Define “liver problems”?
I will tell you I’ve seen a number of folk who ARE hypogonadal and not one improved bc of an independent increase or decrease in SHBG!
And the micromanagement many lament are an effective means of manipulating SHBG are not evidence based, esp from a therapeutic perspective
IME a large portion of these SHBG folk are in search of a physiologic explanation for a psycho-social problem, from obesity to anxiety and depression.
Jim
For starters, TRT with low SHBG sets an extremely low bar for tolerable total testosterone levels before excessive aromatization becomes a problem.
I am quite irritated by your inability to follow the actual conversation. This thread about normalizing deficient SHBG -- not attempting to alter it in isolation.
Deficient SHBG leads to:
1. Accelerated hepatic metabolic clearance of testosterone. As SHBG decreases, MCR increases. As levels decline beneath the lower end of the physiological range, the MCR becomes exponential rather than linear. However, the MCR of estradiol is relatively unaffected by SHBG alterations. Therefore, estrogen is excreted at a much slower rate than testosterone.
2. Excessive free estradiol. SHBG binds estradiol, and due to the lower affinity of SHBG for estradiol versus DHT or testosterone, the free-to-bound ratio of estradiol is the one most affected by low SHBG.
3. Excessive free testosterone. The primary side effect of excessive free testosterone is elevated estradiol. See #2., where this excessive increase in estradiol also circulates in an excessively free state.
For this reason, all reputable clinics (Defy, Dr. Crisler) treat low SHBG patients differently than those with normal SHBG. The current standard of care for impaired SHBG production is twice weekly to daily injections of testosterone. This is the only way that practitioners have found to minimize the free hormone excess from low SHBG. Don't take it from me, though. Call up any of these clinics and ask them yourself. If you instead favor poorly typed broscience and mythology, check out our resident Dr. ALLCAPS (a.k.a. Dr. JIM.)
Finally, you could do yourself the favor of reading the more recent SHBG related studies. It is no longer considered "just a binding protien." We have learned that it plays a direct role in C-AMP signalling and AR signalling.
If there's something you don't believe, just ask me for the study. Don't just shotgun me with an insufferable rants of disjointed soundbytes loosely related to the topic at hand.
As far as psycho-social problems go, the primary concern for low SHBG men is estradiol issues. The anxiety, depression and obesity that you've mentioned are symptoms of hypogonadism, and it is widely known than men with low SHBG often have poor to no response to TRT. You can search Reddit, if you like. See hundreds of low SHBG threads.
You seem to like to conflate these problems with low SHBG, when in fact they are problems with hypogonadism, and hypogonadism is not easily cured in a case of low SHBG due to a lack of hormonal balance.
Are you a fan of Dr. John Crisler? Most of the Internet is. A favorite quote of mine: "SHBG is the centerpiece of TRT." Google it. Learn from real doctors.
How about a case of increased SHBG increasing response to TRT? Yes, we do have one!
I can introduce you to a fellow with a lifetime SHBG of 14 nmol/L with a poor response to TRT. Following berberine administration for 65 days, his SHBG jumped to 28 nmol/L. This resulted in a massive decrease in estradiol, from 56 pg/mL to 22 pg/mL, with a minimal decrease in total testosterone from 822 to 706 ng/dL. His FT% dropped from 3.63% to 2.65%. He no longer needs anti-estrogens. He no longer needs to divide his dose throughout the week and can now take a single weekly dose like a normal man. If you like, Dr. JIM, I can give you his contact details and you can learn a little more about your craft.