Update on protocol to overcome high SHBG

[Youthful55guy]

As many of you know, my problem is high SHBG and low free T. For quite some time, I've been treating this with a combination of very low dose Winstrol (Stanozolol ) in combination with TRT. The low dose stanozolol (0.25 mg 2X/day) is enough to bring my SHBG down into the normal range and the TRT(~100 mg E3D) got my Free T into the upper range of a 30-40 year old guy (my goal).

At the beginning of this year I decided to try a new protocol of no Winstrol and bumping up my TRT to compensate. I also started use of finasteride to lower my typically high DHT while on TRT to help control hemoglobin over production. I started out with a dose that was way too high, but I knew this going in. I just wanted to see how I feel at a bodybuilder dose for a couple of weeks. Then I started adjusting it downward and retested about every 6-8 weeks. The follow table and graph summarizes the data I've collected so far. It seems to indicate that a dose of around 110 mg/week of T-cyp in an E2D protocol is going to be the sweet spot. Recently I adjusted the dose down from about 160 mg/week to 120. I'll retest in about 8 weeks.

My hemoglobin in my recent test was at the high end of normal but not overly high and I have not donated blood since starting finasteride about 7 months ago. This seems to indicate that the finasteride is doing its job of controlling hemoglobin production, even in the face of some very high T doses over this 7 month period. Currently, I'm off finasteride for a month so that I can do a double red donation next week and then I'll resume the finasteride protocol.

The odd thing about my labs is the unpredictability of Estradiol. Currently, I've not used any AI for over 12 weeks and my E2 is very low, even with fairly high T levels. I stopped use of DIM over 6 weeks ago too. Not sure what to make of this. I plan to not take any E2 control and simply monitor levels.

[HoldMyBeer]

What's the finasteride dose?
I have a script but stopped taking it bc my sex drive went to shit

[Youthful55guy]

What's the finasteride dose?
I have a script but stopped taking it bc my sex drive went to shit

It has varied over time from 1 to 2 mg per day. Please see the table in the original post for the exact values. My advice is to monitor your DHT and make sure it stays within range. Finasteride is a very powerful DHT blocker and most doc tend to over-prescribe the dose because it's only available in 1mg and 5mg tablets. Docs simply don't know about or (or won't advise on) the eye dropper method of daily dosing of smaller amounts. The commercially available 1mg tablets are indicated for hair loss and generally not covered by insurance. The 5mg tablets are indicated for BPH and usually are covered by insurance, so the docs go straight for the maximum dose and crush you DHT and hence your libido. My experience is that far less is needed while on TRT.

My goal is to keep it at the 50th percentile of the normal range. Typically, while on even moderate doses of TRT, my DHT runs way above range. It's been variable between 106 (lowest ever) to 247 (highest) on a normal range of 30-85 mg/dL. I think high DHT is true for a lot of guys but they simply don't know it because they don't monitor it. It's DHT more than T that drives red blood cell production.

If overproduction of hemoglobin/hematocrit are a problem, DHT is the first thing I'd look at. I ran across some recent research that strongly correlates the problem to high DHT in guys on TRT.

[HoldMyBeer]

It has varied over time from 1 to 2 mg per day. Please see the table in the original post for the exact values. My advice is to monitor your DHT and make sure it stays within range. Finasteride is a very powerful DHT blocker and most doc tend to over-prescribe the dose because it's only available in 1mg and 5mg tablets. Docs simply don't know about or (or won't advise on) the eye dropper method of daily dosing of smaller amounts. The commercially available 1mg tablets are indicated for hair loss and generally not covered by insurance. The 5mg tablets are indicated for BPH and usually are covered by insurance, so the docs go straight for the maximum dose and crush you DHT and hence your libido. My experience is that far less is needed while on TRT.

My goal is to keep it at the 50th percentile of the normal range. Typically, while on even moderate doses of TRT, my DHT runs way above range. It's been variable between 106 (lowest ever) to 247 (highest) on a normal range of 30-85 mg/dL. I think high DHT is true for a lot of guys but they simply don't know it because they don't monitor it. It's DHT more than T that drives red blood cell production.

If overproduction of hemoglobin/hematocrit are a problem, DHT is the first thing I'd look at. I ran across some recent research that strongly correlates the problem to high DHT in guys on TRT.

He prescribed 5mg and told me to cut it into 4ths. I'll look into the eye dropper method

[Youthful55guy]

He prescribed 5mg and told me to cut it into 4ths. I'll look into the eye dropper method

Best advice I can give is to monitor your DHT levels and adjust the dose to keep it in about the middle of the "normal" range for the lab running the test. For LabCorp, that around 60 mg/dL. I also use 5mg tablets and dissolve one into 2 mL of vodka. Through many measurements, I've arrived at about 0.06003mg/drop to calculate the number of drops per day that I need. I also divide the daily dose into an AM and PM dose because finasteride has a very short half life of around 5-8 hours.

[Youthful55guy]

To anyone following this string, please note that I edited and replaced the table in the original post (but you can still see the first table in a gray box). I edited the table to make it more clear as to how I am using finasteride, which I believe is important. It's not all oral. I also use it topically on my scalp for hair loss. I've read that there is empirical evidence that this is helpful in preventing and/or treating hair loss. It's way too early for me to tell if topical dosing is effective, but if it is, it's no miracle cure. I also put the data in chronological order and included dates.

I started out with oral only finasteride in January 2019 and then added in topical dosing and gradually increased the total daily dose and shifted it from oral to topical. The last lab/dosing schedule of 0.5mg oral and 1.5mg topical put my DHT exactly where I'd like to keep it at a T dose of 163mg/week (E2D protocol). I've subsequently reduced my T dose to 120mg and will retest in about 6 weeks at that same finasteride protocol and make a decision whether to modify the protocol further. Also keep in mind that with both oral and topical finasteride, I use a 2X daily protocol.

Here's the revised table (which you can also find in the original (edited) post.

[Youthful55guy]

Here's an update to my labs. I decided to put the dose-response study on hold and drop way down on T because of some unrelated medical issues that necessitated some unscheduled lab work with my my primary doc. I didn't want her to know that I'm experimenting with the dose. I even dropped below the prescribed dose, so now I have a data point with a T dose less than 100mg/week. She also prescribed 5mg of finasteride, which I took during this low dose trial, and as you can see it sent my DHT levels below the low end of the normal range.

Today I backed off on the finasteride to 2.5mg (oral only) but will maintain the low dose T for another 5 weeks before I retest. At that point, I'll probably resume the dose-response experiment and fill in the gaps with the missing 140mg/wk and 120 mg/wk doses. I'm guessing that I'll end up somewhere between 110 and 120 mg/week as the optimal dose to push free T to the upper end of the normal range but still be within range. At that point, I'll optimize the finasteride dose to maintain DHT about mid-range. I do not plan on doing any E2 control, as it does not appear to be necessary with this T protocol.

[Couchlockd]

Posting so I can come back to this can read this so I don't lose it I do have not shbg

[Youthful55guy]

Got time on my hands today, so I decided to play with graphing the data from my Free T dose-response experiment. The results so far indicate a weekly (divided) dose of about 87 to 112 mg/week will put me in the range of Free T recommended by the Life Extension Organization. Their recommendation is that we target the upper 1/3 of the range for a 21 to 49 year old healthy male, which is about 20-25 pg/mL.

Keep in mind that I have still need to collect some data in the 110 to 140 mg/week range. I plan to do this in the first half of 2020. Also keep in mind that I have very high SHBG levels and that means that I will require a larger T dose than guys with more normal levels to keep my Free T in the recommended optimal range. During this experiment my SHBG levels ranged from 57.7 to 97.6 with a normal range for a 20-49 year old guy being 16.5 to 55.9.