TRT in men with low SHBG

[BBC3]

I have heard that term here once or twice around here. One guy posted something that sounded legitimate one time. He stated that he started on a pretty low trt dose and got up around 300 with same results of t seemly keep on staying unusually low. I have never seen this posted other than once and I am sure it is fantasy on a broad scale.

WHAT I AM THINKING is that E2 matches T and TOTALLY neutralizes it and that "TRT" idoits, I mean doctors, that dont know what they are doing dont know to control E2 with meds.. My guess...

I've heard the term "hypermetabolizer". This is usually someone that has low SHBG. So, is a "hypermetabolizer" so is everyone w/low SHBG considered this or is there some other charecteristic that goes along w/it? Is it even a valid term? I haven't seen any studies that state anything regarding rapid metabolization of T.

Paul

 

[Axl]

I've heard the term "hypermetabolizer". This is usually someone that has low SHBG. So, is a "hypermetabolizer" so is everyone w/low SHBG considered this or is there some other charecteristic that goes along w/it? Is it even a valid term? I haven't seen any studies that state anything regarding rapid metabolization of T.

Paul

Paul, I've just googled the term "hypermetabolizer". It appears to be a laymen's term with no scientific value what so ever. I did not find this word in any scientific study yet.

 

[James23]

"Hypermetabolizer" is a Dr. John term. He coined it on his messageboard. Here is what he says they mean:

Dr. John Crisler
Lord of the Forum

Serum hormone levels can be well within normal range, and urine hormone levels very high ("hyperexcreter") or urine metabolites very high ("hypermetabolizer").

 

[jpswede]

Hello, everyone. Newbie here .

I am a 50 year old male in decent shape (5-9 and 170) who has had problems with ED off/on for the last 15 years or so. I have tried Testim, Clomid, and Tamoxifen in order to raise my T levels and they all worked but only for a week or so. Tamoxifen worked the best I would say. The only labs ever drawn were Total T until just last week.

I had been feeling extremely run down for 2 weeks and couldn't get an erection at all so I had labs done. Not surprisingly, my Total T was 184! My SHBG was 16.6 out of a range of 13-71. My E2 was 19. I have other labs but these are the ones I think you need. Free T was also very low. I did not do an insulin level though but I will this week.

So I started back on Tamoxifen 10 mg twice a day. The first day my genitals were on fire. I had a spontaneous erection. My testicles were getting bigger. I thought alright! But now, after only 1 week, my testicles are no longer getting bigger, I'm having difficulty getting erections again, and I'm very, very tired. This is the same way it happened in the past. I am getting labs done this week and will post those ASAP.

My question though is this: Should I increase or decrease the Tamoxifen? Should I continue the 20 mg but take it only once a day instead of twice a day? Should I take 40 mg a day? I called my doctor but he says to wait a month before doing anything! I think that it too long! Anyone have any ideas? Thanks for any help.

 

[jpswede]

I am confused. But don't you want your SHBG to be low which in turn would mean that your T would be high? If so, why would you want a high SHBG? Sorry about my stupidity.

 

[jpswede]

Sorry. Me again. I understand you would want higher SHBG levels if you want to avoid Syndrome X and DM, etc but what I don't understand is why I have low T levels but yet I have normal SHBG, LH, FSH, and E2 levels. HOW CAN THAT BE? In other words, why aren't my T levels ALSO normal? And TSH, T3, T4 were WNL, BG and A1C were WNL, CMP was WNL, CBC was WNL, etc. Why can't I have normal T!!!!

Is there any way to increase my T in a more natural way besides Tamoxifen so that I don't shut down my testes? Why do these drugs seem to only work for 1 week or so? Why do my levels eventually drop even after I get them back up? Is there something I can do to KEEP them up?

Thanks again for any replies. My doctor is just a Family doc and he doesn't seem to know much about this topic. I live in a very rural area and can't get to a specialist. I know I have 3 posts in a row without any responses. I just keep on thinking of questions lol. I will not submit anymore for awhile .

 

[AverageSuperman]

Hey guys,
I am fairly new here and wanted to say thanks for all the useful info...

I am 22yrs old and have been diagnosed and misdiagnosed with Primary/Secondary Hygonadism.
I see now that low SHBG could have been the reason for messy inconsisten levels... One month i am in normal ranges of T(540), next month I am 340 then another month i am under the low range at (240)

What I can say that is starting out 2 years ago with a high estrogen high prolactin level with unnoticed low SHBG and normal testosterone and high free T, a year ago i was diagnosed with a prolactinoma nothing visible on mri and i was able to suppress the prolactin tumor with .5 e3d Cabergoline aka dostinex I discontinued the cabergoline and it did actually fix my sex libido for some time.

I then retested blood work with another doctor a year after and my T levels had droped to lower normal instead of just average. My Prolactin raised up just a hint but was still in high normal ranges but HIGH estrogen still, normal LH but low FSH. The doctor said he wanted to wait a few more months and see if my sex drive comes back and anxiety might leave cuz it could be all in my head! NO!

So I patiently waited, another 3 months, I got tested again low low Test 240 a 140 drop from prior, estrogen was still high, prolactin was normal high, all he did was total T check and tha was 240. He scripted me androgel 5g in 2 mins of the visit told me to come back in 4 months and said " Doctors orders take it easy" lol he did not issue NO arimidex did not inform me that TRT is for life and that it can cause one to become sterile over time! I knew that I was with an incompetent, lazy old geezer doc who didnt want to spend the time and energy learning how to correctly monitor E2 and work with HCG. I went back to my old General Practioner to get his opinion and he said before seeking out TRT to do a SLEEP APNEA TEST and after the Sleep Apnea test do ONE MORE FULL PANEL OF BLOOD WORK so we could have a clearer starting point of reference because it had been 4 weeks since the original doc issued the script for 5g androgel. The sleep studies took 3 weeks...So i took the full panel test and the next day started androgel 5g. (I HAVE UPDATED RESULTS ON ANDROGEL AND PRETREATMENT AS WELL THE THREAD IS A NEW POSTED THREAD" PLEASE HELP TRT" ) I will bump it here soon tonight.

Thanks to forums and my other doctor I was able to address the reason of not wanting to take a chance on geting women boobs so i convinces him to give me a script for arimidex . like I said thanks to you guys I was able to learn what pros and cons comes with TRT I also learned that both of my doctors disregarded HCG protocols and coined HCG as a womens fertility drug that is only used for pregnancy. At least I had TRT with AI.

Thanks to forums and peoples experiences I was able to understand the logic and differences between trasdermals dosages and injections. I have been able to learn quite fast in the last 3 months. I was able to feel best not with 5g of androgel but 7.5 G with .5 arimidex everyday. I started with 5g androgel and .5 arimidex every 3 days and retested every week thats how I found my sweet spot.

Recently I ran out of the doctors 5g refills since I am using 7.5 g and " going against doctors orders" the nurse refuses to call the pharmacist to refill the androgel. insurance doesnt kick in for another week, Doctor is out of town for another week so I have been off of androgel for 4 days cold turkey , I cut the arimidex as well since the drop in T and E from the agel. I feel horrible but quite calmer no motivation for women or weights I been eating twice daily the last 4 days. I am extrememly tired! Brain fog too! Really I do have this stuff. I dont even want to Play Madden anymore!
I guess I am seeking out anybodys thoughts......

My plan is to wait til my next perscription comes in and then take 7.5g androgel and .5 ai ed which will run out in 2 weeks and by then find a better doctor... to either find a doc that will help me with

A) CORRECTIVE PCT and COMPLETLEY Off Trt ( HCG, ARIMIDEX CLOMID)
B) issue 7.5G agel HCG an Ai and monitor all hormone levels monthly & i do want to have kids!
C) take HCG CLOMID regularly
D) maybe a lifestyle change Sleep apnea gear that will be here in 2 weeks and ZMA VIT E DHEA and Clomid and low dose arimidex can be monitored monthly by a doc to find optimal placing.
Hopefully the doctor will check for insulin resistance and how TRT relates to SHBG...
Anybodys thoughts thanks

 

[jpswede]

Wow. Got my Total T checked again after 7 days of being on Tamoxifen 10 mg twice a day and I'm very disappointed . My Total T only went up to 250 from 184 but I thought as much since I was still having ED issues, etc. Any ideas anyone? Should I decrease Tamoxifen to 10 mg once a day or increase it or what? Is that a decent response after 7 days? My doctor doesn't have a clue he said.

 

[jpswede]

Update just in case people are curious. Last night I ate pork chops and a salad and a few cookies. Not my usual high carb dinner. This morning I wake up and my testicles are much bigger and very, very firm. Nice erection today too. But I ate a bowl of sugary cereal as usual and my testicles seemed smaller about 30 minutes after eating. I then ate more cereal at lunch and 30 minutes later, my testicles started hurting bad. I checked and they were back to same size as yesterday and very soft. It hit me then that maybe my insulin level had shot up and was interfering with my T production. I am still waiting on my insulin level. I am going to stay on 10 mg Tamoxifen twice a day and switch to a low carb diet. I hope it works! If it doesn't, should I increase the Tamoxifen? My Total T only went up tp 250 from 184 in 1 week. I was hoping to get it to 500 or so. Any ideas guys?

 

[pcgizzmo]

Update just in case people are curious. Last night I ate pork chops and a salad and a few cookies. Not my usual high carb dinner. This morning I wake up and my testicles are much bigger and very, very firm. Nice erection today too. But I ate a bowl of sugary cereal as usual and my testicles seemed smaller about 30 minutes after eating. I then ate more cereal at lunch and 30 minutes later, my testicles started hurting bad. I checked and they were back to same size as yesterday and very soft. It hit me then that maybe my insulin level had shot up and was interfering with my T production. I am still waiting on my insulin level. I am going to stay on 10 mg Tamoxifen twice a day and switch to a low carb diet. I hope it works! If it doesn't, should I increase the Tamoxifen? My Total T only went up tp 250 from 184 in 1 week. I was hoping to get it to 500 or so. Any ideas guys?

I hate to break it to you but I don't really think it works like that. I don't know why your testicles seemed smaller after eating. Could be water was pulled into the stomach to help digest food but I can assure you it wasn't a decrease in testosterone that did it.

If you are sensitive to carbs and have Syndrome X or Low SHBG then do your self a favor and stay away from high GI foods. No cookies, potatoes, white rice, bread, coke's etc...

Take.

Chromium Picolinate
ALA
Cinnamon Tablets/Sprinkle cinnamon on steel cut oats in the morning
Omega 3's
Train with weight at least 3x per week.

 

[BBC3]

Why are you taking Tamoxofin?

 

[jpswede]

Thanks for the comments. I must have read others comments wrong. I thought if my T went down, it would make my testicles shrink.

I am taking Tamoxifen to try to increase my LH which I thought I read would stimulate my testicles to get bigger and make more T. My T levels are very, very low for some reason. Total T was 184 before Tamoxifen and now after 1 week in it, it is a little higher at 250. I am trying to get it to 500.

I also thought I read that high insulin levels make your T go down so I thought after eating the high carb foods, my insulin level was going too high which maybe was making my T levels go down which caused my testicles to shrink. If that is all wrong, then I will start all over on my reading and try to get it right. Thanks for the comments.

Anyone have an idea why I am only at 250 Total T after 20 mg a day of Tamoxifen? Should I increase or decrease it? Should I add Clomid or HCG or both? Thanks for any help.

 

[pcgizzmo]

Thanks for the comments. I must have read others comments wrong. I thought if my T went down, it would make my testicles shrink.

I am taking Tamoxifen to try to increase my LH which I thought I read would stimulate my testicles to get bigger and make more T. My T levels are very, very low for some reason. Total T was 184 before Tamoxifen and now after 1 week in it, it is a little higher at 250. I am trying to get it to 500.

I also thought I read that high insulin levels make your T go down so I thought after eating the high carb foods, my insulin level was going too high which maybe was making my T levels go down which caused my testicles to shrink. If that is all wrong, then I will start all over on my reading and try to get it right. Thanks for the comments.

Anyone have an idea why I am only at 250 Total T after 20 mg a day of Tamoxifen? Should I increase or decrease it? Should I add Clomid or HCG or both? Thanks for any help.

I think you misunderstood me. Your testicles will shrink. High insulin can blunt T production. Just not in the 30 minutes of eating your serial

 

[jpswede]

Oh. Ok. Great. Thanks for the clarification. I'm serious though when I say that if I eat a high protein breakfast, my testicles feel full and firm and I have energy for the entire morning but if I eat a high carb breakfast, they get soft and mushy and I feel tired. I just thought that it was odd.

Question: Does your insulin level have to be up continuously to affect T levels? Thanks for your help.

 

[James23]

I'm curious as to whether or not anyone has made any progress in treating their low testosterone in the presence of low SHBG.

I've been scouring various other messageboards without any luck. I assume that all of us low-SHBG men here at MESO-Rx are still in the same boat. This is true, isn it?

 

[hardasnails1973]

low shbg increases with correcting the underlying cause why it is low..IE thyroid or insulin issues.

 

[James23]

HAN,

What tests would you recommend to pinpoint which of these issues (thyroid/insulin) are to blame?

My doctors have run regular thyroid panels and all values are "in lab range." I requisitioned my own fasting insulin/glucose test and those values were also in the healthy range.

I know that these are general tests -- so, is there a better way to test for either of these conditions?

 

[Axl]

James,

I look at the Triglycerides (HDL, LDL and total cholesterol) and the HbA1c levels. I am following Insuline Resistance related issues with these labtests, not Thyroid issues...

My next blood test is due end of the month, after cleaning up my diet (high proteine, low carb, increased meal frequency, healthier food) , I hope to see some difference, I will keep you posted.

 

[Axl]

@HAN: What would you recommend for people that tend to be Insuline Resistant? Is my approach the correct one?

I eat properly (50% carb/30% proeine/20% fat) and more frequnetly (6 times/day) and increased my physical activity (weights + running).

As a result I lost some bodyfat and increased some muscle mass. (I measure this with the Tanita Body Composition analyser, which isn't vey accurate but which gives me a fair idea of my body composition when I calculate moving averages of my readings).

By doing the exercises, I am trying to increase my insuline sensitivy of my muscle tissue.

Any other suggestions to improve Insuline Sensitivity? Any other blood parameters I should keep an eye on?

 

[BBC3]

I have been treating with Glumetza for 3 months now and I have seen no difference.. In fact I swear that i am getting less of a T response than ever. I am sure there is some receptor down regulation going on. I wonder if SHBG is lowered by the body as part of down regulation.??

[/I]

I'm curious as to whether or not anyone has made any progress in treating their low testosterone in the presence of low SHBG.

I've been scouring various other messageboards without any luck. I assume that all of us low-SHBG men here at MESO-Rx are still in the same boat. This is true, isn it?