# SHBG and trt



## BlueDog10 (May 19, 2022)

I just came from my trt clinic. I have been on 200mgs of cypionate per week for close to a year now and my levels aren't very high still. I posted my labs in another post, and it was recommended here to get my SHBG checked. When I asked what labs were being drawn, she said it was just for my thyroid, which I requested. She said the Dr said I didn't need my SHBG checked as I was on trt so the synthetic test bypassed the SHBG, and it had nothing to do with that. Is that true? Can someone explain it to me?


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## Adrenolin (May 19, 2022)

Afaik it shouldn't affect total testosterone. Shbg binds to testosterone, the unbound portion is your free, usable testosterone. Ie Free testosterone is what really matters, not so much the total testosterone.


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## BlueDog10 (May 20, 2022)

Adrenolin said:


> Afaik it shouldn't affect total testosterone. Shbg binds to testosterone, the unbound portion is your free, usable testosterone. Ie Free testosterone is what really matters, not so much the total testosterone.


I'm wondering what could cause me to be on synthetic testosterone and my free test level to still be low?


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## CJ (May 20, 2022)

Synthetic testosterone does not bypass SHBG, unless I'm greatly mistaken. 

If I am, how could it be "seen by" and bound to androgen receptors, but not SHBG? 🤔


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## Send0 (May 20, 2022)

CJ said:


> Synthetic testosterone does not bypass SHBG, unless I'm greatly mistaken.
> 
> If I am, how could it be "seen by" and bound to androgen receptors, but not SHBG? 🤔


You are not mistaken. Testosterone is testosterone. And the point of SHBG is to bind sex hormones. 

This is for anyone reading, not necessarily CJ. Contrary to popular belief, SHBG is not evil. Low SHBG is correlated to high triglycerides and and LDL, and in turn tied to cardiovascular disease. High SHBG is of course tied to suboptimal athletic performance, and even decreased bone density and osteoporosis. These are just a couple of examples of what SHBG does when it's low and when it's high. There are countless more.

When taking bolus shots of testosterone, typically SHBG will be driven way down. If a person is effected in this way, then they *could* mitigate it by increasing the number of weekly injections taken (multiple smaller doses per week, as opposed to fewer bolus doses). This will increase SHBG, so your peak testosterone levels will be lower, but your troughs will also be higher. Taking that approach will also lead to less conversion to estrogen / less bio available estrogen for the same reasons.


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## Send0 (May 20, 2022)

Send0 said:


> You are not mistaken. Testosterone is testosterone. And the point of SHBG is to bind sex hormones.
> 
> This is for anyone reading, not necessarily CJ. Contrary to popular belief, SHBG is not evil. Low SHBG is correlated to high triglycerides and and LDL, and in turn tied to cardiovascular disease. High SHBG is of course tied to suboptimal athletic performance, and even decreased bone density and osteoporosis. These are just a couple of examples of what SHBG does when it's low and when it's high. There are countless more.
> 
> When taking bolus shots of testosterone, typically SHBG will be driven way down. If a person is effected in this way, then they *could* mitigate it by increasing the number of weekly injections taken (multiple smaller doses per week, as opposed to fewer bolus doses). This will increase SHBG, so your peak testosterone levels will be lower, but your troughs will also be higher. Taking that approach will also lead to less conversion to estrogen / less bio available estrogen for the same reasons.


I suspect the reason why the doctor said what she did was really because the bolus shots of testosterone, that is part of the OP's TRT, should create a big drop in SHBG.

However if the OP's free testosterone still looks low, then a test for SHBG may be useful in diagnosing why the free testosterone might be low. So I disagree with her saying it's not necessary in that scenario.


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## BlueDog10 (May 20, 2022)

Send0 said:


> I suspect the reason why the doctor said what she did was really because the bolus shots of testosterone, that is part of the OP's TRT, should create a big drop in SHBG.
> 
> However if the OP's free testosterone still looks low, then a test for SHBG may be useful in diagnosing why the free testosterone might be low. So I disagree with her saying it's not necessary in that scenario.


Wow!! Thank you for that very good and detailed explanation.  With that knowledge, presentation, you could run your own trt clinic and do far more good for people than these clinics. I wish there were more Dr's out there that acted like Dr's and not business people just trying to make a buck.


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## BigBaldBeardGuy (May 20, 2022)

Send0 said:


> I suspect the reason why the doctor said what she did was really because the bolus shots of testosterone, that is part of the OP's TRT, should create a big drop in SHBG.
> 
> However if the OP's free testosterone still looks low, then a test for SHBG may be useful in diagnosing why the free testosterone might be low. So I disagree with her saying it's not necessary in that scenario.


His older post in a different thread has his total test around 536 and his free test at 11.


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## Send0 (May 20, 2022)

BlueDog10 said:


> Wow!! Thank you for that very good and detailed explanation.  With that knowledge, presentation, you could run your own trt clinic and do far more good for people than these clinics. I wish there were more Dr's out there that acted like Dr's and not business people just trying to make a buck.


It's just learned knowledge. Everyone can know that level of detail if they are willing to invest the time.

I'm glad it was useful to you. When I write these things out I often worry I'm giving people too much information, and make them go cross eyed reading my response 😅


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## Send0 (May 20, 2022)

BigBaldBeardGuy said:


> His older post in a different thread has his total test around 536 and his free test at 11.


Wow, that's crazy. If he's on 200mg of test per week, then I'd expect his total to be higher (generally speaking). He could be one of the very rare low responders to testosterone.

Or it could be a compounded issue of low response, and high SHBG 🤷‍♂️


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## BigBaldBeardGuy (May 20, 2022)

BlueDog10 said:


> Wow!! Thank you for that very good and detailed explanation.  With that knowledge, presentation, you could run your own trt clinic and do far more good for people than these clinics. I wish there were more Dr's out there that acted like Dr's and not business people just trying to make a buck.


Blame the cost of medical malpractice insurance and our litigious society. Doctors may KNOW more, but they have standard protocols that they agree to follow (a doctor that stays in his narrow lane is less likely to be sued). I know doctors “pretend” not to know alternative methods because they can’t offer them as options so why bother discussing. 

It sucks.


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## BigBaldBeardGuy (May 20, 2022)

BlueDog10 said:


> I just came from my trt clinic. I have been on 200mgs of cypionate per week for close to a year now and my levels aren't very high still. I posted my labs in another post, and it was recommended here to get my SHBG checked. When I asked what labs were being drawn, she said it was just for my thyroid, which I requested. She said the Dr said I didn't need my SHBG checked as I was on trt so the synthetic test bypassed the SHBG, and it had nothing to do with that. Is that true? Can someone explain it to me?


Did you get the results for the thyroid test? They’re probably checking to see if you have Hashimoto’s disease. That would result in lower natural testosterone levels. I’m not sure how exogenous testosterone would be affected by that though.


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## Send0 (May 20, 2022)

BigBaldBeardGuy said:


> Did you get the results for the thyroid test? They’re probably checking to see if you have Hashimoto’s disease. That would result in lower natural testosterone levels. I’m not sure how exogenous testosterone would be affected by that though.


I can tell you that the thyroid would effect SHBG, but that still wouldn't explain the low total testosterone 🤔


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## Butch_C (May 20, 2022)

I wonder if his TRT clinic has a private lab brewing their own Test. I know some of these clinics like having their own compounds sometimes even blending in nandrolone with the test. If that's the case maybe it is under dosed? His numbers are almost spot on what mine were when they had me at 200 every 14 days. I know everyone responds different and metabolizes different but it seems very low for 200 every 7 days.


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