Blood work results

[Builder15]

I have been a long time member/lurker mostly reading for diet and training tips. Anyway I have been extremely fatigued for the past 2 years and it was recommended that I get my hormone levels checked so I did. I am 32 and have never done any AAS and have been training consistently since I was 15. At my heaviest I was 230 and now I am down to 190. My lifts have all suffered tremendously and I have lost a lot of strength over the past 1-2 years. Currently I train 3-4 days per week. Here are the results of my recent bloodwork.

TESTOSTERONE 792 NG/DL 300 - 1,080 NG/DL
Sex Horm Bind Globulin 95.4 NMOL/L 16.5 - 55.9 NMOL/L
CALC FREE TESTOSTERONE 8.1 NG/DL 4.8 - 25.7 NG/DL

My SHBG is extremely high and I think it is mostly stress related as I have had some major life events happen in the past year. My daughter passed away a little over a year ago which triggered a lot of anxiety and depression for which I see a therapist. I know this sounds silly, but the grief of her passing also seemed to manifest with physical pain that re-aggravated my symptoms of 3 herniated discs that I have had for 10 years which never really caused a problem until she passed. I really don't have any experience in this department so I was hoping somebody could help guide me in the right direction.

I had my liver enzymes checked and they were normal. Had lipid profile done and HDL was good, LDL was under normal value as were my triglycerides. I can post the numbers if that information would help. My first thoughts are that my SHBG is obviously lowering my free test, but my overall test levels look good so I need to figure out how to lower my SHBG. Maybe adding more fats to my diet can help to raise my free test, but overall I think the biggest thing is figuring out how to reduce my stress levels which I have found difficult. Any advice would be appreciated, thanks!

[Slacker78]

Check you thyroid TSH, FT4/T3. About your diet, are you eating enough carbo ? Diet to support your training sessions, is very important in this case, in order to control SHBG also.

[Youthful55guy]

I have been a long time member/lurker mostly reading for diet and training tips. Anyway I have been extremely fatigued for the past 2 years and it was recommended that I get my hormone levels checked so I did. I am 32 and have never done any AAS and have been training consistently since I was 15. At my heaviest I was 230 and now I am down to 190. My lifts have all suffered tremendously and I have lost a lot of strength over the past 1-2 years. Currently I train 3-4 days per week. Here are the results of my recent bloodwork.

TESTOSTERONE 792 NG/DL 300 - 1,080 NG/DL
Sex Horm Bind Globulin 95.4 NMOL/L 16.5 - 55.9 NMOL/L
CALC FREE TESTOSTERONE 8.1 NG/DL 4.8 - 25.7 NG/DL

My SHBG is extremely high and I think it is mostly stress related as I have had some major life events happen in the past year. My daughter passed away a little over a year ago which triggered a lot of anxiety and depression for which I see a therapist. I know this sounds silly, but the grief of her passing also seemed to manifest with physical pain that re-aggravated my symptoms of 3 herniated discs that I have had for 10 years which never really caused a problem until she passed. I really don't have any experience in this department so I was hoping somebody could help guide me in the right direction.

I had my liver enzymes checked and they were normal. Had lipid profile done and HDL was good, LDL was under normal value as were my triglycerides. I can post the numbers if that information would help. My first thoughts are that my SHBG is obviously lowering my free test, but my overall test levels look good so I need to figure out how to lower my SHBG. Maybe adding more fats to my diet can help to raise my free test, but overall I think the biggest thing is figuring out how to reduce my stress levels which I have found difficult. Any advice would be appreciated, thanks!

About 10 to 20% of the population have a gene that causes an additional gycosylation (adding of a sugar molecule) to SHBG. This more than doubles the half life of the molecule. With a longer half life, those of us that carry the gene tend to have much higher SHBG levels. It does not affect women as much as men because the protein has a much higher affinity to testosterone than estrogen. It effectively prevents passage of free T past the blood-brain barrier where we need the T for normal cognitive functions and libido. It usually manifests itself in the 30's and the symptoms become progressively worse as we age because our natural T product tends to decrease, so there is less and less T to saturate the protein, thereby allowing sufficient Free T to feel "normal".

Your labs are classic of high SHBG. Your total T is at the higher end of normal, but your free T is pathetically low. Mine was around 7 before I was diagnosed. The reason Total T is so high is that SHBG protects T from liver metabolism, so Total T is high, but little is available to spill over into free T.

I've posted extensively on this in other recent strings. Your treatment choices are limited, provided you can find a doc that recognizes the importance of high SHBG (many do not).

1) Begin TRT with a sufficient dose to bring Total T to the upper end of the range. This will saturate the protein and allow enough T to spill over into free T. The main drawback to this approach is that SHBG bound T still has some activity in the peripheral system and can stimulate red blood cell production. You will absolutely need to stay on top of that with regular blood donations and/or a script for therapeutic phlebotomies.

2) Go off the reservation and combine TRT with one a several anabolic hormones that are effective at lowering SHBG. I've found that stanozolol (Winstrol ) 2.5 mg twice per day (an extremely low dose compared to bodybuilding doses) highly effective in keeping my SHBG in range. The problem is that the synthetic hormone is suppressive to the HPTA, so you will need to be on TRT, but at much lower doses than without stanozolol. Oxandrolone (Anavar ) is also highly effective but is much more expensive and requires a slightly higher dose. My experience is that 5 mg Oxandrolone twice per day is sufficient.

You will get advice in the forums to try certain supplements like Nettle root or boron, but my experience is that they only lower the level of your pocketbook not your SHBG.

[TRTdrew]

Good post and great answer

[Builder15]

Thanks for all the great info. At this point, with everything else I have going on I am going to try a few things naturally first to see what happens. Here are the steps I am going to take.

1.) Dial in my diet. I eat clean but I know I am barely reaching my maintenance kcals. I need to up all of my macros and I will aim for 500 above TDEE.
2.) Vitamin D supplementation. I'll start with 3000IU daily. I had my vitamin d levels checked several years ago and it was quite low, although the research is conflicting that the norms may just be set too high since a lot of the general population has low vitamin D levels. I did some reading and found that low vitamin D levels was associated with high SHBG
3.) Reduce stress. This will probably be the toughest. I need to figure out how to find joy in life again, but I have a few ideas.
4.) More sex. Life has just been crazy and while I feel like I still have a sex drive, it just hasn't been a constant thing I think about like I used to

I plan on giving this a try for 3-6 months and see if I feel any different. Whether I do or not, I'll still retest and see if my levels have changed at all and if not then I will look more in to TRT. Thanks for all the help!