla haha.

 

[MIP1950]

I appreciate the feedback - it's very helpful in my process of trying to identify the cause of my symptoms, which maybe are just due to natural aging and probably not a hormone deficiency. Nice reminder that we have higher testosterone than a gorilla haha.

But don't mess with his bananas.

 

[Zaskar]

I appreciate the feedback - it's very helpful in my process of trying to identify the cause of my symptoms, which maybe are just due to natural aging and probably not a hormone deficiency. Nice reminder that we have higher testosterone than a gorilla haha.

Did you ever get you SHBG sorted out ? I have a total T 800 -900 free T at 8 … my shbg just came in at 65 … I was on daily .20 Cypionate , Total testosterone shot to over 1500 off the charts .. blood got thick , in less then 3 months .. I stopped Test but , using HCG .

 

[Dudley]

I can relate my own experience: high SHBG (higher than yours), low Free T (by most accurate test available), with Total T in the normal range (by most accurate test available), and I was living with a lot of difficulty getting erections and nowhere near my previous libido. I am 67, and SHBG does tend to increase with age; and I think that was the principal factor, because I don't know why else someone would have normal range Total T and out-of-range low Free T. In addition to the sexual symptoms, I also was finding I needed to work out much less intensely at the gym and take more days off from training to recover than I ever had, even just a couple of years ago. My doc started by having me try the simplest regiments -- first Clomid (increased my T numbers but had no impact on any of the symptoms), then Natesto (I had no problems with the 3x/day regiment but it didn't show up in my numbers or helping abate any of my symptoms), and then compounded cream, which has been incredibly helpful to me. My Total T numbers are near the top of the normal range, my Free T numbers are within the normal range, my SHBG is about the same, and my erections and libido are, if not reminiscent of my being 40 again, at least allow me to enjoy sex, which is a big deal. The Natesto and the compounded cream were my first-ever uses of exogenous T. So I am happily on TRT with the cream, and my lab numbers are stable (and monitored quarterly or more often).

 

[Willyt]

I can relate my own experience: high SHBG (higher than yours), low Free T (by most accurate test available), with Total T in the normal range (by most accurate test available), and I was living with a lot of difficulty getting erections and nowhere near my previous libido. I am 67, and SHBG does tend to increase with age; and I think that was the principal factor, because I don't know why else someone would have normal range Total T and out-of-range low Free T. In addition to the sexual symptoms, I also was finding I needed to work out much less intensely at the gym and take more days off from training to recover than I ever had, even just a couple of years ago. My doc started by having me try the simplest regiments -- first Clomid (increased my T numbers but had no impact on any of the symptoms), then Natesto (I had no problems with the 3x/day regiment but it didn't show up in my numbers or helping abate any of my symptoms), and then compounded cream, which has been incredibly helpful to me. My Total T numbers are near the top of the normal range, my Free T numbers are within the normal range, my SHBG is about the same, and my erections and libido are, if not reminiscent of my being 40 again, at least allow me to enjoy sex, which is a big deal. The Natesto and the compounded cream were my first-ever uses of exogenous T. So I am happily on TRT with the cream, and my lab numbers are stable (and monitored quarterly or more often).

Thanks for followup. How high is your SHBG? Also, what is your dose for the cream?

 

[Dudley]

My SHBG was in the 90's. Now it's a little lower, but still in the 70's or 80's.

The compounded cream I was prescribed is 200 MG/GM. Dosing takes a little while to figure out, because transdermal absorption varies, person to person. I started with 4 clicks once/day in the a.m., on the underside of my upper arm and/ shoulder. then we moved up to 5 clicks once/day in the a.m. and that worked much better. The doc also suggested I take 50 mg of Clomid once/ week to help maintain some natural T production and that seems to be helpful as well.

 

[Systemlord]

The doc also suggested I take 50 mg of Clomid once/ week to help maintain some natural T production and that seems to be helpful as well.

The clomid will increase your SHBG, how much on the prescribed dosage (1x weekly) is anyone’s guess.

 

[Willyt]

My SHBG was in the 90's. Now it's a little lower, but still in the 70's or 80's.

The compounded cream I was prescribed is 200 MG/GM. Dosing takes a little while to figure out, because transdermal absorption varies, person to person. I started with 4 clicks once/day in the a.m., on the underside of my upper arm and/ shoulder. then we moved up to 5 clicks once/day in the a.m. and that worked much better. The doc also suggested I take 50 mg of Clomid once/ week to help maintain some natural T production and that seems to be helpful as well.

With that dose and SHBG, its surprising your TT is not supra levels. Regardless, it sounds like you're doing well, which is always great to hear on this forum.

 

[Zaskar]

I can relate my own experience: high SHBG (higher than yours), low Free T (by most accurate test available), with Total T in the normal range (by most accurate test available), and I was living with a lot of difficulty getting erections and nowhere near my previous libido. I am 67, and SHBG does tend to increase with age; and I think that was the principal factor, because I don't know why else someone would have normal range Total T and out-of-range low Free T. In addition to the sexual symptoms, I also was finding I needed to work out much less intensely at the gym and take more days off from training to recover than I ever had, even just a couple of years ago. My doc started by having me try the simplest regiments -- first Clomid (increased my T numbers but had no impact on any of the symptoms), then Natesto (I had no problems with the 3x/day regiment but it didn't show up in my numbers or helping abate any of my symptoms), and then compounded cream, which has been incredibly helpful to me. My Total T numbers are near the top of the normal range, my Free T numbers are within the normal range, my SHBG is about the same, and my erections and libido are, if not reminiscent of my being 40 again, at least allow me to enjoy sex, which is a big deal. The Natesto and the compounded cream were my first-ever uses of exogenous T. So I am happily on TRT with the cream, and my lab numbers are stable (and monitored quarterly or more often).

Glad to hear ! and I appreciate the information. Sounds like my exact symptoms .. I talked to my doctor today , he swears by Stinging Nettle 250 mg a day lowers SHBG .

I also think I may have iron overload, that definitely raises SHBG . I did the Carnivore diet , which I regret ! about a year ago . We also eat cook are meats on iron skillets. I’ll post back and let you know if the sting nettle works and my blood iron levels .

 

[newuser]

Glad to hear ! and I appreciate the information. Sounds like my exact symptoms .. I talked to my doctor today , he swears by Stinging Nettle 250 mg a day lowers SHBG .

I also think I may have iron overload, that definitely raises SHBG . I did the Carnivore diet , which I regret ! about a year ago . We also eat cook are meats on iron skillets. I’ll post back and let you know if the sting nettle works and my blood iron levels .

Donate you blood and test your SHBG afterwards. If it will drop then its iron overload for sure.

 

[Zaskar]

Donate you blood and test your SHBG afterwards. If it will drop then its iron overload for sure.

Thanks bro ! Actually going to donate today . How long should wait to check SHBG after donation ?

 

[Hyrulewarrior1978]

So you guys don't feel too bad with average or modest fT levels...

"Unachievable" Male Body Image?

Goes back to my bias that T levels on their own aren’t much of the story. A few bottles of cypionate and you still have no chance one-on-one: Ok sorry @carlbm. I’m done.

forums.t-nation.com

View attachment 21718

View attachment 21719

I gotta find this fella's SHBG.

This graph just illustrates that androgen receptors are more potent in the apes. Lol