TRT in men with low SHBG

[zkt]

Consider another globulin: albumin.
It helps regulate blood pressure via plasma volume.
By binding to the plasma and resulting in a molecule too big to pass thru the cap walls into the extracellular fluid, BP is more stable.
If ALB is more than a couple SD low of the low end of the ref range, you get edema. Worse still; acities and BP drops. Because there is not ALB to Keep enough blood in the circulatory system
I
Same idea.

 

[zkt]

Consider another globulin: albumin.
It helps regulate blood pressure via plasma volume.
By binding to the plasma and resulting in a molecule too big to pass thru the cap walls into the extracellular fluid, BP is more stable.
If ALB is more than a couple SD low of the low end of the ref range, you get edema. Worse still; acities and BP drops. Because there is not ALB to Keep enough blood in the circulatory system
I
Same idea.

 

[Kwirion]

More about: ROLE OF ESTRADIOL AND SEX HORMONE BINDING GLOBULIN FOR MALE FITNESS AND HEALTH [PART I] & LOW SEX HORMONE BINDING GLOBULINE (SHBG) POSITIVE AND NEGATIVE EFFECTS [PART II]

 

[James23]

Kwirion,

That is an EXCELLENT link! Everyone with low SHBG ought to check it out.

Perhaps low SHBG isnt the real culprit but an incidential effect of more far reaching problems.
I fail to see how lowering SHBG would cause such a problem.

With low SHBG, FT is often normalized while TT is in the 100-250 ng/dl range. Even though FT is "normal", patients often complain of an absent libido, inability to maintain muscle, lack of facial hair, severely depressed mood. etc. This means that there is more to the picture than FT alone. TT must also be normalized. However, adding exogenous T is not the way to do it, because SHBG will not increase proportionately! Instead, a further imbalance will be created.

Dr. M is right that many things can affect SHBG expression. However, there is a possible genetic component. It is theorized that a variation in the genetic encoding for SHBG can cause low SHBG in males and also results in PCOS in females. If this is the case, it can't be solved by adjusting other imbalances.

 

[stumpy40]

What is considered low?

 

[Kwirion]

What is considered low?

I think 10 - 20 points below standard should be consider low, > 20 very low

Normal Testosterone Levels in Men by Age - Bioavailable, Total, Free Testosterone Ranges

 

[Kwirion]

Dr. M is right that many things can affect SHBG expression. However, there is a possible genetic component. It is theorized that a variation in the genetic encoding for SHBG can cause low SHBG in males and also results in PCOS in females. If this is the case, it can't be solved by adjusting other imbalances.

Yes, I know this thread: https://thinksteroids.com/community/threads/134294681

But there is no cure yet, we should find help with modifying existing HRT / PCT methods..

 

[Kwirion]

From wikipedia:

Some women with polycystic ovary syndrome may have mildly-elevated prolactin levels.

My prolactin is mildly-elevated and my SHBG is low, but I'm a man...

 

[rctriplefresh5]

Dear Doctor J and interested parties,

In the UK I have noticed a strong correlation between fellow
patient's poor response to testosterone and low SHBG.

The widely held belief is that high not low SHBG is a problem.

>From my understanding this is because SHBG is of course the binding
protein (binding 98% of testosterone in the typical male), binding
with greater affinity to testosterone than to E2, therefore high
SHBG adversely affects the testosterone to E2 ratio.

Of course high SHBG can be a problem, but I believe it is more than
a coincidence that many, many men who respond poorly to TRT have low
SHBG, I believe that this too is a problem.

>From what I can see the logic goes that low SHBG will result in a
higher level of free testosterone as less is bound and that this can
only be a good thing. However I think that the problem here is that
SHBG is only being viewed in relation to testosterone.

Low SHBG will also cause an increase in free E2.

Now if this is viewed in the context of testosterone it can be said
that the rise in free testosterone is greater than the rise in free
E2 meaning low SHBG is not a problem because of the binding
affinities.

But like I said this is if SHBG and E2 are viewed in the context of
testosterone. But high E2 in itself is surely likely to cause its
own problems.

I believe those with low SHBG are suffering from high E2, more
specifically high free E2 on TRT and that that is the reason for
poor response to TRT.

My thoughts are merely that, I have no prove whatsoever just a hunch.

Symptomatically those with low SHBG on TRT tend to develop
gynecomastia and see no improvement, in fact sometimes a decrease in
libido on commencement of TRT.

Serum E2 is usually toward the top of the range with no test
available for free E2.

Use of A.Is and anti estrogens seem to have had little benefit to
such men, having had very mixed results.

I am one of these men.

My SHBG is 10nmol/l with a range of 13-75nmol/l.

P.S

There maybe another mechanism of action and my theory maybe wrong, it could be that those with low SHBG share an underlying condition that relates to poor response to TRT, but again this is speculating.

Whatever the mechanism, men with low SHBG who are supposedly those that will do best on TRT are paradoxically those who seem to be fairing the worst.

I would very much like to get to the bottom of why this is. I feel by doing so and finding an answer/reason for this may perhaps pave the way to good health via a TRT protocol which would more appropriate for me and men like me.

A penny for your thoughts?


Regards,

Chris

im thinking of going on trt, but iam not sure my shbg..ive had so many tests i doubt my do wil ltet that..if mmy free test is 91 on a scale of 35-150 i most likely dont have low shbg right?

 

[James23]

It has been 4 years since this was first posted. Has anyone found new information on HRT with low SHBG, or information about how to raise SHBG?

 

[coolcat20]

Has anyone with low SHBG high E2 been succesfully treated?

My doc said my low SHBG of 13 (12-75) is healthy [}]

My E2 is 149 (<=150)

 

[James23]

Has anyone with low SHBG high E2 been succesfully treated?

My doc said my low SHBG of 13 (12-75) is healthy [}]

My E2 is 149 (<=150)

It's not healthy.

Low SHBG causes excess free T and thus higher metabolic clearance and also higher aromatization from T to E2.

High E2 should lead to elevated SHBG. If you have elevated E2, but low SHBG, it means something is preventing your body from balancing hormones. Liver disease, hypothyroidism and insulin resistance can causes this. However, it can also be genetic.

I would get a new doctor, if I were you. It is said that Dr. Mariano in CA is knowledgeable about this particular situation.

Has anyone ever been successfully treated? Not that I know of. Do a search on the board and you can find threads about this situation that go unanswered and are 7 years old.

 

[coolcat20]

Thats worrying,
I wish i lived near CA unfortunately i live in England and have to put up with the AMAZING NHS
after looking up Liver disease, hypothyroidism and insulin resistance i have a hunch its a genetic thing in my case.

 

[zkt]

It might be better to treat the E and let the SHBG alone. It not like brain surgery to control E.
GB might not have the best healthcare system in the world but at least you have one. In the USA we have the medical treatment for profit system.

 

[James23]

It might be better to treat the E and let the SHBG alone. .

FWIW:

I've treated the E alone and without any subjective success. I used to have, according to Dr. Crisler ,while on Arimidex and Depo-Test, the "best estrogen profile [he has] ever seen." (2006.)

Using the bird's eye approach of monitoring FT, T and E2 -- I looked like a gifted athlete on paper. Regardless, I had zero libido, sporadic ED, mood swings, muscle would not grow, major hair loss/shedding and I felt like shit.

Only one offending lab test value appeared on blood tests: a single digit SHBG level.

Arimidex inhibits E2 only and does not reduce total estrogens. Low SHBG will still leave you with the impaired androgen transport, accelerated clearance, over-conversion and receptor related problems. I think these are the key to libido. (Steady state T from an adequate protein-bound buffer that encourages dopamine release in the /appropriate/ areas of the brain, plus SHBG-R receptors in the brain and genital tissue.)

 

[coolcat20]

It might be better to treat the E and let the SHBG alone. It not like brain surgery to control E.
GB might not have the best healthcare system in the world but at least you have one. In the USA we have the medical treatment for profit system.

well my endo seems to be an ignorant prick so i might actually have to go private and pay anyway [)]

 

[coolcat20]

FWIW:

I've treated the E alone and without any subjective success. I used to have, according to Dr. Crisler ,while on Arimidex and Depo-Test, the "best estrogen profile [he has] ever seen." (2006.)

Using the bird's eye approach of monitoring FT, T and E2 -- I looked like a gifted athlete on paper. Regardless, I had zero libido, sporadic ED, mood swings, muscle would not grow, major hair loss/shedding and I felt like shit.

Only one offending lab test value appeared on blood tests: a single digit SHBG level.

Arimidex inhibits E2 only and does not reduce total estrogens. Low SHBG will still leave you with the impaired androgen transport, accelerated clearance, over-conversion and receptor related problems. I think these are the key to libido. (Steady state T from an adequate protein-bound buffer that encourages dopamine release in the /appropriate/ areas of the brain, plus SHBG-R receptors in the brain and genital tissue.)

So what do you believe would fix the issue? if anything at all..

 

[James23]

So what do you believe would fix the issue? if anything at all..

Hope and pray that the low SHBG stems from elevated cortisol, elevated insulin or subclinical hypothyroidism.

Otherwise, the only way to treat low SHBG is to replace or stimulate SHBG production. SHBG is available in research form, but not as an approved medication (at least not in the USA.)

Caffeine (350mg/day+), estrogens, and T3 induced hyperthyroidism have been shown in studies to increase SHBG where it is deficient.

 

[coolcat20]

Hope and pray that the low SHBG stems from elevated cortisol, elevated insulin or subclinical hypothyroidism.

Otherwise, the only way to treat low SHBG is to replace or stimulate SHBG production. SHBG is available in research form, but not as an approved medication (at least not in the USA.)

Caffeine (350mg/day+), estrogens, and T3 induced hyperthyroidism have been shown in studies to increase SHBG where it is deficient.

Can any of those 3 things cause a hormonal imbalance such as high Estrogen? I'm just wondering if maybe i do suffer from one of the things you mentioned that if i were to be treated for it - it could inturn balance my hormones without having to take AI's and other forms of HRT.

 

[kenseth17cd]

I believe that a lot of us with low shbg probably did not need testosterone replacement in the first place. Take my initial bloodwork for example.
Total T of 300
E2 of 74
Ok this seems low for a 21 yr old male, but at that time I did not know my shbg was 9.6. If my dr would have prescribed adex to get the e2 down to a safe level, my total t probably would have went up to 500 or so and with a low shbg that would have been great. I would have a free t as high as most men with a total t over 800. Here is my theory, a lot of us with super low shbg attempt trt at a dosage that is just too high and it puts to much stress on our thyroid and adrenals. I feel that a frequent low dose of testosterone such as eod or e3d along with an AI to monitor e2 levels would be sufficient. If your shbg is low like 12 or less, you do not need a total t level of 800. That would actually be way too high and you would have an overload of free t as well as free estrogens. So maybe we should all quit worrying about having super high total t numbers and shoot for a total t of 400-600, or whatever level would put your free t in the 180-250 range on shippens chart and see if that makes a difference. I personally am trying this and will post my results in the future.