Any advice for guys with low E2, average testosterone, but high SHBG?

AlphaMD's Answer

Great question — we see this profile fairly often. When SHBG is elevated, it can bind up more testosterone, meaning your free (bioavailable) T may be low even if total T looks "normal." That can lead to symptoms like low energy, poor libido, mood changes, or trouble recovering from workouts.

Low estrogen (E2) can also contribute to those symptoms, especially joint discomfort, brain fog, and sexual dysfunction. It's often a sign that free T is too low, since testosterone converts to estrogen.

Here’s what we usually recommend looking into:

• Check free T (either direct measurement or calculated using SHBG, albumin, and total T).
• Identify possible causes of high SHBG — things like overtraining, certain medications, liver function issues, or even excessive fasting.
• For some men, therapeutic intervention (like TRT or enclomiphene) can lower SHBG and optimize both free T and E2 levels.

We’d encourage a full evaluation of your labs, symptoms, and goals before making any decisions. Every case is unique, but this is definitely a pattern where treatment — if appropriate — can make a real difference.