Please Advise Needed on high T low Free T

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    Unhappy Please Advise Needed on high T low Free T


    Hello,

    I am a 54 year old male with the symptoms of low T, most importantly, low libido and lack of “hardness” in erections. In addition, I have been taking variety of antidepressants (currently cymbalta 60 mg, buspar 15 mg for the past 18 months) since the spring of 06. I am fully aware of the sexual side effects of these meds but feel what I have been experiencing is out of the ordinary.

    At a recent appointment with my doctor I convinced her to order a blood test. Even though I printed out the recommended tests from an article written by Dr Crisler, she would not order them all. The following is a partial list of what I was able to gather:

    Cortisol 15.9 UG/DL
    Estradiol 21.4 PG/ML
    Testosterone 754.7 (250-950) NG/DL
    TSH 2.04 (0.38-7.0) UIU/ML
    Free Testosterone 10.7 PG/ML
    Reference range
    Age
    20-29 9.3-26.5
    30-39 8.7-25.1
    40-49 6.8-21.5
    50-59 7.2-24
    ALK Phosphatase 63 (26-126) U/L
    Bilirubin Total 0.4 (0.2-1.2) MG/DL
    Direct Bilirubin 0.1 (0-0.3) MG/DL
    AST (SGOT) 29 (0-46) U/L
    ALT (SGPT) 30 (6-40) U/L

    From what I have researched, it appears my Free Testosterone could be low. I asked my doctor and her answer was “yes, it is on the low side but still normal”. I would like opinions on if I should pursue raising my free T numbers or accept them as being in the “normal” range?

    I have received a second opinion from an urologist; he is not concerned about my free testosterone because my total T number is so high. He blames my symptoms entirely on the anti-depressants.

    Should I accept the AD meds as the cause or look into a third opinion on my testosterone levels? Any help would be greatly appreciated.

    Thank you

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    Quote Originally Posted by zap427 View Post
    Hello,

    I am a 54 year old male with the symptoms of low T, most importantly, low libido and lack of “hardness” in erections. In addition, I have been taking variety of antidepressants (currently cymbalta 60 mg, buspar 15 mg for the past 18 months) since the spring of 06. I am fully aware of the sexual side effects of these meds but feel what I have been experiencing is out of the ordinary.

    At a recent appointment with my doctor I convinced her to order a blood test. Even though I printed out the recommended tests from an article written by Dr Crisler, she would not order them all. The following is a partial list of what I was able to gather:

    Cortisol 15.9 UG/DL
    Estradiol 21.4 PG/ML
    Testosterone 754.7 (250-950) NG/DL
    TSH 2.04 (0.38-7.0) UIU/ML
    Free Testosterone 10.7 PG/ML
    Reference range
    Age
    20-29 9.3-26.5
    30-39 8.7-25.1
    40-49 6.8-21.5
    50-59 7.2-24
    ALK Phosphatase 63 (26-126) U/L
    Bilirubin Total 0.4 (0.2-1.2) MG/DL
    Direct Bilirubin 0.1 (0-0.3) MG/DL
    AST (SGOT) 29 (0-46) U/L
    ALT (SGPT) 30 (6-40) U/L

    From what I have researched, it appears my Free Testosterone could be low. I asked my doctor and her answer was “yes, it is on the low side but still normal”. I would like opinions on if I should pursue raising my free T numbers or accept them as being in the “normal” range?

    I have received a second opinion from an urologist; he is not concerned about my free testosterone because my total T number is so high. He blames my symptoms entirely on the anti-depressants.

    Should I accept the AD meds as the cause or look into a third opinion on my testosterone levels? Any help would be greatly appreciated.

    Thank you
    I would examine your SHBG which was never done
    your thyroid needs to further investigated as well since ft3,ft4 and total t4 and total t3 or antibodies were never done.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Matrix,

    Thanks. I have tried to educate myself on this subject and it seems the logical answer could be high SHBG levels. It concerned me that both docs think since my Total T is so high, that no further information is needed. I saw a new doctor this week (Matt Rosenberg) and inquired about my testosterone numbers. Matt is in primary care and I have linked a panel discussion on hypergonadism he took part in on MedScape. (no permission)

    Rosenberg attributes all of my issues to the AD med cymbalta, and suggests I approach my shrink about lowering the dosage. He says my total T number is high enough and does not warrant further concern.

    I live about 30 miles from Doctor John Crisler. The problem is Dr Crisler charges $500.00 for a consultation. Now this would be a small price to pay for my well being, but I am unsure if I am chasing a ghost. If my total testosterone is above average and I think it is, should I be concerned about free T and high SHBG? Or is the likely hood of a problem so small I would be wasting $500.00 to have Crisler tell me what Rosenberg already has?

    I am just real confused and appreciate the advise.
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    Quote Originally Posted by zap427 View Post
    Matrix,

    Thanks. I have tried to educate myself on this subject and it seems the logical answer could be high SHBG levels. It concerned me that both docs think since my Total T is so high, that no further information is needed. I saw a new doctor this week (Matt Rosenberg) and inquired about my testosterone numbers. Matt is in primary care and I have linked a panel discussion on hypergonadism he took part in on MedScape. (no permission)

    Rosenberg attributes all of my issues to the AD med cymbalta, and suggests I approach my shrink about lowering the dosage. He says my total T number is high enough and does not warrant further concern.

    I live about 30 miles from Doctor John Crisler. The problem is Dr Crisler charges $500.00 for a consultation. Now this would be a small price to pay for my well being, but I am unsure if I am chasing a ghost. If my total testosterone is above average and I think it is, should I be concerned about free T and high SHBG? Or is the likely hood of a problem so small I would be wasting $500.00 to have Crisler tell me what Rosenberg already has?

    I am just real confused and appreciate the advise.
    Here is what I would DO
    1. Rule out adrenals, Thyroid and SHBG with proper testing
    2. If shbg is too high then danazol at 50 mgs everyday will lower it by half which needs to be subscribed by a physcian
    3. Free T is not as important as bio T which you want to go for. If your shbg you can try danazol or need more test to compensate for the test bound up by shbg.

    Damn he went up 100 bucks !! Mental note made..
    inflation is a real killer
    Hypergonadism? You are not clinical no where near that.
    The Anti depressant may have cause damage to liver because they have to be metabolised by the liver throughh the P450 pathways. If these pathways are over loaded it could affect shbg production because shbg is released from the liver . High SHBG can indicate liver malfunctoin or stagnation
    Inflation sucks !!
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Thank you just the kind of advise I was looking for.
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    Quote Originally Posted by zap427 View Post
    Thank you just the kind of advise I was looking for.
    Like I have always said
    Simplicity is some times the most complicated solution.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    correct me if im wrong........ but IIRC, total t is the androgenic signal.... free t is the anabolic side of t........

    If your taking ssri's, i bet its from that. I have NO sex drive on ssri's. They throw off the balance of serotonin & dopamine.
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    Quote Originally Posted by The Matrix View Post
    2. If shbg is too high then danazol at 50 mgs everyday will lower it by half which needs to be subscribed by a physcian
    Danazol didn't help my high SHBG at all. While the conventional wisdom seems to be that Danazol will lower SHBG I have yet to read of it actually working for someone. All anecdotal, but the several people I have seen comment on it had no luck with it.
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    Quote Originally Posted by monomer View Post
    Danazol didn't help my high SHBG at all. While the conventional wisdom seems to be that Danazol will lower SHBG I have yet to read of it actually working for someone. All anecdotal, but the several people I have seen comment on it had no luck with it.
    Clincal danazol does lower SHBG.
    Client had shbg 60 and it went down to 20 with 50 mgs every day, but clincal symptoms did not clear. High SHBG is not the cause by a symptoms of another hormonal, or imbalance in the body.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Quote Originally Posted by The Matrix View Post
    Clincal danazol does lower SHBG.
    Client had shbg 60 and it went down to 20 with 50 mgs every day, but clincal symptoms did not clear. High SHBG is not the cause by a symptoms of another hormonal, or imbalance in the body.
    Dr. Crisler prescribed it for me. He told me upfront that he has had little success with it lowering SHBG. It didn't work for me and the handful of people I have seen posting that have tried it didn't have success either.

    I'm sure it works for some people. It is worth a shot if you have exhausted other options.
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    Quote Originally Posted by monomer View Post
    Dr. Crisler prescribed it for me. He told me upfront that he has had little success with it lowering SHBG. It didn't work for me and the handful of people I have seen posting that have tried it didn't have success either.

    I'm sure it works for some people. It is worth a shot if you have exhausted other options.
    Success for shbg is addessing it indirectly not directly.
    Correcting other things had a major impact.

    case example
    17 year old extremely health TT 560 shbg 45.
    Dr want to put on T.
    Person was anorexic for 2 years and this caused major hormonal issues.
    Further investigation should several nutrient defieincy, low thyroid, vitamin D
    Corrected deficency TT went to 1000 shbg droped down 30
    Correcting the other issues resulted in desire results
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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