Lowering SHBG to Increase Free T -- Treatment Options?

[bkb333]

Hi everyone,

First-time poster -- thank you for taking the time to read. I'm 26, 6'2", 175 pounds, 12%BF (natural to this point). I'm active & eat a clean diet (paleo-ish).

I have all the symptoms of low T, likely being caused by ultra-high SHBG. Numbers:
Total T: 1008 (ref 264-916)
Free T: 7.8 (ref 9.3-26.5)
SHBG: 186 (ref 16.5-55.9)
Albumin: 4.9 (ref 3.6-7.0)

The SHBG is concerning (liver, osteoporosis, etc), so I'm posting here to get your thoughts on treatment. Considering each of the following:
Danazol
hCG
Winstrol
Proviron

I'm open to adding T (likely test-cyp) to maintain total T during treatment, too, but fertility is a priority. What substance(s) & dosage would you try first in this situation? Thanks in advance for your help.

[Youthful55guy]

Hi everyone,

First-time poster -- thank you for taking the time to read. I'm 26, 6'2", 175 pounds, 12%BF (natural to this point). I'm active & eat a clean diet (paleo-ish).

I have all the symptoms of low T, likely being caused by ultra-high SHBG. Numbers:
Total T: 1008 (ref 264-916)
Free T: 7.8 (ref 9.3-26.5)
SHBG: 186 (ref 16.5-55.9)
Albumin: 4.9 (ref 3.6-7.0)

The SHBG is concerning (liver, osteoporosis, etc), so I'm posting here to get your thoughts on treatment. Considering each of the following:
Danazol
hCG
Winstrol
Proviron

I'm open to adding T (likely test-cyp) to maintain total T during treatment, too, but fertility is a priority. What substance(s) & dosage would you try first in this situation? Thanks in advance for your help.

That's one of the highest SHBG levels I've ever seen. Do you have liver damage that we should know about? What other drugs are you taking? That level is so far out, I'm hesitant to recommend starting any treatment until you figure out what's driving it up.

However, here's a copy/paste from a recent post I made in this fourm.

You do not want to go too low on SHBG, because then you will metabolize T too quickly and your Free T will drop like a rock. It's a delicate balance. I would shoot for about 30 to 35 nmol/L with your test range. The difficulty here is that you need either a very open minded doc to get the drugs prescribed, or go off the reservation and obtain them through alternate channels (my approach). There are basically 3 choices in the USA for prescription drugs: Anavar (Oxandrolone), Danazol (Danocrine), and Proviron . In the EU and elsewhere you also have the choice of Winstrol (Oral Stanozolol ). I only have experience with Anavar and Winstrol, and both are EXTREMELY effective at very low dosages so there are minimal side-effects. With Anavar, I've found that 5mg 2X per day is optimal for me. For Winstrol, the dose is lower at 5mg 2X per day. I recommend 2X per day dosing because they both have very short half lives. Winstrol is much less expensive than Anavar, so there is less counterfeiting if you obtain it through alternate channels. I do not have personal experience with Danazol, but I did see two posts where guys found it effective at 20-30 mg per day. It is about as expensive as Anavar, so I see no real reason to use it unless you can get it prescribed and covered by insurance (not likely). There is very little information out there in Proviron and the stuff that's out there is mixed information.

[bkb333]

That's one of the highest SHBG levels I've ever seen. Do you have liver damage that we should know about? What other drugs are you taking? That level is so far out, I'm hesitant to recommend starting any treatment until you figure out what's driving it up.

Thank you for getting back to me! I have heard that from a number of people -- that my SHBG is WAY too high. I do not have any liver damage that I am aware of; I don't drink alcohol currently, and only did so for a couple years in college. I also am not taking any other drugs (outside of basic supplements like multivitamin/turmeric).

I've read mixed information about this, but I think my high-fat/low-carb diet (basically keto) for the past 2 years may have played a role. Additionally, overtraining for a long period of time may have contributed. However, that still doesn't fully explain why that number is so high.

Planning on seeing an endo to discuss hormone options. Do you think I should see any other specialist(s) for tests?

I also looked through your other posts and saw you prefer Winstrol to lower high SHBG. Have you seen any side effects?

[Youthful55guy]

Thank you for getting back to me! I have heard that from a number of people -- that my SHBG is WAY too high. I do not have any liver damage that I am aware of; I don't drink alcohol currently, and only did so for a couple years in college. I also am not taking any other drugs (outside of basic supplements like multivitamin/turmeric).

I've read mixed information about this, but I think my high-fat/low-carb diet (basically keto) for the past 2 years may have played a role. Additionally, overtraining for a long period of time may have contributed. However, that still doesn't fully explain why that number is so high.

Planning on seeing an endo to discuss hormone options. Do you think I should see any other specialist(s) for tests?

There's a genetic anomaly that affects about 20% of the population where we add an extra sugar to the SHBG molecule (wish I could find that original reference). This has the effect of more than doubling the half life of the protein. Since high SHBG don't really impact women much, it means that only about 10% of the population (the men of that 20%) that exhibit clinical manifestations. Since the half life is doubles, and we produce at roughly the same rate as the other 90% of men, it means that we have higher levels because it sticks around longer. Yours however is EXTEMELY high. Has this be corroborated by more than one test? If not, I'd get it retested.

My experience with high SHBG (70 to 95 range untreated) is that it is relatively unaffected by diet and all of the supplements out there claiming to reduce SHBG only reduce the size of your pocketbook. I'm not saying don't give them a try or manage you nutrition, I'm just saying it's a long way to go from 186 nmol/L to the more idea 25-35 nmol/L.

Regarding specialists, few even acknowledge the importance of SHBG in men's health. However, given your extreme case, perhaps you can get their attention. Your insurance may be another issue, even if you can get a doc to prescribe Anavar or Danazol, and the drugs are expensive. They are simply not approved for this indication and they are considered schedule 2 drugs, so they have higher scrutiny. However, I'd go down the specialist route before the self-treatment route. You should see if there is an underlying cause. The drugs are easy to obtain through alternate channels if/when you decide to go down that route.

[bkb333]

Regarding specialists, few even acknowledge the importance of SHBG in men's health. However, given your extreme case, perhaps you can get their attention. Your insurance may be another issue, even if you can get a doc to prescribe Anavar or Danazol, and the drugs are expensive. They are simply not approved for this indication and they are considered schedule 2 drugs, so they have higher scrutiny. However, I'd go down the specialist route before the self-treatment route. You should see if there is an underlying cause. The drugs are easy to obtain through alternate channels if/when you decide to go down that route.

Thank you, seriously, for all your help. Seems like you're the SHBG expert around here! I'm hearing I'll probably have a hard time finding an endo to treat me because my total T is super high. However, as you know, that makes no real difference to my body, as my free T:total T ratio is waaaaay off and my low accessible T is killing me. I'd rather not go the alternate channel route, as I know my wife wouldn't like it. Were you able to find an endo willing to treat your high SHBG? Did you find any channel other than self-medication that helped? Thanks again for all your help

[Youthful55guy]

Thank you, seriously, for all your help. Seems like you're the SHBG expert around here! I'm hearing I'll probably have a hard time finding an endo to treat me because my total T is super high. However, as you know, that makes no real difference to my body, as my free T:total T ratio is waaaaay off and my low accessible T is killing me. I'd rather not go the alternate channel route, as I know my wife wouldn't like it. Were you able to find an endo willing to treat your high SHBG? Did you find any channel other than self-medication that helped? Thanks again for all your help

Four points.

1) Your Total T is high because SHBG is high. SHBG binds and protects T from liver metabolism, so it drives Total T (and probably DHT) way up. On the other hand, it binds T and prevents it from passing through the blood-brain barrier. So, even though you are swimming in T, you feel the mental effects of low T. It really sucks to get help from a Neanderthal medical community that refuses to acknowledge the importance of SHBG in men's health.

2) No, I had no luck finding mainstream medical help other than through the doc that got me on my current protocol. However, his approach was not to treat the SHBG, but rather to saturate it with T through TRT so that enough spilled over to Free T for me to feel normal again. This only works to a certain extent. I had a SHBG in the 70 to 95 nmol/L range, and I have to drive my Total T up into the 1200 to 1600 ng/dL range to get enough Free T. While that approach does work, it has limitations because bound T still has some peripheral effects such as driving up hemoglobin production, so those high Total T ranges at difficult to sustain.

3) Bioavailable T is another testing option that can substitute for Free T. My experience is that the results parallel Free T very well and mainstream docs tend to accept it better than free T. I'm guessing that it's all in the name.

4) I went down the self-treatment route after reading as much as I could find in both the medical literature and the web (careful, it's unfiltered information). I settled on Winstrol as my drug of choice because it is supported with some adequate research (not great, but adequate) and it is fairly inexpensive. Also, there's lots of bodybuilder chat supporting its use for lowering SHBG. My experience corroborates this, but you only need very low doses compared to what BB use. Anavar has some very good randomized controlled studies supporting SHBG suppression, but its expensive (even through alternate channels) and you need a higher dose. In terms of side-effects, I believe they are similar and low when dosed properly.

[kelkel]

Thank you, seriously, for all your help. Seems like you're the SHBG expert around here!

He is that. Excellent with it.

[bkb333]

Since I received such a strong response to my ridiculous SHBG, I've been paranoid about my health. Nothing below is that striking, right?

Blood Urea Nitrogen 19.0 (10-25)
Creatinine .93 (.5-1.4)
Alkaline Phosphatase 49.0 (30-115)
Bilirubin - Total .38 (0.1-1.2)
AST(SGOT) 24.0 (0-41)
ALT(SGPT) 22.0 (0-45)
GGT 12.0 (2-65)

Do you think I have reason to panic, or could a good hormone plan fix my crazy SHBG? I also wonder whether I may have hypothyroidism.

[Youthful55guy]

Since I received such a strong response to my ridiculous SHBG, I've been paranoid about my health. Nothing below is that striking, right?

Blood Urea Nitrogen 19.0 (10-25)
Creatinine .93 (.5-1.4)
Alkaline Phosphatase 49.0 (30-115)
Bilirubin - Total .38 (0.1-1.2)
AST(SGOT) 24.0 (0-41)
ALT(SGPT) 22.0 (0-45)
GGT 12.0 (2-65)

Do you think I have reason to panic, or could a good hormone plan fix my crazy SHBG? I also wonder whether I may have hypothyroidism.

You bloods look good, and in particular the liver enzymes look excellent. So liver damage is probably not the cause. Although it is a known factor that can raise SHBG, it does not appear to be your case.

I would have thyroid labs done, but supplementing thyroid hormones is also known to increase SHBG, so I'd be very careful about going down that road.

All kidding aside, you could just be a genetic mutant. You may have a more extreme case than I do with increased glycosylation (addition of sugar) of the SHBG protein.

I'm running out of suggestions. I would ask a doc about it, but I'm not sure if endocrinologists will be much help. Most of them even acknowledge the existence of the protein, let alone its importance in male health.

You may have to venture down the self-treatment path like I did.

[wellshii]

..............

[wellshii]

If wont be hypo,buy hyperthyroidism. Like mentioned above,get a full thyroid panel as well as estrogens and insulin and adrenals(cortisol especially)

When you say paleoish,what exactly does a daily diet consist of?
You taking a good Multi ?Hows your Iodine intake? Boron also known to lower shbg.

I also did a keto diet for 8 months or so. I started carbs again too quickly which lowered my blood sugar too much(insulin sensitivity)
Went to a doc and got some test done.(He didnt know s**t BTW and this was an endo)
My free test was 92.4 pg/ml(ref range 35-155) and total test 713 ng/dl (250-1100)This was maybe two weeks after the re-indroduction of carbs. Come to think of it,I should have got my shbg tested just to see where it was at. Who knows what my free test was before the carbs. Insulin is known to lower shbg as well.

But I would address the root of course than throw drugs at it.

Edit: Found this thread and the root of his problem,glad he updated it
Skyhigh SHBG Levels - WHY?! | Page 3 | All Things Male Forum

One more thing,do you take flaxseed? I was taking flax daily and decided to get my test measure again,my Free test was lower by a wide margin . That was the only thing I was doing differently at that time and linked it to that. (This was after the above info)

Heres a study on that as well.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752973/

I am extremely curious as to the root cause of this.

[Youthful55guy]

Oh, something I ran across the other day while researching this topic in PubMed. Statins, especially Atrovastin, may actually LOWER SHBG. I did this search in response to another thread asking if Atrovastin might increase it. I found two fairly good papers the point to the opposite.

However, Statins (as a class) do lower Total T production. This has been pretty firmly established, but this should not affect guys on TRT at the same time as Statins since we don't make any endogenous T anymore. This interesting observation in these studies is that while Total T is decreased in guys on statins without TRT, Free T is not decreased. This was an early clue to it's decreasing SHBG production. Now it's been measured that certain statins (such as Atrovastin/Lipitor) do indeed lower SHBG.

I currently take 10mg, but I might discuss a dose increase with my doc, depending on my lipid labs at my next annual visit in the October.

[bkb333]

Thank you for the insight!

When you say paleoish,what exactly does a daily diet consist of?
You taking a good Multi ?Hows your Iodine intake? Boron also known to lower shbg.

Diet: rough macro breakdown has been 15% carbs, 30% protein, 55% fat. My carbs all came from clean sources like sweet potatoes, veggies, and white rice. Really interested in seeing if a change in diet -- I've gone to 30% carbs, 35% protein, 35% fat -- changes SHBG.

I do take a multivitamin and just started taking Boron, but I have never tested (or supplemented with) Iodine. Is that important to add?

I also did a keto diet for 8 months or so. I started carbs again too quickly which lowered my blood sugar too much(insulin sensitivity)
Went to a doc and got some test done.(He didnt know s**t BTW and this was an endo)
My free test was 92.4 pg/ml(ref range 35-155) and total test 713 ng/dl (250-1100)This was maybe two weeks after the re-indroduction of carbs. Come to think of it,I should have got my shbg tested just to see where it was at. Who knows what my free test was before the carbs. Insulin is known to lower shbg as well.

Sorry to hear about your experience. Seems most of these endos don't know anything. Excited to partner with Defy.

One more thing,do you take flaxseed? I was taking flax daily and decided to get my test measure again,my Free test was lower by a wide margin . That was the only thing I was doing differently at that time and linked it to that. (This was after the above info)

I have taken flaxseed on occasion, but definitely not regularly.

Thanks again for all your help.

[bkb333]

If wont be hypo,buy hyperthyroidism.

So hyperthyroidism means producing too many hormones, correct? And that's what happens when SHBG & total T are too high?

When you say paleoish,what exactly does a daily diet consist of?
You taking a good Multi ?Hows your Iodine intake? Boron also known to lower shbg.

I've been eating roughly 15% carbs, 25% protein, and 60% fat. Carbs came from good sources like sweet potatoes, white rice, veggies, fruit. I've changed my macros to 30% carbs, 30% protein, 35% fat -- interested in seeing how this affects SHBG, if at all.

I also did a keto diet for 8 months or so. I started carbs again too quickly which lowered my blood sugar too much(insulin sensitivity)
Went to a doc and got some test done.(He didnt know s**t BTW and this was an endo)

Sorry to hear about your experience. Seems most endos are clueless. I met one today who actually sounds decent. Anyone know how much out of pocket (with insurance) it typically costs to see a local endo and get TRT/associated treatments like hCG? I am also looking into Defy -- which looks GREAT -- but I would love to have insurance take a bite out of the cost. Anyone have experience with Defy? Would you recommend it over a local endo who is willing to treat high SHBG?

One more thing,do you take flaxseed? I was taking flax daily and decided to get my test measure again,my Free test was lower by a wide margin . That was the only thing I was doing differently at that time and linked it to that. (This was after the above info)

I do not take flaxseed.

I am extremely curious as to the root cause of this.

Me too! I should have new labs -- including a full thyroid panel -- later this week or early next week. Will report back! And, as I mentioned, I'll keep everyone updated throughout the process as I strive to reduce SHBG and increase free T.

[bkb333]

Oh, something I ran across the other day while researching this topic in PubMed. Statins, especially Atrovastin, may actually LOWER SHBG. I did this search in response to another thread asking if Atrovastin might increase it. I found two fairly good papers the point to the opposite.

However, Statins (as a class) do lower Total T production. This has been pretty firmly established, but this should not affect guys on TRT at the same time as Statins since we don't make any endogenous T anymore. This interesting observation in these studies is that while Total T is decreased in guys on statins without TRT, Free T is not decreased. This was an early clue to it's decreasing SHBG production. Now it's been measured that certain statins (such as Atrovastin/Lipitor) do indeed lower SHBG.

I currently take 10mg, but I might discuss a dose increase with my doc, depending on my lipid labs at my next annual visit in the October.

This is very interesting. I may look into Atorvastatin + TRT. Is Atorvastatin the statin you currently take? How's your experience been?

[Youthful55guy]

Yes, I take 10 mg per day of Atorvastatin (Lipitor). Zero side-effects that I can discern, but my lipids are back in line. They got skewed after I started TRT. Argues against those who say TRT levels of T do not affect lipid levels.

Something I did not consider when reading those papers was to see if they actually measured LH production. I got to thinking, that perhaps the reason T is decreased while on a statin is that it lowers SHBG. As we know, the higher SHBG goes, the more Total T you have because it sequesters it and protects it from liver metabolism. If the opposite happened, that is, SHBG went down because of statin inhibition, we would expect Total T levels to come down independent of LH or T production because it is being metabolized and excreted at a faster rate. i'll have to go back and read those papers more closely.

[Garbanzo Dude]

Very Interesting.....My TRT Doctor mentioned "he has seen some client's lower SHBG with Danazol, Anavar and Proviron" But flat out told me he would not prescribe these durgs as the "they have a bad rap with the AMA or medical community"

I've always had high SHBG- I think it has to do with those years of hard drinking in my 20's and I have Mild Ulcerative Colitis.......Im 41 now and rarely drink.....UC is under control, but I know high SHBG correlates with high inflammation.

I'm currently on my 12th week of TRT and my last test showed Total Test going down slightly from previous blood test.

So I have read a few times here that 1x per week injection will keep SHBG lower vs. 2x per week. Does anyone know where I can find or reference these studies??


Also has anyone had any luck with Oat Extract or Boron supplements??

[bkb333]

So, I had a bunch more bloodwork done yesterday. I haven't received the results yet, but the doctor just called and said I had high DHEA-S and she thinks this is likely causing my issues. Anyone have experience with this?

Also, she said my SHBG was slightly lower this time around (167) but obviously still super high.

[Youthful55guy]

Very Interesting.....My TRT Doctor mentioned "he has seen some client's lower SHBG with Danazol, Anavar and Proviron" But flat out told me he would not prescribe these durgs as the "they have a bad rap with the AMA or medical community"

I've always had high SHBG- I think it has to do with those years of hard drinking in my 20's and I have Mild Ulcerative Colitis.......Im 41 now and rarely drink.....UC is under control, but I know high SHBG correlates with high inflammation.

I'm currently on my 12th week of TRT and my last test showed Total Test going down slightly from previous blood test.

So I have read a few times here that 1x per week injection will keep SHBG lower vs. 2x per week. Does anyone know where I can find or reference these studies??


Also has anyone had any luck with Oat Extract or Boron supplements??

To my knowledge, there is no research supporting that statement. My guess is that it's gym lore and probably has no basis in research. I simply don't believe it. Dosing weekly goes contrary to my general philosophy of TRT, which is to prevent the rollercoaster ride with smaller and more frequent dosing. That should control E better and we suspect that high E is one of the factors will drive up SHBG (though I have no references for this).

The drugs you mention have a bad rap with the AMA because they are prone to anabolic steroid abuse. Whenever you misuse drugs, the side-effects go up. Bodybuilders often use 40-100 mg of Winstrol or Anavar per day to achieve their desired effect. At that level, there is MUCH research showing that liver damage is inevitable. That is the main reason they cycle it to allow repair of the damage. My experience is that for SHBG lowering effects you need much small doses (in the 5-10 mg per day range). My experience also shows that my liver labs generally stay within normal when I dose at these low rates. It's only when I add other OTC analgesics to the mix where my liver labs go out of range.

[bkb333]

Based on what I've read, I echo what Youthful55guy said about Winstrol. Nothing to be concerned about as long as you control your dose.

Youthful55guy, any thoughts on my doc's DHEA-S comment?

[Garbanzo Dude]

To my knowledge, there is no research supporting that statement. My guess is that it's gym lore and probably has no basis in research. I simply don't believe it. Dosing weekly goes contrary to my general philosophy of TRT, which is to prevent the rollercoaster ride with smaller and more frequent dosing. That should control E better and we suspect that high E is one of the factors will drive up SHBG (though I have no references for this).

The drugs you mention have a bad rap with the AMA because they are prone to anabolic steroid abuse. Whenever you misuse drugs, the side-effects go up. Bodybuilders often use 40-100 mg of Winstrol or Anavar per day to achieve their desired effect. At that level, there is MUCH research showing that liver damage is inevitable. That is the main reason they cycle it to allow repair of the damage. My experience is that for SHBG lowering effects you need much small doses (in the 5-10 mg per day range). My experience also shows that my liver labs generally stay within normal when I dose at these low rates. It's only when I add other OTC analgesics to the mix where my liver labs go out of range.

Thanks man.....I would keep coming across the comment "1x per would keep SHBG lower vs. 2x per week" but could never find a studies or even a member showing labs to prove this. Totally agree orals or AA being abused gets a bad rap. I may go to a new TRT doc, I've heard he's willing to prescribe Anavar at 5-10mg- if not might order some Proviron from a friend in Europe, I hear its easily available there.

[Youthful55guy]

Based on what I've read, I echo what Youthful55guy said about Winstrol. Nothing to be concerned about as long as you control your dose.

Youthful55guy, any thoughts on my doc's DHEA-S comment?

I doubt that DHEA has anything to do with SHBG, but I have no references to document that. What is your dose? I do 25mg per day but I don't monitor my DHEA levels. Given that you are high, I would suggest you lower it to get it in range, but again I doubt it will affect SHBG.

[Youthful55guy]

Thanks man.....I would keep coming across the comment "1x per would keep SHBG lower vs. 2x per week" but could never find a studies or even a member showing labs to prove this. Totally agree orals or AA being abused gets a bad rap. I may go to a new TRT doc, I've heard he's willing to prescribe Anavar at 5-10mg- if not might order some Proviron from a friend in Europe, I hear its easily available there.

I've not done a lot of research into Proviron (Mesterolone). Perhaps I will this weekend to at least get a handle on it's cost compared to Winstrol (stanozolole), my drug of choice.

From what (little) I know, it does not lower SHBG, but rather blocks it with a very strong binding affinity to SHBG. This means that you can't depend on measuring SHBG levels as and indicator of effectiveness. You have to monitor free or bioavailable T.

It also has a low potential for negative feedback, so you may (or may not) need TRT with low doses. It also seems to have an anti-estrogen effect, so you'll need to monitor E levels if you are already taking an AI to make sure that does not go too low.

I also seem to remember that it has a very low potential for liver toxicity, so that gives it a leg up on Winstrol and Anavar, but as I've mentioned numerous times, I monitor liver enzymes closely and they are not a problem with the very low doses of Winstrol that I use (2.5 mg 2X/day).

[bkb333]

I was planning on beginning TRT with Winstrol, but now I am second-guessing that plan after listening to a TRT Revolution podcast (I can't link because my account is new, but it's the January episode with Dr. Nick Sakkas). The summary: "Undergoing TRT and taking an AI suppresses estrogen and puts you at an extreme risk of developing cardiac hypertrophy and organ damage in the long-term."

I figured I'd need an A.I. to lower my SHBG. Thoughts?

[bkb333]

I doubt that DHEA has anything to do with SHBG, but I have no references to document that. What is your dose? I do 25mg per day but I don't monitor my DHEA levels. Given that you are high, I would suggest you lower it to get it in range, but again I doubt it will affect SHBG.

I actually just started taking DHEA -- I had not previously.

[Youthful55guy]

I was planning on beginning TRT with Winstrol, but now I am second-guessing that plan after listening to a TRT Revolution podcast (I can't link because my account is new, but it's the January episode with Dr. Nick Sakkas). The summary: "Undergoing TRT and taking an AI suppresses estrogen and puts you at an extreme risk of developing cardiac hypertrophy and organ damage in the long-term."

I figured I'd need an A.I. to lower my SHBG. Thoughts?

Winstrol is not an AI and has no effect on estrogen levels. I have no idea why he would conclude that an AI with TRT would put you at risk of developing cardiac hypertrophy and organ damage in the long-term. You dose the Ai so that you maintain E within physiological ranges for men. In most cases, if you use frequent low dose TRT as most of us recommend in this forum, you probably will not need an AI anyway. I use an anastrozole at very low levels (see my recent post on my protocol and results). My recent labs show that I should decrease my already low AI (anastrozole) dosing even more.

Winstrol is a synthetic anabolic steroid used for treating chronic wasting diseases such as HIV. The bodybuilding community has found other uses for it though. I use it strictly at very low doses (compared to either HIV patients or Bodybuilders) for effective SHBG control.

[bkb333]

Winstrol is not an AI and has no effect on estrogen levels. I have no idea why he would conclude that an AI with TRT would put you at risk of developing cardiac hypertrophy and organ damage in the long-term. You dose the Ai so that you maintain E within physiological ranges for men. In most cases, if you use frequent low dose TRT as most of us recommend in this forum, you probably will not need an AI anyway. I use an anastrozole at very low levels (see my recent post on my protocol and results). My recent labs show that I should decrease my already low AI (anastrozole) dosing even more.

Winstrol is a synthetic anabolic steroid used for treating chronic wasting diseases such as HIV. The bodybuilding community has found other uses for it though. I use it strictly at very low doses (compared to either HIV patients or Bodybuilders) for effective SHBG control.

Ahh, I see. That makes a lot more sense. Thanks for all the information you're providing -- a huge help!

[bkb333]

I just got full bloodwork back. Free T is better, which was surprising. I hope this minor increase won't keep me from being prescribed TRT, as I really do believe I need it. Estradiol and DHEA-S were both high (DHEA-S was very high). I've included everything significant below. Would love your thoughts!

Total T: 1148 Ref: 264-916 (High)
Free T: 13.8 Ref: 9.3-26.5
DHEA-S: 882.9 Ref: 128.5-475.2 (High)
Luteinizing Hormone: 3.8 Ref: 1.7-8.6
SHBG: 167.0 Ref: 16.5-55.9 (High)

Estradiol: 43.2 Ref: 7.6-42.6 (High)

CBC W/differential
WBC 4.2 Ref: 4.8-10.8 (Low)
NE% 39.2 Ref: 42.2-75.2 (Low)
EO% 0.6 Ref: 0.9-2.9 (Low)
BA% 3.4 Ref: 0.2-1.0 (High)

Metabolic panel: all normal

Lipid profile: normal (total cholesterol 168)

TSH: normal (1.77 Ref: 0.45-4.5)

Prostate: normal

IGF-1: 234 Ref: 98-282

[Youthful55guy]

Total T: 1148 Ref: 264-916 (High)
As we discussed previously, this does not surprise me. SHBG binds T and protect it from liver metabolism, so Total T usually goes way up in guys with high SHBG. This is not necessarily good because most of it is too tightly bound to be of any benefit. It cannot pass the blood-brain barrier in a bound state. Most docs (including endocrinologists) do not acknowledge this fact, which is a sad statement on our medical community.

Free T: 13.8 Ref: 9.3-26.5
As expected. Yes, having Free T within range will make it more difficult to get treatment, but in your case I doubt that mainstream medicine will treat you with any of the available SHBG lowering meds anyway. This means going off label with a schedule 2 drug that is known to be abused by the sports community.

DHEA-S: 882.9 Ref: 128.5-475.2 (High)
Are you supplementing with DHEA? Might consider stopping until you sort out the SHBG problem. Since all steroid hormones including DHEA are also bound to a certain degree by SHBG, it could simply be your high SHBG pushing up your DHEA levels too. However, from what I've read, DHEA has a relatively low binding affinity to SHBG than does T. On the same note, DHT has an extremely strong binding affinity to SHBG. I'm willing to bet your DHT levels are high too.

Luteinizing Hormone: 3.8 Ref: 1.7-8.6
SHBG: 167.0 Ref: 16.5-55.9 (High)
Nothing new here.


Estradiol: 43.2 Ref: 7.6-42.6 (High)
High, but not terribly high. A small dose of an AI could easily bring this into range and may help lower SHBG. E is a well known stimulant for SHBG production.

CBC W/differential
WBC 4.2 Ref: 4.8-10.8 (Low)
NE% 39.2 Ref: 42.2-75.2 (Low)
EO% 0.6 Ref: 0.9-2.9 (Low)
BA% 3.4 Ref: 0.2-1.0 (High)
Good to have these numbers, but with TRT we are more concerned with hemoglobin and hematocrit levels. Please consider posting them in the future. High T and especially high DHT can push up hemoglobin production to dangerous levels and is probably the most limiting side-effect of TRT.

Metabolic panel: all normal
AST, ALT, and Alk Phos are the liver enzymes we usually watch during TRT, especially if you start playing with synthetic anabolic steroids to lower SGBG. They have known liver toxicity issues, but I find it has minimal effect at the low levels I need to lower my SHBG.

Lipid profile: normal (total cholesterol 168)
TSH: normal (1.77 Ref: 0.45-4.5)
Prostate: normal
IGF-1: 234 Ref: 98-282

Nice levels. Interestingly, IGF-1 is known to lower SHBG, but obviously you have other factors at play.

[macmathews]

I'm keeping an eye on this 1

[bkb333]

Thank you for the thorough analysis! I am supplementing with DHEA (just started), but I'll cut that off for now. Regarding the bio-markers you asked about:

HGB 15.3 Ref: 14.0-18.0
HCT 45 Ref: 42-52
AST 20 Ref: 15-37
ALT 31 Ref: 16-63
Alk Phos 53 Ref: 46-116

Nothing really jumps out, right? This whole situation is pretty head-scratching. Someone told me he thinks keto is the real culprit.

[Youthful55guy]

Thank you for the thorough analysis! I am supplementing with DHEA (just started), but I'll cut that off for now. Regarding the bio-markers you asked about:

HGB 15.3 Ref: 14.0-18.0
HCT 45 Ref: 42-52
AST 20 Ref: 15-37
ALT 31 Ref: 16-63
Alk Phos 53 Ref: 46-116

Nothing really jumps out, right? This whole situation is pretty head-scratching. Someone told me he thinks keto is the real culprit.

What does Keto mean?

All your additional labs look good. You need to watch HGB and/or HCT in future labs once you start a TRT protocol. Donate blood to control them. Best to start donations early so that you nip it in the bud.

Watch the liver enzymes if you start Winstrol or Anavar because they can be hard on the liver. However, at the very low dose we need, I have not observed anything out of range that can't be explained by other OTC meds that are even more hard on the liver (Naproxen, Ibuprofen, and Tylenol).

[bkb333]

What does Keto mean?

All your additional labs look good. You need to watch HGB and/or HCT in future labs once you start a TRT protocol. Donate blood to control them. Best to start donations early so that you nip it in the bud.

Watch the liver enzymes if you start Winstrol or Anavar because they can be hard on the liver. However, at the very low dose we need, I have not observed anything out of range that can't be explained by other OTC meds that are even more hard on the liver (Naproxen, Ibuprofen, and Tylenol).

Well, by "Keto" I just meant the relatively high-fat diet I have been following (which I stopped recently due to this bloodwork). I'll keep an eye on those markers! How frequently do you donate (or recommend donating)?

[Youthful55guy]

Well, by "Keto" I just meant the relatively high-fat diet I have been following (which I stopped recently due to this bloodwork). I'll keep an eye on those markers! How frequently do you donate (or recommend donating)?

I sincerely doubt that any dietary factors could screw up SHBG as bad as yours. Yours are more than double mine without treatment, and mine were way out of the norm. There's something else going on.

[wellshii]

Did you read the link I put on my first post?
It was the dudes adrenals,so looks like we found the problem man.
You need to get your cortisol checked and have your adrenals checked.
Havnt had experience with this myself , but I'll link that thread again for reference,
Skyhigh SHBG Levels - WHY?! | Page 3 | All Things Male Forum

[wellshii]

Here is some info on the DHEA-S
https://www.mayomedicallaboratories....erpretive/8493

[bkb333]

Did you read the link I put on my first post?
It was the dudes adrenals,so looks like we found the problem man.
You need to get your cortisol checked and have your adrenals checked.
Havnt had experience with this myself , but I'll link that thread again for reference,

I skimmed this thread when you previously sent it, but just gave it a thorough read. Really interesting. Thank you for sharing! I would not be surprised if I found out my adrenals were f***ed as well. Possibly a low cortisol issue? I'm seeing two different endos in the coming weeks. What tests do you think I should ask for? Just 24-hour 4-point saliva test?

Based on my current understanding of thyroid/hormones, it seems TRT may not be the solution -- correct? It seems to me it would be kind of like putting a band-aid on a bullet wound (trying to fix high SHBG when that's actually a byproduct of a bigger issue).

[Youthful55guy]

I skimmed this thread when you previously sent it, but just gave it a thorough read. Really interesting. Thank you for sharing! I would not be surprised if I found out my adrenals were f***ed as well. Possibly a low cortisol issue? I'm seeing two different endos in the coming weeks. What tests do you think I should ask for? Just 24-hour 4-point saliva test?

Based on my current understanding of thyroid/hormones, it seems TRT may not be the solution -- correct? It seems to me it would be kind of like putting a band-aid on a bullet wound (trying to fix high SHBG when that's actually a byproduct of a bigger issue).

I agree that searching for a root cause before treating symptoms is always the best approach. Particularly in your extreme case. Those are very high SHBG levels. I read through that string that wellshii posted and did not get much out of it. A lot of guys with a lot of opinions. However, I do question whether the high DHEA and high SHBG are just serendipitous. Perhaps there is a common link to the adrenals. Keep us informed of your progress. I'm interested in seeing where you take this.

[wellshii]

Yea that test like you mentioned.You can also do total cortisol as well.
Rare,but that DHEA like the link from the Mayoclinic could indicate a tumor. I want to see what the Endos say. I hope they can help you man.
Glad we are a step closer though.
Problems always have a root cause.

[bkb333]

Yea that test like you mentioned.You can also do total cortisol as well.
Rare,but that DHEA like the link from the Mayoclinic could indicate a tumor. I want to see what the Endos say. I hope they can help you man.
Glad we are a step closer though.
Problems always have a root cause.

Yikes, that’s really scary The endos can’t see me for 3 weeks. Is there any way I could test at home to help figure out if I have something serious like a tumor? Pretty nervous about it.