I am a 27-year-old male. Why am I experiencing fatigue?

Hello,

Welcome to icliniq.com.

I understand your concern.

Based on your laboratory results, your total testosterone is in the high-normal range, but your free testosterone is on the lower side. This is likely due to elevated SHBG (sex hormone–binding globulin) at 99 nmol/L, which binds testosterone and reduces the amount available for your body to use. This imbalance could explain your fatigue and low energy despite having normal total testosterone levels.

Your thyroid hormones (thyroid-stimulating hormone and free T4 (free thyroxin)) and LH (luteinizing hormone) and FSH (follicle-stimulating hormone) are within normal ranges, suggesting that your pituitary–gonadal axis is functioning appropriately. Elevated SHBG can be associated with certain medications (including Sertraline), liver issues, overactive thyroid, excessive alcohol intake, or genetic factors. Since you are taking sertraline, this may be contributing to both your fatigue and elevated SHBG.

At this stage, I would recommend:

1. Discuss with your doctor whether Sertraline could be contributing to your fatigue and elevated SHBG.
2. Checking liver function tests, vitamin D, B12, and iron levels, as deficiencies can mimic low testosterone symptoms.
3. Optimizing lifestyle factors: ensuring good sleep, regular strength training, adequate protein intake, and limiting alcohol.
4. Seeking a referral to an endocrinologist if fatigue persists, so they can investigate causes of elevated SHBG and discuss possible treatment options.

Do not start testosterone therapy on your own. Your total testosterone levels are good, and the priority is to address the underlying cause of elevated SHBG.

Please feel free to reach out at any time if you have questions or need guidance. I am always here to support you.

Thank you.