Lowering SHBG to Increase Free T -- Treatment Options?

[wellshii]

Nah man not that I can think of.
Gonna have to wait it out. I doubt it though.You'll be fine in that times span.

[bkb333]

Wanted to post an update...I saw a local endo yesterday, and he seemed completely befuddled by my situation. He threw a number of ideas out there (including partial androgen insensitivity and Klinefelter syndrome), but he didn't seem convinced about any of them -- because I have normal breast tissue, plenty of body hair, and normal penis/testicle size. He ordered the following tests:

Dihydrotestosterone
FSH
LH
Androstenedione
Estradiol
AMH
Inhibin B
DHEA-S
ACTH
Cortisol
Cytogenetics
Semen analysis

Hoping it's nothing too serious...I'm a little bugged out by the semen analysis. Of course, he didn't seem worried at all about my free testosterone ...

[Youthful55guy]

Wanted to post an update...I saw a local endo yesterday, and he seemed completely befuddled by my situation. He threw a number of ideas out there (including partial androgen insensitivity and Klinefelter syndrome), but he didn't seem convinced about any of them -- because I have normal breast tissue, plenty of body hair, and normal penis/testicle size. He ordered the following tests:

Dihydrotestosterone
FSH
LH
Androstenedione
Estradiol
AMH
Inhibin B
DHEA-S
ACTH
Cortisol
Cytogenetics
Semen analysis

Hoping it's nothing too serious...I'm a little bugged out by the semen analysis. Of course, he didn't seem worried at all about my free testosterone...

Sounds like a good place to start. Look for the root cause and rule out the bad stuff.

Reminds me of my recent liver issue. We spent thousands of dollars of my insurance money to run every imaginable liver test and lab, only to find out it was my use of OTC naproxen that was affecting the labs. At least I know I'm not going to die of any exotic liver diseases anytime soon!

[wellshii]

Still following.
Also,are you any meds?

[bkb333]

Still following.
Also,are you any meds?

Thanks for following. I'm not on any meds and never have been. So far, I've gotten three test results back. I'll post the rest when I receive them. Here's what I've got so far:

CORTISOL AM -- 13.6 ug/dL (Ref: 6.2 - 19.4 ug/dL)
LH -- 3.3 IU/L (Ref: 1.7 - 8.6 IU/L)
FSH -- 3.3 IU/L (Ref: 1.5 - 12.5 IU/L)

Anything stand out? LH and FSH are a little low...hoping that doesn't mean I'll have a hard time reproducing. I was surprised by how high cortisol was.

[bkb333]

Received more results...my interpretation -- nothing all that surprising besides the dramatic difference in DHEA-S from the first test, and I should be able to reproduce. Agree?

ACTH -- 8.8 pg/mL (Ref: 7.2 - 63 pg/mL)
DHEAS -- 215 mcg/dL (Ref: 105 - 728 mcg/dL)
INHIBN B, INFERTILITY -- 377 pg/mL (Ref: <399 pg/mL)
ANTI MULLERIAN HORM -- 10 ng/mL (Ref: 0.7 - 19 ng/mL)
ANDROSTENEDIONE -- 115 ng/dL (Ref: 40 - 150 ng/dL)
DIHYDROTESTOSTERONE -- 1130 pg/mL (Ref: 112 - 955 pg/mL)
SPERM AGGLUTINATION isolated: less than 10 spermatozoa per agglutinate, many free spermatozoa
SEMEN VISCOSITY -- NORMAL
SEMEN PH -- 8.0
SPERM CONCENTRATION -- 180.0 MILLION/ML (Ref: 15.0 - 999.0 MILLION/ML)
SPERM MOTILITY -- 55 % (Ref: 50 - 100 %)
QUALITY MOTILE -- EXCELLENT FORWARD PROGRESSION
SPERM MORPHOLOGY -- 16 (Ref: greater than or equal to 4%)
SEMEN VOLUME -- 2.5 mL -- (Ref: 2 - 6 mL)

[bkb333]

I had my consultation with Defy. Here's what they are prescribing:

900 IU hCG per week + Anastrozole

They said if that doesn't work after 3-6 months, they'll add Danazol. If that doesn't work, they'll add T. They're hesitant to add T because they don't want to shut down my natural production and harm fertility.

I trust their take, but I do have to admit, I'm a bit surprised T wasn't prescribed.

What do you think?

[Youthful55guy]

I had my consultation with Defy. Here's what they are prescribing:

900 IU hCG per week + Anastrozole

They said if that doesn't work after 3-6 months, they'll add Danazol. If that doesn't work, they'll add T. They're hesitant to add T because they don't want to shut down my natural production and harm fertility.

I trust their take, but I do have to admit, I'm a bit surprised T wasn't prescribed.

What do you think?

I hope you have success, but it's not the path I would choose. My gut feeling is that with your SHBG levels, pretty much any protocol will result in treatment failure. I would focus on getting the SHBG down to a reasonable level and then layering in some sort of TRT to bring Free T levels into the normal range.

I probably would have pushed for the Danazol at about 20 mg per day first. Follow up with labs in 4 weeks to understand SHBG response and your new Total/Free T levels (the SHBG response is pretty fast). Then layer in 1000 IU/week HCG for 6 weeks. Repeat the labs. Then layer in T at a dose to bring Free T into range and/or adjust Danazol.

Is your insurance covering this? Danazol is pretty expensive. If I remember correctly about the same as Anavar . So Anavar might be another alternative in the USA. I've not researched Danazol enough to understand it's impact on liver labs. You might want to do that research and insist on liver labs.

For me, since I am treating my high SHBG on my own, I'll stick with Winstrol , as it's so much more effective at very low doses that do not affect my liver labs much.

[wellshii]

Received more results...my interpretation -- nothing all that surprising besides the dramatic difference in DHEA-S from the first test, and I should be able to reproduce. Agree?

ACTH -- 8.8 pg/mL (Ref: 7.2 - 63 pg/mL)
DHEAS -- 215 mcg/dL (Ref: 105 - 728 mcg/dL)
INHIBN B, INFERTILITY -- 377 pg/mL (Ref: <399 pg/mL)
ANTI MULLERIAN HORM -- 10 ng/mL (Ref: 0.7 - 19 ng/mL)
ANDROSTENEDIONE -- 115 ng/dL (Ref: 40 - 150 ng/dL)
DIHYDROTESTOSTERONE -- 1130 pg/mL (Ref: 112 - 955 pg/mL)
SPERM AGGLUTINATION isolated: less than 10 spermatozoa per agglutinate, many free spermatozoa
SEMEN VISCOSITY -- NORMAL
SEMEN PH -- 8.0
SPERM CONCENTRATION -- 180.0 MILLION/ML (Ref: 15.0 - 999.0 MILLION/ML)
SPERM MOTILITY -- 55 % (Ref: 50 - 100 %)
QUALITY MOTILE -- EXCELLENT FORWARD PROGRESSION
SPERM MORPHOLOGY -- 16 (Ref: greater than or equal to 4%)
SEMEN VOLUME -- 2.5 mL -- (Ref: 2 - 6 mL)

Crazy how it went down that much. Varies I guess.
At least they are working with you.

[bkb333]

Hey guys,

To recap, my prescription is hCG 300 IU 3X week (900 IU total) + Anastrozole 0.125mg 2X week. It's only been 2 weeks, but I haven't felt any change in libido, which is becoming a problem in my relationship. From what I've read, 500-1000 3X a week (1500-3000 IU total) is a more standard dosage. Do you think I should bump up the hCG dosage, or would that be problematic?

[wellshii]

IDK about the HCG method like Youthful says.
I am still concerned about those adrenals. Morning cortisol is supposed to relatively high.
Here are some links.

Q&A Doctor Series: Why do we need optimal cortisol levels for thyroid health? (Answer by David Borenstein, MD)

https://metabolichealing.com/heres-h...ur-blood-test/

https://rarediseases.org/rare-diseases/acth-deficiency/

All they tested was morning cortisol and acth? ACTH looked a little on the low side.

[theBrewmeister]

Hi guys, just following along here. I've only been studying this topic for one month, so I'm a total noob. However, the one thing that makes me scratch my head here is the Hcg protocol. Your E2 levels were at the top of the range; and everything I've read and heard is that Hcg can drive up E2 levels as well. It's been a few weeks since you started this protocol, are you experiencing any estrogen-related sides??

[Youthful55guy]

I doubt it's an E2 issue. I have my doubts that there is any connection between E2 and HCG other than HCG can drive T production (to a certain extent) in guys that are low in LH production (secondary hypogonadism).

I don't want to keep repeating the same advice, but you are not going to go anywhere with your treatment program until you get that ridiculously high SHBG level under control. If I remember correctly, your levels were off the charts in the neighborhood of 180 nmol/L. That's about double my very high levels. It's basically a T sponge that you are never going to saturate with endogenous production no matter how much HCG you pump into your body. Until you saturate that sponge, there will be little T spilling over into Free T. ONLY Free T can cross the blood barrier where you need it. So, even though your swimming in T, your brain is starved of it.

Also, SHBG binds and protects T from liver metabolism. That drives up your Total T levels, so that lab is worthless for monitoring T level in guys that have high SHBG. You will always be high in T, even though your brain is starved or it.

[Chrisp83TRT]

Youthful couldn’t have said it any better.

[theBrewmeister]

Although Youthful is clearly super, super knowledgeable on the subject, maybe it's time for a Tele-consult with someone like Dr. Crisler, to get a Dr's opinion; one who focuses on TRT?

[fiddlesticks]

insulin lowers SHBG so increase insulin response.

[Chrisp83TRT]

I’ve actuallt increased my SHBG by taking DHea ... it was low at first then I got it In normal ranges taking dhea 25mg pharm grade dhea every day before bed

[Youthful55guy]

I’ve actuallt increased my SHBG by taking DHea ... it was low at first then I got it In normal ranges taking dhea 25mg pharm grade dhea every day before bed

yes, most androgens will lower SHBG to some extent (DHEA is a very weak androgen), this does not have an appreciable effect on guys like the OP (and me) who have genetically high SHBG. It's like throwing a glass of water onto a raging wildfire. The treatment seems sound, but the magnitude of the effect is negligible. Same goes for manipulating insulin or taking any of a number of supplements purported to help (boron, nettle extract, etc.). The basic problem is that our genetics are programmed to add an extra sugar molecule to the SHBG protein (it's called glycosylation). This more than doubles the half life of the protein. We produce SHBG at the same 'rate' as other guys, but it sticks around more than twice as long. Therefore, the blood levels more than double.


If I remember correctly, the OP has SHBG in the 180 nmol/L range. Thant's about double my very high level, which hovers in the (untreated) range of 80 to 95. The high end of the 'normal' range for is about 75 using LabCorp's test. With his SHBG levels, it's like a T-sponge that will never get saturated. Without saturation there will be little T spilling over to Free-T or Bioavailable T (another good test that parallels Free T). I originally went down the road of trying to saturate my very high levels with T and was moderately successful. I got my abysmally low 7 pg/mL Free T up to around 16 (range 7.2-24). After much experimentation, I found that the magic number for me was around 15 pg/mL for feeling somewat 'normal' and around 20 pg/mL to get my muscle pump back in the gym. Erections and libido are a bit more complicated, but that followed a similar path as Free T.


Bottom line, with his EXTEREMELY high levels of SHBG, he's not going to have any success until he takes a pharmaceutical approach to lowering it into the normal range. Fortunately, there are effective treatments, but getting docs to prescribe them is difficult. I ended up going off the reservation to get what I need.

[bkb333]

Hey everyone,

Thanks again for all your help. I just received my two-month follow-up test results. Here's where I am:

Total T: 1828 (Ref 250-1100)
Free T: 174 (Ref 35-155)
SHBG: 112 (Ref 10-50)
Estradiol: 61 (Ref < 29)

My Free:Total ratio has improved, albeit marginally, and SHBG has gone down (!). However, my estradiol has also increased. Here are my previous numbers:

Total T: 1148 (Ref 264-916)
Free T: 13.8 (Ref 9.3-26.5)
SHBG: 167.0 (Ref 16.5-55.9)
Estradiol: 43.2 (Ref 7.6-42.6)

What do you think? I am currently taking hCG 300 IU 3X week (900 IU total) and Anastrozole 0.125mg 2X week, working with Defy.

I have my follow-up consultation soon -- just want to see your thoughts, as this forum has been a massive help!

[wellshii]

AT least its helped. Free T is great! That SHBG though.
Theyll probally keep you on.

[bkb333]

yes, most androgens will lower SHBG to some extent (DHEA is a very weak androgen), this does not have an appreciable effect on guys like the OP (and me) who have genetically high SHBG. It's like throwing a glass of water onto a raging wildfire. The treatment seems sound, but the magnitude of the effect is negligible. Same goes for manipulating insulin or taking any of a number of supplements purported to help (boron, nettle extract, etc.). The basic problem is that our genetics are programmed to add an extra sugar molecule to the SHBG protein (it's called glycosylation). This more than doubles the half life of the protein. We produce SHBG at the same 'rate' as other guys, but it sticks around more than twice as long. Therefore, the blood levels more than double.


If I remember correctly, the OP has SHBG in the 180 nmol/L range. Thant's about double my very high level, which hovers in the (untreated) range of 80 to 95. The high end of the 'normal' range for is about 75 using LabCorp's test. With his SHBG levels, it's like a T-sponge that will never get saturated. Without saturation there will be little T spilling over to Free-T or Bioavailable T (another good test that parallels Free T). I originally went down the road of trying to saturate my very high levels with T and was moderately successful. I got my abysmally low 7 pg/mL Free T up to around 16 (range 7.2-24). After much experimentation, I found that the magic number for me was around 15 pg/mL for feeling somewat 'normal' and around 20 pg/mL to get my muscle pump back in the gym. Erections and libido are a bit more complicated, but that followed a similar path as Free T.


Bottom line, with his EXTEREMELY high levels of SHBG, he's not going to have any success until he takes a pharmaceutical approach to lowering it into the normal range. Fortunately, there are effective treatments, but getting docs to prescribe them is difficult. I ended up going off the reservation to get what I need.

Hey Youthful55guy,

Long time no talk! I started TRT 4 months ago, and have not yet had much success. The first 3 months, I was on cream (applied trans-scrotally), and I had brief periods of libido 'rushes' (which felt great!), but they were transient and applying the cream to my balls 2 times a day was super inconvenient. So I switched to injections (IM) 1 month ago. My doctor recently prescribed Danazol as well, at 25 mg EOD, because my SHBG is still quite high.

Latest bloodwork:
Total T 2338
Free T 215.1 (per my conversion, this is 1.15%)
SHBG 114
Albumin 5.3
IGF-1 193
Estradiol 50

And here is my full current protocol:
Tcyp 200 mg/week, IM injections (delts) 2X/week
HCG 600 IU/week, SubQ injections 2X/week
Danazol 25 mg EOD
Ibutamoren 25 mg ED
Metformin 500 mg AM & PM (for body comp purposes)
Niacin 500 mg ED (for cholesterol purposes)
Vitamin D
Boron
Magnesium
Zinc
Not currently taking an AI, but do have some Anastrozole on-hand if needed

My doctor did not want to prescribe more Danazol because he said it could harm my fertility (perhaps negating the effects of HCG), which I really don't want to do; we don't want kids now, but will in a few years. Do you think 25 mg EOD is sufficient? 3 weeks in with the Danazol, I haven't felt any different, and I'm debating increasing to 25 mg ED. I'm also thinking perhaps I should change to Winstrol (5 mg ED) once I use up the Danazol -- though I would have to get that through 'alternative sourcing,' and my insurance is covering the Danazol, which is quite nice.

At this point, my libido has been great for two brief runs (several days) on the cream, and has been nonexistent since switching to injections. I'm hoping it's just taking some time for my body to adjust. BUT, I also think I may need to change up my SHBG control method. After 3 weeks, I'd think I'd be at least feeling something. Thoughts?

[Youthful55guy]

Please provide normal ranges and units for you labs. All laboratories have different ranges, so it's difficult to interpret the results without knowing what normal is for the lab you are using.

Total T seems quite high, but with a 100mg 2X per week protocol, that's about what I'd expect. I'm assuming the lab method is LC/MS because the 'normal" RIA lab tops out at 1500 ng/dL.

Free T also seems quite high if the units are pg/mL. The normal ranges for Free T is usually age adjusted, but my goal is to maintain the upper 75th percentile of a 30 year old man. The LabCorp range for Free T for a 30 year old man is 8.7 to 35.1 pg/mL. At 215.1, you blow the doors off of that range if the units are the same. Something is not making sense here.

SHBG is down from your prior ridiculously high 180 nmol/L, but it is still very high. I have never used Danazol, so I don't have any advice to give. But it does seem to be doing the job of brining down SHBG. Increasing the dose might help, but then you are going to run into supply problems if you are on a set script of 25mg EOD. Taking more will use up your monthly supply faster and you will run out before the next refill. You need to get your doc on board to change the script if you are going to continue to do this through legal channels and under insurance (which I recommend if at all possible). Switching to Winstrol will probably be more effective, but then you have supply and legality issues to deal with. it's a last resort as far as I'm concerned.

I don't understand what fertility issues you doc is concerned about with Danazol. I would quiz him more on that. We know that Danazol will suppress the HPTA while you taking it, this is why you are also taking supplemental T. Suppressing the HPTA not only lowers LH but also FSH, so yes fertility will be an issue while on Danazol, but this is most likely temporary and will return to normal once you discontinue therapy. Also, you are maintaining testicular function with HCG , so testicular atrophy will not be an issue if/when you discontinue Danazol therapy.

FYI, I am currently experimenting with a no-Winstrol protocol. Like you, I've increased my T dose to 200 mg/week but with an E2D protocol. I am concerned about long-term importation of an illegal drug, so I want to find an alternative. My goal is to saturate the SHBG protein with T so that enough spills over to Free T to feel and function normally. Keep in mind that while my SHBG is high, it is no where near your untreated levels. You have a much more sever SHBG problem that I doubt will ever be treatable with this approach. I believe you need to combine suppression with TRT.

So far my experiment has been successful. I am also using low dose finasteride and anastrozole to keep DHT and E2 within the upper end of the normal range. My last lab showed my Total T about the sensitivity of the RIA test (>1500 ng/DL) and Free T above range at 32 pg/mL. I'm made some small Finasteride and anastrozole adjustments a couple weeks ago and will retest in about a month. At that time I will make a decision whether to lower my T dose to bring Free T back into the normal range 9for a 30 y/O guy that is). more than likely I'll drop the T dose down to 180 mg/week keeping with the E2D protocol.

[bkb333]

Please provide normal ranges and units for you labs. All laboratories have different ranges, so it's difficult to interpret the results without knowing what normal is for the lab you are using.

Here are those numbers with reference ranges:
Total T 2338 (250-1100)
Free T 215.1 (35-155)
SHBG 114 (10-50)
Albumin 5.3 (3.6-5.1)
IGF-1 193 (63-373)
Estradiol 50 (< 29)

Total T seems quite high, but with a 100mg 2X per week protocol, that's about what I'd expect. I'm assuming the lab method is LC/MS because the 'normal" RIA lab tops out at 1500 ng/dL.

Indeed, total T is very high. I don't know that I should really be concerned about total T, though, because I'll likely always need quite a high value to feel 'normal.' Would you agree?

Free T also seems quite high if the units are pg/mL. The normal ranges for Free T is usually age adjusted, but my goal is to maintain the upper 75th percentile of a 30 year old man. The LabCorp range for Free T for a 30 year old man is 8.7 to 35.1 pg/mL. At 215.1, you blow the doors off of that range if the units are the same. Something is not making sense here.

With the ranges now included, and the total T I have, it's not really all that high, right? By moving the decimal over, I get 21.5. I think I may need to be closer to the upper end of normal (~35) to feel 'normal.'

SHBG is down from your prior ridiculously high 180 nmol/L, but it is still very high. I have never used Danazol, so I don't have any advice to give. But it does seem to be doing the job of brining down SHBG.

I should have made it clear that I was not on Danazol yet at the time of my last bloodwork. So at that point, my SHBG had been driven down from 180 to 114 through exogenous T, HCG , and the other vitamins/supplements enumerated above.

Increasing the dose might help, but then you are going to run into supply problems if you are on a set script of 25mg EOD. Taking more will use up your monthly supply faster and you will run out before the next refill. You need to get your doc on board to change the script if you are going to continue to do this through legal channels and under insurance (which I recommend if at all possible). Switching to Winstrol will probably be more effective, but then you have supply and legality issues to deal with. it's a last resort as far as I'm concerned.

This is good to know. Thank you! I was able to place a sizable order up front, so I don't think I'd have a big issue with running out. But I should probably also just ride it out until my next bloodwork to see what the 25 mg EOD protocol is doing to my SHBG, though I don't feel any different.

I don't understand what fertility issues you doc is concerned about with Danazol. I would quiz him more on that. We know that Danazol will suppress the HPTA while you taking it, this is why you are also taking supplemental T. Suppressing the HPTA not only lowers LH but also FSH, so yes fertility will be an issue while on Danazol, but this is most likely temporary and will return to normal once you discontinue therapy. Also, you are maintaining testicular function with HCG, so testicular atrophy will not be an issue if/when you discontinue Danazol therapy.

FYI, I am currently experimenting with a no-Winstrol protocol. Like you, I've increased my T dose to 200 mg/week but with an E2D protocol. I am concerned about long-term importation of an illegal drug, so I want to find an alternative. My goal is to saturate the SHBG protein with T so that enough spills over to Free T to feel and function normally. Keep in mind that while my SHBG is high, it is no where near your untreated levels. You have a much more sever SHBG problem that I doubt will ever be treatable with this approach. I believe you need to combine suppression with TRT.

Out of curiosity, why are you doing E2D? I think most high SHBG guys still believe in the high dose once per week (max 2X) approach. I have considered injecting more frequently, maybe 3X a week, as I have seen some have success with such a strategy. Are you injecting, IM? I have also considered increasing my T dosage, perhaps to 250-300 mg/week. This may look more like AAS usage, but I really think it may be necessary because my SHBG is so extreme.

So far my experiment has been successful. I am also using low dose finasteride and anastrozole to keep DHT and E2 within the upper end of the normal range. My last lab showed my Total T about the sensitivity of the RIA test (>1500 ng/DL) and Free T above range at 32 pg/mL. I'm made some small Finasteride and anastrozole adjustments a couple weeks ago and will retest in about a month. At that time I will make a decision whether to lower my T dose to bring Free T back into the normal range 9for a 30 y/O guy that is). more than likely I'll drop the T dose down to 180 mg/week keeping with the E2D protocol.

Very good to hear and happy for you! Have you followed Neil Rouzier's work on controlling estrogen? He's the one who convinced me to stop my AI. I know you only use a very, very small dose, and I'm not completely opposed to going back on with a similar small dose at some point.

[Youthful55guy]

Indeed, total T is very high. I don't know that I should really be concerned about total T, though, because I'll likely always need quite a high value to feel 'normal.' Would you agree?
Yes, but if you combine Danazol (or Winstrol ) with TRT, you will be able to lower the T dose substantially.

With the ranges now included, and the total T I have, it's not really all that high, right? By moving the decimal over, I get 21.5. I think I may need to be closer to the upper end of normal (~35) to feel 'normal.'
I still don't understand why it is a magnitude of 10 higher. What are the units reported in? Mine are pg/mL for free T.

I should have made it clear that I was not on Danazol yet at the time of my last bloodwork. So at that point, my SHBG had been driven down from 180 to 114 through exogenous T, HCG , and the other vitamins/supplements enumerated above.
OK. I too have noticed that increasing the T dose lowers my SHBG about 20 to 30%.

Out of curiosity, why are you doing E2D? I think most high SHBG guys still believe in the high dose once per week (max 2X) approach. I have considered injecting more frequently, maybe 3X a week, as I have seen some have success with such a strategy. Are you injecting, IM? I have also considered increasing my T dosage, perhaps to 250-300 mg/week. This may look more like AAS usage, but I really think it may be necessary because my SHBG is so extreme.
I want to avoid sharp peaks in T levels to help prevent conversion to DHT and E2. I just felt that with such a large increase in my T dose when I discontinued Winstrol, I should increase the frequency. I may reconsider this in the future. I much prefer a E3D dose schedule but for now I'm staying with E2D until I get the dose figured out, Then I can fine tune the frequency. Yes I am injecting IM. I use a 28G insulin syringe and alternate upper outer quadriceps.

Very good to hear and happy for you! Have you followed Neil Rouzier's work on controlling estrogen? He's the one who convinced me to stop my AI. I know you only use a very, very small dose, and I'm not completely opposed to going back on with a similar small dose at some point.
I felt that increasing the T dose from 100 to 200 mg/week would require some E2 control. Turns out I over shot the mark. The first 6 weeks at 200 mg/week my anastrozole dose was 1.1 mg per week distributed in small daily doses using the eye dropper method. However, this crushed my E to 13.6 pg/mL (range 8-35). I have since backed off to 0.65 mg/week and will retest in another 4 weeks and adjust from there if necessary. I have to say I am questioning my rationale for going so high on anastrozole from the start. I could tell it was too high. Erections were becoming an problem. Decreasing the dose has helped, so I believe I'm in a better range, but I think it still might be too high. however, I'm going to make these adjustments systematically and with the guidance of labs. This is not something you can do simply by feel.

[bkb333]

As always, an amazing reply. Thanks so much. You're the man!

Indeed, total T is very high. I don't know that I should really be concerned about total T, though, because I'll likely always need quite a high value to feel 'normal.' Would you agree?
Yes, but if you combine Danazol (or Winstrol) with TRT, you will be able to lower the T dose substantially.

That's interesting, because my doctor didn't even mention lowering the dose down the road. He kept me at 200mg when we added Danazol, and I got the sense that he, too, is considering increasing the dose, depending on how SHBG looks on my next bloods.

With the ranges now included, and the total T I have, it's not really all that high, right? By moving the decimal over, I get 21.5. I think I may need to be closer to the upper end of normal (~35) to feel 'normal.'
I still don't understand why it is a magnitude of 10 higher. What are the units reported in? Mine are pg/mL for free T.

These are pg/mL, but they are from Quest rather than LabCorp. My doctor just said to get the same number with a conversion, move the decimal point over one place. I also consulted with another doctor who said he thinks I'll need to be above 30 to feel good.

I should have made it clear that I was not on Danazol yet at the time of my last bloodwork. So at that point, my SHBG had been driven down from 180 to 114 through exogenous T, HCG , and the other vitamins/supplements enumerated above.
OK. I too have noticed that increasing the T dose lowers my SHBG about 20 to 30%.

I've seen mixed results on this. For some guys, going on T or lowering their dose does nothing to their SHBG. I'm very curious what I'll see on my next bloods.

Out of curiosity, why are you doing E2D? I think most high SHBG guys still believe in the high dose once per week (max 2X) approach. I have considered injecting more frequently, maybe 3X a week, as I have seen some have success with such a strategy. Are you injecting, IM? I have also considered increasing my T dosage, perhaps to 250-300 mg/week. This may look more like AAS usage, but I really think it may be necessary because my SHBG is so extreme.
I want to avoid sharp peaks in T levels to help prevent conversion to DHT and E2. I just felt that with such a large increase in my T dose when I discontinued Winstrol, I should increase the frequency. I may reconsider this in the future. I much prefer a E3D dose schedule but for now I'm staying with E2D until I get the dose figured out, Then I can fine tune the frequency. Yes I am injecting IM. I use a 28G insulin syringe and alternate upper outer quadriceps.

Your reasoning is sound. I'm not sure that E2D or E3D will make that big a difference for any one of us. Obviously E2D is preferable from a convenience standpoint. I like doing Monday-Thursday, as it allows for weekend travel without needing to pack anything up. We use the same type of syringe. I've been using the delts rather than quads. I read on some forums that some doctors don't recommend the lower body for injections -- can't recall offhand why.

Very good to hear and happy for you! Have you followed Neil Rouzier's work on controlling estrogen? He's the one who convinced me to stop my AI. I know you only use a very, very small dose, and I'm not completely opposed to going back on with a similar small dose at some point.
I felt that increasing the T dose from 100 to 200 mg/week would require some E2 control. Turns out I over shot the mark. The first 6 weeks at 200 mg/week my anastrozole dose was 1.1 mg per week distributed in small daily doses using the eye dropper method. However, this crushed my E to 13.6 pg/mL (range 8-35). I have since backed off to 0.65 mg/week and will retest in another 4 weeks and adjust from there if necessary. I have to say I am questioning my rationale for going so high on anastrozole from the start. I could tell it was too high. Erections were becoming an problem. Decreasing the dose has helped, so I believe I'm in a better range, but I think it still might be too high. however, I'm going to make these adjustments systematically and with the guidance of labs. This is not something you can do simply by feel.

Where was your E2 before the 1.1 mg per week protocol? I know erections were an issue, but how was your libido? In general, have you found a 'sweet spot' for libido with E2?

[Youthful55guy]

Where was your E2 before the 1.1 mg per week protocol? I know erections were an issue, but how was your libido? In general, have you found a 'sweet spot' for libido with E2?

When I was on my standard 100 to 120 mg per week T-cyp with 3ED dosing using 0.25mg Winstrol 2X per day, my E2 was pretty much always in the 25 to 35 pg/mL range with normal being 8-35 with the LabCorp sensitive test. I did not need an AI, but sometimes I'd add it in at a low dose with the eyedropper method and I could maintain it in the 20-30 range when I wanted to.

However, the more I know about E2, the more I question whether we should be mucking with it unless it goes much over 50 (with a 8-35 normal range). When I started out on the higher T no Winstrol experiment, my E2 shot up to the 70 range so I decided to layer in an AI. I overshot the mark with 1.1 mg anastrozole per week and now I'm adjusting downward. I never have had any gynecomastia issues, but I was concerned that my E2 went above the 50 pg/mL range which is my self-imposed cutoff for treatment.

[Family_guy]

As always, an amazing reply. Thanks so much. You're the man!



That's interesting, because my doctor didn't even mention lowering the dose down the road. He kept me at 200mg when we added Danazol, and I got the sense that he, too, is considering increasing the dose, depending on how SHBG looks on my next bloods.


These are pg/mL, but they are from Quest rather than LabCorp. My doctor just said to get the same number with a conversion, move the decimal point over one place. I also consulted with another doctor who said he thinks I'll need to be above 30 to feel good.



I've seen mixed results on this. For some guys, going on T or lowering their dose does nothing to their SHBG. I'm very curious what I'll see on my next bloods.



Your reasoning is sound. I'm not sure that E2D or E3D will make that big a difference for any one of us. Obviously E2D is preferable from a convenience standpoint. I like doing Monday-Thursday, as it allows for weekend travel without needing to pack anything up. We use the same type of syringe. I've been using the delts rather than quads. I read on some forums that some doctors don't recommend the lower body for injections -- can't recall offhand why.



Where was your E2 before the 1.1 mg per week protocol? I know erections were an issue, but how was your libido? In general, have you found a 'sweet spot' for libido with E2?

There’s a lot of nerves and artery’s/veins relatively near the surface especially on your quad. That’s why it’s not usually recommended. I did it for a week but it never felt right. Always scared of hitting something plus the pip was terrible. Went to delts and never looked back!

[Youthful55guy]

There’s a lot of nerves and artery’s/veins relatively near the surface especially on your quad. That’s why it’s not usually recommended. I did it for a week but it never felt right. Always scared of hitting something plus the pip was terrible. Went to delts and never looked back!

I disagree, the upper outer quadriceps (Rectus Femoris - see attached diagram) is often recommended by experts for due to it's lack of surface vasculature and major nerves. It is also a fairly large muscle and easy to access. However, the deltoid also makes for a good alternative, so it's more of a personal choice. I live in an environment where shorts are worn nearly year round, so the quadriceps is very convenient for me to access. Not so much for the deltoid because I often wear long sleeve pullovers and sweaters in the morning (when I do my injections) so it requires disrobing to access the deltoids. Hence, my preference for the quadriceps.

If one injects larger volumes, as with old school T-cyp once weekly protocols or with Nebido protocols, the large but much more difficult to access gluteal muscles are generally recommended.

[Couchlockd]

I disagree, the upper outer quadriceps (Rectus Femoris - see attached diagram) is often recommended by experts for due to it's lack of surface vasculature and major nerves. It is also a fairly large muscle and easy to access. However, the deltoid also makes for a good alternative, so it's more of a personal choice. I live in an environment where shorts are worn nearly year round, so the quadriceps is very convenient for me to access. Not so much for the deltoid because I often wear long sleeve pullovers and sweaters in the morning (when I do my injections) so it requires disrobing to access the deltoids. Hence, my preference for the quadriceps.

If one injects larger volumes, as with old school T-cyp once weekly protocols or with Nebido protocols, the large but much more difficult to access gluteal muscles are generally recommended.

My quads were my go to for all injections.

But recently I found out if I burry a 1½" needle to the hub, I can get 3-3.5ml in delt, no leaks.

I leave the needle in for about 10 second after injection, and pull out real real slowly.

[bkb333]

My quads were my go to for all injections.

But recently I found out if I burry a 1½" needle to the hub, I can get 3-3.5ml in delt, no leaks.

I leave the needle in for about 10 second after injection, and pull out real real slowly.

I am doing the same with delts. So far, it's been great.

[bkb333]

Hey everyone -- after switching from T cream to injections 6 weeks ago, I have new bloodwork. I definitely feel better, and this delivery system works better with my lifestyle. Further, my Free T:T % has increased from 0.8 to 1.8%! But I am wondering whether I should be concerned about how high my numbers have gotten -- new bloods below:

Free T: 543.1 Ref 35-155
Total T: 2889 Ref 250-1100
DHT: 133 Ref 16-79
Estradiol Ultrasensitive: 91 Ref <29
SHBG: 72 Ref 10-50
T3 Reverse: 31 Ref 8-25
T4 Free 1.0 Ref 0.8-1.8
T3 Free: 2.7 Ref 2.3-4.2
Prolactin: 5.6 Ref 2.0-18.0

Current protocol:
Prescribed 200 mg T cypionate (split into injections 2X/week); been taking 250 mg
25 mg Danazol EOD

A few questions...
Though a high dose of T is likely needed because of my SHBG, could the current approach be detrimental to my long-term health, despite the improvement in Free T:T %? Is this basically a cycle at this point? Would you lower the dose?

The high dose of T and Danazol are both in place to overcome my crazy-high SHBG (was near 200 pre-HOT). Should I back off on either/both medication(s), to protect my long-term health? I have a follow-up with my provider tomorrow. I do not want to damage my long-term well-being, though I have very much enjoyed how much symptom resolution I've experienced -- life has been a lot better!

[DianaEmade]

I am doing the same with delts. So far, it's been great.

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[HoldMyBeer]

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Nice first post
Go fuck yourself

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[Youthful55guy]

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You should read the rules about solicitation to other websites. You've been reported to the monitors and your posts will more than likely be scrubbed for the site after you are barred.

[bkb333]

I'd love to hear what you think of the bloods and next steps, Youthful. Should I lower my dose?

[bkb333]

My follow-up with my provider today went well! We are going to lower my dosage from 200mg/week to 180/week; switch from 2X/week injections to 3X/week; and aim to lower estrogen by increasing Danazol dosage. Further, I need to continue monitoring T3 and increase my caloric consumption.

He wasn’t overly concerned about the high numbers. Right now, my Free T is 54.3 (using the decimal-point conversion system), and we are hoping to see it around 40 next time around. We are also hoping to see SHBG go down more and E go down.

Our meeting largely focused on estrogen. He says our goal is to get the E number to be lower than the SHBG number.

He gave me the flexibility to decide how much to increase my Danazol dosage and was happy to go up to 25 mg ED (previously: 25 mg EOD). I’m hoping for some insight here. I was thinking I would do 25 mg 5X/week. My goal is to get SHBG under 50 (was 72 on these recent bloods after starting at 180 at the beginning of HOT). How much would you increase it? Would you go up to 25 mg ED? I do not want to employ an AI, though I do have some on hand if needed.

It seems Danazol will intermittently be a part of my protocol for the foreseeable future. Once we get SHBG sufficiently low — which will allow me to have a more moderate T level — we will lay off the Danazol for a while, then reintroduce it if SHBG increases too much. This cycling system will be in place to reduce the risk of liver toxicity.

We also talked a lot about my high Reverse T3. He believes this is a result eating too few calories — something he sees a lot in bodybuilders who do caloric restriction. He believes I should be eating a lot more (currently: 1800 cals). My T3 is now 9% of my Reverse T3, and our goal is for it to be 20% or more. But raising thyroid hormones can also raise SHBG, so we are going to leave this alone for now and just roll with the other changes I outlined above. We’ll continue monitoring.

I plan to increase my consumption -- how much do you think I should be eating? I am 6'2", 175 lbs., and rather active (lift 6 days a week, cardio 2 days, 10K+ steps every day). He recommended 3500/day, but that seems like an extreme leap to me.

Final note: he didn’t think I necessarily needed more bloodwork now (as opposed to in 6 weeks), but I asked for it. Thus, I will have a CBC and CMP now. As I understand it, these tests should comprise HCT, HGB, and RBC, among other variables.

He wasn’t super concerned about HCT because my level has been stable throughout treatment on the four tests I’ve had (45, 46.6, 44, 45.7). But it will be interesting to see how much it has jumped up, given the rise in Free T.

[Youthful55guy]

My follow-up with my provider today went well! We are going to lower my dosage from 200mg/week to 180/week; switch from 2X/week injections to 3X/week; and aim to lower estrogen by increasing Danazol dosage. Further, I need to continue monitoring T3 and increase my caloric consumption.
Lowering the dose was a good decision, but I still think it is way too high, particularly given that you are attempting to bring down SHBG with Danazol. once you get the SHBG under 50 (a good target), I suspect that your optimal dose will be closer to 120mg per week in divided doses.

He wasn’t overly concerned about the high numbers. Right now, my Free T is 54.3 (using the decimal-point conversion system), and we are hoping to see it around 40 next time around. We are also hoping to see SHBG go down more and E go down.
Prolonged high T will eventually push your hematocrit out of range and make it very difficult to control E2 and DHT. You are definitely high in E2 in your labs. I do not recommend artificially lowering E2 with and AI, you are much better off lowering the T dose.

Our meeting largely focused on estrogen. He says our goal is to get the E number to be lower than the SHBG number.
Yes, you need to lower the T dose to get control of E2. Getting it under 50 pg/mL is a good target. My goal is to try to stay within the upper end of the normal range, which is about 35 with my test lab and method.

He gave me the flexibility to decide how much to increase my Danazol dosage and was happy to go up to 25 mg ED (previously: 25 mg EOD). I’m hoping for some insight here. I was thinking I would do 25 mg 5X/week. My goal is to get SHBG under 50 (was 72 on these recent bloods after starting at 180 at the beginning of HOT). How much would you increase it? Would you go up to 25 mg ED? I do not want to employ an AI, though I do have some on hand if needed.
I have no experience with Danazol to offer any advice. I've read a couple of posts from guys with high SHBG that put the optimum dose (for them) in the 20-30 mg/day range, so 25 mg sounds like a reasonable starting dose.

It seems Danazol will intermittently be a part of my protocol for the foreseeable future. Once we get SHBG sufficiently low — which will allow me to have a more moderate T level — we will lay off the Danazol for a while, then reintroduce it if SHBG increases too much. This cycling system will be in place to reduce the risk of liver toxicity.
I think cycling is a bad idea. In my experience, to make it sustainable, you need to get your TRT protocol to a stable point so that it is on auto pilot. having to muck with T and Danazol doses periodically is going to get old after a while. The goal is to get back to you normal life.

We also talked a lot about my high Reverse T3. He believes this is a result eating too few calories — something he sees a lot in bodybuilders who do caloric restriction. He believes I should be eating a lot more (currently: 1800 cals). My T3 is now 9% of my Reverse T3, and our goal is for it to be 20% or more. But raising thyroid hormones can also raise SHBG, so we are going to leave this alone for now and just roll with the other changes I outlined above. We’ll continue monitoring.
yes, caloric restriction is known to increase rT3. I would recommend focusing on getting that under control. I suspect that your use of thyroid hormones is your root cause for the high SHBG. There is a known connection between supplemental T3 and/or T4 and increased SHBG.

I plan to increase my consumption -- how much do you think I should be eating? I am 6'2", 175 lbs., and rather active (lift 6 days a week, cardio 2 days, 10K+ steps every day). He recommended 3500/day, but that seems like an extreme leap to me.

Final note: he didn’t think I necessarily needed more bloodwork now (as opposed to in 6 weeks), but I asked for it. Thus, I will have a CBC and CMP now. As I understand it, these tests should comprise HCT, HGB, and RBC, among other variables.

He wasn’t super concerned about HCT because my level has been stable throughout treatment on the four tests I’ve had (45, 46.6, 44, 45.7). But it will be interesting to see how much it has jumped up, given the rise in Free T.

See above comments in blue/bold.

[bkb333]

Thanks for all the insight, Youthful! Great stuff as always.

Lowering the dose was a good decision, but I still think it is way too high, particularly given that you are attempting to bring down SHBG with Danazol. once you get the SHBG under 50 (a good target), I suspect that your optimal dose will be closer to 120mg per week in divided doses.

Would you lower the dose even more at this point? I was thinking I'd take it down to 180 for now, then eventually get it down lower (maybe 150, or even 120 as you mentioned), but that I would do that over time and as SHBG decreases further with the increased Danazol supplementation. It seems to me like drastically dropping the T dose quickly could cause problems.

I think cycling is a bad idea. In my experience, to make it sustainable, you need to get your TRT protocol to a stable point so that it is on auto pilot. having to muck with T and Danazol doses periodically is going to get old after a while. The goal is to get back to you normal life.

Oh, I totally agree -- I would much rather be on a steady protocol that doesn't change. But as I understand it, Danazol comes with risks of liver toxicity. I don't want to do any damage there, though it seems Danazol could be a lynchpin of my protocol for years to come. So I'm trying to weigh the pros and cons.

I suspect that your use of thyroid hormones is your root cause for the high SHBG. There is a known connection between supplemental T3 and/or T4 and increased SHBG.

Out of curiosity, what do you mean by this? As far as I know, I haven't taken any thyroid hormones, unless something I am taking is affecting thyroid and I am unaware of it. I'm thinking I may have just caused confusion with the way I worded that section. I just meant that we aren't going to fool around with any thyroid meds (as I haven't to date) for now.

[Youthful55guy]

Would you lower the dose even more at this point? I was thinking I'd take it down to 180 for now, then eventually get it down lower (maybe 150, or even 120 as you mentioned), but that I would do that over time and as SHBG decreases further with the increased Danazol supplementation. It seems to me like drastically dropping the T dose quickly could cause problems.

Yes, You posted these results from 200 mg/week:
Free T: 543.1 Ref 35-155
Total T: 2889 Ref 250-1100
DHT: 133 Ref 16-79
Estradiol Ultrasensitive: 91 Ref <29
SHBG: 72 Ref 10-50

Those are insanely high levels of T, and no doubt driving your E2 issues. it's going to cause problems down the road if you don't get it within range. By comparison, at one point when I was not using Winstrol to lower my SHBG and my SHBG was 81.6 (not far from your last lab) and my T dose was 103 mg/week (0.22 mL E3D), my Total T was 779 (normal range 241-827 ng/dL) and my bioavailable T (the doc rant that test instead of Free T) was 214 ng/dL (normal range 48-344). I was way above the 50th percentile in both TT and FT. I suspect that 120 mg/week will put you at the top of the range.

Bottom line is at 120 mg/wk, you will be well with in the range and if you break it up into at least 2X per week dosing, you should not feel it. You might even feel better because your E2 will also drop down into the normal range. With TRT, just because a little makes you feel good (normal), a lot more does not make you feel a lot better. You want to strive for a stable protocol that is sustainable.

Danazol comes with risks of liver toxicity.

Possibly. My understanding is that it has a lower toxicity than Winstrol or Anavar (your other 2 choices). I'd focus your labs on finding the highest sustainable dose without sending your liver labs out of range and then adjusting the T dose around it. Again, my experience is that a T dose of 120 should be your starting point. If you have to back off on Danazol, you can always increase the T-dose to compensate.

I haven't taken any thyroid hormones … I just meant that we aren't going to fool around with any thyroid meds (as I haven't to date) for now.

A misunderstanding on my part. I would not introduce ANY thyroid medication with your SHBG problem. it will just exasperate the problem.

[bkb333]

Thank you, Youthful. You are the man.