Anyone who is heading into self medicating for “Low T” - especially low bioactive T with a normal range total T really needs to listen to this before heading down a very poorly thought out pathway!
I listened to this today - all information I knew - but a wonderful presentation, nicely mediated by Joe. But I wish this information was widely a part of practice as men are getting the wrong treatment.
Anyway, hats off to Joe Lavelle. Such a quality member on the forum!
@DrFraser Wow. Thank you very much. I try very hard to produce a useful podcast but the main goal is to learn. TRT is marketed very well. I meet people out in the world who don’t know about WiseAthletes who tell me TRT is the great thing ever. Maybe so. I say be careful with potentially irreversible decisions.
I had a consult the hour after I listened to this of a patient who had a Testosterone of 900 while being metabolically unhealthy - and having symptoms the “doctor” thought could be low T - even though he didn’t have low T - so now 4 years on, is on testosterone injections - when what he needed was someone who understood the issues, did things to lower his SHBG … now I’m left with the mess of backing out of this mismanagement. This interview demonstrates the issue at hand nicely. Bottom line is … get an expert to review you before you head down into a somewhat difficult to reverse path - that you may never have needed to head down.
Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men: Individual Participant Data Meta-analyses
Conclusion:
Men with low testosterone, high LH, or very low estradiol concentrations had increased all-cause mortality. SHBG concentration was positively associated and DHT concentration was nonlinearly associated with all-cause and CVD mortality.
Sadly, this needed to be bioavailable testosterone - and the association would be meaningful as you can have high total T and low bioavailable due to a high SHBG due to poor metabolic health. It is unfortunate that wasn’t controlled for as then the association would be much stronger.
Perhaps higher SHBG is separately also consistent with longevity phenotypes - in addition to bad issues (when eg driven by poor metabolic health) - so important to disentangle
See some papers in posts below.
I.e. depending how one arrives at above average SHBG it could be either good or bad
SHBG is essentially the only such protein that increases with age. This is the confusion - if you look in isolation - high SHBG is associated with health, but the context is different - it is with a high total testosterone and an adequate Free or Bioactive T.
It is a different animal in an older or metabolically unhealthy individual who has an adequate total testosterone, but they have so much SHBG that their Free or Bioactive T is now below normal limits or very low. Those individuals are not healthy and this is a bad thing - and it is an individual assessment to sort our what is wrong - Cortisol/Melatonin Curve, Stress, Obesity, too much protein, too little exercise, metabolic syndrome? Many of the same things interestingly listed in the situation of a low SHBG - but in a different context.
Just looking at the literature it would be confusing to see why I’d want to lower a SHBG – it is context.
Also a quick item for folks to understand the Total, SHBG, Free and Bioavailable - you simply need a Total Testosterone, a SHBG and an Albumin - and you can get a Free T and Bioavailable. I see some people paying extra for the last 2 items - but these are calculated. Use this Calculator.
