Low Free T Due To Normal TT But High SHBG & Albumin

[FreeTest96]

Hi,

I have a problem for which seemingly no solution and not even an explanation exists: normal total testosterone, but low free & bioavailable testosterone due to high SHBG and Albumin.

My blood levels in short:

1. Low normal total testosterone, high SHBG & Albumin, therefore low free & bioavailable testosterone, low free androgen index
   
   
2. TSH sometimes high, sometimes normal. fT3 normal, but not optimal. fT4 low. No thyroid antibodies. Thyroid volume is low (right 7ml + left 3ml = 10ml), "harmless cysts", sonography shows no signs of autoimmune thyroiditis.
   
   
3. High progesterone (depending on the used reference range; mine seems too narrow)
   
   
4. Low estradiol
   
   
5. LH seems fine, FSH rather low
   
   
6. Cortisol seems fine, only slightly high once
   
   
7. Lipids are fine
   
   
8. GPT slightly high only once
   
   
9. Prolactin, IGF-1, STH seem fine
   
   
10. Some values seem to correlate: especially SHBG and total testosterone. I had relatively high total testosterone once, but SHBG also climbed to about 140%. This was also the only time where my estradiol fell in the optimal range - it was twice as high as my usual levels. Also my fT3 was almost in the optimal range (upper third).
    

Free testosterone

• Afaik it's not 100% certain that the "free hormone hypothesis" (only free testosterone can be used) is true
  
  
• For example, I also read that SHBG protects testosterone from being metabolized too early and that a slightly high SHBG is good. Or that the effects of total and free testosterone differ: total testosterone affects libido, drive, mood etc, but free testosterone is necessary for gaining muscle.
  
  
• But there are also at least 2 studies* that show exactly that: androgen deficiency symptoms are possible when somebody has normal total testosterone, but low free testosterone
  
  
• therefore I also think that free testosterone matters (even if SHBG protects testosterone etc)
  

Reference ranges:

1. Free testosterone: 0.174-0.672 nmol/l or: >0,25 nmol/l or: >0,2 nmol/l
   
   
2. Bioavailable testosterone: 3.68-15.3 nmol/l or: >4,37 nmol/l or: > 4,54 nmol/l
   
   
3. Free Androgen Index: 35-150

My values:

Estradiol
Reference range: 11-43 pg/ml

My values:

• 2017: 18,5 pg/ml
• 2018: 14,8 pg/ml
• 2019: 28,7 pg/ml
• 2019: 11,70 pg/ml

• Afaik E2 should be between 20-30 pg/ml -> I only fell in this range once, when my total testosterone and SHBG were also high
  
  
• My other values are rather low and the last one is at the lower limit
  
  
• Average E2 for <29 yrs is about 25 pg/ml. Levels below 20 pg/ml have negative consequences for bones, levels below 12 pg/ml cause a 3 times higher death rate.
  
  
• I think, my E2 was measured with the wrong method (not sensitive test), so my "true" E2 values could be even lower.
  
  
• I think, these levels are low enough to cause their own symptoms (independent of low testosterone). Some of my symptoms that could be due to low E2: very dry skin, eyes, lips. Hot flashes. Cracking joints. Low libido.
  
  
• In one study people who had normal total testosterone but low free testosterone also had low E2
  
  
• Testosterone has a higher binding affinity to SHBG than E2 does. But could it be, that due to my high SHBG my free E2 is below the reference range?
  
  
• The only way to raise E2 seems to be raising testosterone
  

Questions

1. Do you think my levels of free & bioavailable testosterone and estradiol are a problem? I have some testosterone and estrogen deficiency symptoms (some are more intensive, some less).
   
   
2. Assuming diet, sleep, exercise etc are good, is there even anything I could do about it, aside from proviron, TRT, ostarine or clomid?
   

____________

*References:

1. Sex hormone-binding globulin is associated with androgen deficiency features independently of total testosterone. - PubMed - NCBI
   
   
2. Low Free Testosterone Is Associated with Hypogonadal Signs and Symptoms in Men with Normal Total Testosterone. - PubMed - NCBI

Some more blood levels:

 

[Tom K]

Keto diets elevate SHBG. You did not mention keto as your dietary pattern, but this effective way of eating can result in elevated SHBG. This is another reason keto diets should be cycled.

 

[Aleeri]

You have very similar labs to what I had in the past. Maybe you should check out my threads.

I do not agree about total T being related to libido, my libido was non-existent with top of range total T. I also have high DHT. I could not handle a lot of heavy weight training and no morning wood. My SHBG was in the 60s and free androgens low. Now I have SHBG in the 40s and feeling a lot better. My estradiol and estrogens where normal though throughout.

I see some slightly high prolactin on one of your labs.

Also, your progesterone levels are exactly like mine, I have a thread here where I was discussing that I'm thinking they might be too low at this point, but it seems like there is no good reference ranges for progesterone in men. I've tried many things to increase further without success so now I am thinking they might be normal range, progesterone cream did not improve further, numb d-i-c-k issues.

How is your morning wood?

These are the major things that worked for me to lower SHBG and increase free T in a couple of months:

1. Small amount of NDT, I was using 0.5 grains.

2. Drastically increase sugar consumption, this will lower SHBG if you did not have a lot in your diet previously. Preferably from whole fruit or juice, I did 200-300g per day from fruit or milk. Diabetics have sky-high blood sugar and they have too low SHBG as a clinical marker. Track your blood sugar and you will be able to tell when you have overdone it. Stick to fructose or lactose.

3. Lift weights. Mental states also influence hormones (sex, life success, posture etc), lifting weights is a good way to let your body know that you NEED more T. If there is no behavioural need for it why would the body prioritize it? Martial arts are even better.

4. Avoid masturbation. Tends to make you more assertive and outgoing as a man, relating to mental states like above.


Currently, I am a big fan of Cistanche as a supplement, it's a long term supplement (takes a while to get going) but I find it corrects many core issues and is androgenic. Also seems to increase progesterone and other hormones that might be needed no matter the gender. Might be worthwhile looking into but the above 4 points fixed me without Cistanche.

 

[Douglas Ek]

High carb low fat. Specially low in mufa and pufa. Saturated fat lowers SHBG but carbohydrate heavy diet does so even more. Keto is a stress state and it inactivates your bodys androgens coz the body doesnt feel it has to focus on building muscles or having sex. More like it needs to survive. Ketogenic diets are terrible.

 

[Douglas Ek]

Hi,

I have a problem for which seemingly no solution and not even an explanation exists: normal total testosterone, but low free & bioavailable testosterone due to high SHBG and Albumin.

My blood levels in short:

1. Low normal total testosterone, high SHBG & Albumin, therefore low free & bioavailable testosterone, low free androgen index
   
   
2. TSH sometimes high, sometimes normal. fT3 normal, but not optimal. fT4 low. No thyroid antibodies. Thyroid volume is low (right 7ml + left 3ml = 10ml), "harmless cysts", sonography shows no signs of autoimmune thyroiditis.
   
   
3. High progesterone (depending on the used reference range; mine seems too narrow)
   
   
4. Low estradiol
   
   
5. LH seems fine, FSH rather low
   
   
6. Cortisol seems fine, only slightly high once
   
   
7. Lipids are fine
   
   
8. GPT slightly high only once
   
   
9. Prolactin, IGF-1, STH seem fine
   
   
10. Some values seem to correlate: especially SHBG and total testosterone. I had relatively high total testosterone once, but SHBG also climbed to about 140%. This was also the only time where my estradiol fell in the optimal range - it was twice as high as my usual levels. Also my fT3 was almost in the optimal range (upper third).

Free testosterone

• Afaik it's not 100% certain that the "free hormone hypothesis" (only free testosterone can be used) is true
  
  
• For example, I also read that SHBG protects testosterone from being metabolized too early and that a slightly high SHBG is good. Or that the effects of total and free testosterone differ: total testosterone affects libido, drive, mood etc, but free testosterone is necessary for gaining muscle.
  
  
• But there are also at least 2 studies* that show exactly that: androgen deficiency symptoms are possible when somebody has normal total testosterone, but low free testosterone
  
  
• therefore I also think that free testosterone matters (even if SHBG protects testosterone etc)

Reference ranges:

1. Free testosterone: 0.174-0.672 nmol/l or: >0,25 nmol/l or: >0,2 nmol/l
   
   
2. Bioavailable testosterone: 3.68-15.3 nmol/l or: >4,37 nmol/l or: > 4,54 nmol/l
   
   
3. Free Androgen Index: 35-150

My values:

Estradiol
Reference range: 11-43 pg/ml

My values:

• 2017: 18,5 pg/ml
• 2018: 14,8 pg/ml
• 2019: 28,7 pg/ml
• 2019: 11,70 pg/ml

• Afaik E2 should be between 20-30 pg/ml -> I only fell in this range once, when my total testosterone and SHBG were also high
  
  
• My other values are rather low and the last one is at the lower limit
  
  
• Average E2 for <29 yrs is about 25 pg/ml. Levels below 20 pg/ml have negative consequences for bones, levels below 12 pg/ml cause a 3 times higher death rate.
  
  
• I think, my E2 was measured with the wrong method (not sensitive test), so my "true" E2 values could be even lower.
  
  
• I think, these levels are low enough to cause their own symptoms (independent of low testosterone). Some of my symptoms that could be due to low E2: very dry skin, eyes, lips. Hot flashes. Cracking joints. Low libido.
  
  
• In one study people who had normal total testosterone but low free testosterone also had low E2
  
  
• Testosterone has a higher binding affinity to SHBG than E2 does. But could it be, that due to my high SHBG my free E2 is below the reference range?
  
  
• The only way to raise E2 seems to be raising testosterone

Questions

1. Do you think my levels of free & bioavailable testosterone and estradiol are a problem? I have some testosterone and estrogen deficiency symptoms (some are more intensive, some less).
   
   
2. Assuming diet, sleep, exercise etc are good, is there even anything I could do about it, aside from proviron, TRT, ostarine or clomid?

____________

*References:

1. Sex hormone-binding globulin is associated with androgen deficiency features independently of total testosterone. - PubMed - NCBI
   
   
2. Low Free Testosterone Is Associated with Hypogonadal Signs and Symptoms in Men with Normal Total Testosterone. - PubMed - NCBI

Some more blood levels:

Are you taking any supplements? Whoch ones?