Question about SHBG and other blood levels

[Winters1jm]

Hey guys, I just spoke with my doc within the last few days and from my latest blood tests and past history he thinks i have a low Total Testosterone because of a low SHBG level or something. I couldn't understand what he was exactly talking about over the phone. He said something about maybe a problem with the liver producing too much Albumin or something causing my Total T to be low while my Free T was still ok. Like i said i didnt really understand him but i thought i would post these results and see if you guys had any idea. He said he didnt think HCG or TRT would really do that much good because of this. He did tell me to seek another opinion if i wanted and i am trying to get consulted with Dr. John with my PCP.

After 10 weeks off of Androgel or any TRT, these were taken back in June.

Total Testosterone - 287. (241-827 NG/DL)
Testosterone, Free and Weakly Bound - 201. (84-402 NG/DL)
Testosterone, Free - 85. (34-194 PG/ML)
LH - 5.1 (1.5-9.3 MIU/ML)
Albumin - 5.2 (3.7-5.1 G/DL)
SHBG - 13. (7-44 NMOL/L)

[love_en]

A low SHBG just means that you are not producing enough T to be stored. SHBG is the storage mechanism for T. When I was tested my SHBG was low as well. Fire that doctor. He is unwilling to do his job. How are you feeling with a total T of 287? I cannot imagine surviving a level that low.

[Winters1jm]

Like i said i may have misunderstood him. It may have been the albumin he was talking about.

I felt good for a while, my Free T was decent. However, it dropped to 233 about 3 weeks ago when i had it checked and i've been having some nasty symptoms.

[farmerjohn]

Cant albumin loosely bond with testosterone like SHBG does? I may be confused on that but for some reason albumin rings a bell. According the Dr. Shippens book, high E2 and low T both increase SHBG while high T will reduce SHBG.

[love_en]

If you have low body fat and low aromatization of what little T you produce, there is little E2. I had a similar situation where all of my levels were low. Low free T, total T and SHBG. Don't know where I am at now, but 125 mg of enanthate per week gave me my life back.

[love_en]

If you have low body fat and low aromatization of what little T you produce, there is little E2. I had a similar situation where all of my levels were low. Low free T, total T and SHBG. Don't know where I am at now, but 125 mg of enanthate per week gave me my life back.

[Ruper]

Even with the freeT levels, total T that low is not too good.

Albumin levels like that are easy to get. You just have to be a bit dehydrated.

Low SHGB might hide some of the symptoms of low T, but it isn't a long-term solution for your body.. I'm not sure what controls SHGB becuase when I had low T my SHGB was highish, which to me also makes sense in that your body is trying to store as much T as possible since it knows you are not producing much and freeT only lasts 60-90 minutes. Either way I think out of ballance SHGB is a warning sign that bad things are happening, not a 'well your freeT is OK, so you're fine' thing.

[pmgamer18]

Originally Posted by farmerjohn

Cant albumin loosely bond with testosterone like SHBG does? I may be confused on that but for some reason albumin rings a bell. According the Dr. Shippens book, high E2 and low T both increase SHBG while high T will reduce SHBG.

I believe it's the higher the Free T the lower the SHBG. With testing of Free T there is no need to check SHBG.

4. What are free and bioavailable testosterone?
Testosterone is present in the blood as "free" testosterone (2-3%) or bound testosterone. The latter may be bound to either albumin (a serum protein) or to a specific binding protein called Sex Steroid Binding Globulin (SSBG) or Sex Hormone Binding Globulin (SHBG). The binding of testosterone to albumin is not very tight and is easily reversed; so the term bioavailable testosterone (BAT) refers to the sum of free testosterone plus albumin-bound testosterone. Alternatively, it is the fraction of circulating testosterone that is not bound to SSBG. It is suggested that BAT represents the fraction of circulating testosterone that readily enters cells and better reflects the bioactivity of testosterone than does the simple measurement of serum total testosterone. Also, varying levels of SSBG can result in inaccurate measurements of BAT. Decreased SSBG levels can be seen in obesity, hypothyroidism, androgen use, and nephritic syndrome. Increased levels are seen in cirrhosis, hyperthyroidism, and estrogen use. In these situations, measurement of free testosterone may be more useful. However, technically, free testosterone is difficult to measure accurately.

[marianco]

Originally Posted by Winters1jm

Total Testosterone - 287. (241-827 NG/DL)
Testosterone, Free and Weakly Bound - 201. (84-402 NG/DL)
Testosterone, Free - 85. (34-194 PG/ML)
LH - 5.1 (1.5-9.3 MIU/ML)
Albumin - 5.2 (3.7-5.1 G/DL)
SHBG - 13. (7-44 NMOL/L)

Symptoms of testosterone deficiency are more common as the total testosterone level dips below 300 ng/dl.

Sex Hormone Binding Globulin (SHBG) binds testosterone and allows testosterone to have a longer duration of action. SHBG also has its own receptors and transmits signals to cells with these receptors when testosterone or estrogens are bound to it. The exact result of these signals are not clear.

SHBG is increased by thyroid hormone and estrogens.
SHBG is lowered by insulin resistance (e.g. high insulin levels, diabetes), testosterone, DHEA, growth hormone, other androgens.

With low SHBG and pure testosterone replacement therapy (e.g. gels or creams), one can get large amounts of free testosterone temporarily, but as it is quickly destroyed, one gets lower than expected testosterone levels. A roller coaster experience can result. Depo-testosterone injections work better under this circumstance.

The initial target total testosterone level with testosterone replacement therapy (assuming a normal range of 300-1000 ng/dl) is about 650 ng/dl - a mid-range level. This is recommended by the Endocrine Society's new 2006 guidelines. I think it is a great conservative initial target because I've seen too many practitioners who won't make adjustments because the initial treatment (e.g. with androgel) caused the total testosterone to go over 300 - e.g. 400, into the "normal range" - then declaring the treatment as adequate when the person still has symptoms of hypogonadism.

[Winters1jm]

So in all honesty, whats the chances that my levels are gonna get back up to where they need to be naturally? I mean, even if there is some underlying reason that they find to be the reason my testosterone levels are low and that is corrected, what are the chances it will raise again significantly?