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Anabolic Steroids
TRT in men with low SHBG
- Thread starter chris_az
- Start date
Chris is not here anymore you can find him at.roro said:
http://health.groups.yahoo.com/group/hypogonadism2/
and this site.
http://www.andropause.org.uk/newforum/forum_frameset.htm
marianco
Doctor of Medicine
TRT with Low SHBG is not simple to do because there are many other complicating factors such as:
1. SHBG is reduced further by the increase in testosterone.
2. Insulin resistance. Low SHBG is one sign of insulin resistance/diabetes. Insulin resistance can cause other hormone imbalances and impair nerve signal transmission.
3. Hypothyroidism. Low SHBG may be a sign of inadequate thyroid hormone levels. Hypothyroidism is often present clinically though the lab tests are normal.
4. The duration action of testosterone is shortened by low SHBG - making one prone to a roller coaster experiences.
5. Testosterone can reduce thyroid hormone activity - resulting in anxiety or depressive symptoms depending on the severity of the reduction. There are multiple mechanisms of action which can cause this.
6. Low SHBG may result in high free Testosterone. High Free testosterone is not necessarily good. For example, if estradiol levels and progesterone levels are normal, the high free testosterone may result in high blood pressure. Testosterone can either lower or raise blood pressure depending on its relationship to the other hormones.
7. etc.
Testosterone functions depend on its relationship with other hormones, neurotransmitters, and cytokines - these all are chemical messengers in the body. Low SHBG complicates matters but is not an unsolvable problem in most people.
1. SHBG is reduced further by the increase in testosterone.
2. Insulin resistance. Low SHBG is one sign of insulin resistance/diabetes. Insulin resistance can cause other hormone imbalances and impair nerve signal transmission.
3. Hypothyroidism. Low SHBG may be a sign of inadequate thyroid hormone levels. Hypothyroidism is often present clinically though the lab tests are normal.
4. The duration action of testosterone is shortened by low SHBG - making one prone to a roller coaster experiences.
5. Testosterone can reduce thyroid hormone activity - resulting in anxiety or depressive symptoms depending on the severity of the reduction. There are multiple mechanisms of action which can cause this.
6. Low SHBG may result in high free Testosterone. High Free testosterone is not necessarily good. For example, if estradiol levels and progesterone levels are normal, the high free testosterone may result in high blood pressure. Testosterone can either lower or raise blood pressure depending on its relationship to the other hormones.
7. etc.
Testosterone functions depend on its relationship with other hormones, neurotransmitters, and cytokines - these all are chemical messengers in the body. Low SHBG complicates matters but is not an unsolvable problem in most people.
chris_az said:
Axl
New Member
marianco said:
Marianco,
I've have had low SHBG all my life, before AND after TRT.
Here are my two latets labs values, always taken right before my next shot.
april 2006 - august 2006 - (Ref Range)
TSH 0,8 mIU/L - ? (0,3 - 4,0)
FT3 4,8 pmol/L - ? (2,6 - 5,7)
Total T 890 ng/dl - 635 (280 - 1100)
Free T 292,8 pg/ml - 199 (50 - 280)
SHBG 9 nmol/L - 10 (13 - 71)
How can I get my SHBG up? What should be my aim here? Around 30 nmol/L?
marianco
Doctor of Medicine
Axl said:
Focusing on increasing SHBG is like treating a lab value rather than treating a patient.
The question I would have for a person with low SHBG is: What problems does one have?
Is it low libido, high blood pressure, heart attack risk, depression, anxiety, lack of energy, impaired concentration, urinary frequency, gynecomastia, hot flashes, etc.?
By identifying one's problems, it will be easier to see whether or not SHBG level contributes to the problem.
SHBG has signaling properties of its own. It has its own receptors on cell membranes. When testosterone or estrogens are bound to SHBG, it can bind to its receptors and send its message to the cell. What happens afterwards is not clear. It may be related to the formation of more hormone receptors - but that is speculation at this point.
SHBG helps prolong the duration of action of testosterone, DHT, and estrogens. Low SHBG will increase the amount of free hormone.
Swings in hormone level may occur when low SHBG is present as destruction of the hormone is accelerated by having high free levels. This may cause problems experienced during testosterone replacement. For example, if estrogen is more quickly destroyed/metabolized and levels drop more quickly, one can get hot flashes or anxiety or hypertension, etc. If testosterone levels fluctuate from high to low, depression can occur as the day progresses.
SHBG is made in the liver in response to levels of many hormones:
1. Increasing Testosterone reduces SHBG
2. Increasing DHT lowers SHBG
3. Increasing DHEA lowers SHBG
4. Increasing Growth Hormone lowers SHBG
5. Increasing Insulin lowers SHBG
6. Increasing Estrogen increases SHBG
7. Increasing Thyroid Hormone increases SHBG
The SHBG level is determine by the balance of the hormone levels.
Given one's assumed goals in TRT (high libido, good energy, etc.), it may be difficult to increase SHBG without causing problems since SHBG is determine by a balance of hormones.
For example, having high Testosterone and high DHEA is not a situation where SHBG is going to be high without corresponding problems with estrogen or thyroid.
If anything, SHBG should be most often viewed as an indicator of a problem that needs to be solved - rather than as a problem itself.
For example, SHBG is most commonly an indicator of high insulin levels - i.e. insulin resistance or diabetes. It would be then far more important to address insulin resistance or diabetes in treatment than to focus on SHBG.
If low thyroid is a factor in low SHBG, addressing hypothyroidism is far more important.
If low estradiol is a factor in low SHBG, addressing this is more important.
If the low SHBG itself is a problem because it causes large swings in hormone levels, then working around this by achieving more stable hormone levels is indicated.
More frequent dosing of testosterone may be required to stabilize levels. With testosterone cypionate or enanthate injections, dosing twice a week would be better than once a week.
If frequent dosing of testosterone cannot be achieved with transdermals or injections, then a constant dose solution may be needed. This includes testosterone patches, the buccal system, or testosterone pellet insertions. Testosterone pellet insertions may be viewed as fairly drastic since it involves regular minor surgical procedures, but does give the most stable levels - so is a viable solution for the men with problems due to highly variable hormone levels resulting from low SHBG.
If one suspects swings in hormone levels as a cause of problems, one can look for the swings in hormone levels by obtaining a peak and trough level of the hormones (e.g. total testosterone, estradiol, DHT, etc.). For testosterone injections, this is a level about 24-48 hours after an injection and a level just before the next injection. One can also obtain a midpoint level to fill out the level curve.
Axl
New Member
Great post Marianco!
I can understand what you are saying, SHBG comes in second.
I don't always agree with you, and I will take my specific case as an example to explain why. I truly believe that some HRT patients can benifit from treating SHBG.
I will try to explain this. Before TRT, I had very low T, low free T, low E2, low DHT and extremely low SHBG. On top of that, I had osteopenia, caused by overall low hormonal levels, muscle waisting, lack of energy and I got stuck in Tanner stage 4 or 5 with mild pseudo-gynecomastia and no facial hair.
Now, here comes the "chicken or the egg" question:
Most people say it is the latter: "one has low SHBG because of low overall hormones".
BUT: if this was correct, increasing my overall hormones with TRT, SHOULD have increased SHBG. However: this has never happened.
So, isn't it better to try to increase SHBG (eg by increasing Thyroid levels or by stimulating the liver), this way I could have naturally higher hormone levels, without the need of testosterone injections. Antoher great benefit would be the fact that by increasing SHBG, I would reduce the risk of insuline resistence and developing diabetes. Even my osteopenia would improve because of higher overall average hormone levels.
How come the medical community hasn't figured this out yet? I think this can be the answer to a lot of problems for a lot of HRT patients with low SHBG.
I can understand what you are saying, SHBG comes in second.
I don't always agree with you, and I will take my specific case as an example to explain why. I truly believe that some HRT patients can benifit from treating SHBG.
I will try to explain this. Before TRT, I had very low T, low free T, low E2, low DHT and extremely low SHBG. On top of that, I had osteopenia, caused by overall low hormonal levels, muscle waisting, lack of energy and I got stuck in Tanner stage 4 or 5 with mild pseudo-gynecomastia and no facial hair.
Now, here comes the "chicken or the egg" question:
are my overall hormones low because I have a low SHBG
OR
do I have low SHBG because I have low overall hormones?
OR
do I have low SHBG because I have low overall hormones?
Most people say it is the latter: "one has low SHBG because of low overall hormones".
BUT: if this was correct, increasing my overall hormones with TRT, SHOULD have increased SHBG. However: this has never happened.
So, isn't it better to try to increase SHBG (eg by increasing Thyroid levels or by stimulating the liver), this way I could have naturally higher hormone levels, without the need of testosterone injections. Antoher great benefit would be the fact that by increasing SHBG, I would reduce the risk of insuline resistence and developing diabetes. Even my osteopenia would improve because of higher overall average hormone levels.
How come the medical community hasn't figured this out yet? I think this can be the answer to a lot of problems for a lot of HRT patients with low SHBG.
Axl,
It isn't yet possible to synthesize SHBG or to just "stimulate the liver." Messing with thyroid hormones is dangerous.
No one on the board, nor any doctor that visits or has been discussed on this board has been able to adequately treat low SHBG.
It is a sad state of affairs for the men affected by it.
It isn't yet possible to synthesize SHBG or to just "stimulate the liver." Messing with thyroid hormones is dangerous.
No one on the board, nor any doctor that visits or has been discussed on this board has been able to adequately treat low SHBG.
It is a sad state of affairs for the men affected by it.
Axl
New Member
I guess we'll just have to keep looking for it, James.
I suppose so, but one of us is going to have to take a leap and "experiment" before anything new is learned, and we're running low on people willing to do that. All of the studies done on low SHBG are in relation to obesity and diabetes (as it is highly correlated with both.) Low testosterone is often listed as a side effect, but is not often a point of concern.
I think HaN said he is on to a solution, but I'm you'll be more likely to get a sales pitch than a direct answer from him these days. IIRC, it has to do with dietary levels of fat and/or fiber. Certainly, dietary deficiencies can cause hormonal problems, but for the man with an internal/genetic imbalance, this would likely prove ineffective. The same goes for testosterone. It can be modulated through dietary means, but diet will in no way completely suffice for a man whose body isn't working correctly.
I can answer a few of your questions, however.
It is low SHBG that is causing the low hormones levels. Increasing testosterone via exogenous means will only lead to slight changes, but will not bring SHBG to a healthy level. SHBG production is being actively suppressed in your body.
The likliest culprit is excess insulin. The imbalance is not the usual form that would be easily detected by a fasting serum insulin/glucose test. You'd need an euglycemic clamp to make the determination. Metformin or similar would then be your solution. If you aren't willing to aggressively test your insulin response and markers of proper liver function, you will spin your wheels indefinately. Low SHBG is not something that will be cured by taking hormones. It is an entirely different issue that needs to be fixed before hormones can ever be regulated.
I think HaN said he is on to a solution, but I'm you'll be more likely to get a sales pitch than a direct answer from him these days. IIRC, it has to do with dietary levels of fat and/or fiber. Certainly, dietary deficiencies can cause hormonal problems, but for the man with an internal/genetic imbalance, this would likely prove ineffective. The same goes for testosterone. It can be modulated through dietary means, but diet will in no way completely suffice for a man whose body isn't working correctly.
I can answer a few of your questions, however.
It is low SHBG that is causing the low hormones levels. Increasing testosterone via exogenous means will only lead to slight changes, but will not bring SHBG to a healthy level. SHBG production is being actively suppressed in your body.
The likliest culprit is excess insulin. The imbalance is not the usual form that would be easily detected by a fasting serum insulin/glucose test. You'd need an euglycemic clamp to make the determination. Metformin or similar would then be your solution. If you aren't willing to aggressively test your insulin response and markers of proper liver function, you will spin your wheels indefinately. Low SHBG is not something that will be cured by taking hormones. It is an entirely different issue that needs to be fixed before hormones can ever be regulated.
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Axl
New Member
Guys,
I have foudn a number of very interesting articles on the link between Insulin and SHBG and Testosterone. It seems T and SHBG is VERY predictive for the development of Insuline Resistance. High Insulin levels produce lower T-levels. So people with low T should also look into their insulin levels and their body composition.
See document attached.
I have foudn a number of very interesting articles on the link between Insulin and SHBG and Testosterone. It seems T and SHBG is VERY predictive for the development of Insuline Resistance. High Insulin levels produce lower T-levels. So people with low T should also look into their insulin levels and their body composition.
See document attached.
I am trying to follow this one as I have just determined that I currently have a low level of SHBG and way high estradiol. Axl, this post started out like you were still in disagreement with marciano, however, it appears that you agree with him on all points? Am I reading it wrong? Just trying to understand. as I too appear to be one with (1) Low SHBG, (2) High Free test and Estradiol levels, high blood sugar, and a bit of a slow thyroid. Am I correct that marciano just said that applying testosterone only adds to the low shbg fire?? And that treating my low thyroid is the first avenue I need to look down in order to balance my hormones? (Given that I quit goofing around with occasional abusive levels of T). Keep in mind that my numbers are also skewed in these directions regardless if I am supplementing testosterone, low amounts, high amounts, or what. My latest concern is the proportions of T/E... I am only a beginner at this, the clock is ticking now.
Axl
New Member
BBC3,
I do not disagree with Marianco, I was just wondering if there was a way to increase SHBG "unconventionally".
You mention that you have high blood sugar? That is probably the main cause of your low SHBG: high blood sugar will induce increased levels of Insulin as the pancreas is trying to compensate. The elevated insuline will lead to low SHBG. It is called Insuline Resistance.
Check out your HbA1c-levels: they indicate how high your blood sugar levels have been on average in the last month. Also look into yout diet: is it too high in sugar and carbs? Try to eat low carb 6 times a day. Finally, try to do an aerobic activity for 30 minutes every day: it will increase the insuline sensitivity of your sceletal muscle tissue, so it will be more able to take the blood sugar in the cells by means of insulin. Do you have a father or mother with diabetis? Then you have an increased risk at Insuline Resistance.
I am adhering this program at the moment as I want to avoid Insuline Resistance. I have cardiovascular issues at the moment, and I am prone to develop Insuline Resistance, I think. I will post an update after a few months, after my next bloodwork.
Regarding your other questions:
Do check your thyroid, but bear in mind that the levels can be skewed indeed because of your T-use.
About your Estrogen question: your estradiol E2 (not estrogen) should be below (and around) 40 pg/ml. That's what you need to keep an eye on. You will find a lot of information on E2 if you do a search in this forum.
I do not disagree with Marianco, I was just wondering if there was a way to increase SHBG "unconventionally".
You mention that you have high blood sugar? That is probably the main cause of your low SHBG: high blood sugar will induce increased levels of Insulin as the pancreas is trying to compensate. The elevated insuline will lead to low SHBG. It is called Insuline Resistance.
Check out your HbA1c-levels: they indicate how high your blood sugar levels have been on average in the last month. Also look into yout diet: is it too high in sugar and carbs? Try to eat low carb 6 times a day. Finally, try to do an aerobic activity for 30 minutes every day: it will increase the insuline sensitivity of your sceletal muscle tissue, so it will be more able to take the blood sugar in the cells by means of insulin. Do you have a father or mother with diabetis? Then you have an increased risk at Insuline Resistance.
I am adhering this program at the moment as I want to avoid Insuline Resistance. I have cardiovascular issues at the moment, and I am prone to develop Insuline Resistance, I think. I will post an update after a few months, after my next bloodwork.
Regarding your other questions:
Do check your thyroid, but bear in mind that the levels can be skewed indeed because of your T-use.
About your Estrogen question: your estradiol E2 (not estrogen) should be below (and around) 40 pg/ml. That's what you need to keep an eye on. You will find a lot of information on E2 if you do a search in this forum.
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Axl,
Did you read my last post at all? Here it is again:
So, yes, there IS a very high correlation between insulin resistance and low SHBG. I'm offended and surprised that it took 20+ posts in this thread for this fact to be acknowledged, especially since it is one of the very first things that a simple Google search will reveal.
Like I said, testing for insulin resistance is the first step you must take in treating low SHBG. However, beware that it may not be so simple. In my case, I have passed blood related insulin tests with flying colors. I'm currently looking into options for more specialized tests, including an euglycemic clamp.
Did you read my last post at all? Here it is again:
So, yes, there IS a very high correlation between insulin resistance and low SHBG. I'm offended and surprised that it took 20+ posts in this thread for this fact to be acknowledged, especially since it is one of the very first things that a simple Google search will reveal.
Like I said, testing for insulin resistance is the first step you must take in treating low SHBG. However, beware that it may not be so simple. In my case, I have passed blood related insulin tests with flying colors. I'm currently looking into options for more specialized tests, including an euglycemic clamp.
Axl
New Member
Hi James, it was exactly yor post that has put me on the right track. I knew there was a correlation, but I did not expect it to so big. Hence why I posted the attachments: now everybody can see that Insulin levels are a major factor in controlling SHBG. Moreover, the studies clearly state that low T combined with low SHBG are induced by high levels of insulin and that they predict Insuline Resistance and Diabetis Mellitus Type 2. I think this is extremely important for the people on this forum.
Moreover, the studies also prove that the risk of getting diabetis can be reduced by 58% by controlling your diet and starting exercise.
I have had in ITT (insuline tolerance test) done some years ago, but the tests did not reveal anything special. I understand that euglycimic clamp is the gold standard, but it is hard to get tested. Anyway, I closely monitor my carbs and I don't feel that "sugar craving" after meals anymore. That's enough proof for me to start treatment: diet and exercise!
Offended? come on, isnt this site about knuckleheads like me. I am learning a lit of new stuff right now, so as a stubborn fool, I have to ask some of you to pound it into my head. I too saw your post. Axl was just the last one to speak on it. At least as I read in my mind. All this info is great.
Axl, My Estradiol is kinda what has started me on this final quest for metabolic perfection. A recent test revealed that I was about 114 on the scale you referred to. Others tell me that is not good enough and I need to get an "ultra sensative E2 test". It apparently has a scale of 20-29 for correct ranges, at least to my knowledge so far. Keep in mind though that was after 10 weeks of supping test cyp 150-200mgs/wk. So it may be where expected. Total and free test not in yet so I am not sure how the T/E ration stacks up.
Regarding blood sugar being "high". I just cant be sure here. I have run about 125 from the age of 20-36. A stress test ( the one where you drink the sugar and see how your body deals with it reveals healthy). While I may run 125 very easily, it also seems to "check up" there as well. I was 99 the other day when having blood work. this was not fasting, however, i had not eaten very much and much earlier. Further note is that I do have a strong affinity for simple sugars and get edgy without, until any diet changes have been in force for at least a month. . My doctor gave me something called Glumetza. I think it may also be referred to as "glucophage". Not sure about spelling. He does not think I am even a full blown type II diabetic yet, however, he thought this might help to control some blood sugar and prevent so much fat from sticking to my body when I eat. They are 500mg extended release. QUESTION, if my insuline levels are improper, will this be the right step in direction to prove of disprove SHBG. With time on this I should see an increase in SHBG, right??
So, I am thinking it looks like i am addressing blood sugar first. Maybe once that is stabilized at whatever these meds do I can again recheck thyroid...
Anyone else feel free to chime in if you think I am not on the right page...
Axl, My Estradiol is kinda what has started me on this final quest for metabolic perfection. A recent test revealed that I was about 114 on the scale you referred to. Others tell me that is not good enough and I need to get an "ultra sensative E2 test". It apparently has a scale of 20-29 for correct ranges, at least to my knowledge so far. Keep in mind though that was after 10 weeks of supping test cyp 150-200mgs/wk. So it may be where expected. Total and free test not in yet so I am not sure how the T/E ration stacks up.
Regarding blood sugar being "high". I just cant be sure here. I have run about 125 from the age of 20-36. A stress test ( the one where you drink the sugar and see how your body deals with it reveals healthy). While I may run 125 very easily, it also seems to "check up" there as well. I was 99 the other day when having blood work. this was not fasting, however, i had not eaten very much and much earlier. Further note is that I do have a strong affinity for simple sugars and get edgy without, until any diet changes have been in force for at least a month. . My doctor gave me something called Glumetza. I think it may also be referred to as "glucophage". Not sure about spelling. He does not think I am even a full blown type II diabetic yet, however, he thought this might help to control some blood sugar and prevent so much fat from sticking to my body when I eat. They are 500mg extended release. QUESTION, if my insuline levels are improper, will this be the right step in direction to prove of disprove SHBG. With time on this I should see an increase in SHBG, right??
So, I am thinking it looks like i am addressing blood sugar first. Maybe once that is stabilized at whatever these meds do I can again recheck thyroid...
Anyone else feel free to chime in if you think I am not on the right page...
Axl
New Member
Offended? come on, isnt this site about knuckleheads like me. I am learning a lit of new stuff right now, so as a stubborn fool, I have to ask some of you to pound it into my head. I too saw your post. Axl was just the last one to speak on it. At least as I read in my mind. All this info is great.
Axl, My Estradiol is kinda what has started me on this final quest for metabolic perfection. A recent test revealed that I was about 114 on the scale you referred to. Others tell me that is not good enough and I need to get an "ultra sensative E2 test". It apparently has a scale of 20-29 for correct ranges, at least to my knowledge so far. Keep in mind though that was after 10 weeks of supping test cyp 150-200mgs/wk. So it may be where expected. Total and free test not in yet so I am not sure how the T/E ration stacks up.
Regarding blood sugar being "high". I just cant be sure here. I have run about 125 from the age of 20-36. A stress test ( the one where you drink the sugar and see how your body deals with it reveals healthy). While I may run 125 very easily, it also seems to "check up" there as well. I was 99 the other day when having blood work. this was not fasting, however, i had not eaten very much and much earlier. Further note is that I do have a strong affinity for simple sugars and get edgy without, until any diet changes have been in force for at least a month. . My doctor gave me something called Glumetza. I think it may also be referred to as "glucophage". Not sure about spelling. He does not think I am even a full blown type II diabetic yet, however, he thought this might help to control some blood sugar and prevent so much fat from sticking to my body when I eat. They are 500mg extended release. QUESTION, if my insuline levels are improper, will this be the right step in direction to prove of disprove SHBG. With time on this I should see an increase in SHBG, right??
So, I am thinking it looks like i am addressing blood sugar first. Maybe once that is stabilized at whatever these meds do I can again recheck thyroid...
Anyone else feel free to chime in if you think I am not on the right page...
Glumetza
GLUMETZA (metformin hydrochloride extended release tablets) is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.
-> Your doc is already giving you metformin. See James's post: he also mentioned methformin as step 1 to tackle Insuline resistance issues. So your doc is on the right track. The abdominal fat sticking to your body is partly due to this. The main reason, however, is you are having the wrong diet and not enough exercise. Please do read the attachments I've posted in this thread: they are 100% suited for you.
And yes, you need the ultra sensitive test when testing E2. The high E2 could be due to the messing about with testosterone.
Here is what I would do. Stop messing around with T, clean up your diet and exercise scheme, take a baseline total T and E2 value, correct E2 if necessary by titrating 1/4 of a tablet of Arimidex every 3 days, remeasure E2 and total T, and adjust E2 until you are in the ref range. Only at this point I would add Testosterone (only if you are low on total T, at replacement dosages). Remeasure and adjust. Have your fat% measured by bio impedance or fat callipers. Set your goals: you should be as low on fat as possible to avoid future issues with diabetes mellitus (again: read the 2 pdf's I've posted in this thread)!!
Oh yeah... and stop "popping whoppers"! ;-)
If others think I'm wrong, please feel free to correct me. I'm certainly not a doc and I'm not pretending to be knowledgeable on this subject. I'm still looking for answers myself and I'm happy to share my findings woth others ...just trying to help out BBC3 here...
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I cant say that I will cut back the test below 150-200 mgs/wk as that was the amount I had been on for 10 weeks at that last lab date. I would like to keep that previous scenario as a baseline to determine the effectiveness of the diabetes treatment in lowering SHBG. Regarding the E2 it is obvious I need the other test, so without any gynosign, I am going to relax on that issue till the results are in. Regarding the body fat, its funny because belly fat was exactly the area of body fat he spoke of. I used to never have a problem there. I always put everything on even. Regarding the Woppers, they are hard to stop poppin. It is a good thing the BK by my house sucks. I appreciate all your input. Thanks.
Axl
New Member
BBC, I think you've got it wrong: the effectiveness of the "diabetes treatment" is not measured by how much your SHGB is lowered (I don't understand where you get this from??), but is measured by how much your overall blood glucose levels and insuline levels have dropped. By decreasing circulating insuline levels, your SHBG will probably rise slightly.
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