35 with high SHBG, libido and erection issues. Labs inside, should I call defy?

[YoungOldMan]

Hello,

I've had libido and erection issues off and on for at least five years. During the same time frame I've also experienced periods of melancholy mood. I have a bit of anxiety but I've not needed medication. My sex drive and erection quality have both taken a huge dive over the past 12 months. I've tried cialis and viagra which worked initially for my erection (but not for libido) but are now hit or miss. In college, as a stupid and uninformed kid, I did take testosterone and trenbolone for the better part of a year. I stopped them cold turkey without trying to restart my system, I don't know if that caused any permanent changes. I have more stress lately, partly due to these issues, but this has been happening since before the stress started. I also lost 25lbs over the course of 2-3 months earlier this year.

My SHBG has been high since it was first tested in 2011. My progesterone is also high and the doctors aren't sure if that's a concern or not. An endocrinologist in town thinks my Free Testosterone is too low and wants to start me on Test cyp injections. He will add in an anti-E as needed and only mentioned HCG if I want to have kids. I've asked for testosterone gel instead of test cyp, thinking the extra DHT conversion may help, but now I'm not sure. I have never done HRT and have not yet started. I don't want to take it if it is not needed.

Based on my age, symptoms, and labs, should I consider starting TRT? If so, I will contact Defy Medical for an expert opinion.


Labs (not shown here are: blood pressure, cholesterol, triglycerides, and liver metabolites, which are all in good range):

[TABLE="width: 643, align: left"]
[TR]
[TD]Date[/TD]
[TD]Test[/TD]
[TD]Value[/TD]
[TD]Reference Range[/TD]
[/TR]
[TR]
[TD="align: right"]03/09/11[/TD]
[TD]Total Testosterone[/TD]
[TD]408 ng/dl[/TD]
[TD]400-1080[/TD]
[/TR]
[TR]
[TD="align: right"]05/17/11[/TD]
[TD]Total Testosterone[/TD]
[TD]546 ng/dl[/TD]
[TD]400-1080[/TD]
[/TR]
[TR]
[TD="align: right"]05/17/11[/TD]
[TD]Free Testosterone[/TD]
[TD]8.02 ng/dl[/TD]
[TD]4.7-24.4[/TD]
[/TR]
[TR]
[TD="align: right"]05/17/11[/TD]
[TD]% Free Testosterone[/TD]
[TD]1.5[/TD]
[TD]1.6-2.9[/TD]
[/TR]
[TR]
[TD="align: right"]05/17/11[/TD]
[TD]SHBG[/TD]
[TD]52.6 nmol/L[/TD]
[TD]13-71[/TD]
[/TR]
[TR]
[TD="align: right"]04/29/15[/TD]
[TD]Total Testosterone[/TD]
[TD]805 ng/dl[/TD]
[TD]348-1197[/TD]
[/TR]
[TR]
[TD="align: right"]04/29/15[/TD]
[TD]Free Testosterone[/TD]
[TD]13.45 ng/dl[/TD]
[TD]4 -25.0[/TD]
[/TR]
[TR]
[TD="align: right"]04/29/15[/TD]
[TD]% Free Testosterone[/TD]
[TD]1.67[/TD]
[TD]1.50-4.2[/TD]
[/TR]
[TR]
[TD="align: right"]05/20/16[/TD]
[TD]Total Testosterone[/TD]
[TD]908.3 ng/dl[/TD]
[TD]348-1197[/TD]
[/TR]
[TR]
[TD="align: right"]05/20/16[/TD]
[TD]Free Testosterone (direct)[/TD]
[TD]12.1 pg/ml[/TD]
[TD]8.7-25.1[/TD]
[/TR]
[TR]
[TD="align: right"]05/20/16[/TD]
[TD]LH[/TD]
[TD]5.2 mIU/mL[/TD]
[TD]1.7-8.6[/TD]
[/TR]
[TR]
[TD="align: right"]05/20/16[/TD]
[TD]FSH[/TD]
[TD]4.4 mIU/mL[/TD]
[TD]1.5-12.4[/TD]
[/TR]
[TR]
[TD="align: right"]05/20/16[/TD]
[TD]Prolactin[/TD]
[TD]10.4 ng/mL[/TD]
[TD]4.0-15.2[/TD]
[/TR]
[TR]
[TD="align: right"]05/20/16[/TD]
[TD]Estradiol[/TD]
[TD]27.4 pg/mL[/TD]
[TD]8.0-35[/TD]
[/TR]
[TR]
[TD="align: right"]05/20/16[/TD]
[TD]SHBG[/TD]
[TD]56.5 nmol/L[/TD]
[TD]16.5-55.9[/TD]
[/TR]
[TR]
[TD="align: right"]07/15/16[/TD]
[TD]DHT[/TD]
[TD]684 pg/mL[/TD]
[TD]106-719.0[/TD]
[/TR]
[TR]
[TD="align: right"]07/15/16[/TD]
[TD]Prolactin[/TD]
[TD]4.76 ng/mL[/TD]
[TD]4.0-15.2[/TD]
[/TR]
[TR]
[TD="align: right"]07/15/16[/TD]
[TD]SHBG[/TD]
[TD]61.57 nmol/L[/TD]
[TD]10.0-80[/TD]
[/TR]
[TR]
[TD="align: right"]07/15/16[/TD]
[TD]Free T3[/TD]
[TD="align: right"]3.68[/TD]
[TD]2.5-4.3[/TD]
[/TR]
[TR]
[TD="align: right"]07/15/16[/TD]
[TD]Free T4[/TD]
[TD="align: right"]1.62[/TD]
[TD]0.71-1.7[/TD]
[/TR]
[TR]
[TD="align: right"]08/02/16[/TD]
[TD]Progesterone[/TD]
[TD]2.0 ng/ml[/TD]
[TD]0.2-1.5[/TD]
[/TR]
[TR]
[TD="align: right"]08/02/16[/TD]
[TD]DHEA[/TD]
[TD]366 ng/dl[/TD]
[TD]61.0-1636[/TD]
[/TR]
[TR]
[TD="align: right"]08/02/16[/TD]
[TD]Total Testosterone[/TD]
[TD]573 ng/dl[/TD]
[TD]250.0-1100[/TD]
[/TR]
[TR]
[TD="align: right"]08/02/16[/TD]
[TD]Free Testosterone (direct)[/TD]
[TD]53.9 pg/ml[/TD]
[TD]35.0-155.0[/TD]
[/TR]
[TR]
[TD="align: right"]08/02/16[/TD]
[TD]LH[/TD]
[TD]2.7 mIU/mL[/TD]
[TD]0.8-10.5[/TD]
[/TR]
[TR]
[TD="align: right"]08/02/16[/TD]
[TD]FSH[/TD]
[TD]4.0 mIU/mL[/TD]
[TD]1.6-9.7[/TD]
[/TR]
[TR]
[TD="align: right"]08/02/16[/TD]
[TD]Estrone[/TD]
[TD]25 pg/mL[/TD]
[TD]<68[/TD]
[/TR]
[TR]
[TD="align: right"]08/02/16[/TD]
[TD]Estradiol, Free[/TD]
[TD]12 pg/mL[/TD]
[TD]<29[/TD]
[/TR]
[TR]
[TD="align: right"]08/02/16[/TD]
[TD]Estriol[/TD]
[TD]<.20 ng/mL[/TD]
[TD]<=.18[/TD]
[/TR]
[TR]
[TD="align: right"]08/05/16[/TD]
[TD]Cortisol Free, Urine 24h[/TD]
[TD]45.8 mcg/24hr[/TD]
[TD]4.0-50.0[/TD]
[/TR]
[TR]
[TD="align: right"]08/08/16[/TD]
[TD]Total Testosterone[/TD]
[TD]676.2 ng/dl[/TD]
[TD]249.0-836[/TD]
[/TR]
[TR]
[TD="align: right"]08/08/16[/TD]
[TD]Free Testosterone[/TD]
[TD]8.95 ng/dl[/TD]
[TD]4.7-24.4[/TD]
[/TR]
[TR]
[TD="align: right"]08/08/16[/TD]
[TD]% Free Testosterone[/TD]
[TD]1.3[/TD]
[TD]1.6-2.9[/TD]
[/TR]
[TR]
[TD="align: right"]08/08/16[/TD]
[TD]SHBG[/TD]
[TD]65.78[/TD]
[TD]10.0-80[/TD]
[/TR]
[TR]
[TD="align: right"]08/08/16[/TD]
[TD]Albumin[/TD]
[TD]4.7[/TD]
[TD]3.5-5.0[/TD]
[/TR]
[TR]
[TD="align: right"]08/10/16[/TD]
[TD]DHEAS[/TD]
[TD]274.1 ug/dL[/TD]
[TD]138.5-475[/TD]
[/TR]
[TR]
[TD="align: right"]08/10/16[/TD]
[TD]Estradiol[/TD]
[TD]27.5 pg/mL[/TD]
[TD]8.0-35[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]DHT[/TD]
[TD]574 pg/mL[/TD]
[TD]106-719.0[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]SHBG[/TD]
[TD]57 nmol/L[/TD]
[TD]11-80[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]Prolactin[/TD]
[TD]5.8 ng/mL[/TD]
[TD]2.5-17[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]Vitamin D[/TD]
[TD]60.1 ng/mL[/TD]
[TD]30-80[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]Hemoglobin[/TD]
[TD]15.5 g/dL[/TD]
[TD]13.7-17.5[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]Hematocrit[/TD]
[TD]46.40%[/TD]
[TD]39.0–55.0[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]PSA[/TD]
[TD]1.59 ng/mL[/TD]
[TD].09-2.5[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]Estradiol[/TD]
[TD]25 pg/mL[/TD]
[TD]6.0-66[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]LH[/TD]
[TD]1.5 mIU/mL[/TD]
[TD][/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]FSH[/TD]
[TD]2.9 mIU/mL[/TD]
[TD]1.6-9.7[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]TSH[/TD]
[TD]0.92 uIU/mL[/TD]
[TD]0.47-4.68[/TD]
[/TR]
[TR]
[TD="align: right"]10/20/16[/TD]
[TD]Total Testosterone[/TD]
[TD]319 ng/dL[/TD]
[TD]160-726[/TD]
[/TR]
[TR]
[TD="align: right"]11/07/16[/TD]
[TD]Progesterone[/TD]
[TD]0.5 ng/mL[/TD]
[TD]0.0-0.1[/TD]
[/TR]
[TR]
[TD="align: right"]11/07/16[/TD]
[TD]Total Testosterone[/TD]
[TD]883 ng/dL[/TD]
[TD]348-1197[/TD]
[/TR]
[/TABLE]
Thanks!

 

[CoastWatcher]

Welcome to EM. I certainly think you should contact Defy. That doesn't mean that I think you should start TRT, it means you are presenting with an enormous number of variables that an expert should evaluate. Your total testosterone sits at a very comfortable level, 883, except when it falls to an absurdly low level of 319. Were all of these labs drawn in the morning? Or were some, perhaps the lower recorded testosterone levels, drawn later in the day? That wouldn't explain the enormous variation in scores, but it's something to consider.

Your instincts - that someone who knows androgen replacement should be consulted - is a strong one. You have gone round and round testing. Contact someone who can bring some order to the data you have, match it to your symptoms, and help you manage your health.

 

[johndoesmith]

Consult defy, they're great at what they do, but I honest to God don't think you should consider TRT, most of your levels are 900! I mean, I'm on TRT and that's my trough.

Yes you do have fairly high SHBG, but your free test is not bad, E2 is fine, DHT is upper range, I do not think your issues are hormonal.

 

[YoungOldMan]

All of the labs were taken between 9am and 11am. I don't know why it fluctuates so much. In 2011 I had been dieting pretty heavily which I'm sure didn't help. I'm a healthy weight right now, 5' 10" and 170 lbs. What do you think about the progesterone being so high? My family doc mentioned trying Wellbutrin to see if its a mood or dopamine issue. I could try that but I am hesitant to mess with neurochemistry. There is also the unfortunate possibility of a physical issue causing my erection problems.

 

[johndoesmith]

All of the labs were taken between 9am and 11am. I don't know why it fluctuates so much. In 2011 I had been dieting pretty heavily which I'm sure didn't help. I'm a healthy weight right now, 5' 10" and 170 lbs. What do you think about the progesterone being so high? My family doc mentioned trying Wellbutrin to see if its a mood or dopamine issue. I could try that but I am hesitant to mess with neurochemistry. There is also the unfortunate possibility of a physical issue causing my erection problems.

A bad nights sleep can crash a guys testosterone pretty reliably.

Also, progesterone is not high. Labcorp recently changed their reference range for no reason from 0-1.4 IIRC. 0-0.1 is a complete joke.

 

[Vince]

If you're total testosterone is 883, you definitely don't want to start TRT. I would think there's other reasons why you lost your libido.

 

[Vince Carter]

Have you been using stomach acid reducers, PPIs like Prilosec, Omeprazole, etc.., Those are known erection killers thru destroying nitric oxide. Like my friends Im thinking something other than hormonal.

 

[YoungOldMan]

I took H2 blockers (pepcid, zantac) every night for 12 years. I have been able to stop them and haven't taken any for about 6 weeks. My progesterone was 2.0 on the original reference range (0.4 - 1.5). I went months (maybe years) without nocturnal erections. I get them some nights now, but they aren't firm and go away quickly. From what I've read, going too long without night erections can cause permanent fibrosis. I didn't realize that at the time.

 

[Vince Carter]

Im wondering now about perm damage thru use of those PPIs, I used for about 2 years or 3 and I can correlate much of my ED problems right around that period. I've stopped about a year ago at least but may not have recovered fully I don't think. I use a lot of nitric oxide supps like Citrulline and Arginine.

 

[CoastWatcher]

I took H2 blockers (pepcid, zantac) every night for 12 years. I have been able to stop them and haven't taken any for about 6 weeks. My progesterone was 2.0 on the original reference range (0.4 - 1.5). I went months (maybe years) without nocturnal erections. I get them some nights now, but they aren't firm and go away quickly. From what I've read, going too long without night erections can cause permanent fibrosis. I didn't realize that at the time.

Have you had a urological consultation?

 

[YoungOldMan]

I've seen a couple urologists. My family doc and one urologist said I had a "boggy" prostate. One said my prostate felt fine. I've been doing stretches in case my pelvic floor is too tight. I don't have symptoms of bacterial prostatitis but I could try a round of antibiotics anyway. One doctor didn't see a venous leak on an ultrasound, but did see signs of corporal scarring. He thought the scarring could be causing a venous leak that wasn't detected on the ultrasound due to the strength of the erection injection they gave me. He recommended injecting my penis when I want to have sex.... At 35 I want to make damn sure that's the issue before I start doing that. I've started getting occasional night time erections, so I am thinking it may be hormonal or mood. That same doctor said my SHBG should be down closer to 10 and wanted to put me on clomid and arimidex. From what I've read that doesn't sound like a good plan.

My free T is sometimes in the lower quartile but that may not be the cause (DHT is okay). Can SHBG bind to E2 and DHT as well?

There is always the possibility that it's depression, that's why I've considered Wellbutrin. I am stressed for sure, but I don't feel overly depressed, still it may be worth a shot. Either way my libido is very low too.

 

[CoastWatcher]

I've seen a couple urologists. My family doc and one urologist said I had a "boggy" prostate. One said my prostate felt fine. I've been doing stretches in case my pelvic floor is too tight. I don't have symptoms of bacterial prostatitis but I could try a round of antibiotics anyway. One doctor didn't see a venous leak on an ultrasound, but did see signs of corporal scarring. He thought the scarring could be causing a venous leak that wasn't detected on the ultrasound due to the strength of the erection injection they gave me. He recommended injecting my penis when I want to have sex.... At 35 I want to make damn sure that's the issue before I start doing that. I've started getting occasional night time erections, so I am thinking it may be hormonal or mood. That same doctor said my SHBG should be down closer to 10 and wanted to put me on clomid and arimidex. From what I've read that doesn't sound like a good plan.

My free T is sometimes in the lower quartile but that may not be the cause (DHT is okay). Can SHBG bind to E2 and DHT as well?

There is always the possibility that it's depression, that's why I've considered Wellbutrin. I am stressed for sure, but I don't feel overly depressed, still it may be worth a shot. Either way my libido is very low too.

You've run blood test after blood test - with conflicting results, consulted a number of doctors - and you're right to be wary of quick fixes, so now what? You indicated you were open to a consultation with Defy (I am not a Defy patient, I have no vested interest in your consulting them), and I think it's a good idea. A medical team that understands how to fully evaluate your hormonal situation will do just that.

 

[YoungOldMan]

I agree, Defy Medical sounds like the logical next step. I've sent them everything I have and will get in ASAP. It's always possible that the heartburn medicine or stopping AAS without a restart caused permanent penile damage; obviously I am hoping that is not the case and examining every other possibility.

 

[Vince]

I agree, Defy Medical sounds like the logical next step. I've sent them everything I have and will get in ASAP. It's always possible that the heartburn medicine or stopping AAS without a restart caused permanent penile damage; obviously I am hoping that is not the case and examining every other possibility.

Hopefully Defy can help, keep us updated on your progress.

 

[CoastWatcher]

I agree, Defy Medical sounds like the logical next step. I've sent them everything I have and will get in ASAP. It's always possible that the heartburn medicine or stopping AAS without a restart caused permanent penile damage; obviously I am hoping that is not the case and examining every other possibility.

Pas Vince noted above, we hope you'll keep us updated. All the best.

 

[CSI007]

Curious if you have lost penile sensitivity or is it just erection issues you have been dealing with?