Never found a root cause to my Low T. Any ideas?

[WindFish1993]

Hi, I originally started investigating my low T levels by happenstance when I was 23 and went in for a physical for some erection problems and excessive fatigue. Testosterone didn’t even cross my mind and I didn’t even ask for it on the blood test but it came back at ~313ng/dL. My PCP disregarded it and gave me Viagra and sent me on my way. Fast forward a few years I have a new doctor and I am going because I’m losing my hair all of a sudden and I want finasteride but I mentioned my low testosterone too him and asked him to run the test again. It comes back even lower at ~264ng/dL. There’s no way I’m taking finasteride I asked him for help with T and he says he spoke with an endocrinologist and everything is fine but I can get some SSRIs because I sound depressed… I wonder why.

Finally I got the courage to just go to a clinic. They do my blood work and it’s a lot more in depth. My total T is really low, but my free T is in range and pretty average. I see this is because I have really low SHBG.

I started researching SHBG and it says I could be diabetic, obese, fatty liver, drink too much etc.

I am 6’1 175lbs and 15% body fat at the time, going to the gym 3-4 times a week doing 5x5 strength training but never making any progress. My diet was probably better than the average American but nothing to write home about and certainly not diabetes inducing.

So is my low SHBG pushing my T down or is it the other way around? Or is it something else entirely? My estrogen seemed fine, my prolactin seemed fine, my TSH seemed fine, my pituitary seems to be signaling my balls but they’re just not pumping enough out. My cholesterol also seems to be a factor in the SHBG picture. I have been able to lower these numbers but I have no clue why someone of my fitness level has such a low HDL. My hair loss also seems to be amplified by the low SHBG even prior to TRT. As I understand T converts to DHT and E and with low SHBG it converts at a higher rate to these, but since my E is relatively low I likely have higher DHT levels causing more hair loss.

Why do I have low SHBG? Why do I have low T? It’s a question that has bothered me since starting TRT. Does anyone have any ideas? Has anyone ever succeeded in coming off TRT and getting back into a normal range?

 

[Systemlord]

So is my low SHBG pushing my T down or is it the other way around?

The low SHBG is a symptom, not a cause. Low-T is a symptom secondary to something else that is lowering it.

Why do I have low SHBG?

Genetics, fat mass play a role in SHBG levels, in metabolic syndrome, SHBG is suppressed. Most secondary (pituitary failure) cases are caused by either obesity, metabolic syndrome and or type 2 diabetes.

Has anyone ever succeeded in coming off TRT and getting back into a normal range?

Most guys that come here and ask this question sadly aren’t able to increase T naturally enough to relieve all symptoms of low-T. Also the fact you’re asking the question, if you were a go-getter, the type of guy can achieve anything in life, an alpha male, you would be out there reversing low-T instead of asking if you can do it.

A young man (23 yrs old) has a much better chance are turning things around than an older men with declining T.

 

[WindFish1993]

Thanks for the reply, but in regards to SHBG I have ruled out all of those.

Obesity - Definitely not, been working since I was 18

Metabolic Syndrome - Again, I’m not obese

Diabetes - If I was diabetic I think I would have found out by now and my PCP would have intervened.

This leads me to believe it’s genetic.

But if SHBG is not a cause of low T but a symptom then something else was bringing it down. But what? I’m not sure what you mean by saying to go out and reverse it, I live an active life and eat a healthy diet. I’m almost 30 now and on TRT already, 23 is just when the gears started turning that this is something that could be the problem. Is this just a genetic lottery type thing? Possible testicular damage?

 

[Systemlord]

Is this just a genetic lottery type thing?

That’s what it really boils down to, genetics, bad hands and good ones. I want to look like Dwayne Johnson, but I just don’t have the genetics for it.

The low-T may even be environmental.

We are NOT all born equal.

 

[Systemlord]

Testosterone Levels 100 Years Ago - TestosteroneDecline.com

Here's real data on testosterone from 1962, and estimated testosterone 100 - 300 years ago. There's also a study of testosterone almost 2000 years ago in Egypt!

testosteronedecline.com

 

[Guided_by_Voices]

There must be something(s) in the environment (human-caused) that are creating wide-spread hormonal issues. Flouride, atrazine, plastics and other endocrine disrupters, personal care products, seed oils, high insulin levels, and lots of other potential things all could be involved. Like cancer and autism, hormonal issues do not have the pattern of things for which genetics is the root cause.

 

[sammmy]

Your posted labs are more than 1 year old. Are you currently on TRT and have you done labs 6 weeks after you started TRT?

 

[sammmy]

Thanks for the reply, but in regards to SHBG I have ruled out all of those.

Obesity - Definitely not, been working since I was 18

Metabolic Syndrome - Again, I’m not obese

Diabetes - If I was diabetic I think I would have found out by now and my PCP would have intervened.

This leads me to believe it’s genetic.

But if SHBG is not a cause of low T but a symptom then something else was bringing it down. But what? I’m not sure what you mean by saying to go out and reverse it, I live an active life and eat a healthy diet. I’m almost 30 now and on TRT already, 23 is just when the gears started turning that this is something that could be the problem. Is this just a genetic lottery type thing? Possible testicular damage?

High triglycerides are typically related to eating lots of sugary foods.
Sugar converts to triglycerides by the liver, which is a process that competes with production of SHBG in the liver. That's why SHBG is lower in people that overconsume sugar.
Your body has a set point for free testosterone. When your SHBG is lower, that set point is achieved at low total testosterone level, as yours.

This is my theory of your pre TRT levels. It is not necessarily correct. There was either a problem with your diet or there is a problem with your liver. Skinny people can get high triglycerides or fatty liver too. You don't need to be actually fat.

If the problem was the diet, you could have tried to resolve it by limiting fast carbs - no added sugar (avoid processed foods, they typically contain added sugar), less fruits full of sugar (get vitamins from vegetables), no honey, no milk products (lactose is a fast sugar). This should bring your SHBG up and then, if the theory is correct, your total testosterone will go up too. This all is a speculation applying to the time you are not using TRT.

The behavior of SHBG on TRT is driven by the external testosterone that you are supplying so it is a completely different scenario.

Regarding your hair loss, you should have tested the DHT level.

 

[WindFish1993]

Your posted labs are more than 1 year old. Are you currently on TRT and have you done labs 6 weeks after you started TRT?

Yes, I have labs on TRT but not really interested in those. My triglycerides dropped 50 points after starting as well as my LDL which went down to like 100. I did clean up my diet by cutting out the saturated fat as much as possible and any excess sugar because I saw my cholesterol numbers were terrible but unfortunately I was on TRT after I did that. I wasn’t a nutrition expert prior to this (still not) I just tried to eat what I thought was good which in my mind was high protein, low carb, medium fat foods.

Breakfast might be either oatmeal or eggs and then milk

Lunch was basically Greek yogurt, granola, fruit, cheese, nuts etc.

Dinner was usually meat, veggie, carb like chicken with corn tortillas and carrots on the side.

I did drink a ton of milk and I did like having dessert. But I always ate this stuff in limited portions or not every day. I just didn’t feel like my diet was terrible enough to warrant my numbers. But maybe if I had done a stricter diet I could have seen some success.

Maybe knowing what I know now I could attempt to come off and see if I can diet how I do now to improve my numbers, but something tells me the results wouldn’t be extraordinary.

 

[wannabefan]

You appear to be supplementing with DHEA. You might stop. You might get a Pregnenolone lab. You might get a urine metabolite (DUTCH) test, and see if you are a responder/converter. You might get a DHT lab.

 

[WindFish1993]

You appear to be supplementing with DHEA. You might stop. You might get a Pregnenolone lab. You might get a urine metabolite (DUTCH) test, and see if you are a responder/converter. You might get a DHT lab.

No DHEA supplements ever. My DHEA maxed out the reference range after starting TRT as did my IGF-1.

What would the urine test be for? Why DHT & Preg too?

Do you mean a TRT responder? I’ve done pretty well on ED injections. 18mg/day is probably my max tolerated amount before I start breaking out. Muscle mass went up 20lbs, strength up, libido up, energy up. What I fail to understand is if low SHBG is so bad and exogenous androgens decrease SHBG then how are people on huge cycle doses able to build muscle? One would think 300mg+ doses would suppress SHBG in them heavily, but they seem to do great.

Also, I thought it was strange that my free testosterone showed as in range but if I actually calculate it from Albumin, SHBG, and TT it’s actually below the range at 66pg/ml. That’s 2.5th percentile according to the NCBI study. So I’m not sure what they calculated I can’t find anything with their reference ranges.

Reference Ranges for Testosterone in Men Generated Using Liquid Chromatography Tandem Mass Spectrometry in a Community-Based Sample of Healthy Nonobese Young Men in the Framingham Heart Study and Applied to Three Geographically Distinct Cohorts - PMC

Reference ranges are essential for partitioning testosterone levels into low or normal and making the diagnosis of androgen deficiency. We established reference ranges for total testosterone (TT) and free testosterone (FT) in a community-based ...

www.ncbi.nlm.nih.gov

With an LH of 3, it’s in range but on the lower end. I believe with low to low-Normal LH I am secondary hypo? I noticed when I used Enclomiphene I had a lot of pressure behind my nasal cavity where the pituitary gland exists. I am curious if there is something causing my LH to be on the lower end of what I need to stimulate my testes. Is the relationship with LH and TT linear? E.g. if I triple LH would that triple my TT? That puts me in a much better range and I assume it would come with a response for SHBG too?

 

[wannabefan]

It’s unclear if at the time of your serum labs if you had washed out prior TRT.

You have LH so I assume you were either “coming down” from TRT or had fully washed out prior use.

DHEA is upstream Testosterone, and feeds T. You have shown the metabolite “S” of DHEA. I would want a fuller picture of what is upstream DHEA, namely Pregnenolone, and what my metabolite conversion is for both adrenal and androgen pathways. I wouldn’t fixate on SHBG as that is a by-product of T, not causative; your Albumin levels are normal.

I don’t believe T to DHEA is a 2-way street so unclear why TRT would increase DHEA-S, as it typically does not. DHEA-S also regulates glucose uptake, possibly impacting your sugar level noted and high triglycerides, typical of carbohydrate intake. I would do a fasting lab draw and get a urine metabolite test when on nothing and then add one thing back at a time, TRT if that is your goal, to go from 266 to 700 (but unclear what physical or cognitive goals you have).

And get a HCt next time as well-standard for a CBC.

 

[Systemlord]

That puts me in a much better range and I assume it would come with a response for SHBG too?

SHBG is made in the liver, thyroid hormones, diet, (genetics) influence SHBG production. You have early signs of metabolic syndrome, lipids, glucose and lower end SHBG. Give it enough time and type 2 diabetes is a certainty.

Since you’re not overweight, your metabolic syndrome is either environmental or genetics, neither of which you can do anything about.

 

[WindFish1993]

Maybe some confusion here, but the labs I have shared are prior to any TRT use. I just wanted to share them since I never got a good answer prior to starting TRT as to what I did or didn’t do to cause my low T.

As systemlord stated, it could very likely be something beyond my control. Simply genetics. I am not so sure about type 2 diabetes though. Because going back to the steroid user example, wouldn’t we see these people developing type 2 diabetes too?

But I am reading more into the type 2 diabetes causes in otherwise healthy weight individuals and it seems that you can have organ fat without looking physically fat.

 

[wannabefan]

SHBG is made in the liver, thyroid hormones, diet, (genetics) influence SHBG production. You have early signs of metabolic syndrome, lipids, glucose and lower end SHBG. Give it enough time and type 2 diabetes is a certainty.

Since you’re not overweight, your metabolic syndrome is either environmental or genetics, neither of which you can do anything about.

Intermittent fasting and a CGM would help.

 

[WindFish1993]

Intermittent fasting and a CGM would help.

“As for men, intermittent fasting reduced testosterone levels in lean, physically active, young males, but it did not affect SHBG concentrations”

Effect of Intermittent Fasting on Reproductive Hormone Levels in Females and Males: A Review of Human Trials - PMC

Intermittent fasting is a popular diet for weight loss, but concerns have been raised regarding the effects of fasting on the reproductive health of women and men. Accordingly, we conducted this literature review to clarify the effects of fasting on ...

www.ncbi.nlm.nih.gov

This hormone sucks…

From another study

“We conclude that insulin and PRL inhibit SHBG production and confirm that T4, T, and E2 stimulate SHBG production in vitro.”

I don’t get it. In Males, it seems intermittent fasting has no effect on SHBG. IM probably increases insulin sensitivity, but that’s not going to help if insulin resistance isn’t the cause. So maybe it’s not so much that my SHBG is being inhibited but that it is not being stimulated into production to begin with.

My TSH was in range, but my T and E2 are low. Which brings me back to the LH signaling. If it were higher perhaps I would see these other marks fall in line? I don’t know enough to say.

Are SERMs the best/only drug to do this? I tried Enclomiphene but it gave me eye floaters and pressure behind my nasal cavity where my pituitary is located.

 

[wannabefan]

It sounds like you may actually need a metabolic workup and a complete insulin resistance challenge test, some monitoring, etc. before you tackle TRT.

 

[Cataceous]

...
Also, I thought it was strange that my free testosterone showed as in range but if I actually calculate it from Albumin, SHBG, and TT it’s actually below the range at 66pg/ml. That’s 2.5th percentile according to the NCBI study. So I’m not sure what they calculated I can’t find anything with their reference ranges.
...

The immunoassay-based direct free testosterone test is so inaccurate that it should not be used. I would definitely trust the Vermeulen calculation over it. Ideally you would retest with an accurate method, such as equilibrium dialysis. Your numbers do suggest secondary hypogonadism. You have to be a bit cautious in interpreting LH measurements, because the hormone is pulsatile, as depicted below. Primary hypogonadism is generally accompanied by continuous upper-range or higher LH, which is not the case with you.

My impression is that the majority of cases of secondary hypogonadism are caused by either hypothalamic dysfunction or upstream brain-mediated dysfunction, e.g. an inappropriate starvation response. Regarding restoration or enhancement of LH signaling, SERMs are the best-studied treatment, but kisspeptin shows some promise. GnRH is an option with FDA approval, but the protocol is complex, requiring either frequent injections or a pump system.

 

[muhusmanguj]

View attachment 30234View attachment 30235View attachment 30236Hi, I originally started investigating my low T levels by happenstance when I was 23 and went in for a physical for some erection problems and excessive fatigue. Testosterone didn’t even cross my mind and I didn’t even ask for it on the blood test but it came back at ~313ng/dL. My PCP disregarded it and gave me Viagra and sent me on my way. Fast forward a few years I have a new doctor and I am going because I’m losing my hair all of a sudden and I want finasteride but I mentioned my low testosterone too him and asked him to run the test again. It comes back even lower at ~264ng/dL. There’s no way I’m taking finasteride I asked him for help with T and he says he spoke with an endocrinologist and everything is fine but I can get some SSRIs because I sound depressed… I wonder why.

Finally I got the courage to just go to a clinic. They do my blood work and it’s a lot more in depth. My total T is really low, but my free T is in range and pretty average. I see this is because I have really low SHBG.

I started researching SHBG and it says I could be diabetic, obese, fatty liver, drink too much etc.

I am 6’1 175lbs and 15% body fat at the time, going to the gym 3-4 times a week doing 5x5 strength training but never making any progress. My diet was probably better than the average American but nothing to write home about and certainly not diabetes inducing.

So is my low SHBG pushing my T down or is it the other way around? Or is it something else entirely? My estrogen seemed fine, my prolactin seemed fine, my TSH seemed fine, my pituitary seems to be signaling my balls but they’re just not pumping enough out. My cholesterol also seems to be a factor in the SHBG picture. I have been able to lower these numbers but I have no clue why someone of my fitness level has such a low HDL. My hair loss also seems to be amplified by the low SHBG even prior to TRT. As I understand T converts to DHT and E and with low SHBG it converts at a higher rate to these, but since my E is relatively low I likely have higher DHT levels causing more hair loss.

Why do I have low SHBG? Why do I have low T? It’s a question that has bothered me since starting TRT. Does anyone have any ideas? Has anyone ever succeeded in coming off TRT and getting back into a normal range?

Hello, i also have similar situation low T and low SHBG, i am facing troubles with erections. How did you solve this problem. Did viagra help you? Are you still taking it? Did TRT help with erections

Thanks

 

[WindFish1993]

I took viagra prior to TRT and it does work. I am now on TRT and my erections are fine without the need for cialis or viagra.