Let's talk about Depression

[juice2012]

Here's a little back story on me:

In my early 20s I had two really bad episodes in my life, one was major depression and the other was depersonalization disorder from panic attacks, resulting in me going to the hospital. During the 4 year period I was on and off way too many psychiatric drugs, the last being an SSRI in 2009.

I chose to go off of my SSRI because my insurance was running out and I didn't want to "be on drugs for the rest of my life". Funny thinking back on this because I'm on TRT now.

After going off my SSRI on 2009 I became depressed again but it was a different kind of depression, I didn't have thoughts of suicide, I just lost all interest in my hobbies and became miserable and got fat. I decided I was going to try to beat it without drugs and ended up moving across the country, getting a new job, new girlfriend etc. I tried different diets, and got back in to exercising again.


Fast forward to this year:

Something happened in the spring of this year after I had been lifting like crazy for months. I started getting fatigued, losing my sex drive, missing work etc. This lead me down the path of going on TRT and I was really hoping that testosterone was going to also fix my depression issues. My reason for going on TRT had nothing to do with depression, all my issues were physical and they just started this year.

It wasn't until I started taking Provigil to deal with my fatigue issues this year that I realized I've been in denial about being depressed for the last 3 years, mainly because the type of depression I'm feeling isn't suicidal depression. It's better summed up by the symptoms of Dysthymia:

According to the DSM's definition of dysthymia, it is a serious state of chronic depression, which persists for at least 2 years; it is less acute and severe than major depressive disorder.As dysthymia is a chronic disorder, sufferers may experience symptoms for many years before it is diagnosed, if diagnosis occurs at all. As a result, they may believe that depression is a part of their character, so they may not even discuss their symptoms with doctors, family members, or friends.

After taking Provigil for 2 days pretty much all my old interests came back and I felt motivated and interested in things I haven't cared about in years. It pretty much made me realize that how I feel day-to-day is NOT normal, but I've been feeling this way for 3 years so I am like in denial about there being anything wrong. The problem with provigil is after taking it for 2 days in a row my mind is moving way too fast and I start feeling and acting "weird", like not wanting to be around people. It's definitely not something I can take daily.

I'm currently taking:

60mg of test cyp 2x per week
0.5 mg of caberoline 2x per week
0.25 mg of adex 2x per week

and to battle my daily fatigue issues I rotate:

5mg of Ritalin 2x per day
Or
100mg of Provigil
Or
12mg of ephedrine 2x per day

Also using a CPAP nightly, but I am still tired everyday and usually need at least 10 hours of sleep per night even with the CPAP. Even after 10 hours of sleep I still need some stimulant to go to work.

I've been on TRT for 3 months and my mood has not changed at all. My sex drive is back up to normal and I can lift more at the gym but it has done absolutely nothing for my mental state and I'm still fatigued everyday.

I think 3 years is enough and that I'm going to go back on some antidepressant. I just can't decide what one right now. Should I just hop back on an SSRI? Should I try something different? What about T3 for depression? Deprenyl? I feel like since provigil restores my interests that this is some dopamine related issue but I have no clue at this point.

Sorry this is such a long post but it's been a very rough road for me the last 8 years.


Latest bloodwork:

Testosterone 430 241 - 827 This was 366 prior to TRT
Estradiol 41 0-39.8pg/mL This was before starting adex


Prolactin <0.3 This is very low because of caberoline
PSA 0.79 0.0 - 4.0

White Blood Cell Count 6.9 4.0 - 11.0 K/uL
Red Blood Cell Count 5.16 4.40 - 6.00 M/uL
Hemoglobin 15.3 13.5 - 18.0 g/dL
Hematocrit 46.5 40.0 - 52.0 %
MCV 90 80 - 100 fL
MCH 29.7 27.0 - 33.0 pg
MCHC 32.9 31.0 - 36.0 g/dL
RDW 13.0 <16.4 %
Platelet Count 211 150 - 400 K/uL

Sodium 143 136 - 145 mmol/L
Note New Normal Range
Potassium 4.1 3.5 - 5.1 mmol/L
Chloride 107 98 - 107 mmol/L
Bicarbonate 28 21 - 32 mmol/L
Glucose 92 70 - 99 mg/dL
BUN 12 6 - 25 mg/dL
CREATININE 0.8 0.8 - 1.3 mg/dL
Note New Normal Range
GFR Est-Other >60 >60 See Cmnt
GFR Est-African American >60 >60 See Cmnt
Calcium 8.9 8.2 - 10.2 mg/dL
Total Protein 7.0 6.4 - 8.2 g/dL
Albumin 4.1 3.2 - 4.7 g/dL
Total Bilirubin 0.5 <1.1 mg/dL
Alkaline Phosphatase 80 26 - 137 U/L
AST 14 0 - 37 U/L
ALT 19 15 - 60 U/L

VitD,25-Hydroxy Tot 58 30 - 100 (I'm taking 5,000IU Vitamin D 2x a day)

DHEA SULFATE 164 110 - 510

SexHormone Bind Glob 9.83 10 - 57
Pregnenolone 41 13 - 208
IGF1 402 126 - 382


Total cholesterol 149 <200 mg/dL
Desirable: <200 mg/dL
Borderline: 200-239 mg/dL
High: >240 mg/dL
Triglyceride 151 <150 mg/dL (This came down from the 180s since my last pull, very happy about that)
Note New Normal Range
HDL cholesterol 46 >40 mg/dL
LDL Calculated 73 <130 mg/dL
LDL CHOLESTEROL CLASSIFICATION
<100 mg/dL Optimal
100-129 mg/dL Near or above optimal
130 - 159 Borderline high
160-189 High
>189 Very high
Cholesterol to HDL Ratio 3.2 1.0 - 4.0
VLDL (Calculated) 30 5 - 40 mg/dL

Cortisol, AM Level 19.8 5.0 - 25.0
Free T3 4.18 2.3 - 4.2
Free T4 1.02 0.59 - 1.61
Thyroglobulin AutoAb <20 <20
Thyroid Perox AutoAb 10 <35

Total Testosterone 534 250 - 1100
Free Testosterone 187.1 35.0 - 155.0

[steroid.com 1]

Can you post your most recent blood work complete with ranges?

[xtitan1]

B/W would be nice.

A lot of people think depression is a state of feeling really sad or suicidal. While depression can present this way, it more often is a sense of hopelessness or grayness where you don't care about anything. It seems like this does fit your situation.

SSRIs aren't all the same. If one doesn't work for you, you need to try a different one and keep going until it makes a difference. Sometimes adding Wellbutrin or another drug my also enhance an SSRI's effectiveness. Of course, depression could just be a secondary effect of some other thing you got going on like inadequately treated testosterone levels or thyroid levels. So post up your latest B/W

[juice2012]

Updated OP to include most recent bloodwork.

[steroid.com 1]

These all look ok to me; nothing really stands out.

You would do well to supplement with micronized DHEA and Pregnenlone 50mg of both daily in the morning.

SHBG is really low and can cause some anxiety for some men when on a TRT protocol...this is best in the mid range.

[THE-DET-OAK]

I bet money your estradiol is in the dirt, and your adex is driving SHBG into the ground by suppressing estrogen.

You need to re think if you need an AI. Really low SHBG is very serious, it is linked to a host of things including insulin resistance.

SHBG is the carrier protein for testosterone , and while it makes sense that a low number there is good to free up testosterone, this also means you will not have enough to carry the testosterone to its target tissues.

When people talk about the negative effects of low estrogen, I personally believe it is actually the low SHBG that that causes the erectile and low libido problems. Obviously the low estrogen can have an effect on BMD, no one is positive that it actually is the low estrogen causing the other problems, it could very well be related to the low SHBG that coincides with the low estrogen.

SHBG not only carries the testosterone in the blood, it also plays a role in how testosterone binds to the androgen receptor, although the research is not crystal clear, there is extreme negative correlation with low SHBG.

Testosterone also increases serotonin but simultaneously down regulates its receptor, some believe this is why men can get a very increased sense of well being when initially starting TRT that sometimes fades away a short time later.

Before going back to the SSRI it might be beneficial for you to look into supplements that can modulate the GABAergic pathways.

It is possible that reducing or eliminating your AI, and supplementing something that affects this pathway, may bring back that sense of well-being your missing. The reduction in the receptor activity can lead to this anxiety.

Hope this helps

http://www.cnsforum.com/imagebank/it...D/default.aspx

[steroid.com 1]

I agree his SHBG is too low and would be better at mid range.

Is it the cause of his depression in his case?

Questionable given his long history with depression.

Without question an AI is a very powerful antagonist but .25mg twice a week to his 120mg of Test a week is rather conservative from a practical standpoint.

That said, I have been on the same protocol for a number of years now and stopped taking an AI as my E2 serum levels were in the low teens...that's to low.

Since then I haven't had blood drawn yet but there are no physical symptoms of elevated E2...much better libido...but only BW will tell the truth.

I think your assessment is pretty accurate; his SHBG levels need to rise and he needs to have this discussion with his Doc; SHBG buffers exogenous test and with low SHBG levels can/may cause these types of symptoms.

[THE-DET-OAK]

Im not saying the AI is the cause of his depression, I am saying that and the reduced serotonin receptor activity may be why TRT has not alleviated his depression.

I bet his E is lower than the teens, on a sensitive test. When E2 reads in teens on non sensitive, it is most likely 10 points lower. There is no way to increase SHBG, except by reducing androgen intake and stopping aroma suppression.

[steroid.com 1]

Hmmm, not quite sure about this----> "There is no way to increase SHBG, except by reducing androgen intake and stopping aroma suppression."

Stopping the aromatase suppression; yes I agree.

The best way to increase SHBG is by increasing androgen serum levels...there's no other way in everything I've ever read or studied...except for some liver dysfunction/diseases...but that's not something we don't want or can control.

Either way, and not wanting to hijack this thread, he needs to speak to his Doctor on such matters.

[HRTstudent]

Describe your fatigue for us please.

Next, 3 months on TRT is not very long. Not only that, but your levels are not very high despite what appears to be a fairly hefty protocol. You need to get blood work that is current and represents where you are now that you're on T and an AI. Be sure to get the SENSITIVE estradiol test.

Why are you taking cabergoline? Does your doctor want your prolactin SO low?

Your DHEA is quite low. DHEA has actually been implicated in depression. I would talk to your doctor and try to bring that up. I'd like to see mine around 400 to 450 personally. Micronized DHEA is quite inexpensive and very effective. Too much DHEA can readily aromatize, but doses of only 25mg per day are fair starting points.

If you're not on HCG then a lot of people recommend pregnenolone. If you have anxiety pregnenolone seems to be a no-brainer. But regardless, it has a lot of anecdotes to support it but not as much research as something like DHEA or testosterone . I've been experimenting with various oral preg products and doses. I can't say it has done anything, but it's been less than 50 dollars - pregnenolone is not expensive.

Regarding your thoughts on thyroid and depression, it is interesting. I don't see your TSH, but that's important to have. I would definitely be looking at fine-tuning my thyroid before I tried out an SSRI or other anti-depressent. But that's just my opinion.

Regarding your SHBG, sure its low. But so is mine. That's just something some people have I figure. There isn't really anything worthwhile we can do about it. I'm of the opinion that for people with low SHBG we might be better off with smaller, more frequent doses of testosterone cypionate /enanthate .

I do look forward to your journey, and hopefully, your improvement.

[THE-DET-OAK]

Androgen supplementation always decreases SHBG, not the other way around. So I don't know where you picking that up, it is pretty common knowledge that the introduction of androgens reduce SHBG.

Trust me when I say there is no way to increase it, I know a few guys that have been on the boards for years, and they low SHBG and have no way to fix it.

If your SHBG is low you have no business on an Aromatase inhibitor.

[HRTstudent]

Also, I really want to clarify exactly what are your goals?

You mention that modafinil really worked for you on the few days at first but you didn't like the sustained feeling of it. I know nothing about this drug, but if you could try smaller doses I would definitely run that by your doctor. I only mention this because you said it worked really well for a short period.

Beyond that, if you now seem to have some more mild form of depression there are "safer" things out there that are worth talking to your doctor about. Namely, St Johns Wort has been studied and for MILD (not severe) depression it does appear to work well for some people. It's probably less than a copay for your monthly drugs as well.

Nobody on this site can really treat or diagnose mental illnesses via a forum, of course. It's so complex.

If you have the resources, however, Dr Mariano out of California (I believe) is an expert in TRT and he is actually trained as a psychiatrist. You would probably not regret going to him for treatment.

[HRTstudent]

Androgen supplementation always decreases SHBG, not the other way around. So I don't know where you picking that up, it is pretty common knowledge that the introduction of androgens reduce SHBG.

Trust me when I say there is no way to increase it, I know a few guys that have been on the boards for years, and they low SHBG and have no way to fix it.

If your SHBG is low you have no business on an Aromatase inhibitor.

How can you make a blanket statement like that? (I genuinely want to know and I'm not just inciting you.)

Myself as an example, I always had low SHBG and even on a mild T dose I ran into high E2 and gynecomastia . I opted for an AI rather than coming off TRT.

[THE-DET-OAK]

How can you make a blanket statement like that? (I genuinely want to know and I'm not just inciting you.)

Myself as an example, I always had low SHBG and even on a mild T dose I ran into high E2 and gynecomastia. I opted for an AI rather than coming off TRT.

You had a blood test, and your E2 was really high, and your SHBG was low?

[steroid.com 1]

"How can you make a blanket statement like that? (I genuinely want to know and I'm not just inciting you.)"

No inciting HRT, I know that with you...]

Crisler speaks to it; I will get it tomorrow.

[THE-DET-OAK]

If that were really the case then your dose was too high, or you have sleep apnea, or diabetes most likely. Either way all those things would need to be considered.

and yes I would lower my dose or switch to cream before adding an AI if my SHBG was below 10, your asking for some serious negative health risks by adding the AI, it will simply further suppress SHBG, and I can not stress enough how that is bad for you.

If one could correct there insulin resistance they may be able to get SHBG to rise.

[HRTstudent]

You had a blood test, and your E2 was really high, and your SHBG was low?

I've had lots. Never had SHBG over 20. E2 has been anywhere from almost nothing to around 50 (<29 range).

Before I got on an AI my E2 was going up until I had to start an AI after taking 3 pumps androgel a day.

If that were really the case then your dose was too high, or you have sleep apnea, or diabetes most likely. Either way all those things would need to be considered.

and yes I would lower my dose or switch to cream before adding an AI if my SHBG was below 10, your asking for some serious negative health risks by adding the AI, it will simply further suppress SHBG, and I can not stress enough how that is bad for you

Don't have diabetes and my blood sugar tests were all really good.

Dose being too high is interesting because it did not take too much for me to get gyno even on androgel 4 pumps or less.

My SHBG has never been below 10 according to bloods, but thereabouts.

What is so bad about low SHBG? Do you mean low-normal or below-normal only?

[THE-DET-OAK]

what was your testosterone level? one must consider the TT level when determining SHBG, the range means nothing, the ratio means everything.

You had gyno with an E number at 50? was it sensitive? are you sure you didn't think you had gyno? 50 is not that bad when on TRT, unless your getting unwanted side effects.

what is so bad about low shbg?

low SHBG is the first marker for metabolic syndromes, on top of other chronic illnesses, i have the studies and are looking for them now.


also check this story out

Originally Posted by Ex Dubio
OK, first thing that comes to mind in addressing SHBG then would be an anti-hyperlipidemic drug. I'd imagine considering a statin -- despite your age -- might be worthwhile, if triglycerides are significantly elevated. I presume the triglycerides tests have been performed fasting?
To what extent did it raise testosterone? You had no subjective benefits on it? What dose and frequency?
A Clomid stimulation test 50mg twice daily for 7 days brought my < 300 ng/dL T to 700+ng/dL. I was then prescribed 15mg every two days, which was boosted to 30mg every two days. Blood labs were not taken after this. My doctor only asked to see TT, which made me mad enough to drop him (he didn't request E2, DHT or anything else.)

I broke down into tears once or twice on Clomid. That essentially describes the effect on my mood.

I meant using it combined with testosterone therapy . It won't do anything good by itself.
Dr. John Crisler made a mistake by prescribing me testosteone cyptionate injections, plus Arimidex , plus pregnenelone. The testosteorne injections shot my FT and E through the roof. The Arimidex successfully brought my estrogen (and other estrogens!) into the "perfect" range, enough that he claimed that he had never seen such an ideal estrogen profile.

It didn't matter. Erections were extremely hard to summon and when they'd come, they'd dissapear just as fast. I was able to have awkward and dissatisfying sex a few times on this combination I didn't enjoy it at all, and it would take one hour or more of foreplay for me to get an erection that I thought would last to the point of getting it near the vagina before it vanished.

And none of these had any effect on libido? Let me ask a few more questions then:

1. When did your problems start? Have you ever had a healthy libido?
The problems started as young as I can remember. I began to have masturbatory problems at 13. My libido kept vanishing, and I'd masturbate anyway out of frustration, hoping to reignite it. If I did so, I'd basically masturbate a half-flaccid penis to an orgasm and ejaculation without any neurotransmitter release.

In highschool, I had to keep a calendar to mark the days I masturbated. I needed to "skip 2 days" inbetween each, or I was guaranteed to destroy my libido. By college, this interval had expaneded to at least a week, and sometimes my libido would vanish for multiple weeks at a time.

My body odor continually shifts. Apocrine sweat completely vanishes and I smell like a kid instead of an adult. It is truly bizarre. If ever my hormones balance and I can 'get horny', I suddenly require deodorant.

2. What was your original diagnosis? How low are your serum testosterone levels ?
At age 19, secondary hypogonadism. I went in to have my thyroid tested since I wasn't getting morning erections or spontaneous erections, nor had I ever had a nocturnal emission in my life. My doctor secretly threw in TT/FT and it was discovered that I had 185 ng/dL TT at age 19 -- clinical hypogonadism.

3. Can you post the latest numbers for testosterone, E2, SHBG, etc.?
Testosterone, serum 326 ng/dL (241-827)
Free testosterone 7.0 pg/mL (9.3 - 26.5)
SHBG, serum 19 nmol/L (13-71)

This was at a time when I was avoiding both meat and sugar, which, according to studies, elevates SHBG. My normal level of SHBG is 9-13, on the same scale.

Previous labs (while on a normal diet) look the same, except SHBG is much lower and FT is slightly higher, but still too low.

4. Can you give us a list of drugs you're taking now?
At this point only hCG , 350 IU every 4th day. I dropped the T3 and deprenyl cold turkey. No side effects.

What the ****? Is this the same doctor who's been prescribing everything else? How has he been prescribing the rest?
He ordered it from a compounding pharmacy. It is testosterone in propylene glycol. Dr. Eugene Shippen prescribed it. He has a few books out, so I figured he knew his stuff. He insists that I should also apply this preparation to the head of my penis. (Yes, seriously.)

Is there any data whatsoever on this condition of low SHBG? Does the condition have a name? I'm not doubting you, but you're either referencing data I don't have or engaging in speculation as to what might happen when you don't have much information.
There is. It is simply called SHBG deficiency. I have a list of studies bookmarked, but I'll have to follow up to this post to link some of them. I'm short on time, but I'd like to answer as much of your questions as I can before I go.

Also, given how many things you've tried that have failed, I'd think you'd be willing to accept a mild increase in DHT to give this treatment a try. A temporary increase in DHT is not going to magically make you go bald, but quite frankly it sounds like your priorities are not aligned. Regardless, ketoconazole scrub ought to prevent any unwanted effects of DHT on the scalp.
My FT and DHT both rose astronomically when I was on Androgel . To give you an idea of what an SHBG deficiency can to do a male that attempts traditional HRT:

A standard dose of Androgel brought TT up to 850ng/dL. This would have been within that particular lab's range. Meanwhile, FT was DOUBLE the highest end of that particular lab's range. Needless to say, that did not lead to anything except a ton of hair falling out in the shower.

rs#? Would like to know more details of this. His point was that taking drugs that increase libido is going to get you nowhere, which is why you have to go after other TRT methodologies or SHBG itself.
I have the rs#'s in the studies that I mentioned. Again, I'll post them as soon as I can.

OK, is there any evidence for any of this actually increasing SHBG? I see a few things here that have evidence along those lines, but some of this seems a little "out there".
Yes, the green tea, caffeine, a vegan diet, dietary fiber, soy isoflavones and phytoestrogens have all been shown in studies to raise SHBG. Low SHBG is strongly correlated with insulin resistance and PCOS in females.

FWIW, both my mother and sister have very serious cases of PCOS (low SHBG in females causes female beard growth, insulin resistance, the same messed up lipid profile that I have, etc.)

Low SHBG is a very common side effect of insulin resistance, and some studies claim to have shown a /causal/ link between low SHBG and insulin resistance. That is to say, increasing SHBG alone was able to restore glucose metabolism in women with insulin resistance.

Low SHBG is a very common side effect of insulin resistance, and some studies claim to have shown a /causal/ link between low SHBG and insulin resistance. That is to say, increasing SHBG alone was able to restore glucose metabolism in women with insulin resistance. It was previously assumed that the excess insulin from insulin resistance was lowering SHBG. It is now more widely believed that SHBG is lowered by improper glucose metabolism in the liver and that the SHBG itself affects the way sugar is brought into muscle tissue. (Cells have receptors for SHBG. It's not just a binding protien. Also, SHBG binding is required to bring androgens into certain tissues.)

Can you masturbate? Have any drugs ever helped with this?
At present, I can only masturbate a "semi" to a mostly sensationless orgasm. Every few weeks, randomly, my libido returns and I am able to masturbate normally. I attribute this to the rollercoaster of metabolic clearance that the inadequate SHBG creates.

Drugs have not helped. Even Cialis before masturbation is worthless. I once tried some of the sublingual testosterone suspension drops, plus Cialis. No dice.

[THE-DET-OAK]

What is so bad about low SHBG?

Patients suffering from low-grade chronic inflammatory diseases, such as rheumatoid arthritis, osteoarthritis, diabetes, and obesity, have low plasma sex hormone-binding globulin (SHBG) levels. These diseases are characterized among other features by high plasma IL1β levels. The aim of the present study is to explore whether IL1β could regulate hepatic SHBG production to account for low SHBG levels in these diseases. We provide evidence that daily IL1β treatment reduces SHBG production in HepG2 cells by the down-regulation of HNF-4A via the MAPK kinase (MEK)-1/2 and c-Jun N-terminal kinase (JNK) MAPK signaling pathways through the activation c-Jun transcription factors. The human SHBG promoter sequence contains two putative activator protein 1 (AP1) binding sites recognized by c-Jun transcription factors, but they are not necessary for the IL1β-induced down-regulation of SHBG promoter activity in luciferase reporter gene assays. Daily treatment with IL1β reduces hepatic nuclear factor (HNF)-4α mRNA and protein levels via the MEK-1/2 and JNK MAPK signaling pathways. Moreover, IL1β rapidly decreased HNF-4α mRNA and protein levels while increased phospho-c-Jun protein levels after the treatment. Finally, daily IL1β treatment of human SHBG transgenic mice reduced plasma SHBG and SHBG mRNA levels. Moreover, IL1β treatment also reduced HNF-4α mRNA and protein levels while increased hepatic phospho-c-Jun protein levels. Our results show that IL1β reduces hepatic SHBG production by decreasing HNF-4α via MEK-1/2 and JNK MAPK pathways. In addition, our findings suggest that IL1β could be involved the low plasma SHBG levels reported in chronic low-grade inflammatory diseases.

http://www.ncbi.nlm.nih.gov/pubmed/22902540

Introduction and objectives. Sex hormone-binding globulin (SHBG) is a key regulator of the actions of anabolic steroids. Chronic heart failure (HF) has been associated with anabolic steroid deficiency, but its relationship with SHBG is not known. Methods. The study involved 104 men (53±11 years) with HF (i.e. left ventricular ejection fraction [LVEF] <40 attending a specialist clinic on optimum treatment and in stable condition at enrolment the median interquartile range iqr shbg level was determined associated hormone levels were measured known risk factors recorded study end-point cardiac death within 3 years results 34 5 nmol l 27-50 correlated with n-terminal probrain natriuretic peptide r="0.332," p lvef body mass index total testosterone higher 16 patients 15 4 who died 48 36-69 vs 33 25 3-48 7 high an increased of hazard ratio hr 95 confidence interval ci 1 021-1 069 <.001). The association remained significant after adjustment in Cox multivariate regression modeling, at HR=1.049 (95% CI 1.020-1.079; P=.001). Analysis by SHBG tertiles showed mortality was 30% in the third tertile, 14% in the second, and 4% in the first (log rank 0.007; HR=3.25, 95% CI 1.43-7.34; P=.004). Conclusions. The SHBG level correlated with measures of HF severity and was associated with a higher risk of cardiac death. Further studies are needed to clarify whether SHBG plays a role in HF pathophysiology.

http://www.revespcardiol.org/en/sex-...culo/13146166/

Conclusions
Low SHBG and high T levels are significantly and independently associated with the presence of PAD in older men and women, respectively.

http://www.atherosclerosis-journal.c...632-6/abstract

CONCLUSIONS
Low circulating levels of sex hormone–binding globulin are a strong predictor of the risk of type 2 diabetes in women and men. The clinical usefulness of both SHBG genotypes and plasma levels in stratification and intervention for the risk of type 2 diabetes warrants further examination.

http://www.nejm.org/doi/full/10.1056/NEJMoa0804381

[juice2012]

Wow, I walked away from this thread for a day and lots of activity!

Where to start..

Before TRT my TT was 300, E2 was 25, after 50mg of cyp 2x a week my TT went to 430 like you saw here and E2 jumped up to 41. That's when I asked my doctor for an AI and we upped my T dose to 60mg 2x a week


It's been about 5 weeks since I started adex and I'm getting blood work tomorrow to see where all my levels are. I'll know in about a week what my TT, FT, and E2 are currently.


As far as SHBG:

Before TRT: 5/24/2012 13.70
100mg of T per week: 9/20/2012 9.83 L

As you can see it was pretty low to begin with. Also, that low SHBG result is from BEFORE I started arimidex . Also, all E2 tests have been sensitive.

HRT: describe my fatigue? Most days when I wake up I don't want to get out of bed because I'm so tired. I usually don't go in to work until 11am (California lol), but I do still go to bed around midnight. This gives me about 10 hours to sleep before getting up. If I go to work without taking some form of a stimulant I pretty much just stare at my computer and barely get anything done. Even with a stimulant I barely get much done these days. Usually I just wish I was back in bed but try to make it through the day. This fatigue stuff didn't start happening until May this year. I was taking creatine, protein, MSM, beta-alanine and taurine and lifting intensely, regularly. I still think these supplements were the cause of my fatigue but no doctors or anyone here seemed to think they would be an issue. This sudden onset of fatigue resulted in me going to the doctor and getting bloodwork etc and we found out my T was low so after a few months of suffering and nothing else working I saw screw it and went on TRT, I felt like I was going to lose my job anyway and had no other options. I'm not as bad as I was back in May, but I still feel like I could sleep 12 hours everyday. I never have energy, I feel sluggish, my brain is foggy, my memory is hazy. My job involves doing technical work on the computer and I feel pretty worthless as it's so hard for me to concentrate.

I'm taking the caberoline because my prolactin was high back in May. I'm taking the lowest dose and as you can see it's nuking any bit of prolactin, my doctor thinks this is fine and says I will have to be on caber for life.

Here is my TSH from back in May:

TSH 2.75 0.34 - 4.82


I'm going to order some DHEA and Preg from amazon this week after I get my bloodwork back and see if I need to make any changes to my TRT. I am not on HCG and don't really want to be, because I don't want to be fertile lol.



As far as why I'm coming to you guys to talk about depression, well everyone has been really helpful here since I joined and I was curious to hear what other antidepressants people are on. For me I was hoping TRT would alleviate this feeling I've had for the last 3 years but it hasn't. I'm going to not give up though until something does. I was particularly interested in alternatives to SSRIs, mainly because I don't believe an SSRI is going to fix what I'm feeling, or lack thereof.