Endo says SHBG doesn’t need to be tested. Need advice

[mg707]

This site has been a huge help to me on my TRT journey, so big thanks to Nelson and the other mods for running it and responding to posts!

I’m 48 YO and Ive been on TRT since 10/10/2018 after my 3rd bout of MDD and 2 blood tests that showed I was at 110 and 150 TT. Traditional ADs were not working and I tried them all. As an aside, they may be what crashed my TEST, but also could be MDD. No way to tell.

People mostly talk about physical benefits of TRT, but I will tell you that TRT, along with some other holistic treatments, has literally saved my life and I’ve never felt better mentally

My protocol has settled into injecting 40mg (0.2ML) of Test Cyp 2x per week, Wed evening and Sunday morning. So 80 mg per week total.

I have side effects of acne on shoulders, higher overall sebum production and water retention, but the pros way outweigh the cons

I’m getting treated by an Endocrinologist, who is one of the best around. However, I asked to get SHBG tested and he said that was unnecessary, only need TT, FT and Estradial (although I had to suggest this get tested originally so not sure that he does a lot of TRT).

Here are my most recent labs taken on a Thursday morning with my prior last injection being Sunday - so trough.

Total Test (serum) 555
Free Test direct - 17.6
T4 Free (thyroxine) - 1.47
TSH - 0.91
Estradiol - 29.9 (Roche ECLIA methodology)
PSA - 1.7

Should I insist that SHBG be done and if so, what is the logic for having it done, what can I learn?


I asked about HCG as well because I have some significant atrophy and he said he doesn’t prescribe that bc of adverse side effects. I do take an AI nor have I.

I know I probably need to switch doctors and get one that is more versed in current treatment standards based on all the above.

My goal is to reduce acne and water retention while maintaining my positive mental and physical benefits of TRT some I’m hesitant to tweak too much

Appreciate anyone that responds with some insights

 

[ERO]

If you are feeling great as-is, then no big need to test. Its good to know SHBG as a reference sure, but if the protocol is working, don't break it.

 

[Cataceous]

As @ERO says, SHBG is good to have for reference. If it's low or high you might adjust your dosing pattern accordingly. SHBG is also used to get an estimate for free testosterone that is better than the standard direct test, though not as good as a high quality test such as equilibrium dialysis.

Adding hCG can be good, bad, or a mixed bag. It almost always reduces testicular atrophy. Sometimes it improves libido and well-being. In some cases it raises estradiol levels enough to throw things out of balance.

With twice-weekly injections you could be having peak serum testosterone around 50% above the trough value. That's about 800 ng/dL, which isn't high for TRT, but is well above average for natural men. This could be giving you the side effects. You could see if you like smoother levels better by injecting 22 mg EOD. This would put your level closer to the average value all the time, perhaps somewhat under 700 ng/dL.

 

[Match]

Como [USER = 1210] @ERO [/ USER] diz, é bom ter SHBG como referência. Se estiver baixo ou alto, você pode ajustar seu padrão de dosagem de acordo. SHBG também é usado para obter uma estimativa de testosterona livre que é melhor do que o teste direto padrão, embora não tão boa quanto um teste de alta qualidade, como a diálise de equilíbrio.

Estimativa de Testosterona vc quis dizer calculo da TF por formulas que tem na net, com base na T e SHBG?
Teste padrão é direto o que se usa em Laboratório com base somente na Testosterona? Ocorre que não solicitei SHBG, mas sim apenas T, TF e Estradiol, mas não resultado consta SHBG. Entao como descobriram essa SHBG? Pelo Estradiol?

 

[ERO]

The big question is how do you feel on your protocol? If you feel good, then no worries about testing or not testing. If you feel bad and adjustments are needed, then knowing your SHBG is super helpful. If your endo doesn't think it matters, I would think about switching docs.

 

[Systemlord]

Total Test (serum) 555
Free Test direct - 17.6

While these levels aren't optimal, how you feel is more important. Smaller more frequent dosing might get rid of the water retention and possibly the ance as well.

The water retention is expected in those who have only been on TRT in the short-term, which usually subsides as your body gets used to TRT.

It's true HCG can have side effects, but that's not the case for everyone. Water retention is common side effect of HCG.

 

[tcmi]

If you really want to know your SHBG levels, just get the test done yourself. Self-pay cash lab costs are pretty cheap and easily accessible.

 

[Jake_from_StateFarm]

My Urologist also does not pull SHBG nor does he order labs at trough. I administer 100mg T per week and my TT was over 1,000 48hrs after injection. He was not concerned because he's "treating the symptoms" while most notably monitoring my estradiol, PSA and RBCs.

IMO, having the most exhaustive panel is important when you're struggling to get dialed-in. Otherwise, if you feel good and the results are evident just make sure your panel reflects TRT is not compromising your physical health.

 

[Match]

Como o TF é T-SHBG, como obter o TF sem SHBG? A fórmula que vi na rede requer o valor SHBG, como no caso do tru-t. Laboratórios não sei como administram FT

Alguém pode me explicar melhor?

 

[madman]

Since TF is T-SHBG, how do I get TF without SHBG? The formula I saw on the network requires the value SHBG, as in the case of tru-t. Laboratories do not know how to administer FT

Can someone explain it to me better?

cFT (TT / SHBG / Albumin)

They used the cFTV - TT 637 ng/dL, SHBG 62.5 nmol/L, and Albumin 4.37 g/dL (4.3 mean)

Top left.....your SHBG is 62.5 nmol/L and bottom left FT 8.95 ng/dL.

 

[Nelson Vergel]

This site has been a huge help to me on my TRT journey, so big thanks to Nelson and the other mods for running it and responding to posts!

I’m 48 YO and Ive been on TRT since 10/10/2018 after my 3rd bout of MDD and 2 blood tests that showed I was at 110 and 150 TT. Traditional ADs were not working and I tried them all. As an aside, they may be what crashed my TEST, but also could be MDD. No way to tell.

People mostly talk about physical benefits of TRT, but I will tell you that TRT, along with some other holistic treatments, has literally saved my life and I’ve never felt better mentally

My protocol has settled into injecting 40mg (0.2ML) of Test Cyp 2x per week, Wed evening and Sunday morning. So 80 mg per week total.

I have side effects of acne on shoulders, higher overall sebum production and water retention, but the pros way outweigh the cons

I’m getting treated by an Endocrinologist, who is one of the best around. However, I asked to get SHBG tested and he said that was unnecessary, only need TT, FT and Estradial (although I had to suggest this get tested originally so not sure that he does a lot of TRT).

Here are my most recent labs taken on a Thursday morning with my prior last injection being Sunday - so trough.

Total Test (serum) 555
Free Test direct - 17.6
T4 Free (thyroxine) - 1.47
TSH - 0.91
Estradiol - 29.9 (Roche ECLIA methodology)
PSA - 1.7

Should I insist that SHBG be done and if so, what is the logic for having it done, what can I learn?


I asked about HCG as well because I have some significant atrophy and he said he doesn’t prescribe that bc of adverse side effects. I do take an AI nor have I.

I know I probably need to switch doctors and get one that is more versed in current treatment standards based on all the above.

My goal is to reduce acne and water retention while maintaining my positive mental and physical benefits of TRT some I’m hesitant to tweak too much

Appreciate anyone that responds with some insights

Your Free T is 3.2 percent of total (I assume you used something like this panel:
Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration) )

I would not worry about SHBG if my free T is above 2 % of total.

 

[Match]

cFT (TT / SHBG / Albumin)

They used the cFTV - TT 637 ng/dL, SHBG 62.5 nmol/L, and Albumin 4.37 g/dL (4.3 mean)View attachment 13693


Top left.....your SHBG is 62.5 nmol/L and bottom left FT 8.95 ng/dL.

View attachment 13692

I understood, but wanted to know in relation to direct TF of 17.6 of the topic author, who obtained without SHBG.
If it was not made texte of QUALITY DE and neither by formula TruH or other, which requires SHBG, how did you and what is the credibility of this TF?
I just wanted to understand better

 

[VacationMan]

I use SHBG as a measure as to where my E2 should be. The two should be "close" in range - according to my PA at Defy. My last labs had SHBG at 27 and E2 at 29. Close enough.

 

[mqsymth]

I use SHBG as a measure as to where my E2 should be. The two should be "close" in range - according to my PA at Defy. My last labs had SHBG at 27 and E2 at 29. Close enougE

Pubmed Reference from your PA please. What can be asserted without proof can be dismissed without prof.

 

[Match]

Even if it's another unit of measure, should the numbers be close?

 

[VacationMan]

Pubmed Reference from your PA please. What can be asserted without proof can be dismissed without prof.

I don't question my PA or the physician behind it all. All I know is how I feel, and I know my E2 levels have a lot to do with how I feel. When my E2 is in the 25-30 range, I'm feeling great. The correlation to SHBG though? Maybe reality, maybe made up. Go search and see what you come up with. I'd like to know fact from fiction myself.

 

[Cataceous]

Pubmed Reference from your PA please. What can be asserted without proof can be dismissed without prof.

It's just a rule of thumb, which I'm sure has never been validated scientifically. If it does work, at least in a statistical sense, then it may be because the ratio of free estradiol to free testosterone increases as SHBG decreases—if free testosterone is held constant. So if you assume there's a preferred range for the fE2:fT ratio then guys with lower SHBG might tend to exceed the range if they didn't compensate as directed by this rule.