Low T, Low SHBG, High E (22 y.o.)

[lxm]

I am 22 years old and have suffered my symptoms since I was 18. I was always an overweight child where my weight in stones matched my age to the point where I was 16 years old and weighed 17 stone (240lbs) After this point my weight slowly reduced down to the 15 stone (210lbs) mark which it remained until I reached 21 years old.

At 21 I decided to try and cut back as much weight and fat as possible, I was sitting at 15 stone 7lbs (220lbs) and through a low carb diet reduced my weight down to 158lbs. Even at this weight, I was standing at 6ft tall and still carrying excessive bodyfat (20% +). Without any success getting rid of the 'skinnyfat' physique' I plateaued back to 190-200lbs.

I visited my GP back in 2011 when I was 20 with my symptoms, after research I requested testosterone test, which came back at 13.7nmol (8.6-28.8 range). I was sent away and told my symptoms were psychological...

In 2012 I lost 48lbs, started cardio, lifting weights, changed my lifestyle for a period of over 8 months, nothing changed symptom wise so I went back to the doctor and requested another test, my blood testosterone came back at 12.5nmol (8.6-28. I got a referral to an endocrinologist.

Jan 2013 I saw an endocrinologist, bloods were taken;

Serum test - 10.8nmol (8.6-28.
E2 222pmol (40-156)
SHBG 12.2nmol (18-45)
LH 6.5 (1-9)
FSH 6.5 (1-9)

March 2013 I saw endocrinologist again, bloods ;
 
Serum test - 11.5nmol (8.6-28.
E2 210pmol (40-156)
SHGB 12nmol (18-45)
LH 6.2 (1-9)
FSH 6.5 (1-9)

Endocrinologist told me that nothing was wrong, and gave me a prescription for Viagra. After speaking with my mother who is a medical professional, she went berserk. I researched and found out the NHS guidelines for doctors dealing with testosterone therapy. It stated that between 8-12nmol is a 'grey area' and doctors are guided to give a TRT trial. I sent these to my endocrinologist and he agreed a TRT trial.

I was started on a TRT trial March 2013. 1ml Sustanon250 injected one time every 4 weeks. After 2 months I was going crazy and being on this protocol was worse than pre TRT. I told my doctor the frequency is wrong and he agreed to change to 1ml sustanon250 every 3 weeks..... The first week my symptoms cleared, but I felt 'strange' and not normal. The second week I felt great! and the third week I felt terrible, symptoms were back. All of my trough bloods at weeks 3 and weeks 4 showed testosterone level below 8nmol! My trough at weeks 2 showed a level of 10nmol.
 
I continued on this treatment until September 2013 when a senior endocrinologist took over my case. Because I reported that my symptoms were coming back on treatment he stopped the TRT trial. I was taken off TRT cold turkey, which my HPTA shut down. I experienced exacerbated symptoms for 5 months which was complete hell. Daily for these 5 months my testicles tingled, and in Feb 2014 this sensation stopped, and my symptoms returned to a pre TRT state.

Results Feb 2014

Test 8.7 (8.6-28.
E2 156pmol (50-156)
SHBG 12nmol (18-45)

In Sept 2013 the Senior consultant stated that he wanted to start the case over with a baseline, and investigate every other mean because low SHGB could be an indicator of other medical illness/disease.

In Feb 2014 the senior consultant said that testosterone is a 'red herring' and that he thinks my issue is being overweight weight... (190lbs, 6ft tall) He thinks that if I loose my weight that everything will return to normal. I explained to him that I dropped to 158lbs! @ 6ft tall..... BF still high @ 20% + It is clearly a hormonal issue. He mentioned chronic fatigue syndrome as the next avenue.....

I have had the following tests and investigations; all came back OK.

Pituitary & Pineal MRI
Pelvic & Abdomen CT
Cortisol suppression test
XXY genetic testing
Mild Androgen insensitivity testing
Sleep assessment
DEXA bone scan
Fertility test - SPERM COUNT 0 (3 weeks on sustanon - possible false)
Testicular ultrasound
Full blood work (immune etc)
 

I have researched that low SHGB means lots of unbound free testosterone, which leads to higher levels of aromatization, and quicker clearance ,testosterone  being metabolized. From this I believe that the trial of sustanon250 was the wrong choice for me? The initial large dosage causing a spike in E2 which could explain the feeling 'strange' during week1, and the return of symptoms during week 3 because of the testosterone clearance rate ? If sustanon was ever a choice again, the use of an AI, and a shorter frequency to combat the above issues, 

I'm aware of the implications that long term TRT can cause. Whilst not ruling out another method of TRT, Fertility is important to me and I am keen to look at other types of treatment, the single use of an AI, or the use of a SERM, HCG/CLOMID to try and boot and support my own natural testosterone production.

I am looking for your thoughts and advice please, Also can anyone link me to medical reports of the use of AI, HCG and CLOMID so that I can print them off and show my doctor ?

These are my symptoms below. Also please find attached an image of my physique.

(note I had extreme difficulty typing this up, my cognitive function is terrible, trying to plan structure and content for this post had my mind turning like a pickle..... )


ZERO libido (no sexual desire, fantasy, never horny)
 - Normal Erectile function
 -  NO MORNING ERRECTIONS
 - poor orgasm & ejaculation
 - Cold night sweats (soaking cold wet sheets, sweat smells very 'meaty')
 - awaken daily feeling groggy - unrefreshed **worst symptom**
 - Extremely irritable (with people)
 - Non sociable (feel crap dont want to talk to people - See above)
 - No enjoyment in life, hobbies, socializing.. no humor, no excitement. No goals.
 - 'baseline' mood, not depressed, not miserable but not happy.
 - Achey burning neck, shoulders (blades) upper arms.
 - Nausea (mornings)
 - Headspace is constantly muffled, like im in a vegative state.
 - Poor concentration on tasks
 - Poor short term memory.

[PeakT]

Hey, sorry to hear about all the struggles.  I can tell you that half the guys on the board have similar stories to yours, so at least take some comfort in that fact.

Before I go make any comments, I have a big favor to ask:  can you ask your Mom where she got those guidelines.  Unfortunately, the UK and NHS system is where the US was about 15 years ago and so knowing those guidelines is something I can pass on to other guys on the forum if you let me know where they are at.

First of all, I could not disagree more with your endocrinologist.  There is NO magic number where a man will start feeling classic low testosterone symptoms.  Some men will be miserable at 10, some at 11, some at 12, some at 13, some at 14, etc.  Furthermore, different symptoms will start to be issues at different levels on a given guy.  Example:  I get my morning erections back when my testosterone is boosted over about 20.  I have seen this time and again.  However, my extreme anxiety and fatigue and poor sleep occur at much lower levels - I'd guess around 13 or so. 

So it's really a continuum.  As you testosterone levels fall, you would tend to lose libido gradually per the studies - it's dose dependent.  Then other symptoms would start to kick in as tesosterone falls even further.  And every guy would be different.

So let me tell you what your doc can NOT say:  that low T is NOT causing problems.  He does not know that.  It definitely could be causing some of your issues and many guys on this forum have had low T issues right at the level you are at. 

Here is the deal:  endos the world over - this is universal in all countries as far as I can tell - hate HRT unless you're HRT is VERY low, almost castrate levels.  There are very good endos that use common sense such as I described above and tailor a treatment based on the patients symptoms and situations, but that is pretty rare.

Now let's go to the Sustanon.  I am not that good with Sustanon and it is complicated by the fact that it is a four ester product.  I don't think docs prescribe it in the U.S.  But check this out:

http://thinksteroids.com/articles/how-to-use-sustanon-250/

(I am against steroid level T doses but just posted the article for interest:

"For Sustanon there is no such fixed time period. I estimate that after the last injection levels drop to one-half by the 4 day point; to one-quarter by the 10 day point; to one-eighth by the 16 day point; and to one-sixteenth by the 23 day point. Or if preferring to work with round numbers in terms of percent, as approximate values levels drop to 40% by day 6; to 30% by day 8; to 20% by day 11; and to 10% by day 18."

Assuming this is reasonably accurate, then a three week cycle with Sustanon is way too long.  Endos do the same ridiculous protocol here in the U.S. and will give a guy cypionate every three weeks!.  This leaves him with very little in his system.

So I believe what happened is that you were given a terrible protocol and then they said, "Hey, look testosterone is not your problem!"  But I need to do some research on the Sustanon.  There are longer lasting esters.

[Sam]

You need to focus on liver health and glucose control.

Do you have historical a1c and fasting glucose levels?

What have your lipids been like historically?  Today?

Testosterone for you should be a crutch you use to get you back in the gym consistently.

You need to lose that mid section fat.  Classic metabolic syndrome.

[PeakT]

Please listen to what Sam wrote above.  His SHBG was almost as low as yours at one time and he is now doing famously:

Check this out:

https://www.peaktestosterone.com/forum/index.php?topic=3866.0

I meant to write a bit about the low SHBG, but here is a page with some starter info.  Sam has much more cutting edge research and practical applications that I have not had a chance to put in that page yet:

http://www.peaktestosterone.com/low_shbg

[lxm]

Thank you Peak for the reply.

The guidelines are set out in the 'British society for sexual medicine' - these are the only UK guidelines for male androgen treatment. It states that a level between 8-12 nmol is a grey area, and should be re-tested. Recommendation is that a serum testosterone level between this range should qualify for a trial of TRT if symptoms are present.

I think these guidelines are very important, I've read on other forums that TRT has been full out refused to guys who are anywhere from 5-10nmol, clinically hypogondal according to NHS lab ranges and yet on production or mention of these guidelines doctors backtrack and give treatment.

I believe that there is a huge professional snobbery in the UK with medical professionals. Because medical knowledge and material is to an extent 'closed' to the public, what they say is gospel and not often are they met with someone who will challenge them or has a basic/moderate knowledge.

http://www.bssm.org.uk/downloads/UK_Guidelines_Androgens_Male_2010.pdf

You need to focus on liver health and glucose control.

Do you have historical a1c and fasting glucose levels?

What have your lipids been like historically?  Today?

Testosterone for you should be a crutch you use to get you back in the gym consistently.

You need to lose that mid section fat.  Classic metabolic syndrome.

This is my conundrum, my hormone ratio at present makes it very difficult to shift body fat. I can drop 'weight' no problem on a calorie restricted diet, but body fat refuses to drop and I end up hammering any LBM that I have. At one point I got down to 158lbs, at 6ft tall and body fat was estimated 22%

I am hoping that a short-medium term AI therapy will support my effort to get out of this 'metabolic syndrome' rutt. I shall get copies of all my blood work and let you know lipids, liver values etc.

[PeakT]

It's not just the UK - trust me.  Endos here in the U.S. are just like endos in the UK and these are just like endos in Canada and they are just like endos in Australia, etc.  They are just almost always highly anti-HRT.  Why I will never understand.  Seriously, I'd like to put them on anti-androgens for about six months and watch them cry like little school girls when their testosterone dropped below 350 ng/dl.  The way they treat their patients is just cruel.

Well, okay, going to the body fat issue:  when any man cuts calories significantly, many hormonal changes occur that make it very difficult to lose weight.  Appetite increases, cortisol can increase, testosterone lowers and, perhaps worst of all, the thyroid slows down.  So you're definitely swimming upstream as you lose weight. 

One of the biggest problems with losing weight - and testosterone can help with this - is that as you lose weight, it's very easy to shed muscle.  The rule of thumb is that about a quarter of your total weight loss will be muscle unless you intervene.

So, yes, increasing testosterone can help a little.  But testosterone is certainly not a panacea when it comes to weight loss and I would also check out your thyroid as well.  Highish cortisol can put on the belly fat as well.

And thx for the guidelines, but if you actually run across where those are online, it would really help.  Then I can just refer any UK guys to it. 

[lxm]

http://www.bssm.org.uk/

[PeakT]

I missed the great link that you had above!  Thx!  All over it...

[davie12]

I have had the following tests and investigations; all came back OK.

Pituitary & Pineal MRI
Pelvic & Abdomen CT
Cortisol suppression test
XXY genetic testing
Mild Androgen insensitivity testing
Sleep assessment
DEXA bone scan
Fertility test - SPERM COUNT 0 (3 weeks on sustanon - possible false)
Testicular ultrasound
Full blood work (immune etc)
 

These are my symptoms below. Also please find attached an image of my physique.

(note I had extreme difficulty typing this up, my cognitive function is terrible, trying to plan structure and content for this post had my mind turning like a pickle..... )


ZERO libido (no sexual desire, fantasy, never horny)
 - Normal Erectile function
 -  NO MORNING ERRECTIONS
 - poor orgasm & ejaculation
 - Cold night sweats (soaking cold wet sheets, sweat smells very 'meaty')
 - awaken daily feeling groggy - unrefreshed **worst symptom**
 - Extremely irritable (with people)
 - Non sociable (feel crap dont want to talk to people - See above)
 - No enjoyment in life, hobbies, socializing.. no humor, no excitement. No goals.
 - 'baseline' mood, not depressed, not miserable but not happy.
 - Achey burning neck, shoulders (blades) upper arms.
 - Nausea (mornings)
 - Headspace is constantly muffled, like im in a vegative state.
 - Poor concentration on tasks
 - Poor short term memory.

lxm: I just wanted to add a comment to supplement what the others said on your thread. I realize you had a cortisol suppression test. I would be interested in the details of that test. You have a couple of symptoms highlighted above that relate to cortisol/DHEA/adrenal issues. I realize a lot of thyroid/testosterone/adrenal symptoms overlap. However, the cold night sweats is indicative of hormones bouncing around looking for homeostasis, and the body is looking to adjust resulting in irregular temperatures, the outcome of which is night sweats. Also, waking up with an unrefreshed feeling is indicative of low cortisol. And finally, that fat pattern shows the body in a catabolic state which is indicative of possible high cortisol. However, this is just speculation. If you have the numbers related to that test, feel free to post them.

[lxm]

Maybe some relevant info from my history, As stated previously I lost 48lbs. Here are the images..

Obviously with the change in lifestyle over the year period, I felt no different symptom wise, but as others have stated its a double edged sword, cutting calories initially wrecks T levels.... Anyhow I piled back on the lbs. after struggling to drop the remaining love handles etc. This may also account for my hormone levels, coupled with going through puberty in a clinically obese state.

220lbs (Mid 2011)

158lbs (Mid 2012)