Considering injections - seeking advice

[Trt trt]

Hello,
My situation was posted on another forum with no response so I'm hoping someone here can comment.
I Was diagnosed with low T and a thyroid problem about a year ago. Thyroid numbers are better but T numbers have never really improved. Thinking about starting injections but wanted to get opinions here first.
I'm 56. 5'11" about 190 lbs. Normal hair. A few lbs. of fat I don't need.

Synthroid is the only med I'm taking. Diet consists of lots of carbs and protein. A little weight training a few times a week. Low libido and a little low on energy. Morning wood- I can almost say "what is that".

First test results over a year ago for thyroid were:
TSH 22(.34-5.6)
TT 246 (241-827)
PSA .79
DRE OK

Asked for the antibody tests. Can't remember the numbers but they were high so I have Hashimoto's.
Tried Nature Throid for a while but am now using 100MCG of levothyroxine.
Latest Thyroid tests:
TSH .503 (.450-4.5)
T4 6.6 (4.5-12)
T4Free 1.19 (.82-1.77)
T3Free 2.5 (2.0-4.4)
Used to be cold all the time, now much better. Last time I checked temps they were 98.2 first thing and 98.6 mid day. Less irritable. Less dry skin.

Went through LEF and had a male comprehensive panel done about 3 months ago.
Glucose, Serum 89 mg/dL 65-99
Uric Acid, Serum 5.9 mg/dL 3.7-8.6
BUN 13 mg/dL 6-24
Creatinine, Serum 0.88 mg/dL 0.76-1.27
eGFR If NonAfricn Am 97 mL/min/1.73 >59
eGFR If Africn Am 113 mL/min/1.73 >59
BUN/Creatinine Ratio 15 9-20
Sodium, Serum 138 mmol/L 134-144
Potassium, Serum 4.3 mmol/L 3.5-5.2
Chloride, Serum 101 mmol/l, 97-108
Carbon Dioxide, Total 24 mmol/L 19-28
Calcium, Serum 10.0 mg/dL 8.7-10.2
Phosphorus, Serum 3.6 mg/dL 2.5-4.5
Protein, Total, Serum 7.7 g/dL 6.0-8.5
Albumin, Serum 4.7 g/dL 3.5-5.5
Globulin, Total 3.0 g/dL 1.5-4.5
A/G Ratio 1.6 1.1-2.5
Bilirubin, Total 1.1 mg/dL 0.0-1.2
Alkaline Phosphatase, S 61 IU/L 39-117
LDH 148 IU/L 0-225
AST (SGOT) 27 0-40
ALT (SGPT) 25 0-44
Iron, Serum 136 40-155 LEF said to stop taking multivitamin with iron
Cholesterol -total 210 (high) 100-199
Triglycerides 65 0-149
HDL Cholesterol 62 over 39
VLDL Cholesterol Cal 13 5-40
LDL Cholesterol Calc 138 (high) 0-99
T. Chol/HDL Ratio 3.4 .0-5.0
Estimated CHD risk .5 .0-1.0
WBC 4.5 x10E3/uL 3.4-10.8
RBC 4.69 x10E6/uL 4.14-5.80
Hemoglobin 14.9 g/dL 12.6-17.7
Hematocrit 42.6 % 37.5-51.0
r4CV 91 fL 79-97
MCH 31.8 pg 26.6-33.0
MCHC 35.0 g/dL 31.5-35.7
ROW 14.2 % 12.3-15.4
Platelets 248 x10E3/uL 155-379
Neutrophils 44 % 40-74
Lymphs 42 % 14-46
Monocytes 10 % 4-12
Eos 4 % 0-5
Basos 0 % 0-3
Immature Cells
Neutrophils (Absolute) 2.0 xlOE3/uL 1.4-7.0
Lymphs (Absolute) 1.9 xlOE3juL 0.7-3.1
Monocytes(Absolute) 0.5 x10E3/uL 0.1-0.9
Eos (Absolute) 0.2 xl0E3juL 0.0-0.4
Baso (Absolute) 0.0 x10E3/uL 0.0-0.2
Immature Granulocytes 0 % 0-2
Immature Grans (Abs) 0.0 xl0E3/uL 0.0-0.1

Testosterone, Serum 315 (low) 348-1197
Testosterone, Free 9.5 7.2-24.0
Pregnenolone MS 40 No range given but LEF said they preferred (125-175) They recommended 50mg per day supplement.
Dihydrotestosterone 31 No range given but LEF said they preferred (30-50)
DHEA- Sulfate 125.5 71.6-375.4 Lef recommended (275-400) Said to take DHEA 25mg supplement.
Estradiol 22.5 7.6-42.6
PSA .8 .0-4.0
Sex Horm Binding Glob (serum) 21.2 30-40
TSH .503 (.450-4.5)
T4 6.6 (4.5-12)
T4Free 1.19 (.82-1.77)
T3Free 2.5 (2.0-4.4)
Didn't know it at the time but this comprehensive panel did not include LH/FSH. I've read that for older men( how old?) it may not be as important to check.
About 2 months ago I tried androgel. For the first 2 weeks I felt really good, more energy, mental clarity, and interest in sex. After that the effects gradually wore off. Used it for 5 weeks total but saw no reason to get bloodwork done because it started to really irritate my skin and burn when applied. The boys really pulled up tight though and I didn't like that. My guess is with my own natural T plus the androgel my T level was pretty good. But with my T shutting down I wasn't absorbing enough with the androgel alone to have a decent level. As read in a sticky a thyroid "non absorber". Maybe E went up but it didn't matter beacuse my skin was not liking the androgel at all. I was a little cranky for the first week after stopping the androgel but am about back to my old normal.
Went back to my PCP armed with information from T forums including the following protocol:
* 100mg test cypionate or ethanate injected per week with two or more injections per week.
* 250iu hCG SC EOD [every other day]
* 1.0mg Arimidex/anastrozole per week in divided doses.

. I was pleasantly relieved that he was open minded about it. He was not familiar with all the information but said he would do some research and get back to me. Long story short, he has agreed to the suggested protocol 100%, including the suggested starting doses. My insurance partially covers the T and the Armidex. I found a compounding pharmacy in Texas for the hCG.
My thyroid numbers can still be improved (I'd like a higher T3free) but will that help my Test numbers? I doubt it.
So what am I missing? Other tests? I'm not miserable the way I am now but 2 weeks of higher T sure felt better.

I'm just not sure if this is the right thing to do.

Thanks for any comments.

 

[Mr.TT]

LH is needed to figure out if you are primary or secondary.
If you are secondary, HcG would be a good first protocol, and watch E2 because you may need an AI.
If you are primary, your posted TRT plan is good, but I would do half those drugs for a month, without the AI, and blood test.
Are you on any meds that interfere with Testosterone production? opiates, statins, soy, ginseng?????

 

[Trt trt]

Mr.TT,
Thank you for the reply. Luckily, I'm not on any other meds except levothyroxine. I used androgel for 5 weeks and stopped taking it about 2 1/2 weeks ago.

How long till my LH/FSH numbers are back to my normal levels?

 

[Thunder13]

Mr TT, not trying to hijack this thread, but real quick about LH. My bloods from Nov 2013, revealed my value at 3.6 QUEST ref range 1.5-9.3 miu/ml. Is this sufficient? also FH was 7.0 range is 1.6-8.0

LH is needed to figure out if you are primary or secondary.
If you are secondary, HcG would be a good first protocol, and watch E2 because you may need an AI.
If you are primary, your posted TRT plan is good, but I would do half those drugs for a month, without the AI, and blood test.
Are you on any meds that interfere with Testosterone production? opiates, statins, soy, ginseng?????

 

[Mr.TT]

Thunder13, your first post had your TT at 600+ without TRT, so it really is not a question if you were primary or secondary, you can and do make testosterone.

 

[Thunder13]

got ya and yes are correct. hell My last Bloods just done late Jan 2014 and I had a TT of 834 ! Free and Bio seemed "low-normal" to me 67.5 range 46-224, and 144.7 range 110-575. So I guess I need to address the High SHBG 63. Thanks sorry this condition(s) I have leave me very confused , but i get the picture now.

Thunder13, your first post had your TT at 600+ without TRT, so it really is not a question if you were primary or secondary, you can and do make testosterone.

 

[Onlychevy6]

If your being prescribed 100 mg per week do two injections of 50 separated say Tuesday and Friday (Just an example, Talk to you Dr for his or her recommendation). On the HCG run 500iU a week. Try to get that injected 2 days before Test. There is a few other things that should be used. and you will get different opinions as well. Talk to your Dr about also getting DHEA 25mg at waking and 25mg mid afternoon pregnolone 50mg at waking. Inserting these hormones helps restore natural hormonal pathways, "backfilling" them, if you will, once we have suppressed the HPTA with TRT. We will probably never know all the intermediary steps in these pathways, much less all the actions of each substance upon the body.

I have read that thread on the other place and it is very informative. There has been more advancements since that was originated. I think you pretty much covered everything but just to double check here is a list of lab work one should do before thinking about trt.

INITIAL LABWORK

Following a good Medical History, which laboratory assays should be run as part of your initial hypogonadism workup? Following is a list, but certainly other specialists in this area run expanded or attenuated panels, per individual clinical experience and expertise. Of note, additional tests which should be included to complete the true comprehensive Anti-Aging Medicine workup (i.e. inflammatory markers, insulin, good and true comprehensive thyroid study, etc.); this is concerned solely with administering TRT. And as always, the panel is tailored to the individual patient. Here they are:

• Total Testosterone
• Bioavailable Testosterone (AKA “Free and Loosely Bound”)
• Free Testosterone (if Bioavailable T is unavailable)
• SHBG
• DHT (perhaps)
• Estradiol (specify “sensitive” assay for males)
• LH
• FSH
• Prolactin
• Cortisol
• Thyroid Panel
• CBC
• Comprehensive Metabolic Panel
• Lipid Profile
• PSA (age dependent)
• IGF-1, IGFBP-3 (if HGH therapy is being considered)


FOLLOW-UP LABS

Four weeks after initiating or changing dose for transdermal, six weeks for IM injection TRT. The time delay provides for stabilization via HPTA suppression and pharmacokinetics of medication:

• Total Testosterone
• Bioavailable Testosterone
• Free Testosterone (if Bioavailable T is still unavailable)
• Estradiol (specify “sensitive” assay for males)
• LH
• FSH
• CBC
• Comprehensive Metabolic Panel
• Lipid Profile
• PSA (for those over 40 with Family Hx of prostate CA, >45 yo. all others)
• IGF-1, IGFBP-3 (if GH Therapy has been initiated already)

I don't know your medical history, or what kind of physical shape your in. But looking at your age here is some info just to think about.

THINGS TO LOOK OUT FOR
CO-MORBIDITIES. Only breast and active prostate cancer are absolute contraindications for TRT, at this time. Patients with serious cardiac, hepatic or renal disease must be monitored carefully; this is true for any medical therapy, of course. Also, TRT may potentiate sleep apnea in some chronic pulmonary disease patients, although studies have also shown it can actually ameliorate the symptoms of same as well.

DRUG INTERACTIONS. TRT decreases insulin or oral diabetic medication requirements in diabetic patients. Therefore make sure to warn them to closely monitor their sugar. It also increases clearance of propranolol, and decreases clearance of oxyphenbutazone in those receiving such medications.

TRT may increase coagulation times as well. This is minimal, and easily accounted for by proper pre-surgical evaluation. The reverse risk of increased coagulation that terrifies surgeons and anesthesiologists results only in cases of severe polycythemia secondary to non-monitored TRT. Again, proper work-up removes risk. On this topic, I am absolutely amazed when surgeons, anesthesiologists, cardiologists, etc. hold TRT prior to their own labors. Let’s take inventory of the results of their misguided actions: anabolism turns to catabolism, inflammation runs wild, weakness and fatigue, estrogen goes through the roof, depression, etc. as the body is generally thrown into a state of turmoil. Just what you want while undergoing surgery or an MI! Cases where “specialists” actually consult with the qualified administering physician are rare. Not only is this profoundly detrimental to the patient, same is also a gross violation of medical ethics.


TESTOSTERONE INJECTION

When considering dosing of testosterone cypionate, it is important to remember that, due to the weight of the cypionate ester, a 100mg injection delivers, at best, 70mg of testosterone. This is important to keep in mind when comparing the effects of a 100mg weekly injection of test cyp to the 35mg total initial dose provided by Androgel/Testim 5gms QD over the same period.

HCG

Many practitioners consider this incredible hormone treatment of choice for hypogonadotropic (secondary) hypogonadism. Such certainly is intuitive, as supplementing with a LH analog indeed increases testosterone production in patients who do not concurrently suffer primary hypogonadism. But for some unexplained reason, while serum T levels may be adequately elevated, the patients simply do not report realization of the subjective benefits of TRT, when HCG is administered as sole TRT. You also run the risk of inducing LH insensitivity at higher dosages, and therefore may actually cause primary hypogonadism while attempting to treat secondary hypogonadism. HCG, especially at higher doses (defined as >500IU per shot), also dramatically increases aromatase activity, thus inappropriately elevating estrogens. Progesterone—a feminizing hormone in adult males—also elevates at those dosages. It is recommended giving no more than 100IU of HCG per day, as starting dose. And please give it some time to work.

A real benefit of HCG is that it will prevent testicular atrophy. I do not think we should ignore the aesthetics of that consideration.

If a patient has “nipple issues”, even while estrogen is within normal range, add a SERM. Some prefer Nolvadex over Clomid. Clomid often induces untoward visual effects (i.e. “tracers”), and can cause emotional lability by virtue of its estrogen agonistic effects at the more peripheral (emotion) brain sites. Nolvadex is then initiated, should they experience nipple swelling or sensitivity, at 40mg per day until the symptoms abate, and then taper down 10mg every 10 days to discontinue.

TRT male patients who suffer E2 elevations above the top of normal range are placed on between 0.25 and 0.5mg Arimidex every one to third day, depending upon the specific situation. It is possible to cut the tiny 1mg tabs into quarters, but here a compounded prep, to convenient dosing, makes a lot of sense. A month later recheck E2, (as subsequently lowered SHBG will affect subjective response as well) and make further adjustment if necessary. Always remember it is important to not lower estrogen too far.

I am no med Dr. but have studied this at great length. Always consult your Dr. before just jumping in with no knowledge. Sound like you have done your homework which I applaud you on.

Hope any thing I said help. I am sure you will get many different opinions.

Thanks

 

[Trt trt]

Onlychevy6,
Thank you for the very informative post. I read through it several times. Are you suggesting to have all of the following done one time 6 weeks after starting injections or every 6 weeks? Are all of those necessary? My Doc is not big on ordering tests and most of mine have been paid for by me through LEF on my own.
Total Testosterone
• Bioavailable Testosterone
• Free Testosterone (if Bioavailable T is still unavailable)
• Estradiol (specify “sensitive” assay for males)
• LH
• FSH
• CBC
• Comprehensive Metabolic Panel
• Lipid Profile
• PSA (for those over 40 with Family Hx of prostate CA, >45 yo. all others)
• IGF-1, IGFBP-3 (if GH Therapy has been initiated already)

I'm testing LH/FSH later this week through LEF.

 

[Onlychevy6]

6 weeks after first injection. Are they necessary? Well the answer is yes and no. Would be nice to see where you sit after the first six weeks to see if adjustments need to be made. But not entirely needed. If you are feeling good.

 

[Trt trt]

Results came back low.
LH. 2.2 (1.7-8.6)
FSH 3.3 (1.5-12.4)
So I'm secondary. Testosterone may not be the right way to go yet for me. Maybe hcg with Armidex if E goes up, a 6-8 week test? Maybe what I'll do is work on getting my thyroid dialed in better(higher t3) I've already added pregnenolone and dhea(pills from lef). Also, I never did a 24 hr saliva test because my doc said it wasn't necessary, that I will definitely do.

 

[Thunder13]

hey Guys hope this isnt hijacking this thread, but on my Labs for LH and FSH, from Nov 2013. How do these numbers appear

Quest Labs

FSH=7.0 range 1.6-8.0
LH =3.6 range 1.5-9.3

Thanks Everyone !

Onlychevy6,
Thank you for the very informative post. I read through it several times. Are you suggesting to have all of the following done one time 6 weeks after starting injections or every 6 weeks? Are all of those necessary? My Doc is not big on ordering tests and most of mine have been paid for by me through LEF on my own.
Total Testosterone
• Bioavailable Testosterone
• Free Testosterone (if Bioavailable T is still unavailable)
• Estradiol (specify “sensitive” assay for males)
• LH
• FSH
• CBC
• Comprehensive Metabolic Panel
• Lipid Profile
• PSA (for those over 40 with Family Hx of prostate CA, >45 yo. all others)
• IGF-1, IGFBP-3 (if GH Therapy has been initiated already)

I'm testing LH/FSH later this week through LEF.

 

[Trt trt]

Thank you for the reply Onlychevy6.

Well, I tried something (perhaps not to smart) . I did one injection of test c 40mg and over a couple days 2 injections of hcg @ 200iu. Sex drive way up after 24hr. but for the last 4 days have been very jittery and anxious. Sleeping even worse than normal. No fatigue, energy level is the same as usual, just jittery. Also, Waking body temps went up to about 98.4. After about 3 hours down to 97.5-98 or so then back up to around 98.6-98.7. I've always been a very light sleeper and usually get about 6 hrs of not great sleep. Yesterday, I didn't take my usual dose of 100 MCG of synthroid because it feels like I'm hyperthyroid. Felt better yesterday and better yet today with no synthroid. (I'll take some tomorrow, not sure how much)
When I used androgel for a month I had no reaction like this so I'm confused??
My 24 hr. saliva test should be here soon and I really want to test my adrenals. I just had blood drawn for another thyroid panel and got rt3 this time.
Could it be that the test and hcg raised my metabolism and made my dose of synthroid excessive? or weak adrenals? or am I just totally clueless here?

 

[Onlychevy6]

Thank you for the reply Onlychevy6.

Well, I tried something (perhaps not to smart) . I did one injection of test c 40mg and over a couple days 2 injections of hcg @ 200iu. Sex drive way up after 24hr. but for the last 4 days have been very jittery and anxious. Sleeping even worse than normal. No fatigue, energy level is the same as usual, just jittery. Also, Waking body temps went up to about 98.4. After about 3 hours down to 97.5-98 or so then back up to around 98.6-98.7. I've always been a very light sleeper and usually get about 6 hrs of not great sleep. Yesterday, I didn't take my usual dose of 100 MCG of synthroid because it feels like I'm hyperthyroid. Felt better yesterday and better yet today with no synthroid. (I'll take some tomorrow, not sure how much)
When I used androgel for a month I had no reaction like this so I'm confused??
My 24 hr. saliva test should be here soon and I really want to test my adrenals. I just had blood drawn for another thyroid panel and got rt3 this time.
Could it be that the test and hcg raised my metabolism and made my dose of synthroid excessive? or weak adrenals? or am I just totally clueless here?

any more updates?

 

[pmgamer18]

Hi Trt trt,

You can't test LH and FSH once you have been on TRT evern if you stopped for weeks going on TRT shuts you down your brain sees the T in your blood and slows down sending the LH and FSH messages that tell your testis to make T. And using HCG acts like LH and when the brain sees HCG in your blood same thing it shuts down sending LH and FSH. But stopping T the LH and FSH will not come back up to base line levels your stuck on TRT for life I have yet in all the 33 yrs that I have been on TRT seen anyone stop TRT and go back to base line levels.

As for your Thyroid I use Synthroud 150 mcgs/ day and to help keep my Free T3 levels up my Dr. added Cytomel 5mcgs 4x’s /day after I showed him this study out about mixing T3 with Synthroid.
http://thyroid.about.com/b/2010/05/17/t3-superior-t4-levothyroxine-hypothyroidism-thyroid.htm?nl=1

Here is a cut and paste about using gels, creams or the patch with a Thyroid problem you can end up with a thicker skin and them kinds of TRT can't get through the skin very well and you end up with lower levels. Today I do 80 mgs of Depo T E3D and I do 250 IU's of HCG the day before my Depo T shot E3D and I keep my Estradiol levels down using Aromasin. Your not feeling well on TRT because your levels are not up into the upper 1/3 of your labs range and your Estradiol levels are to high for your lower levels of SHBG the lower SHBG is the lower you need to keep Estradiol once you do this you will have Rem Sleep Wood again.

Here is a cut and paste from a post by Dr. M about Gels, Creams and the Patch with a thyroid problem.
========================================================
DrMariano
Physician, Psychiatrist


Join Date: Mar 2009
Location: Carmel, California
Posts: 712 Default Transdermal Hormone Replacement

--------------------------------------------------------------------------------

Quote:
Originally Posted by chaos View Post
What is your opinion as to the steadiest release from a transdermal. I used them prior to injectibles, but my testosterone never increased, just DHT. I used androgel and a 10% PLO.

People on the boards told me I didn't absorb (since T didn't increase), but my doc said the increase in DHT was proof something absorbed, though he was uncertain as to why all of it seemed to go to DHT.

Speaking to your comment, he postulated I absorbed it "in one shot" as opposed to a steady release, so I therefore had a spike in DHT, similar to the spike the day after an IM injection.

Ideally, for hormone replacement therapy, the transdermally based hormone is transferred into the fat layer of the skin. From there, the hormone can be released gradually into the bloodstream, producing stable level.

Alcohol-based gels are more useful for hormone replacement since they allow the hormone to be absorbed into the skin fat and to be slowly released into the blood stream.

Oil-based transdermal gels or creams - such as the PLO gels - are good for rapidly introducing substances into the system. They aren't as useful for hormone replacement therapy because they cause the hormone to bypass the skin fat and allow the hormone to directly go into the blood stream. This causes a large peak and a rapid fall in blood levels.

Both alcohol-based and oil-based gels or creams will result in good absorption generally. They generally result in predictable blood levels of hormones and medications. If the blood level does not go up, then it is not being absorbed. Thus if a testosterone transdermal does not result in an appreciable increase in testosterone it is not well absorbed.

Some people will have difficult absorbing a transdermal preparation. For example, people with hypothyroidism, can develop mxedema. This is a thickening of the skin due to the accumulation of mucin - a glue that holds cells together. This prevents transdermal absorption. In my patients, if a person develops lower thyroid hormone levels from either transdermal testosterone or estradiol, testosterone and estradiol levels fall. When I address thyroid hormone, testosterone and estradiol will again be abssorbed and levels rise. Other reasons for non-absorption include possible ethnic differences or genetic differences in skin such as oilier skin, etc.

One other reason a hormone level does not go up is that the dose used is too low. For example, many patients are given one 5 gram packet of Androgel to use. This is too low for many men. Since there is negative feedback controlling testosterone production, at a certain dose, the dose is too low to make up for the loss of one's testicular testosterone production, when exogenous testosterone is added. Testosterone level actually will decrease when only 1 5-gram pack is used in many men. The percentage of men where testosterone will be low rather than high decreases when two 5-gram packs of Androgel are used. This would be the starting dose I would use. In these men, there is evidence of absorption - such as DHT (dihydrotestosterone) levels going up. But testosterone is either the same or LOWER. In these men, testosterone in Androgel IS absorbed. But the dose is too low.
__________________
Romeo B. Mariano, MD, physician, psychiatrist
Any information provided on www.definitivemind.com is for informational purposes only, is not medical advice, does not create a doctor/patient relationship, is not exhaustive, does not cover all conditions or their treatment, and will change as knowledge progresses. Seek the advice of your physician or other qualified health provider before undertaking any diet, exercise, supplement, medical, or other health program.

Results came back low.
LH. 2.2 (1.7-8.6)
FSH 3.3 (1.5-12.4)
So I'm secondary. Testosterone may not be the right way to go yet for me. Maybe hcg with Armidex if E goes up, a 6-8 week test? Maybe what I'll do is work on getting my thyroid dialed in better(higher t3) I've already added pregnenolone and dhea(pills from lef). Also, I never did a 24 hr saliva test because my doc said it wasn't necessary, that I will definitely do.

 

[Trt trt]

Onlychevy6, Still waiting for the results of the 24hr saliva test, been feeling better though.

pmgamer18 said:
"You can't test LH and FSH once you have been on TRT evern if you stopped for weeks going on TRT shuts you down your brain sees the T in your blood and slows down sending the LH and FSH messages that tell your testis to make T. And using HCG acts like LH and when the brain sees HCG in your blood same thing it shuts down sending LH and FSH. But stopping T the LH and FSH will not come back up to base line levels your stuck on TRT for life I have yet in all the 33 yrs that I have been on TRT seen anyone stop TRT and go back to base line levels"

Well that's disappointing. I'm hoping that because I was only on T for a short time that is not the case. But I appreciate the reality check. Also, thanks for the other information. I will mention the t4/t3 combination to my pcp.

How do you raise SHBG?

 

[pmgamer18]

Why raise your SHBG the higher it gets the more it binds up all the Testosterone in your body. But high Estradiol will raise SHBG as for me my Dr. is fine with my lower levels of SHBG it just means I need more T more often.

Onlychevy6, Still waiting for the results of the 24hr saliva test, been feeling better though.

pmgamer18 said:
"You can't test LH and FSH once you have been on TRT evern if you stopped for weeks going on TRT shuts you down your brain sees the T in your blood and slows down sending the LH and FSH messages that tell your testis to make T. And using HCG acts like LH and when the brain sees HCG in your blood same thing it shuts down sending LH and FSH. But stopping T the LH and FSH will not come back up to base line levels your stuck on TRT for life I have yet in all the 33 yrs that I have been on TRT seen anyone stop TRT and go back to base line levels"

Well that's disappointing. I'm hoping that because I was only on T for a short time that is not the case. But I appreciate the reality check. Also, thanks for the other information. I will mention the t4/t3 combination to my pcp.

How do you raise SHBG?

 

[Onlychevy6]

What is your SHBG at currently?

 

[Onlychevy6]

The question I would have for a person with low SHBG is: What problems does one have?

Is it low libido, high blood pressure, heart attack risk, depression, anxiety, lack of energy, impaired concentration, urinary frequency, gynecomastia, hot flashes, etc.?

By identifying one's problems, it will be easier to see whether or not SHBG level contributes to the problem.

SHBG has signaling properties of its own. It has its own receptors on cell membranes. When testosterone or estrogens are bound to SHBG, it can bind to its receptors and send its message to the cell. What happens afterwards is not clear. It may be related to the formation of more hormone receptors - but that is speculation at this point.

SHBG helps prolong the duration of action of testosterone, DHT, and estrogens. Low SHBG will increase the amount of free hormone.

Swings in hormone level may occur when low SHBG is present as destruction of the hormone is accelerated by having high free levels. This may cause problems experienced during testosterone replacement. For example, if estrogen is more quickly destroyed/metabolized and levels drop more quickly, one can get hot flashes or anxiety or hypertension, etc. If testosterone levels fluctuate from high to low, depression can occur as the day progresses.

SHBG is made in the liver in response to levels of many hormones:
1. Increasing Testosterone reduces SHBG
2. Increasing DHT lowers SHBG
3. Increasing DHEA lowers SHBG
4. Increasing Growth Hormone lowers SHBG
5. Increasing Insulin lowers SHBG
6. Increasing Estrogen increases SHBG
7. Increasing Thyroid Hormone increases SHBG

The SHBG level is determine by the balance of the hormone levels.

Given one's assumed goals in TRT (high libido, good energy, etc.), it may be difficult to increase SHBG without causing problems since SHBG is determine by a balance of hormones.

For example, having high Testosterone and high DHEA is not a situation where SHBG is going to be high without corresponding problems with estrogen or thyroid.

If anything, SHBG should be most often viewed as an indicator of a problem that needs to be solved - rather than as a problem itself.

For example, SHBG is most commonly an indicator of high insulin levels - i.e. insulin resistance or diabetes. It would be then far more important to address insulin resistance or diabetes in treatment than to focus on SHBG.

If low thyroid is a factor in low SHBG, addressing hypothyroidism is far more important.

If low estradiol is a factor in low SHBG, addressing this is more important.

If the low SHBG itself is a problem because it causes large swings in hormone levels, then working around this by achieving more stable hormone levels is indicated.

More frequent dosing of testosterone may be required to stabilize levels. With testosterone cypionate or enanthate injections, dosing twice a week would be better than once a week.

If frequent dosing of testosterone cannot be achieved with transdermals or injections, then a constant dose solution may be needed. This includes testosterone patches, the buccal system, or testosterone pellet insertions. Testosterone pellet insertions may be viewed as fairly drastic since it involves regular minor surgical procedures, but does give the most stable levels - so is a viable solution for the men with problems due to highly variable hormone levels resulting from low SHBG.

If one suspects swings in hormone levels as a cause of problems, one can look for the swings in hormone levels by obtaining a peak and trough level of the hormones (e.g. total testosterone, estradiol, DHT, etc.). For testosterone injections, this is a level about 24-48 hours after an injection and a level just before the next injection. One can also obtain a midpoint level to fill out the level curve.

If those 7 things above can ALL influence SHBG, then changing one of them can influence SHBG but then may ALSO change one of the others which can change SHBG in another direction. So it becomes ridiculous trying to chase SHBG. Fix the underlying problems that a low level is pointing towards. Insulin levels, Thyroid levels, etc. or.... simply spacing Test dosage to a more frequent pattern.

Know you do not really want to raise your SHBG.

It will find its own level. Try to work around it.

The notion we have to tinker with everything is foolish.

Yes there are things to do like T3 etc etc. but we should looks at the real issue. It might just be as simple as lowering the dose or Test.

 

[Trt trt]

Thank you both for your comments. All this information is appreciated more than I convey. So much great information!! How do you guys keeps all this in your heads???

My main concerns are: low libido, lack of energy, and brain fog.

The only time i had SHBG tested it was:
SHBG. 21.2 (30-40)

24 hr saliva test results are:

Dheas 10.8 (2-23)
Cortisol 6.8 (3.7-9.5) morning
Cortisol 1.7 (1.2-3.0) noon
Cortisol 1.2 (.6-1.9) evening
Cortisol .8 (.4-1.0) night

I guess they aren't to bad. Morning could be higher and night could be lower. Since those results I've made some changes. 8 hrs sleep instead of my usual 6. Also, no more alcohol (was 2 or 3 beers a night). With the extra sleep my cortisol levels should get even better.

Maybe i'll give it a try again.

So watch SHBG but don't try to change it directly, I get it. With my low SHBG I may need very small, frequent injections correct?. Subq should help also correct?

Again, thanks for helping me with this.