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So You Think You Want Your SHBG Lower?

Discussion in 'Random Thoughts from Dr. John' started by Dr. John Crisler, Dec 20, 2014.

  1. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Not necessarily.

    If you are not on TRT, then higher SHBG gobbles up your testosterone. Then, as your T production lowers with age, you get less (and less) Free T. Even with upgrading of LH in response, you just can't produce any more T. Eventually it falls below the point you can maintain health and happiness

    Now add in that SHBG normally increases with age.

    But if you are on TRT, I actually prefer SHBG on the upper end of normal range. Sure, it binds to the T, but I can easily mass action over the top, by increasing the dose.

    At this point it is important to remember SHBG binds nearly all sex hormones. This includes the class of hormones known collectively as "estrogen".

    So lower SHBG gives more Free T, but it also leaves more Free Estrogen to do its dirty work. There are some guys who can tolerate very little estrogen for this reason.

    You can think of SHBG as a buffer to protect us from too much estrogen.
     
    Last edited: Dec 20, 2014
  2. hebsie

    hebsie Super Moderator Staff Member Super Moderator

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    KYinchampaign likes this.
  3. Weasels

    Weasels Member

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    Doc,

    What do you consider as ideal SHBG levels?
     
  4. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    I'm most comfortable with SHBG at mid-range. Then it really is not having an effect of things.

    Remember, SHBG is the centerpiece of the proper hormonal evaluation.
     
  5. TX Tornado

    TX Tornado Member

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    Wow!
    This could be one of the valuable posts I've read on here!
     
  6. xks201

    xks201 Active Member

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    Could it also transport estrogen to cells, thereby enhancing estrogenic effects?
     
  7. BadassBlues

    BadassBlues Super Moderator Staff Member Super Moderator

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    Great post.
     
  8. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    ...just gettin' warmed up.
     
  9. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Yes--that is precisely the point. SHBG level can be a double-edged sword.
     
  10. xks201

    xks201 Active Member

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    You literally said it was a buffer to protect us from estrogen yet that isn't the case exactly if it is also a transport protein to the estrogen receptor. If it binds estrogen and then transports it to the receptor I would think that would be even more lethal than having it free with a relatively shorter half life. I don't expect omniscience from you because I have read some scientific literature that basically amounts to no one claiming to know which side is more capable of producing estrogenic effects. I guess we will just have to wait for some intricate study that measures effects or something of bound and unbound estrogen.
     
  11. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    When SHBG goes down, estrogenic effects go up, for the same amount of estrogen.

    Yes, there is some fascinating research going on that we are all eagerly watching, but the above can not be avoided. It is a reality we see every day in clinical practice.
     
  12. Katzenjammer

    Katzenjammer Active Member

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    superb post thanks.
     
  13. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    A lower SHBG, because it allows increased metabolization/excretion of testosterone, must be accounted for when evaluating labs.

    If you are drawing labs toward the end of your injection week, T and E will both be lower than would be expected with a higher SHBG level. That makes it more difficult to predict how much you should raise/lower the testosterone dose. And, in that same case, T 9and E) could be very high at peak--too high--and cause problems.

    These are the guys who say they felt good the day after the shot, then they didn't feel so good, then better, then not so good at the end of the week. Using your diagram shows why this is so.

    Questions?
     
  14. Jimstigator

    Jimstigator Member

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    Loving this information.

    Is there a standard approach to assist someone with low SHBG? While I have read (from your presentation) you generally start men on sub 100mg test cyp a week injected once or twice, do you modify this up front for fellas you know have low SHBG from the go?

    Thanks!
     
  15. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Great question.
    I usually start guys at 80mg per week. And usually do so for those with lower SHBG as well; even though I know we will probably have to evolve the regimen later. But the initial weekly dosing, upon careful review of subjective report from the patient, yields valuable insight into how his body works.
     
  16. Testosterone

    Testosterone Member

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    What is your view of using Clomid or T3 to attempt to increase SHBG in cases where the body is doing a horrible job with the math?
     
  17. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    Good question.

    Not appropriate, unless otherwise indicated.
     
  18. xks201

    xks201 Active Member

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    I have tried adex, letrozole, and aromasin. Adex and letrozole did not suppress E1. I have yet to test aromasin's ability to block e1 conversion. Perhaps elevated DHEA is the cuprit. Do you have any experience with micronized DHEA not increasing estrogen as much as non micronized dhea? Do you have any experience with E1 monitoring?
     
  19. Dr. John Crisler

    Dr. John Crisler Lord of the Forum Staff Member Super Moderator

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    It's not that these aromatase inhibitors are not suppressing E1, as it is the same enzyme which produces E2.

    Rather, the shifting back and forth between E2 and E1 is favoring the latter.

    I assume your testing is appropriate (LC/MS), and E2 is okay?
     
  20. xks201

    xks201 Active Member

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    Yeah E2 is fine. 10 to 20 always even when e1 is 10x the reference range. If i take any oral non micronized dhea... even 25mg and I get all the high estrogen symptoms. Baseline dheas without treatment is only like 150 and I am on cortisol for a failed acth stim test. spectracell showed biotin and copper deficiency but other than that I don't know why I get such high estrogen symptoms from dhea. Sublingual micronized dhea at about 15mg is about all I can handle before high estrogen symptoms kick in. If I take more of any AI on oral regular dhea it doesn't stop the symptoms like sore nipples and ED. This leads me to think something else is going on other than aromatase. I find it crazy how e1 can be ten times the reference range when e2 is good. E3 is always 0. Not sure if this means that the estrogen isn't converting to e3 or what.

    Even without dhea and just on test at even low amounts I need an AI or I get the high estrogen symptoms and high e1. I don't think my body is metabolizing the estrogen out to the e3 pathway. It is blocked or something Is my guess. I don't know enough about estrogen metabolism to try and fix all of my sex hormones turning to e1 tho. When I first had my t level tested before therapy it was 300 and e2 was 35. I don't know at that time what e1 was.
     

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