A great podcast - Testosterone Envy & Longevity

@Joseph_Lavelle has a great series!

This podcast is excellent!

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.


Reviews, 14 May 2024

Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men: Individual Participant Data Meta-analyses


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.

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What did you do to lower SHBG?

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

Any perspectives?


@Neo has it right. Context.

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.