Annual checkup with dr, had him test for low t - results - strange

I'm hoping that someone here can give me a little understanding about some test results I just got back.
When I went to me doctor about a week ago for my annual checkup I told him I was feeling ab normal, tired, no energy, muscle weakness, no middle of the night erections and just a general run down kind of feeling. The blood work he ordered for that visit all came back normal. I was thinking in the back of my mind it was low t, so I asked him about that he said it's possible but not too likely at my age, I'm 44. Anyway he agreed to send me for some more blood work, total test, free test, bio available and shbg levels. I just got the results back from quest, my doctor appointment to follow up those tests is next week.

Here are the results from quest diagnostics and the normal range:

total testosterone 685 range 250 to 1100 ng/dl
free testosterone 49.0 range 35-155 pg/ml
bio available test 98.6 range 110 - 575 ng/dl
sbhg 70 range 10 - 50 nmol/l

So my total test is ok, and even free test is in the normal range, but my bio available is low. Is that because the shbg is high? Is a low bio available testosterone level part of the cause of my symptoms? Is there a treatment for this imbalance?

Any help or advise would be greatly appreciated.

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Originally Posted by wannabebig2

I'm hoping that someone here can give me a little understanding about some test results I just got back.
When I went to me doctor about a week ago for my annual checkup I told him I was feeling ab normal, tired, no energy, muscle weakness, no middle of the night erections and just a general run down kind of feeling. The blood work he ordered for that visit all came back normal. I was thinking in the back of my mind it was low t, so I asked him about that he said it's possible but not too likely at my age, I'm 44. Anyway he agreed to send me for some more blood work, total test, free test, bio available and shbg levels. I just got the results back from quest, my doctor appointment to follow up those tests is next week.

Here are the results from quest diagnostics and the normal range:

total testosterone 685 range 250 to 1100 ng/dl
free testosterone 49.0 range 35-155 pg/ml
bio available test 98.6 range 110 - 575 ng/dl
sbhg 70 range 10 - 50 nmol/l

So my total test is ok, and even free test is in the normal range, but my bio available is low. Is that because the shbg is high? Is a low bio available testosterone level part of the cause of my symptoms? Is there a treatment for this imbalance?

Any help or advise would be greatly appreciated.

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Maybe is another gland or thyroid issue. The test is not in the treatable range for most doctors. There could be other issues, maybe other medications or diet?

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Originally Posted by Sh0tsf1red

Maybe is another gland or thyroid issue. The test is not in the treatable range for most doctors. There could be other issues, maybe other medications or diet?

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Previous to my appointment with him he sent me for blood work, he said everything was normal, I can post results if it would help.

Your elevated shbg is binding your free testosterone. Work on lowering this. Optimizing Vit D levels will help as can Stinging Nettle Root and/or Avenacosides. Take your D with a large meal and be sure you test your levels.

I don't mean to hijack but its not worth a new thread. What does low normal Free Test and low normal SHBG mean? Its what I have and my TT is low. I read Jay Campbell's book and only talks about high FT with low shbd or high shbd and low FT.

It means your pituitary is probably not signalling downstream as strong as you'd like it to. Low LH from the pituitary will ultimately result in a lower total T level. SHBG is the protein that transports hormones in your blood, the majority of which are bound but a small amount remain free. This amount of free T is what works for you. Bound testosterone does not. Low normal shbg is fine by me.

So, elevated shbg is not healthy for the reasons above and many others. Excessively low shbg can be problematic as well for some (not all) and possibly lead to signs of metabolic syndrome. It's more complicated that that but hopefully that helps.

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Originally Posted by kelkel

Your elevated shbg is binding your free testosterone. Work on lowering this. Optimizing Vit D levels will help as can Stinging Nettle Root and/or Avenacosides. Take your D with a large meal and be sure you test your levels.

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Thanks, I've already read about Vit D, also mentioned in a few places is magnesium, boron, zinc, tongkat ali and fish oils. Maybe if my Dr. won't do TRT for my symptoms I'll try a couple months of those supps and get my blood tested again.

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Originally Posted by kelkel

Your elevated shbg is binding your free testosterone. Work on lowering this. Optimizing Vit D levels will help as can Stinging Nettle Root and/or Avenacosides. Take your D with a large meal and be sure you test your levels.

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Thanks again, Considering my options, I might just go the self administered route if my GP doesn't agree with TRT treatment. Honestly I think that might be a good route for me anyway, probably cheaper than a TRT program. And it's not in my medical record. I'd start out low, maybe 125 mg of test e a week and go up or down from there, most likely it would be up from there. My body metabolized meds quick. I'll order blood tests online every 3 to 6 months, or as I feel it's needed.

Wannabebig my response in post 6 was directed at Zoomy.

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Originally Posted by kelkel

Wannabebig my response in post 6 was directed at Zoomy.

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Oh ok, sorry. You seem to know a lot about TRT and noticed that you are a specialist, in your sig. So what are your thoughts on self administered TRT? I mean I know it may not be the BEST way to go, but can a person who follows the same protocols as a TRT doctor see good results? Medical records tend to follow people around for the rest of their lives in todays world. I'm not too sure I want TRT records to follow me unless it becomes absolutely necessary, I.E. steroid / medication suppliers get shut down and become unavailable via the normal internet.

Self-imposed TRT would be a last resort, imho. Can it be done, sure, but that doesn't mean it's the smartest thing to do. Even doctors go to doctors for treatment.

TRT is mainstream, there are no negative connotations to starting a medically supervised protocol and having it on your doctors records.

SHBG is produced in liver, and in many cases, is a response to increased cortisol. High cortisol most common cause is stress.

Do you have a stressful life and/or job?

IMO is a shame to go on TRT with a total T of 685. Get on a good dosage of vit D and zinc.

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Originally Posted by Mr.BB

SHBG is produced in liver, and in many cases, is a response to increased cortisol. High cortisol most common cause is stress.

Do you have a stressful life and/or job?

IMO is a shame to go on TRT with a total T of 685. Get on a good dosage of vit D and zinc.

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Well I've had a rough few months as far as stress is concerned. Maybe I will give the vitamins a chance to work maybe 2 months.

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Originally Posted by wannabebig2

So my total test is ok, and even free test is in the normal range, but my bio available is low. Is that because the shbg is high? Is a low bio available testosterone level part of the cause of my symptoms? Is there a treatment for this imbalance?

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Absolutely!

I have a very similar problem with similar numbers. The problem with high SHBG is that it's difficult to get a doctor to take you seriously when you have Total T levels well within normal. They often do not test for Free T or bioavailable (different tests but they tell you the same thing), even when you tell them you feel like crap. Their first inclination is to hand a script for antidepressants to get you out of their face. believe me, it's frustrating. You have to pretty much interview docs to find which ones do and do not believe that SHBG can be a problem. Unfortunately, the ones that do are generally private TRT specialists or TRT clinics and they are usually expensive and don't take insurance. Again, frustrating.

Regarding treatment, your options are limited. Go ahead and try the various OTC fixes for SHBG, but in my experience with SHBG numbers as high as yours your probably won't have a lot of luck, but it's worth a shot. Your second option is to jack up the Total T high enough to saturate the SHBG protein so that enough spills over to Free T that you at least get up to mid-range. With a SHBG value of 70, my experience is that you will need a Total T of around 1400 to 1500 ng/dL, but this may cause polycythemia problems in the long run and you end up having to dump blood, which can lead to other side-effects.

My current approach is to go off the reservation and use a drug that is no longer sold in the USA (for marketing, not safety reasons). It's an oral anabolic steroid called Winstrol (stanozolol). My experience is that very small doses (5 mg twice per day) is sufficient. Others I've talked to say that even 5 is too much and still others say they have to go up to 15 mg. So dosing appears to be variable and needs to be supported with labs. The drug is readily available overseas through normal bodybuilding steroid sources. Typical BB doses are in the 50 to 100 mg range and they do have some potential liver damage issues, but at 10 mg per day, my liver labs always seem to be OK.

Another option is a drug that is available in the USA if you can get a doc to prescribe it off label (good luck) and it's call Danazol. I have not attempted this treatment, mainly because stanozolol works and is cheaper), but others I've communicated with have had luck with doses in the 20 mg per day range. I've heard conflicting evidence that it does not actually lower SHBG, but rather competes with T for binding sites on it, so the word is still out. however, it does seem to be effective.

Special note: with either stanozolol or Danzol, you will have to still do TRT because they both suppress the natural production of T. The benefit is that you can get by with lower T doses and minimize the side-effects of excessively large T doses.

Good luck!

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Originally Posted by Youthful55guy

Absolutely!

I have a very similar problem with similar numbers. The problem with high SHBG is that it's difficult to get a doctor to take you seriously when you have Total T levels well within normal. They often do not test for Free T or bioavailable (different tests but they tell you the same thing), even when you tell them you feel like crap. Their first inclination is to hand a script for antidepressants to get you out of their face. believe me, it's frustrating. You have to pretty much interview docs to find which ones do and do not believe that SHBG can be a problem. Unfortunately, the ones that do are generally private TRT specialists or TRT clinics and they are usually expensive and don't take insurance. Again, frustrating.

Regarding treatment, your options are limited. Go ahead and try the various OTC fixes for SHBG, but in my experience with SHBG numbers as high as yours your probably won't have a lot of luck, but it's worth a shot. Your second option is to jack up the Total T high enough to saturate the SHBG protein so that enough spills over to Free T that you at least get up to mid-range. With a SHBG value of 70, my experience is that you will need a Total T of around 1400 to 1500 ng/dL, but this may cause polycythemia problems in the long run and you end up having to dump blood, which can lead to other side-effects.

My current approach is to go off the reservation and use a drug that is no longer sold in the USA (for marketing, not safety reasons). It's an oral anabolic steroid called Winstrol (stanozolol). My experience is that very small doses (5 mg twice per day) is sufficient. Others I've talked to say that even 5 is too much and still others say they have to go up to 15 mg. So dosing appears to be variable and needs to be supported with labs. The drug is readily available overseas through normal bodybuilding steroid sources. Typical BB doses are in the 50 to 100 mg range and they do have some potential liver damage issues, but at 10 mg per day, my liver labs always seem to be OK.

Another option is a drug that is available in the USA if you can get a doc to prescribe it off label (good luck) and it's call Danazol. I have not attempted this treatment, mainly because stanozolol works and is cheaper), but others I've communicated with have had luck with doses in the 20 mg per day range. I've heard conflicting evidence that it does not actually lower SHBG, but rather competes with T for binding sites on it, so the word is still out. however, it does seem to be effective.

Special note: with either stanozolol or Danzol, you will have to still do TRT because they both suppress the natural production of T. The benefit is that you can get by with lower T doses and minimize the side-effects of excessively large T doses.

Good luck!

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Well you sound like you been trying to treat your condition for a while, seems like you've learned a lot about what works for you.

I'm going to try the simple thing first, I'm going to try to use some of the over the counter supplements first, probably for a month and a half maybe two months and then get my tests done again. And then see where I stand. I don't have much hope for the OTC stuff. But it's a start. The worst that could happen is it does nothing for my SHBG problem and makes my wallet a little lighter.

I like your method of stanozolol and trt, seems like a good method except that you need to do trt. But adding stan to trt might let you keep the testosterone doses down a bit.

So anyway, I'll check back in when I get my next blood work done, hopefully there will be some progress to report on.

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Originally Posted by wannabebig2

Well you sound like you been trying to treat your condition for a while, seems like you've learned a lot about what works for you.

I'm going to try the simple thing first, I'm going to try to use some of the over the counter supplements first, probably for a month and a half maybe two months and then get my tests done again. And then see where I stand. I don't have much hope for the OTC stuff. But it's a start. The worst that could happen is it does nothing for my SHBG problem and makes my wallet a little lighter.

I like your method of stanozolol and trt, seems like a good method except that you need to do trt. But adding stan to trt might let you keep the testosterone doses down a bit.

So anyway, I'll check back in when I get my next blood work done, hopefully there will be some progress to report on.

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I agree with your approach, though it never worked for me. Best to start conservatively and go from there.

Yes, stanozolol or danzol will require supplemental TRT because they are both suppressive.

Yes, I've been dealing with it for quite some time. I believe it started in my late 30's (first time I had any ED issues) and then slowly got worse over the decades. I never had any tests done until about 5 1/2 years ago and that uncovered the problem. I've read just about everything there is to read on both the internet and medical journals, which unfortunately is supported with a paucity of research. I don't think there's a stone I haven't turned over, and if there is, I'd love to hear about it.

*Follow up*

I started taking Vitamin D, zinc and magnesium 3 days ago. Obviously I can not say about the effects on my testosterone, free T, shbg levels or bio-availability of testosterone, but I feel much better. Could it be placebo effect, possible, but for the last 2 days at work I didn't feel like I need a nap. I'm not feeling so run down after work, so I don't think it's placebo. I just find it odd that a vitamin and 2 mineral could make me so much better. Later this week I will be adding stinging nettle root and tongkat ali to my daily supps.

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Originally Posted by wannabebig2

*Follow up*

I started taking Vitamin D, zinc and magnesium 3 days ago. Obviously I can not say about the effects on my testosterone, free T, shbg levels or bio-availability of testosterone, but I feel much better. Could it be placebo effect, possible, but for the last 2 days at work I didn't feel like I need a nap. I'm not feeling so run down after work, so I don't think it's placebo. I just find it odd that a vitamin and 2 mineral could make me so much better. Later this week I will be adding stinging nettle root and tongkat ali to my daily supps.

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My testosterone decreased with suplementing with those...imo they do nothing for low test. however i do feel i get a more restful sleep when taking zma at night

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Originally Posted by hollowedzeus

My testosterone decreased with suplementing with those...imo they do nothing for low test. however i do feel i get a more restful sleep when taking zma at night

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Well I am going to get my blood tests done again in somewhere around 2 months, if my total test, free t are lower or my shbg is higher than my baseline from 2 weeks ago I will stop the supps and find something else.

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Originally Posted by kelkel

Your elevated shbg is binding your free testosterone. Work on lowering this. Optimizing Vit D levels will help as can Stinging Nettle Root and/or Avenacosides. Take your D with a large meal and be sure you test your levels.

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A,D,E,K are fat soluble vitamins. Make sure the meal has fat in it.

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Originally Posted by Quester

A,D,E,K are fat soluble vitamins. Make sure the meal has fat in it.

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Yes, and I split my dosage morning and night.

Well I had my follow up visit with my general practioner Dr. this afternoon. Nothing really new from him.
He said my total t is right in the middle of the normal range, I knew this.
He said my free t is at the bottom end of the normal range, I knew that too.
He said he wan't even completely sure how SHBG factored in to the bio availalbe t. Huh? Ok I guess that might be for a specialist.
He said he normally only looks at total t and free t, and based on my results he would not put me on TRT.
He is giving me a referal to an endocronologist, he said that would know more about the SHBG levels being low than he knows.
So now I wait to have an appointment with the endo.