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Thread: Lowering SHBG to Increase Free T -- Treatment Options?

  1. #41
    wellshii is offline Associate Member
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    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.

  2. #42
    bkb333 is offline New Member
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    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 ...

  3. #43
    Youthful55guy is offline Knowledgeable Member
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    Quote Originally Posted by bkb333 View Post
    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!

  4. #44
    wellshii is offline Associate Member
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    Still following.
    Also,are you any meds?

  5. #45
    bkb333 is offline New Member
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    Quote Originally Posted by wellshii View Post
    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.

  6. #46
    bkb333 is offline New Member
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    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)
    Last edited by bkb333; 06-02-2018 at 05:43 PM.

  7. #47
    bkb333 is offline New Member
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    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?

  8. #48
    Youthful55guy is offline Knowledgeable Member
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    Quote Originally Posted by bkb333 View Post
    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.

  9. #49
    wellshii is offline Associate Member
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    Quote Originally Posted by bkb333 View Post
    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.

  10. #50
    bkb333 is offline New Member
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    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?

  11. #51
    wellshii is offline Associate Member
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    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.

  12. #52
    theBrewmeister is offline New Member
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    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??

  13. #53
    Youthful55guy is offline Knowledgeable Member
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    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 likes this.

  14. #54
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    Youthful couldn’t have said it any better.

  15. #55
    theBrewmeister is offline New Member
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    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?

  16. #56
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    fiddlesticks is offline Junior Member
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    insulin lowers SHBG so increase insulin response.

  17. #57
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    Chrisp83TRT is online now Knowledgeable Member
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    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

  18. #58
    Youthful55guy is offline Knowledgeable Member
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    Quote Originally Posted by Chrisp83TRT View Post
    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.

  19. #59
    bkb333 is offline New Member
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    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!

  20. #60
    wellshii is offline Associate Member
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    AT least its helped. Free T is great! That SHBG though.
    Theyll probally keep you on.

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