# STEROIDS FORUM > HORMONE REPLACEMENT THERAPY- Low T, Anti-Aging >  Lowering SHBG to Increase Free T -- Treatment Options?

## bkb333

Hi everyone,

First-time poster -- thank you for taking the time to read. I'm 26, 6'2", 175 pounds, 12%BF (natural to this point). I'm active & eat a clean diet (paleo-ish).

I have all the symptoms of low T, likely being caused by ultra-high SHBG. Numbers:
Total T: 1008 (ref 264-916)
Free T: 7.8 (ref 9.3-26.5)
SHBG: 186 (ref 16.5-55.9)
Albumin: 4.9 (ref 3.6-7.0)

The SHBG is concerning (liver, osteoporosis, etc), so I'm posting here to get your thoughts on treatment. Considering each of the following:
Danazol
hCG 
Winstrol 
Proviron 

I'm open to adding T (likely test-cyp) to maintain total T during treatment, too, but fertility is a priority. What substance(s) & dosage would you try first in this situation? Thanks in advance for your help.

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## Youthful55guy

> Hi everyone,
> 
> First-time poster -- thank you for taking the time to read. I'm 26, 6'2", 175 pounds, 12%BF (natural to this point). I'm active & eat a clean diet (paleo-ish).
> 
> I have all the symptoms of low T, likely being caused by ultra-high SHBG. Numbers:
> Total T: 1008 (ref 264-916)
> Free T: 7.8 (ref 9.3-26.5)
> SHBG: 186 (ref 16.5-55.9)
> Albumin: 4.9 (ref 3.6-7.0)
> ...


That's one of the highest SHBG levels I've ever seen. Do you have liver damage that we should know about? What other drugs are you taking? That level is so far out, I'm hesitant to recommend starting any treatment until you figure out what's driving it up.

However, here's a copy/paste from a recent post I made in this fourm. 

You do not want to go too low on SHBG, because then you will metabolize T too quickly and your Free T will drop like a rock. It's a delicate balance. I would shoot for about 30 to 35 nmol/L with your test range. The difficulty here is that you need either a very open minded doc to get the drugs prescribed, or go off the reservation and obtain them through alternate channels (my approach). There are basically 3 choices in the USA for prescription drugs: Anavar (Oxandrolone), Danazol (Danocrine), and Proviron . In the EU and elsewhere you also have the choice of Winstrol (Oral Stanozolol ). I only have experience with Anavar and Winstrol, and both are EXTREMELY effective at very low dosages so there are minimal side-effects. With Anavar, I've found that 5mg 2X per day is optimal for me. For Winstrol, the dose is lower at 5mg 2X per day. I recommend 2X per day dosing because they both have very short half lives. Winstrol is much less expensive than Anavar, so there is less counterfeiting if you obtain it through alternate channels. I do not have personal experience with Danazol, but I did see two posts where guys found it effective at 20-30 mg per day. It is about as expensive as Anavar, so I see no real reason to use it unless you can get it prescribed and covered by insurance (not likely). There is very little information out there in Proviron and the stuff that's out there is mixed information.

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## bkb333

> That's one of the highest SHBG levels I've ever seen. Do you have liver damage that we should know about? What other drugs are you taking? That level is so far out, I'm hesitant to recommend starting any treatment until you figure out what's driving it up.


Thank you for getting back to me! I have heard that from a number of people -- that my SHBG is WAY too high. I do not have any liver damage that I am aware of; I don't drink alcohol currently, and only did so for a couple years in college. I also am not taking any other drugs (outside of basic supplements like multivitamin/turmeric).

I've read mixed information about this, but I think my high-fat/low-carb diet (basically keto) for the past 2 years may have played a role. Additionally, overtraining for a long period of time may have contributed. However, that still doesn't fully explain why that number is so high.

Planning on seeing an endo to discuss hormone options. Do you think I should see any other specialist(s) for tests?

I also looked through your other posts and saw you prefer Winstrol to lower high SHBG. Have you seen any side effects?

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## Youthful55guy

> Thank you for getting back to me! I have heard that from a number of people -- that my SHBG is WAY too high. I do not have any liver damage that I am aware of; I don't drink alcohol currently, and only did so for a couple years in college. I also am not taking any other drugs (outside of basic supplements like multivitamin/turmeric).
> 
> I've read mixed information about this, but I think my high-fat/low-carb diet (basically keto) for the past 2 years may have played a role. Additionally, overtraining for a long period of time may have contributed. However, that still doesn't fully explain why that number is so high.
> 
> Planning on seeing an endo to discuss hormone options. Do you think I should see any other specialist(s) for tests?


There's a genetic anomaly that affects about 20% of the population where we add an extra sugar to the SHBG molecule (wish I could find that original reference). This has the effect of more than doubling the half life of the protein. Since high SHBG don't really impact women much, it means that only about 10% of the population (the men of that 20%) that exhibit clinical manifestations. Since the half life is doubles, and we produce at roughly the same rate as the other 90% of men, it means that we have higher levels because it sticks around longer. Yours however is EXTEMELY high. Has this be corroborated by more than one test? If not, I'd get it retested.

My experience with high SHBG (70 to 95 range untreated) is that it is relatively unaffected by diet and all of the supplements out there claiming to reduce SHBG only reduce the size of your pocketbook. I'm not saying don't give them a try or manage you nutrition, I'm just saying it's a long way to go from 186 nmol/L to the more idea 25-35 nmol/L.

Regarding specialists, few even acknowledge the importance of SHBG in men's health. However, given your extreme case, perhaps you can get their attention. Your insurance may be another issue, even if you can get a doc to prescribe Anavar or Danazol, and the drugs are expensive. They are simply not approved for this indication and they are considered schedule 2 drugs, so they have higher scrutiny. However, I'd go down the specialist route before the self-treatment route. You should see if there is an underlying cause. The drugs are easy to obtain through alternate channels if/when you decide to go down that route.

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## bkb333

> Regarding specialists, few even acknowledge the importance of SHBG in men's health. However, given your extreme case, perhaps you can get their attention. Your insurance may be another issue, even if you can get a doc to prescribe Anavar or Danazol, and the drugs are expensive. They are simply not approved for this indication and they are considered schedule 2 drugs, so they have higher scrutiny. However, I'd go down the specialist route before the self-treatment route. You should see if there is an underlying cause. The drugs are easy to obtain through alternate channels if/when you decide to go down that route.


Thank you, seriously, for all your help. Seems like you're the SHBG expert around here! I'm hearing I'll probably have a hard time finding an endo to treat me because my total T is super high. However, as you know, that makes no real difference to my body, as my free T:total T ratio is waaaaay off and my low accessible T is killing me. I'd rather not go the alternate channel route, as I know my wife wouldn't like it. Were you able to find an endo willing to treat your high SHBG? Did you find any channel other than self-medication that helped? Thanks again for all your help  :Smilie:

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## Youthful55guy

> Thank you, seriously, for all your help. Seems like you're the SHBG expert around here! I'm hearing I'll probably have a hard time finding an endo to treat me because my total T is super high. However, as you know, that makes no real difference to my body, as my free T:total T ratio is waaaaay off and my low accessible T is killing me. I'd rather not go the alternate channel route, as I know my wife wouldn't like it. Were you able to find an endo willing to treat your high SHBG? Did you find any channel other than self-medication that helped? Thanks again for all your help


Four points.

1) Your Total T is high because SHBG is high. SHBG binds and protects T from liver metabolism, so it drives Total T (and probably DHT) way up. On the other hand, it binds T and prevents it from passing through the blood-brain barrier. So, even though you are swimming in T, you feel the mental effects of low T. It really sucks to get help from a Neanderthal medical community that refuses to acknowledge the importance of SHBG in men's health.

2) No, I had no luck finding mainstream medical help other than through the doc that got me on my current protocol. However, his approach was not to treat the SHBG, but rather to saturate it with T through TRT so that enough spilled over to Free T for me to feel normal again. This only works to a certain extent. I had a SHBG in the 70 to 95 nmol/L range, and I have to drive my Total T up into the 1200 to 1600 ng/dL range to get enough Free T. While that approach does work, it has limitations because bound T still has some peripheral effects such as driving up hemoglobin production, so those high Total T ranges at difficult to sustain.

3) Bioavailable T is another testing option that can substitute for Free T. My experience is that the results parallel Free T very well and mainstream docs tend to accept it better than free T. I'm guessing that it's all in the name.

4) I went down the self-treatment route after reading as much as I could find in both the medical literature and the web (careful, it's unfiltered information). I settled on Winstrol as my drug of choice because it is supported with some adequate research (not great, but adequate) and it is fairly inexpensive. Also, there's lots of bodybuilder chat supporting its use for lowering SHBG. My experience corroborates this, but you only need very low doses compared to what BB use. Anavar has some very good randomized controlled studies supporting SHBG suppression, but its expensive (even through alternate channels) and you need a higher dose. In terms of side-effects, I believe they are similar and low when dosed properly.

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## kelkel

> Thank you, seriously, for all your help. Seems like you're the SHBG expert around here!



He is that. Excellent with it.

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## bkb333

Since I received such a strong response to my ridiculous SHBG, I've been paranoid about my health. Nothing below is that striking, right?

Blood Urea Nitrogen 19.0 (10-25)
Creatinine .93 (.5-1.4)
Alkaline Phosphatase 49.0 (30-115)
Bilirubin - Total .38 (0.1-1.2)
AST(SGOT) 24.0 (0-41)
ALT(SGPT) 22.0 (0-45)
GGT 12.0 (2-65)

Do you think I have reason to panic, or could a good hormone plan fix my crazy SHBG? I also wonder whether I may have hypothyroidism.

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## Youthful55guy

> Since I received such a strong response to my ridiculous SHBG, I've been paranoid about my health. Nothing below is that striking, right?
> 
> Blood Urea Nitrogen 19.0 (10-25)
> Creatinine .93 (.5-1.4)
> Alkaline Phosphatase 49.0 (30-115)
> Bilirubin - Total .38 (0.1-1.2)
> AST(SGOT) 24.0 (0-41)
> ALT(SGPT) 22.0 (0-45)
> GGT 12.0 (2-65)
> ...


You bloods look good, and in particular the liver enzymes look excellent. So liver damage is probably not the cause. Although it is a known factor that can raise SHBG, it does not appear to be your case.

I would have thyroid labs done, but supplementing thyroid hormones is also known to increase SHBG, so I'd be very careful about going down that road.

All kidding aside, you could just be a genetic mutant. You may have a more extreme case than I do with increased glycosylation (addition of sugar) of the SHBG protein. 

I'm running out of suggestions. I would ask a doc about it, but I'm not sure if endocrinologists will be much help. Most of them even acknowledge the existence of the protein, let alone its importance in male health.

You may have to venture down the self-treatment path like I did.

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## wellshii

..............

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## wellshii

If wont be hypo,buy hyperthyroidism. Like mentioned above,get a full thyroid panel as well as estrogens and insulin and adrenals(cortisol especially)

When you say paleoish,what exactly does a daily diet consist of?
You taking a good Multi ?Hows your Iodine intake? Boron also known to lower shbg. 

I also did a keto diet for 8 months or so. I started carbs again too quickly which lowered my blood sugar too much(insulin sensitivity)
Went to a doc and got some test done.(He didnt know s**t BTW and this was an endo)
My free test was 92.4 pg/ml(ref range 35-155) and total test 713 ng/dl (250-1100)This was maybe two weeks after the re-indroduction of carbs. Come to think of it,I should have got my shbg tested just to see where it was at. Who knows what my free test was before the carbs. Insulin is known to lower shbg as well.

But I would address the root of course than throw drugs at it.

Edit: Found this thread and the root of his problem,glad he updated it
Skyhigh SHBG Levels - WHY?! | Page 3 | All Things Male Forum

One more thing,do you take flaxseed? I was taking flax daily and decided to get my test measure again,my Free test was lower by a wide margin . That was the only thing I was doing differently at that time and linked it to that. (This was after the above info)

Heres a study on that as well. 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752973/

I am extremely curious as to the root cause of this.

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## Youthful55guy

Oh, something I ran across the other day while researching this topic in PubMed. Statins, especially Atrovastin, may actually LOWER SHBG. I did this search in response to another thread asking if Atrovastin might increase it. I found two fairly good papers the point to the opposite. 

However, Statins (as a class) do lower Total T production. This has been pretty firmly established, but this should not affect guys on TRT at the same time as Statins since we don't make any endogenous T anymore. This interesting observation in these studies is that while Total T is decreased in guys on statins without TRT, Free T is not decreased. This was an early clue to it's decreasing SHBG production. Now it's been measured that certain statins (such as Atrovastin/Lipitor) do indeed lower SHBG. 

I currently take 10mg, but I might discuss a dose increase with my doc, depending on my lipid labs at my next annual visit in the October.

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## bkb333

Thank you for the insight!




> When you say paleoish,what exactly does a daily diet consist of?
> You taking a good Multi ?Hows your Iodine intake? Boron also known to lower shbg.


Diet: rough macro breakdown has been 15% carbs, 30% protein, 55% fat. My carbs all came from clean sources like sweet potatoes, veggies, and white rice. Really interested in seeing if a change in diet -- I've gone to 30% carbs, 35% protein, 35% fat -- changes SHBG.

I do take a multivitamin and just started taking Boron, but I have never tested (or supplemented with) Iodine. Is that important to add?




> I also did a keto diet for 8 months or so. I started carbs again too quickly which lowered my blood sugar too much(insulin sensitivity)
> Went to a doc and got some test done.(He didnt know s**t BTW and this was an endo)
> My free test was 92.4 pg/ml(ref range 35-155) and total test 713 ng/dl (250-1100)This was maybe two weeks after the re-indroduction of carbs. Come to think of it,I should have got my shbg tested just to see where it was at. Who knows what my free test was before the carbs. Insulin is known to lower shbg as well.


Sorry to hear about your experience. Seems most of these endos don't know anything. Excited to partner with Defy.




> One more thing,do you take flaxseed? I was taking flax daily and decided to get my test measure again,my Free test was lower by a wide margin . That was the only thing I was doing differently at that time and linked it to that. (This was after the above info)


I have taken flaxseed on occasion, but definitely not regularly. 

Thanks again for all your help.

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## bkb333

> If wont be hypo,buy hyperthyroidism.


So _hyper_thyroidism means producing too many hormones, correct? And that's what happens when SHBG & total T are too high?




> When you say paleoish,what exactly does a daily diet consist of?
> You taking a good Multi ?Hows your Iodine intake? Boron also known to lower shbg.


I've been eating roughly 15% carbs, 25% protein, and 60% fat. Carbs came from good sources like sweet potatoes, white rice, veggies, fruit. I've changed my macros to 30% carbs, 30% protein, 35% fat -- interested in seeing how this affects SHBG, if at all.




> I also did a keto diet for 8 months or so. I started carbs again too quickly which lowered my blood sugar too much(insulin sensitivity)
> Went to a doc and got some test done.(He didnt know s**t BTW and this was an endo)


Sorry to hear about your experience. Seems most endos are clueless. I met one today who actually sounds decent. Anyone know how much out of pocket (with insurance) it typically costs to see a local endo and get TRT/associated treatments like hCG ? I am also looking into Defy -- which looks GREAT -- but I would love to have insurance take a bite out of the cost. Anyone have experience with Defy? Would you recommend it over a local endo who is willing to treat high SHBG?




> One more thing,do you take flaxseed? I was taking flax daily and decided to get my test measure again,my Free test was lower by a wide margin . That was the only thing I was doing differently at that time and linked it to that. (This was after the above info)


I do not take flaxseed.




> I am extremely curious as to the root cause of this.


Me too! I should have new labs -- including a full thyroid panel -- later this week or early next week. Will report back! And, as I mentioned, I'll keep everyone updated throughout the process as I strive to reduce SHBG and increase free T.

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## bkb333

> Oh, something I ran across the other day while researching this topic in PubMed. Statins, especially Atrovastin, may actually LOWER SHBG. I did this search in response to another thread asking if Atrovastin might increase it. I found two fairly good papers the point to the opposite. 
> 
> However, Statins (as a class) do lower Total T production. This has been pretty firmly established, but this should not affect guys on TRT at the same time as Statins since we don't make any endogenous T anymore. This interesting observation in these studies is that while Total T is decreased in guys on statins without TRT, Free T is not decreased. This was an early clue to it's decreasing SHBG production. Now it's been measured that certain statins (such as Atrovastin/Lipitor) do indeed lower SHBG. 
> 
> I currently take 10mg, but I might discuss a dose increase with my doc, depending on my lipid labs at my next annual visit in the October.


This is very interesting. I may look into Atorvastatin + TRT. Is Atorvastatin the statin you currently take? How's your experience been?

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## Youthful55guy

Yes, I take 10 mg per day of Atorvastatin (Lipitor). Zero side-effects that I can discern, but my lipids are back in line. They got skewed after I started TRT. Argues against those who say TRT levels of T do not affect lipid levels.

Something I did not consider when reading those papers was to see if they actually measured LH production. I got to thinking, that perhaps the reason T is decreased while on a statin is that it lowers SHBG. As we know, the higher SHBG goes, the more Total T you have because it sequesters it and protects it from liver metabolism. If the opposite happened, that is, SHBG went down because of statin inhibition, we would expect Total T levels to come down independent of LH or T production because it is being metabolized and excreted at a faster rate. i'll have to go back and read those papers more closely.

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## Garbanzo Dude

Very Interesting.....My TRT Doctor mentioned "he has seen some client's lower SHBG with Danazol, Anavar and Proviron " But flat out told me he would not prescribe these durgs as the "they have a bad rap with the AMA or medical community" 

I've always had high SHBG- I think it has to do with those years of hard drinking in my 20's and I have Mild Ulcerative Colitis.......Im 41 now and rarely drink.....UC is under control, but I know high SHBG correlates with high inflammation. 

I'm currently on my 12th week of TRT and my last test showed Total Test going down slightly from previous blood test. 

So I have read a few times here that 1x per week injection will keep SHBG lower vs. 2x per week. Does anyone know where I can find or reference these studies??


Also has anyone had any luck with Oat Extract or Boron supplements??

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## bkb333

So, I had a bunch more bloodwork done yesterday. I haven't received the results yet, but the doctor just called and said I had high DHEA-S and she thinks this is likely causing my issues. Anyone have experience with this? 

Also, she said my SHBG was slightly lower this time around (167) but obviously still super high.

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## Youthful55guy

> Very Interesting.....My TRT Doctor mentioned "he has seen some client's lower SHBG with Danazol, Anavar and Proviron " But flat out told me he would not prescribe these durgs as the "they have a bad rap with the AMA or medical community" 
> 
> I've always had high SHBG- I think it has to do with those years of hard drinking in my 20's and I have Mild Ulcerative Colitis.......Im 41 now and rarely drink.....UC is under control, but I know high SHBG correlates with high inflammation. 
> 
> I'm currently on my 12th week of TRT and my last test showed Total Test going down slightly from previous blood test. 
> 
> S*o I have read a few times here that 1x per week injection will keep SHBG lower vs. 2x per week. Does anyone know where I can find or reference these studies??
> 
> *
> Also has anyone had any luck with Oat Extract or Boron supplements??


To my knowledge, there is no research supporting that statement. My guess is that it's gym lore and probably has no basis in research. I simply don't believe it. Dosing weekly goes contrary to my general philosophy of TRT, which is to prevent the rollercoaster ride with smaller and more frequent dosing. That should control E better and we suspect that high E is one of the factors will drive up SHBG (though I have no references for this). 

The drugs you mention have a bad rap with the AMA because they are prone to anabolic steroid abuse . Whenever you misuse drugs, the side-effects go up. Bodybuilders often use 40-100 mg of Winstrol or Anavar per day to achieve their desired effect. At that level, there is MUCH research showing that liver damage is inevitable. That is the main reason they cycle it to allow repair of the damage. My experience is that for SHBG lowering effects you need much small doses (in the 5-10 mg per day range). My experience also shows that my liver labs generally stay within normal when I dose at these low rates. It's only when I add other OTC analgesics to the mix where my liver labs go out of range.

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## bkb333

Based on what I've read, I echo what Youthful55guy said about Winstrol . Nothing to be concerned about as long as you control your dose.

Youthful55guy, any thoughts on my doc's DHEA-S comment?

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## Garbanzo Dude

> To my knowledge, there is no research supporting that statement. My guess is that it's gym lore and probably has no basis in research. I simply don't believe it. Dosing weekly goes contrary to my general philosophy of TRT, which is to prevent the rollercoaster ride with smaller and more frequent dosing. That should control E better and we suspect that high E is one of the factors will drive up SHBG (though I have no references for this). 
> 
> The drugs you mention have a bad rap with the AMA because they are prone to anabolic steroid abuse. Whenever you misuse drugs, the side-effects go up. Bodybuilders often use 40-100 mg of Winstrol or Anavar per day to achieve their desired effect. At that level, there is MUCH research showing that liver damage is inevitable. That is the main reason they cycle it to allow repair of the damage. My experience is that for SHBG lowering effects you need much small doses (in the 5-10 mg per day range). My experience also shows that my liver labs generally stay within normal when I dose at these low rates. It's only when I add other OTC analgesics to the mix where my liver labs go out of range.


Thanks man.....I would keep coming across the comment "1x per would keep SHBG lower vs. 2x per week" but could never find a studies or even a member showing labs to prove this. Totally agree orals or AA being abused gets a bad rap. I may go to a new TRT doc, I've heard he's willing to prescribe Anavar at 5-10mg- if not might order some Proviron from a friend in Europe, I hear its easily available there.

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## Youthful55guy

> Based on what I've read, I echo what Youthful55guy said about Winstrol . Nothing to be concerned about as long as you control your dose.
> 
> Youthful55guy, any thoughts on my doc's DHEA-S comment?


I doubt that DHEA has anything to do with SHBG, but I have no references to document that. What is your dose? I do 25mg per day but I don't monitor my DHEA levels. Given that you are high, I would suggest you lower it to get it in range, but again I doubt it will affect SHBG.

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## Youthful55guy

> Thanks man.....I would keep coming across the comment "1x per would keep SHBG lower vs. 2x per week" but could never find a studies or even a member showing labs to prove this. Totally agree orals or AA being abused gets a bad rap. I may go to a new TRT doc, I've heard he's willing to prescribe Anavar at 5-10mg- if not might order some Proviron from a friend in Europe, I hear its easily available there.


I've not done a lot of research into Proviron (Mesterolone). Perhaps I will this weekend to at least get a handle on it's cost compared to Winstrol (stanozolole), my drug of choice.

From what (little) I know, it does not lower SHBG, but rather blocks it with a very strong binding affinity to SHBG. This means that you can't depend on measuring SHBG levels as and indicator of effectiveness. You have to monitor free or bioavailable T.

It also has a low potential for negative feedback, so you may (or may not) need TRT with low doses. It also seems to have an anti-estrogen effect, so you'll need to monitor E levels if you are already taking an AI to make sure that does not go too low.

I also seem to remember that it has a very low potential for liver toxicity, so that gives it a leg up on Winstrol and Anavar , but as I've mentioned numerous times, I monitor liver enzymes closely and they are not a problem with the very low doses of Winstrol that I use (2.5 mg 2X/day).

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## bkb333

I was planning on beginning TRT with Winstrol , but now I am second-guessing that plan after listening to a TRT Revolution podcast (I can't link because my account is new, but it's the January episode with Dr. Nick Sakkas). The summary: "Undergoing TRT and taking an AI suppresses estrogen and puts you at an extreme risk of developing cardiac hypertrophy and organ damage in the long-term." 

I figured I'd need an A.I. to lower my SHBG. Thoughts?

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## bkb333

> I doubt that DHEA has anything to do with SHBG, but I have no references to document that. What is your dose? I do 25mg per day but I don't monitor my DHEA levels. Given that you are high, I would suggest you lower it to get it in range, but again I doubt it will affect SHBG.


I actually just started taking DHEA -- I had not previously.

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## Youthful55guy

> I was planning on beginning TRT with Winstrol , but now I am second-guessing that plan after listening to a TRT Revolution podcast (I can't link because my account is new, but it's the January episode with Dr. Nick Sakkas). The summary: "Undergoing TRT and taking an AI suppresses estrogen and puts you at an extreme risk of developing cardiac hypertrophy and organ damage in the long-term." 
> 
> I figured I'd need an A.I. to lower my SHBG. Thoughts?


Winstrol is not an AI and has no effect on estrogen levels. I have no idea why he would conclude that an AI with TRT would put you at risk of developing cardiac hypertrophy and organ damage in the long-term. You dose the Ai so that you maintain E within physiological ranges for men. In most cases, if you use frequent low dose TRT as most of us recommend in this forum, you probably will not need an AI anyway. I use an anastrozole at very low levels (see my recent post on my protocol and results). My recent labs show that I should decrease my already low AI (anastrozole) dosing even more.

Winstrol is a synthetic anabolic steroid used for treating chronic wasting diseases such as HIV. The bodybuilding community has found other uses for it though. I use it strictly at very low doses (compared to either HIV patients or Bodybuilders) for effective SHBG control.

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## bkb333

> Winstrol is not an AI and has no effect on estrogen levels. I have no idea why he would conclude that an AI with TRT would put you at risk of developing cardiac hypertrophy and organ damage in the long-term. You dose the Ai so that you maintain E within physiological ranges for men. In most cases, if you use frequent low dose TRT as most of us recommend in this forum, you probably will not need an AI anyway. I use an anastrozole at very low levels (see my recent post on my protocol and results). My recent labs show that I should decrease my already low AI (anastrozole) dosing even more.
> 
> Winstrol is a synthetic anabolic steroid used for treating chronic wasting diseases such as HIV. The bodybuilding community has found other uses for it though. I use it strictly at very low doses (compared to either HIV patients or Bodybuilders) for effective SHBG control.


Ahh, I see. That makes a lot more sense. Thanks for all the information you're providing -- a huge help!

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## bkb333

I just got full bloodwork back. Free T is better, which was surprising. I hope this minor increase won't keep me from being prescribed TRT, as I really do believe I need it. Estradiol and DHEA-S were both high (DHEA-S was very high). I've included everything significant below. Would love your thoughts!

Total T: 1148 Ref: 264-916 (High)
Free T: 13.8 Ref: 9.3-26.5
DHEA-S: 882.9 Ref: 128.5-475.2 (High)
Luteinizing Hormone: 3.8 Ref: 1.7-8.6
SHBG: 167.0 Ref: 16.5-55.9 (High)

Estradiol: 43.2 Ref: 7.6-42.6 (High)

CBC W/differential
WBC 4.2 Ref: 4.8-10.8 (Low)
NE% 39.2 Ref: 42.2-75.2 (Low)
EO% 0.6 Ref: 0.9-2.9 (Low)
BA% 3.4 Ref: 0.2-1.0 (High)

Metabolic panel: all normal

Lipid profile: normal (total cholesterol 168)

TSH: normal (1.77 Ref: 0.45-4.5)

Prostate: normal

IGF-1: 234 Ref: 98-282

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## Youthful55guy

> Total T: 1148 Ref: 264-916 (High)
> As we discussed previously, this does not surprise me. SHBG binds T and protect it from liver metabolism, so Total T usually goes way up in guys with high SHBG. This is not necessarily good because most of it is too tightly bound to be of any benefit. It cannot pass the blood-brain barrier in a bound state. Most docs (including endocrinologists) do not acknowledge this fact, which is a sad statement on our medical community.
> 
> Free T: 13.8 Ref: 9.3-26.5
> As expected. Yes, having Free T within range will make it more difficult to get treatment, but in your case I doubt that mainstream medicine will treat you with any of the available SHBG lowering meds anyway. This means going off label with a schedule 2 drug that is known to be abused by the sports community. 
> 
> DHEA-S: 882.9 Ref: 128.5-475.2 (High)
> Are you supplementing with DHEA? Might consider stopping until you sort out the SHBG problem. Since all steroid hormones including DHEA are also bound to a certain degree by SHBG, it could simply be your high SHBG pushing up your DHEA levels too. However, from what I've read, DHEA has a relatively low binding affinity to SHBG than does T. On the same note, DHT has an extremely strong binding affinity to SHBG. I'm willing to bet your DHT levels are high too.
> 
> ...


Nice levels. Interestingly, IGF-1 is known to lower SHBG, but obviously you have other factors at play.

----------


## macmathews

I'm keeping an eye on this 1

----------


## bkb333

Thank you for the thorough analysis! I am supplementing with DHEA (just started), but I'll cut that off for now. Regarding the bio-markers you asked about**:

HGB 15.3 Ref: 14.0-18.0
HCT 45 Ref: 42-52
AST 20 Ref: 15-37
ALT 31 Ref: 16-63
Alk Phos 53 Ref: 46-116

Nothing really jumps out, right? This whole situation is pretty head-scratching. Someone told me he thinks keto is the real culprit.

----------


## Youthful55guy

> Thank you for the thorough analysis! I am supplementing with DHEA (just started), but I'll cut that off for now. Regarding the bio-markers you asked about**:
> 
> HGB 15.3 Ref: 14.0-18.0
> HCT 45 Ref: 42-52
> AST 20 Ref: 15-37
> ALT 31 Ref: 16-63
> Alk Phos 53 Ref: 46-116
> 
> Nothing really jumps out, right? This whole situation is pretty head-scratching. Someone told me he thinks *keto* is the real culprit.


What does Keto mean?

All your additional labs look good. You need to watch HGB and/or HCT in future labs once you start a TRT protocol. Donate blood to control them. Best to start donations early so that you nip it in the bud.

Watch the liver enzymes if you start Winstrol or Anavar because they can be hard on the liver. However, at the very low dose we need, I have not observed anything out of range that can't be explained by other OTC meds that are even more hard on the liver (Naproxen, Ibuprofen, and Tylenol).

----------


## bkb333

> What does Keto mean?
> 
> All your additional labs look good. You need to watch HGB and/or HCT in future labs once you start a TRT protocol. Donate blood to control them. Best to start donations early so that you nip it in the bud.
> 
> Watch the liver enzymes if you start Winstrol or Anavar because they can be hard on the liver. However, at the very low dose we need, I have not observed anything out of range that can't be explained by other OTC meds that are even more hard on the liver (Naproxen, Ibuprofen, and Tylenol).


Well, by "Keto" I just meant the relatively high-fat diet I have been following (which I stopped recently due to this bloodwork). I'll keep an eye on those markers! How frequently do you donate (or recommend donating)?

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## Youthful55guy

> Well, by "Keto" I just meant the relatively high-fat diet I have been following (which I stopped recently due to this bloodwork). I'll keep an eye on those markers! How frequently do you donate (or recommend donating)?


I sincerely doubt that any dietary factors could screw up SHBG as bad as yours. Yours are more than double mine without treatment, and mine were way out of the norm. There's something else going on.

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## wellshii

Did you read the link I put on my first post? 
It was the dudes adrenals,so looks like we found the problem man.
You need to get your cortisol checked and have your adrenals checked. 
Havnt had experience with this myself , but I'll link that thread again for reference,
Skyhigh SHBG Levels - WHY?! | Page 3 | All Things Male Forum

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## wellshii

Here is some info on the DHEA-S
https://www.mayomedicallaboratories....erpretive/8493

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## bkb333

> Did you read the link I put on my first post? 
> It was the dudes adrenals,so looks like we found the problem man.
> You need to get your cortisol checked and have your adrenals checked. 
> Havnt had experience with this myself , but I'll link that thread again for reference,


I skimmed this thread when you previously sent it, but just gave it a thorough read. Really interesting. Thank you for sharing! I would not be surprised if I found out my adrenals were f***ed as well. Possibly a low cortisol issue? I'm seeing two different endos in the coming weeks. What tests do you think I should ask for? Just 24-hour 4-point saliva test?

Based on my current understanding of thyroid/hormones, it seems TRT may not be the solution -- correct? It seems to me it would be kind of like putting a band-aid on a bullet wound (trying to fix high SHBG when that's actually a byproduct of a bigger issue).

----------


## Youthful55guy

> I skimmed this thread when you previously sent it, but just gave it a thorough read. Really interesting. Thank you for sharing! I would not be surprised if I found out my adrenals were f***ed as well. Possibly a low cortisol issue? I'm seeing two different endos in the coming weeks. What tests do you think I should ask for? Just 24-hour 4-point saliva test?
> 
> Based on my current understanding of thyroid/hormones, it seems TRT may not be the solution -- correct? It seems to me it would be kind of like putting a band-aid on a bullet wound (trying to fix high SHBG when that's actually a byproduct of a bigger issue).


I agree that searching for a root cause before treating symptoms is always the best approach. Particularly in your extreme case. Those are very high SHBG levels. I read through that string that wellshii posted and did not get much out of it. A lot of guys with a lot of opinions. However, I do question whether the high DHEA and high SHBG are just serendipitous. Perhaps there is a common link to the adrenals. Keep us informed of your progress. I'm interested in seeing where you take this.

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## wellshii

Yea that test like you mentioned.You can also do total cortisol as well. 
Rare,but that DHEA like the link from the Mayoclinic could indicate a tumor. I want to see what the Endos say. I hope they can help you man.
Glad we are a step closer though. 
Problems always have a root cause.

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## bkb333

> Yea that test like you mentioned.You can also do total cortisol as well. 
> Rare,but that DHEA like the link from the Mayoclinic could indicate a tumor. I want to see what the Endos say. I hope they can help you man.
> Glad we are a step closer though. 
> Problems always have a root cause.


Yikes, thats really scary  :Frown:  The endos cant see me for 3 weeks. Is there any way I could test at home to help figure out if I have something serious like a tumor? Pretty nervous about it.

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## wellshii

Nah man not that I can think of. 
Gonna have to wait it out. I doubt it though.You'll be fine in that times span.

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## bkb333

Wanted to post an update...I saw a local endo yesterday, and he seemed completely befuddled by my situation. He threw a number of ideas out there (including partial androgen insensitivity and Klinefelter syndrome), but he didn't seem convinced about any of them -- because I have normal breast tissue, plenty of body hair, and normal penis/testicle size. He ordered the following tests:

Dihydrotestosterone
FSH
LH
Androstenedione
Estradiol
AMH
Inhibin B
DHEA-S
ACTH
Cortisol
Cytogenetics
Semen analysis

Hoping it's nothing too serious...I'm a little bugged out by the semen analysis. Of course, he didn't seem worried at all about my free testosterone ...

----------


## Youthful55guy

> Wanted to post an update...I saw a local endo yesterday, and he seemed completely befuddled by my situation. He threw a number of ideas out there (including partial androgen insensitivity and Klinefelter syndrome), but he didn't seem convinced about any of them -- because I have normal breast tissue, plenty of body hair, and normal penis/testicle size. He ordered the following tests:
> 
> Dihydrotestosterone
> FSH
> LH
> Androstenedione
> Estradiol
> AMH
> Inhibin B
> ...


Sounds like a good place to start. Look for the root cause and rule out the bad stuff. 

Reminds me of my recent liver issue. We spent thousands of dollars of my insurance money to run every imaginable liver test and lab, only to find out it was my use of OTC naproxen that was affecting the labs. At least I know I'm not going to die of any exotic liver diseases anytime soon!

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## wellshii

Still following. 
Also,are you any meds?

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## bkb333

> Still following. 
> Also,are you any meds?


Thanks for following. I'm not on any meds and never have been. So far, I've gotten three test results back. I'll post the rest when I receive them. Here's what I've got so far:

CORTISOL AM -- 13.6 ug/dL (Ref: 6.2 - 19.4 ug/dL)
LH -- 3.3 IU/L (Ref: 1.7 - 8.6 IU/L)
FSH -- 3.3 IU/L (Ref: 1.5 - 12.5 IU/L)

Anything stand out? LH and FSH are a little low...hoping that doesn't mean I'll have a hard time reproducing. I was surprised by how high cortisol was.

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## bkb333

Received more results...my interpretation -- nothing all that surprising besides the dramatic difference in DHEA-S from the first test, and I should be able to reproduce. Agree?

ACTH -- 8.8 pg/mL (Ref: 7.2 - 63 pg/mL)
DHEAS -- 215 mcg/dL (Ref: 105 - 728 mcg/dL)
INHIBN B, INFERTILITY -- 377 pg/mL (Ref: <399 pg/mL)
ANTI MULLERIAN HORM -- 10 ng/mL (Ref: 0.7 - 19 ng/mL)
ANDROSTENEDIONE -- 115 ng/dL (Ref: 40 - 150 ng/dL)
DIHYDROTESTOSTERONE -- 1130 pg/mL (Ref: 112 - 955 pg/mL)
SPERM AGGLUTINATION isolated: less than 10 spermatozoa per agglutinate, many free spermatozoa	
SEMEN VISCOSITY -- NORMAL
SEMEN PH -- 8.0	
SPERM CONCENTRATION -- 180.0 MILLION/ML (Ref: 15.0 - 999.0 MILLION/ML)
SPERM MOTILITY -- 55 % (Ref: 50 - 100 %)
QUALITY MOTILE -- EXCELLENT FORWARD PROGRESSION	
SPERM MORPHOLOGY -- 16 (Ref: greater than or equal to 4%)
SEMEN VOLUME -- 2.5 mL -- (Ref: 2 - 6 mL)

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## bkb333

I had my consultation with Defy. Here's what they are prescribing:

900 IU hCG per week + Anastrozole

They said if that doesn't work after 3-6 months, they'll add Danazol. If that doesn't work, they'll add T. They're hesitant to add T because they don't want to shut down my natural production and harm fertility.

I trust their take, but I do have to admit, I'm a bit surprised T wasn't prescribed.

What do you think?

----------


## Youthful55guy

> I had my consultation with Defy. Here's what they are prescribing:
> 
> 900 IU hCG per week + Anastrozole
> 
> They said if that doesn't work after 3-6 months, they'll add Danazol. If that doesn't work, they'll add T. They're hesitant to add T because they don't want to shut down my natural production and harm fertility.
> 
> I trust their take, but I do have to admit, I'm a bit surprised T wasn't prescribed.
> 
> What do you think?


I hope you have success, but it's not the path I would choose. My gut feeling is that with your SHBG levels, pretty much any protocol will result in treatment failure. I would focus on getting the SHBG down to a reasonable level and then layering in some sort of TRT to bring Free T levels into the normal range.

I probably would have pushed for the Danazol at about 20 mg per day first. Follow up with labs in 4 weeks to understand SHBG response and your new Total/Free T levels (the SHBG response is pretty fast). Then layer in 1000 IU/week HCG for 6 weeks. Repeat the labs. Then layer in T at a dose to bring Free T into range and/or adjust Danazol.

Is your insurance covering this? Danazol is pretty expensive. If I remember correctly about the same as Anavar . So Anavar might be another alternative in the USA. I've not researched Danazol enough to understand it's impact on liver labs. You might want to do that research and insist on liver labs. 

For me, since I am treating my high SHBG on my own, I'll stick with Winstrol , as it's so much more effective at very low doses that do not affect my liver labs much.

----------


## wellshii

> Received more results...my interpretation -- nothing all that surprising besides the dramatic difference in DHEA-S from the first test, and I should be able to reproduce. Agree?
> 
> ACTH -- 8.8 pg/mL (Ref: 7.2 - 63 pg/mL)
> DHEAS -- 215 mcg/dL (Ref: 105 - 728 mcg/dL)
> INHIBN B, INFERTILITY -- 377 pg/mL (Ref: <399 pg/mL)
> ANTI MULLERIAN HORM -- 10 ng/mL (Ref: 0.7 - 19 ng/mL)
> ANDROSTENEDIONE -- 115 ng/dL (Ref: 40 - 150 ng/dL)
> DIHYDROTESTOSTERONE -- 1130 pg/mL (Ref: 112 - 955 pg/mL)
> SPERM AGGLUTINATION isolated: less than 10 spermatozoa per agglutinate, many free spermatozoa	
> ...


Crazy how it went down that much. Varies I guess.
At least they are working with you.

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## bkb333

Hey guys,

To recap, my prescription is hCG 300 IU 3X week (900 IU total) + Anastrozole 0.125mg 2X week. It's only been 2 weeks, but I haven't felt any change in libido, which is becoming a problem in my relationship. From what I've read, 500-1000 3X a week (1500-3000 IU total) is a more standard dosage. Do you think I should bump up the hCG dosage, or would that be problematic?

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## wellshii

IDK about the HCG method like Youthful says.
I am still concerned about those adrenals. Morning cortisol is supposed to relatively high. 
Here are some links. 

Q&A Doctor Series: Why do we need optimal cortisol levels for thyroid health? (Answer by David Borenstein, MD) 

https://metabolichealing.com/heres-h...ur-blood-test/

https://rarediseases.org/rare-diseases/acth-deficiency/

All they tested was morning cortisol and acth? ACTH looked a little on the low side.

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## theBrewmeister

Hi guys, just following along here. I've only been studying this topic for one month, so I'm a total noob. However, the one thing that makes me scratch my head here is the Hcg protocol. Your E2 levels were at the top of the range; and everything I've read and heard is that Hcg can drive up E2 levels as well. It's been a few weeks since you started this protocol, are you experiencing any estrogen-related sides??

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## Youthful55guy

I doubt it's an E2 issue. I have my doubts that there is any connection between E2 and HCG other than HCG can drive T production (to a certain extent) in guys that are low in LH production (secondary hypogonadism).

I don't want to keep repeating the same advice, but you are not going to go anywhere with your treatment program until you get that ridiculously high SHBG level under control. If I remember correctly, your levels were off the charts in the neighborhood of 180 nmol/L. That's about double my very high levels. It's basically a T sponge that you are never going to saturate with endogenous production no matter how much HCG you pump into your body. Until you saturate that sponge, there will be little T spilling over into Free T. ONLY Free T can cross the blood barrier where you need it. So, even though your swimming in T, your brain is starved of it.

Also, SHBG binds and protects T from liver metabolism. That drives up your Total T levels, so that lab is worthless for monitoring T level in guys that have high SHBG. You will always be high in T, even though your brain is starved or it.

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## Chrisp83TRT

Youthful couldn’t have said it any better.

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## theBrewmeister

Although Youthful is clearly super, super knowledgeable on the subject, maybe it's time for a Tele-consult with someone like Dr. Crisler, to get a Dr's opinion; one who focuses on TRT?

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## fiddlesticks

insulin lowers SHBG so increase insulin response.

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## Chrisp83TRT

I’ve actuallt increased my SHBG by taking DHea ... it was low at first then I got it In normal ranges taking dhea 25mg pharm grade dhea every day before bed

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## Youthful55guy

> I’ve actuallt increased my SHBG by taking DHea ... it was low at first then I got it In normal ranges taking dhea 25mg pharm grade dhea every day before bed


yes, most androgens will lower SHBG to some extent (DHEA is a very weak androgen), this does not have an appreciable effect on guys like the OP (and me) who have genetically high SHBG. It's like throwing a glass of water onto a raging wildfire. The treatment seems sound, but the magnitude of the effect is negligible. Same goes for manipulating insulin or taking any of a number of supplements purported to help (boron, nettle extract, etc.). The basic problem is that our genetics are programmed to add an extra sugar molecule to the SHBG protein (it's called glycosylation). This more than doubles the half life of the protein. We produce SHBG at the same 'rate' as other guys, but it sticks around more than twice as long. Therefore, the blood levels more than double.


If I remember correctly, the OP has SHBG in the 180 nmol/L range. Thant's about double my very high level, which hovers in the (untreated) range of 80 to 95. The high end of the 'normal' range for is about 75 using LabCorp's test. With his SHBG levels, it's like a T-sponge that will never get saturated. Without saturation there will be little T spilling over to Free-T or Bioavailable T (another good test that parallels Free T). I originally went down the road of trying to saturate my very high levels with T and was moderately successful. I got my abysmally low 7 pg/mL Free T up to around 16 (range 7.2-24). After much experimentation, I found that the magic number for me was around 15 pg/mL for feeling somewat 'normal' and around 20 pg/mL to get my muscle pump back in the gym. Erections and libido are a bit more complicated, but that followed a similar path as Free T.


Bottom line, with his EXTEREMELY high levels of SHBG, he's not going to have any success until he takes a pharmaceutical approach to lowering it into the normal range. Fortunately, there are effective treatments, but getting docs to prescribe them is difficult. I ended up going off the reservation to get what I need.

----------


## bkb333

Hey everyone,

Thanks again for all your help. I just received my two-month follow-up test results. Here's where I am:

Total T: 1828 (Ref 250-1100) 
Free T: 174 (Ref 35-155) 
SHBG: 112 (Ref 10-50) 
Estradiol: 61 (Ref < 29)

My Free:Total ratio has improved, albeit marginally, and SHBG has gone down (!). However, my estradiol has also increased. Here are my previous numbers:

Total T: 1148 (Ref 264-916)
Free T: 13.8 (Ref 9.3-26.5)
SHBG: 167.0 (Ref 16.5-55.9)
Estradiol: 43.2 (Ref 7.6-42.6)

What do you think? I am currently taking hCG 300 IU 3X week (900 IU total) and Anastrozole 0.125mg 2X week, working with Defy.

I have my follow-up consultation soon -- just want to see your thoughts, as this forum has been a massive help!

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## wellshii

AT least its helped. Free T is great! That SHBG though. 
Theyll probally keep you on.

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## bkb333

> yes, most androgens will lower SHBG to some extent (DHEA is a very weak androgen), this does not have an appreciable effect on guys like the OP (and me) who have genetically high SHBG. It's like throwing a glass of water onto a raging wildfire. The treatment seems sound, but the magnitude of the effect is negligible. Same goes for manipulating insulin or taking any of a number of supplements purported to help (boron, nettle extract, etc.). The basic problem is that our genetics are programmed to add an extra sugar molecule to the SHBG protein (it's called glycosylation). This more than doubles the half life of the protein. We produce SHBG at the same 'rate' as other guys, but it sticks around more than twice as long. Therefore, the blood levels more than double.
> 
> 
> If I remember correctly, the OP has SHBG in the 180 nmol/L range. Thant's about double my very high level, which hovers in the (untreated) range of 80 to 95. The high end of the 'normal' range for is about 75 using LabCorp's test. With his SHBG levels, it's like a T-sponge that will never get saturated. Without saturation there will be little T spilling over to Free-T or Bioavailable T (another good test that parallels Free T). I originally went down the road of trying to saturate my very high levels with T and was moderately successful. I got my abysmally low 7 pg/mL Free T up to around 16 (range 7.2-24). After much experimentation, I found that the magic number for me was around 15 pg/mL for feeling somewat 'normal' and around 20 pg/mL to get my muscle pump back in the gym. Erections and libido are a bit more complicated, but that followed a similar path as Free T.
> 
> 
> Bottom line, with his EXTEREMELY high levels of SHBG, he's not going to have any success until he takes a pharmaceutical approach to lowering it into the normal range. Fortunately, there are effective treatments, but getting docs to prescribe them is difficult. I ended up going off the reservation to get what I need.


Hey Youthful55guy,

Long time no talk! I started TRT 4 months ago, and have not yet had much success. The first 3 months, I was on cream (applied trans-scrotally), and I had brief periods of libido 'rushes' (which felt great!), but they were transient and applying the cream to my balls 2 times a day was super inconvenient. So I switched to injections (IM) 1 month ago. My doctor recently prescribed Danazol as well, at 25 mg EOD, because my SHBG is still quite high. 

Latest bloodwork:
Total T 2338
Free T 215.1 (per my conversion, this is 1.15%) 
SHBG 114
Albumin 5.3
IGF-1 193
Estradiol 50

And here is my full current protocol:
Tcyp 200 mg/week, IM injections (delts) 2X/week
HCG 600 IU/week, SubQ injections 2X/week
Danazol 25 mg EOD
Ibutamoren 25 mg ED
Metformin 500 mg AM & PM (for body comp purposes)
Niacin 500 mg ED (for cholesterol purposes)
Vitamin D
Boron
Magnesium
Zinc
Not currently taking an AI, but do have some Anastrozole on-hand if needed

My doctor did not want to prescribe more Danazol because he said it could harm my fertility (perhaps negating the effects of HCG), which I really don't want to do; we don't want kids now, but will in a few years. Do you think 25 mg EOD is sufficient? 3 weeks in with the Danazol, I haven't felt any different, and I'm debating increasing to 25 mg ED. I'm also thinking perhaps I should change to Winstrol (5 mg ED) once I use up the Danazol -- though I would have to get that through 'alternative sourcing,' and my insurance is covering the Danazol, which is quite nice.

At this point, my libido has been great for two brief runs (several days) on the cream, and has been nonexistent since switching to injections. I'm hoping it's just taking some time for my body to adjust. BUT, I also think I may need to change up my SHBG control method. After 3 weeks, I'd think I'd be at least feeling _something_. Thoughts?

----------


## Youthful55guy

Please provide normal ranges and units for you labs. All laboratories have different ranges, so it's difficult to interpret the results without knowing what normal is for the lab you are using.

Total T seems quite high, but with a 100mg 2X per week protocol, that's about what I'd expect. I'm assuming the lab method is LC/MS because the 'normal" RIA lab tops out at 1500 ng/dL.

Free T also seems quite high if the units are pg/mL. The normal ranges for Free T is usually age adjusted, but my goal is to maintain the upper 75th percentile of a 30 year old man. The LabCorp range for Free T for a 30 year old man is 8.7 to 35.1 pg/mL. At 215.1, you blow the doors off of that range if the units are the same. Something is not making sense here.

SHBG is down from your prior ridiculously high 180 nmol/L, but it is still very high. I have never used Danazol, so I don't have any advice to give. But it does seem to be doing the job of brining down SHBG. Increasing the dose might help, but then you are going to run into supply problems if you are on a set script of 25mg EOD. Taking more will use up your monthly supply faster and you will run out before the next refill. You need to get your doc on board to change the script if you are going to continue to do this through legal channels and under insurance (which I recommend if at all possible). Switching to Winstrol will probably be more effective, but then you have supply and legality issues to deal with. it's a last resort as far as I'm concerned.

I don't understand what fertility issues you doc is concerned about with Danazol. I would quiz him more on that. We know that Danazol will suppress the HPTA while you taking it, this is why you are also taking supplemental T. Suppressing the HPTA not only lowers LH but also FSH, so yes fertility will be an issue while on Danazol, but this is most likely temporary and will return to normal once you discontinue therapy. Also, you are maintaining testicular function with HCG , so testicular atrophy will not be an issue if/when you discontinue Danazol therapy.

FYI, I am currently experimenting with a no-Winstrol protocol. Like you, I've increased my T dose to 200 mg/week but with an E2D protocol. I am concerned about long-term importation of an illegal drug, so I want to find an alternative. My goal is to saturate the SHBG protein with T so that enough spills over to Free T to feel and function normally. Keep in mind that while my SHBG is high, it is no where near your untreated levels. You have a much more sever SHBG problem that I doubt will ever be treatable with this approach. I believe you need to combine suppression with TRT.

So far my experiment has been successful. I am also using low dose finasteride and anastrozole to keep DHT and E2 within the upper end of the normal range. My last lab showed my Total T about the sensitivity of the RIA test (>1500 ng/DL) and Free T above range at 32 pg/mL. I'm made some small Finasteride and anastrozole adjustments a couple weeks ago and will retest in about a month. At that time I will make a decision whether to lower my T dose to bring Free T back into the normal range 9for a 30 y/O guy that is). more than likely I'll drop the T dose down to 180 mg/week keeping with the E2D protocol.

----------


## bkb333

> Please provide normal ranges and units for you labs. All laboratories have different ranges, so it's difficult to interpret the results without knowing what normal is for the lab you are using.


Here are those numbers with reference ranges:
Total T 2338 (250-1100)
Free T 215.1 (35-155)
SHBG 114 (10-50)
Albumin 5.3 (3.6-5.1)
IGF-1 193 (63-373)
Estradiol 50 (< 29)




> Total T seems quite high, but with a 100mg 2X per week protocol, that's about what I'd expect. I'm assuming the lab method is LC/MS because the 'normal" RIA lab tops out at 1500 ng/dL.


Indeed, total T is _very_ high. I don't know that I should really be concerned about total T, though, because I'll likely always need quite a high value to feel 'normal.' Would you agree?




> Free T also seems quite high if the units are pg/mL. The normal ranges for Free T is usually age adjusted, but my goal is to maintain the upper 75th percentile of a 30 year old man. The LabCorp range for Free T for a 30 year old man is 8.7 to 35.1 pg/mL. At 215.1, you blow the doors off of that range if the units are the same. Something is not making sense here.


With the ranges now included, and the total T I have, it's not really all that high, right? By moving the decimal over, I get 21.5. I think I may need to be closer to the upper end of normal (~35) to feel 'normal.'




> SHBG is down from your prior ridiculously high 180 nmol/L, but it is still very high. I have never used Danazol, so I don't have any advice to give. But it does seem to be doing the job of brining down SHBG.


I should have made it clear that I was not on Danazol yet at the time of my last bloodwork. So at that point, my SHBG had been driven down from 180 to 114 through exogenous T, HCG , and the other vitamins/supplements enumerated above.




> Increasing the dose might help, but then you are going to run into supply problems if you are on a set script of 25mg EOD. Taking more will use up your monthly supply faster and you will run out before the next refill. You need to get your doc on board to change the script if you are going to continue to do this through legal channels and under insurance (which I recommend if at all possible). Switching to Winstrol will probably be more effective, but then you have supply and legality issues to deal with. it's a last resort as far as I'm concerned.


This is good to know. Thank you! I was able to place a sizable order up front, so I don't think I'd have a big issue with running out. But I should _probably_ also just ride it out until my next bloodwork to see what the 25 mg EOD protocol is doing to my SHBG, though I don't feel any different.




> I don't understand what fertility issues you doc is concerned about with Danazol. I would quiz him more on that. We know that Danazol will suppress the HPTA while you taking it, this is why you are also taking supplemental T. Suppressing the HPTA not only lowers LH but also FSH, so yes fertility will be an issue while on Danazol, but this is most likely temporary and will return to normal once you discontinue therapy. Also, you are maintaining testicular function with HCG, so testicular atrophy will not be an issue if/when you discontinue Danazol therapy.
> 
> FYI, I am currently experimenting with a no-Winstrol protocol. Like you, I've increased my T dose to 200 mg/week but with an E2D protocol. I am concerned about long-term importation of an illegal drug, so I want to find an alternative. My goal is to saturate the SHBG protein with T so that enough spills over to Free T to feel and function normally. Keep in mind that while my SHBG is high, it is no where near your untreated levels. You have a much more sever SHBG problem that I doubt will ever be treatable with this approach. I believe you need to combine suppression with TRT.


Out of curiosity, why are you doing E2D? I think most high SHBG guys still believe in the high dose once per week (max 2X) approach. I have considered injecting more frequently, maybe 3X a week, as I have seen some have success with such a strategy. Are you injecting, IM? I have also considered increasing my T dosage, perhaps to 250-300 mg/week. This may look more like AAS usage, but I really think it may be necessary because my SHBG is so extreme.




> So far my experiment has been successful. I am also using low dose finasteride and anastrozole to keep DHT and E2 within the upper end of the normal range. My last lab showed my Total T about the sensitivity of the RIA test (>1500 ng/DL) and Free T above range at 32 pg/mL. I'm made some small Finasteride and anastrozole adjustments a couple weeks ago and will retest in about a month. At that time I will make a decision whether to lower my T dose to bring Free T back into the normal range 9for a 30 y/O guy that is). more than likely I'll drop the T dose down to 180 mg/week keeping with the E2D protocol.


Very good to hear and happy for you! Have you followed Neil Rouzier's work on controlling estrogen? He's the one who convinced me to stop my AI. I know you only use a very, very small dose, and I'm not completely opposed to going back on with a similar small dose at some point.

----------


## Youthful55guy

*Indeed, total T is very high. I don't know that I should really be concerned about total T, though, because I'll likely always need quite a high value to feel 'normal.' Would you agree?
*Yes, but if you combine Danazol (or Winstrol ) with TRT, you will be able to lower the T dose substantially.

*With the ranges now included, and the total T I have, it's not really all that high, right? By moving the decimal over, I get 21.5. I think I may need to be closer to the upper end of normal (~35) to feel 'normal.'
*I still don't understand why it is a magnitude of 10 higher. What are the units reported in? Mine are pg/mL for free T.

*I should have made it clear that I was not on Danazol yet at the time of my last bloodwork. So at that point, my SHBG had been driven down from 180 to 114 through exogenous T, HCG , and the other vitamins/supplements enumerated above.*
OK. I too have noticed that increasing the T dose lowers my SHBG about 20 to 30%.

*Out of curiosity, why are you doing E2D? I think most high SHBG guys still believe in the high dose once per week (max 2X) approach. I have considered injecting more frequently, maybe 3X a week, as I have seen some have success with such a strategy. Are you injecting, IM? I have also considered increasing my T dosage, perhaps to 250-300 mg/week. This may look more like AAS usage, but I really think it may be necessary because my SHBG is so extreme.*
I want to avoid sharp peaks in T levels to help prevent conversion to DHT and E2. I just felt that with such a large increase in my T dose when I discontinued Winstrol, I should increase the frequency. I may reconsider this in the future. I much prefer a E3D dose schedule but for now I'm staying with E2D until I get the dose figured out, Then I can fine tune the frequency. Yes I am injecting IM. I use a 28G insulin syringe and alternate upper outer quadriceps.

*Very good to hear and happy for you! Have you followed Neil Rouzier's work on controlling estrogen? He's the one who convinced me to stop my AI. I know you only use a very, very small dose, and I'm not completely opposed to going back on with a similar small dose at some point.* 
I felt that increasing the T dose from 100 to 200 mg/week would require some E2 control. Turns out I over shot the mark. The first 6 weeks at 200 mg/week my anastrozole dose was 1.1 mg per week distributed in small daily doses using the eye dropper method. However, this crushed my E to 13.6 pg/mL (range 8-35). I have since backed off to 0.65 mg/week and will retest in another 4 weeks and adjust from there if necessary. I have to say I am questioning my rationale for going so high on anastrozole from the start. I could tell it was too high. Erections were becoming an problem. Decreasing the dose has helped, so I believe I'm in a better range, but I think it still might be too high. however, I'm going to make these adjustments systematically and with the guidance of labs. This is not something you can do simply by feel.

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## bkb333

As always, an amazing reply. Thanks so much. You're the man!




> *Indeed, total T is very high. I don't know that I should really be concerned about total T, though, because I'll likely always need quite a high value to feel 'normal.' Would you agree?
> *Yes, but if you combine Danazol (or Winstrol) with TRT, you will be able to lower the T dose substantially.


That's interesting, because my doctor didn't even mention lowering the dose down the road. He kept me at 200mg when we added Danazol, and I got the sense that he, too, is considering increasing the dose, depending on how SHBG looks on my next bloods.




> *With the ranges now included, and the total T I have, it's not really all that high, right? By moving the decimal over, I get 21.5. I think I may need to be closer to the upper end of normal (~35) to feel 'normal.'
> *I still don't understand why it is a magnitude of 10 higher. What are the units reported in? Mine are pg/mL for free T.


These are pg/mL, but they are from Quest rather than LabCorp. My doctor just said to get the same number with a conversion, move the decimal point over one place. I also consulted with another doctor who said he thinks I'll need to be above 30 to feel good.




> *I should have made it clear that I was not on Danazol yet at the time of my last bloodwork. So at that point, my SHBG had been driven down from 180 to 114 through exogenous T, HCG , and the other vitamins/supplements enumerated above.*
> OK. I too have noticed that increasing the T dose lowers my SHBG about 20 to 30%.


I've seen mixed results on this. For some guys, going on T or lowering their dose does nothing to their SHBG. I'm very curious what I'll see on my next bloods.




> *Out of curiosity, why are you doing E2D? I think most high SHBG guys still believe in the high dose once per week (max 2X) approach. I have considered injecting more frequently, maybe 3X a week, as I have seen some have success with such a strategy. Are you injecting, IM? I have also considered increasing my T dosage, perhaps to 250-300 mg/week. This may look more like AAS usage, but I really think it may be necessary because my SHBG is so extreme.*
> I want to avoid sharp peaks in T levels to help prevent conversion to DHT and E2. I just felt that with such a large increase in my T dose when I discontinued Winstrol, I should increase the frequency. I may reconsider this in the future. I much prefer a E3D dose schedule but for now I'm staying with E2D until I get the dose figured out, Then I can fine tune the frequency. Yes I am injecting IM. I use a 28G insulin syringe and alternate upper outer quadriceps.


Your reasoning is sound. I'm not sure that E2D or E3D will make _that_ big a difference for any one of us. Obviously E2D is preferable from a convenience standpoint. I like doing Monday-Thursday, as it allows for weekend travel without needing to pack anything up. We use the same type of syringe. I've been using the delts rather than quads. I read on some forums that some doctors don't recommend the lower body for injections -- can't recall offhand why.




> *Very good to hear and happy for you! Have you followed Neil Rouzier's work on controlling estrogen? He's the one who convinced me to stop my AI. I know you only use a very, very small dose, and I'm not completely opposed to going back on with a similar small dose at some point.* 
> I felt that increasing the T dose from 100 to 200 mg/week would require some E2 control. Turns out I over shot the mark. The first 6 weeks at 200 mg/week my anastrozole dose was 1.1 mg per week distributed in small daily doses using the eye dropper method. However, this crushed my E to 13.6 pg/mL (range 8-35). I have since backed off to 0.65 mg/week and will retest in another 4 weeks and adjust from there if necessary. I have to say I am questioning my rationale for going so high on anastrozole from the start. I could tell it was too high. Erections were becoming an problem. Decreasing the dose has helped, so I believe I'm in a better range, but I think it still might be too high. however, I'm going to make these adjustments systematically and with the guidance of labs. This is not something you can do simply by feel.


Where was your E2 before the 1.1 mg per week protocol? I know erections were an issue, but how was your libido? In general, have you found a 'sweet spot' for libido with E2?

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## Youthful55guy

> Where was your E2 before the 1.1 mg per week protocol? I know erections were an issue, but how was your libido? In general, have you found a 'sweet spot' for libido with E2?


When I was on my standard 100 to 120 mg per week T-cyp with 3ED dosing using 0.25mg Winstrol 2X per day, my E2 was pretty much always in the 25 to 35 pg/mL range with normal being 8-35 with the LabCorp sensitive test. I did not need an AI, but sometimes I'd add it in at a low dose with the eyedropper method and I could maintain it in the 20-30 range when I wanted to.

However, the more I know about E2, the more I question whether we should be mucking with it unless it goes much over 50 (with a 8-35 normal range). When I started out on the higher T no Winstrol experiment, my E2 shot up to the 70 range so I decided to layer in an AI. I overshot the mark with 1.1 mg anastrozole per week and now I'm adjusting downward. I never have had any gynecomastia issues, but I was concerned that my E2 went above the 50 pg/mL range which is my self-imposed cutoff for treatment.

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## Family_guy

> As always, an amazing reply. Thanks so much. You're the man!
> 
> 
> 
> That's interesting, because my doctor didn't even mention lowering the dose down the road. He kept me at 200mg when we added Danazol, and I got the sense that he, too, is considering increasing the dose, depending on how SHBG looks on my next bloods.
> 
> 
> These are pg/mL, but they are from Quest rather than LabCorp. My doctor just said to get the same number with a conversion, move the decimal point over one place. I also consulted with another doctor who said he thinks I'll need to be above 30 to feel good.
> 
> ...


There’s a lot of nerves and artery’s/veins relatively near the surface especially on your quad. That’s why it’s not usually recommended. I did it for a week but it never felt right. Always scared of hitting something plus the pip was terrible. Went to delts and never looked back!  :Wink:

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## Youthful55guy

> There’s a lot of nerves and artery’s/veins relatively near the surface especially on your quad. That’s why it’s not usually recommended. I did it for a week but it never felt right. Always scared of hitting something plus the pip was terrible. Went to delts and never looked back!


I disagree, the upper outer quadriceps (Rectus Femoris - see attached diagram) is often recommended by experts for due to it's lack of surface vasculature and major nerves. It is also a fairly large muscle and easy to access. However, the deltoid also makes for a good alternative, so it's more of a personal choice. I live in an environment where shorts are worn nearly year round, so the quadriceps is very convenient for me to access. Not so much for the deltoid because I often wear long sleeve pullovers and sweaters in the morning (when I do my injections) so it requires disrobing to access the deltoids. Hence, my preference for the quadriceps.

If one injects larger volumes, as with old school T-cyp once weekly protocols or with Nebido protocols, the large but much more difficult to access gluteal muscles are generally recommended.

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## Couchlockd

> I disagree, the upper outer quadriceps (Rectus Femoris - see attached diagram) is often recommended by experts for due to it's lack of surface vasculature and major nerves. It is also a fairly large muscle and easy to access. However, the deltoid also makes for a good alternative, so it's more of a personal choice. I live in an environment where shorts are worn nearly year round, so the quadriceps is very convenient for me to access. Not so much for the deltoid because I often wear long sleeve pullovers and sweaters in the morning (when I do my injections) so it requires disrobing to access the deltoids. Hence, my preference for the quadriceps.
> 
> If one injects larger volumes, as with old school T-cyp once weekly protocols or with Nebido protocols, the large but much more difficult to access gluteal muscles are generally recommended.


My quads were my go to for all injections.

But recently I found out if I burry a 1½" needle to the hub, I can get 3-3.5ml in delt, no leaks.

I leave the needle in for about 10 second after injection, and pull out real real slowly.

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## bkb333

> My quads were my go to for all injections.
> 
> But recently I found out if I burry a 1½" needle to the hub, I can get 3-3.5ml in delt, no leaks.
> 
> I leave the needle in for about 10 second after injection, and pull out real real slowly.


I am doing the same with delts. So far, it's been great.

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## bkb333

Hey everyone -- after switching from T cream to injections 6 weeks ago, I have new bloodwork. I definitely feel better, and this delivery system works better with my lifestyle. Further, my Free T:T % has increased from 0.8 to 1.8%! But I am wondering whether I should be concerned about how high my numbers have gotten -- new bloods below: 

Free T: 543.1 Ref 35-155
Total T: 2889 Ref 250-1100
DHT: 133 Ref 16-79 
Estradiol Ultrasensitive: 91 Ref <29
SHBG: 72 Ref 10-50
T3 Reverse: 31 Ref 8-25
T4 Free 1.0 Ref 0.8-1.8
T3 Free: 2.7 Ref 2.3-4.2
Prolactin: 5.6 Ref 2.0-18.0

Current protocol:
Prescribed 200 mg T cypionate (split into injections 2X/week); been taking 250 mg
25 mg Danazol EOD

A few questions...
Though a high dose of T is likely needed because of my SHBG, could the current approach be detrimental to my long-term health, despite the improvement in Free T:T %? Is this basically a cycle at this point? Would you lower the dose?

The high dose of T and Danazol are both in place to overcome my crazy-high SHBG (was near 200 pre-HOT). Should I back off on either/both medication(s), to protect my long-term health? I have a follow-up with my provider tomorrow. I do not want to damage my long-term well-being, though I have very much enjoyed how much symptom resolution I've experienced -- life has been a lot better!

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## DianaEmade

> I am doing the same with delts. So far, it's been great.


drugstore420.com 

Sent from my SC-05G using Tapatalk

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## HoldMyBeer

> drugstore420.com 
> 
> Sent from my SC-05G using Tapatalk


Nice first post
Go fuck yourself

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## Youthful55guy

> drugstore420.com 
> 
> Sent from my SC-05G using Tapatalk


You should read the rules about solicitation to other websites. You've been reported to the monitors and your posts will more than likely be scrubbed for the site after you are barred.

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## bkb333

I'd love to hear what you think of the bloods and next steps, Youthful. Should I lower my dose?

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## bkb333

My follow-up with my provider today went well! We are going to lower my dosage from 200mg/week to 180/week; switch from 2X/week injections to 3X/week; and aim to lower estrogen by increasing Danazol dosage. Further, I need to continue monitoring T3 and increase my caloric consumption.

He wasn’t overly concerned about the high numbers. Right now, my Free T is 54.3 (using the decimal-point conversion system), and we are hoping to see it around 40 next time around. We are also hoping to see SHBG go down more and E go down.

Our meeting largely focused on estrogen. He says our goal is to get the E number to be lower than the SHBG number.

He gave me the flexibility to decide how much to increase my Danazol dosage and was happy to go up to 25 mg ED (previously: 25 mg EOD). I’m hoping for some insight here. I was thinking I would do 25 mg 5X/week. My goal is to get SHBG under 50 (was 72 on these recent bloods after starting at 180 at the beginning of HOT). How much would you increase it? Would you go up to 25 mg ED? I do not want to employ an AI, though I do have some on hand if needed.

It seems Danazol will intermittently be a part of my protocol for the foreseeable future. Once we get SHBG sufficiently low — which will allow me to have a more moderate T level — we will lay off the Danazol for a while, then reintroduce it if SHBG increases too much. This cycling system will be in place to reduce the risk of liver toxicity.

We also talked a lot about my high Reverse T3. He believes this is a result eating too few calories — something he sees a lot in bodybuilders who do caloric restriction. He believes I should be eating a lot more (currently: 1800 cals). My T3 is now 9% of my Reverse T3, and our goal is for it to be 20% or more. But raising thyroid hormones can also raise SHBG, so we are going to leave this alone for now and just roll with the other changes I outlined above. We’ll continue monitoring. 

I plan to increase my consumption -- how much do you think I should be eating? I am 6'2", 175 lbs., and rather active (lift 6 days a week, cardio 2 days, 10K+ steps every day). He recommended 3500/day, but that seems like an extreme leap to me.

Final note: he didn’t think I necessarily needed more bloodwork now (as opposed to in 6 weeks), but I asked for it. Thus, I will have a CBC and CMP now. As I understand it, these tests should comprise HCT, HGB, and RBC, among other variables.

He wasn’t super concerned about HCT because my level has been stable throughout treatment on the four tests I’ve had (45, 46.6, 44, 45.7). But it will be interesting to see how much it has jumped up, given the rise in Free T.

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## Youthful55guy

> My follow-up with my provider today went well! We are going to lower my dosage from 200mg/week to 180/week; switch from 2X/week injections to 3X/week; and aim to lower estrogen by increasing Danazol dosage. Further, I need to continue monitoring T3 and increase my caloric consumption.
> *Lowering the dose was a good decision, but I still think it is way too high, particularly given that you are attempting to bring down SHBG with Danazol. once you get the SHBG under 50 (a good target), I suspect that your optimal dose will be closer to 120mg per week in divided doses.*
> 
> He wasn’t overly concerned about the high numbers. Right now, my Free T is 54.3 (using the decimal-point conversion system), and we are hoping to see it around 40 next time around. We are also hoping to see SHBG go down more and E go down.
> *Prolonged high T will eventually push your hematocrit out of range and make it very difficult to control E2 and DHT. You are definitely high in E2 in your labs. I do not recommend artificially lowering E2 with and AI, you are much better off lowering the T dose.*
> 
> Our meeting largely focused on estrogen. He says our goal is to get the E number to be lower than the SHBG number.
> *Yes, you need to lower the T dose to get control of E2. Getting it under 50 pg/mL is a good target. My goal is to try to stay within the upper end of the normal range, which is about 35 with my test lab and method.*
> 
> ...


See above comments in blue/bold.

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## bkb333

Thanks for all the insight, Youthful! Great stuff as always.




> Lowering the dose was a good decision, but I still think it is way too high, particularly given that you are attempting to bring down SHBG with Danazol. once you get the SHBG under 50 (a good target), I suspect that your optimal dose will be closer to 120mg per week in divided doses.


Would you lower the dose even more at this point? I was thinking I'd take it down to 180 for now, then eventually get it down lower (maybe 150, or even 120 as you mentioned), but that I would do that over time and as SHBG decreases further with the increased Danazol supplementation. It seems to me like drastically dropping the T dose quickly could cause problems.




> I think cycling is a bad idea. In my experience, to make it sustainable, you need to get your TRT protocol to a stable point so that it is on auto pilot. having to muck with T and Danazol doses periodically is going to get old after a while. The goal is to get back to you normal life.


Oh, I totally agree -- I would much rather be on a steady protocol that doesn't change. But as I understand it, Danazol comes with risks of liver toxicity. I don't want to do any damage there, though it seems Danazol could be a lynchpin of my protocol for years to come. So I'm trying to weigh the pros and cons.




> I suspect that your use of thyroid hormones is your root cause for the high SHBG. There is a known connection between supplemental T3 and/or T4 and increased SHBG.


Out of curiosity, what do you mean by this? As far as I know, I haven't taken any thyroid hormones, unless something I am taking is affecting thyroid and I am unaware of it. I'm thinking I may have just caused confusion with the way I worded that section. I just meant that we aren't going to fool around with any thyroid meds (as I haven't to date) for now.

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## Youthful55guy

*Would you lower the dose even more at this point? I was thinking I'd take it down to 180 for now, then eventually get it down lower (maybe 150, or even 120 as you mentioned), but that I would do that over time and as SHBG decreases further with the increased Danazol supplementation. It seems to me like drastically dropping the T dose quickly could cause problems.*

Yes, You posted these results from 200 mg/week:
Free T: 543.1 Ref 35-155
Total T: 2889 Ref 250-1100
DHT: 133 Ref 16-79 
Estradiol Ultrasensitive: 91 Ref <29
SHBG: 72 Ref 10-50

Those are insanely high levels of T, and no doubt driving your E2 issues. it's going to cause problems down the road if you don't get it within range. By comparison, at one point when I was not using Winstrol to lower my SHBG and my SHBG was 81.6 (not far from your last lab) and my T dose was 103 mg/week (0.22 mL E3D), my Total T was 779 (normal range 241-827 ng/dL) and my bioavailable T (the doc rant that test instead of Free T) was 214 ng/dL (normal range 48-344). I was way above the 50th percentile in both TT and FT. I suspect that 120 mg/week will put you at the top of the range.

Bottom line is at 120 mg/wk, you will be well with in the range and if you break it up into at least 2X per week dosing, you should not feel it. You might even feel better because your E2 will also drop down into the normal range. With TRT, just because a little makes you feel good (normal), a lot more does not make you feel a lot better. You want to strive for a stable protocol that is sustainable.

*Danazol comes with risks of liver toxicity.* 

Possibly. My understanding is that it has a lower toxicity than Winstrol or Anavar (your other 2 choices). I'd focus your labs on finding the highest sustainable dose without sending your liver labs out of range and then adjusting the T dose around it. Again, my experience is that a T dose of 120 should be your starting point. If you have to back off on Danazol, you can always increase the T-dose to compensate.

*I haven't taken any thyroid hormones … I just meant that we aren't going to fool around with any thyroid meds (as I haven't to date) for now.* 

A misunderstanding on my part. I would not introduce ANY thyroid medication with your SHBG problem. it will just exasperate the problem.

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## bkb333

Thank you, Youthful. You are the man.

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## Dr.V.P.C.

I treat some cases like this with : (compound here in Brazil, once a day, everyday). 
Ostarine 5mg lower shbg and anabolic with low hpta impact
Clomid 7mg - boosts test 
Exemestane 3mg - boost test without crash e2
Tadalafil 5mg - nitric oxide 
Great results.

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## bkb333

After my most recent round of bloodwork, I was curious where some longevity biomarkers were sitting, so I asked for follow-up tests. I had them done Monday and just got the results. The key numbers — HCT is midrange and has not changed significantly (45.7-46.3); same for HGB (15.5-15.6); and same for RBC (5.19-5.20).

However, I have seen notable changes in ALT (34 in February, shortly after I first started TRT, and now 61) and AST (33 in February, 62 now). Additionally, ALP has dropped from 48-36. I don’t know anything about these biomarkers but have learned workout timing affects liver enzymes. I had these tests conducted at 8 a.m. Monday, did an hour of intense cardio on Sunday evening (6 p.m.), and lifted hard (back) on Saturday afternoon. I spoke with my provider, who wasn't very concerned and chalked the numbers up to workout timing. I ordered some NAC to supplement.

As a reminder, my T numbers exploded on my last bloodwork. Total T shot up to 2889, with Free T at 543.1. The ratio of Free:Total T was significantly better than what I’d seen before — an encouraging sign — but I lowered my dose (from 200-180/week) because of warnings about the sky-high T levels and how those may harm my long-term health. I also increased Danazol from 25 mg EOD to 25 mg ED (SHBG was still somewhat high at 72).

Given these new results, do you think I should stick with that plan moving forward? I am very happy to see the HCT/HGB/RBC numbers!

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## bkb333

> I treat some cases like this with : (compound here in Brazil, once a day, everyday). 
> Ostarine 5mg lower shbg and anabolic with low hpta impact
> Clomid 7mg - boosts test 
> Exemestane 3mg - boost test without crash e2
> Tadalafil 5mg - nitric oxide 
> Great results.


Thanks for sharing. That's interesting. I haven't used any of these medications. How does this type of protocol typically impact free/total T ratios?

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## Youthful55guy

> After my most recent round of bloodwork, I was curious where some longevity biomarkers were sitting, so I asked for follow-up tests. I had them done Monday and just got the results. The key numbers — HCT is midrange and has not changed significantly (45.7-46.3); same for HGB (15.5-15.6); and same for RBC (5.19-5.20).
> 
> However, I have seen notable changes in ALT (34 in February, shortly after I first started TRT, and now 61) and AST (33 in February, 62 now). Additionally, ALP has dropped from 48-36. I don’t know anything about these biomarkers but have learned workout timing affects liver enzymes. I had these tests conducted at 8 a.m. Monday, did an hour of intense cardio on Sunday evening (6 p.m.), and lifted hard (back) on Saturday afternoon. I spoke with my provider, who wasn't very concerned and chalked the numbers up to workout timing. I ordered some NAC to supplement.
> 
> As a reminder, my T numbers exploded on my last bloodwork. Total T shot up to 2889, with Free T at 543.1. The ratio of Free:Total T was significantly better than what I’d seen before — an encouraging sign — but I lowered my dose (from 200-180/week) because of warnings about the sky-high T levels and how those may harm my long-term health. I also increased Danazol from 25 mg EOD to 25 mg ED (SHBG was still somewhat high at 72).
> 
> Given these new results, do you think I should stick with that plan moving forward? I am very happy to see the HCT/HGB/RBC numbers!


Just repeating previous advice, given that you are using Danazol, you will more than likely need to decrease T a lot more. I suggest 120/week and then retest in 6 weeks.

Yes, intense exercise can affect liver enzymes, but so can a lot of OTC such as most oral analgesics (ibuprofen, naproxen, etc.) and prescription drugs (e.g., SRIs). However, it may be the rather stout dose of Danazol. I'd do some research on that drug to understand more about potential side-effects. I have no experience with it.

Those are getting to be rather high ALT and AST levels. However, many docs don't worry about moderately high liver enzymes if they know that a particular drug is pushing them out of range. Out of range liver enzymes can be indicative of liver disease, or it can simply indicate that you liver is working harder to detoxify the drugs. Adding NAC is a good idea (I do twice daily regardless of whether or not I'm taking Winstrol ). I'd also consider adding in some Silymarin.

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## Ashop

I do all my experiment with blood work and I've seen both ANAVAR and WINSTROL work well in this situation.

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## Youthful55guy

> I do all my experiment with blood work and I've seen both ANAVAR and WINSTROL work well in this situation.


Same experience with me. I've tried them both and they both are extremely effective at suppressing SHBG. There's good RCT publications for Anavar as well. My experience is that (mg for mg) Winstrol is more effective, meaning you need about half the amount to get the same effect. For me, Winstrol optimized my SHBG at 2.5mg 2X per day, whereas I need 5mg 2X per day for Anavar for the same effect. You should dose 2X per day with either drug because they have very short half lives. Another point in Winstrol's favor is that it is about 6X less expensive, so less apt to be counterfeit (not worth their time).

Regarding liver toxicity, not much published (that I've found) on Winstrol. The RCT study on Anavar that I discussed earlier showed that at 20mg/day it was tolerated with acceptable liver toxicity. There was a dose-response in toxicity with the various dose groups (placebo, 20, 40, and 80 mg). The most interesting finding (for me anyway) is that hemoglobin was unaffected at all dose groups. This is contrary to some of the Bro Science I've read that part of Anavar's benefit to athletic performance is stimulation of RBC production for increased endurance. This study would argue that is not the case (at least in HIV patients).

Here's the link and full citation: https://www.ncbi.nlm.nih.gov/pubmed/16540931
Grunfeld, C., Kotler, D.P., Dobs, A., Glesby, M., and Bhasin, S. (2006). Oxandrolone in the treatment of HIV-associated weight loss in men: a randomized, double-blind, placebo-controlled study. J Acquir Immune Defic Syndr 41, 304-314.

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## Dr.V.P.C.

> Thanks for sharing. That's interesting. I haven't used any of these medications. How does this type of protocol typically impact free/total T ratios?


Every time i tried , both total T and free T jumped .
Shgb got low but not too low like happens most times with var and winny.
And hdl did not crash to lower than 40.

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## bkb333

> Those are getting to be rather high ALT and AST levels. However, many docs don't worry about moderately high liver enzymes if they know that a particular drug is pushing them out of range. Out of range liver enzymes can be indicative of liver disease, or it can simply indicate that you liver is working harder to detoxify the drugs. Adding NAC is a good idea (I do twice daily regardless of whether or not I'm taking Winstrol). I'd also consider adding in some Silymarin.


This did seem to be the case with my doctor -- he chalked it up to my workouts and to the danazol, and said we may scale back the danazol if the liver numbers get closer to 100. I did order some NAC (1000 mg tablets). How much would you recommend taking?

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## Youthful55guy

> This did seem to be the case with my doctor -- he chalked it up to my workouts and to the danazol, and said we may scale back the danazol if the liver numbers get closer to 100. I did order some NAC (1000 mg tablets). How much would you recommend taking?


I take 1200 mg twice daily (AM and PM). The product I use (NOW brand) also has some Selenium and Molybdenum in it. Not sure why it's included or if that is useful in liver detoxification.

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