Discussion in 'Random Thoughts from Dr. John' started by Dr. John Crisler, Dec 20, 2014.
Interesting as I use androgel due to SHBG of 59nmol/L
as a low SHBG guy I find that I just can't get a point that I don't require an AI, largely due to the free Estrogen that comes along with my free T. my dosing on Cyp is somewhat high @ 60mg 3x week, my peak is very high at >1450 and my trough is low @ 814. I have to do things frequently...M/W/F injections and I need a small amount of Anastrozole on each injection, .20mg currently. Keeping the estrogen in check has been the toughest part, starting out it was way up then way down...it's been a long journey of tweaking things. I'm in a good place though right now, very happy to the point I don't feel the need to continue seeking improvement.
You may be just plain taking too much. Even if the T excretes into your urine, it still gets to be converted into estrogen first.
You may need to go to daily shots. Some do.
I have high SHBG and high estrone. How does one lower both?
SHBG 73.7 (16.5-55.9)
Estrone Serum 138 pg/mL (12-72)
Very interesting thread! Thanks for starting it. This is a subject I think more older men, and the doctors that treat them, should understand better.
I'm one of those guys with high SHBG and normal TT (before TRT). I could not get my original GP to measure Free T or SHBG even though I had classic Low T symptoms. He just wanted to start me on an anti depressant and get me out of his face. After finding the right doc, I got started on a program that adjusted my dose to overwhelm SHBG so that enough T spills over to keep my Free T in range ("Mass Action" as Dr. J describes it). It works very well for me and I've been doing this for over 3 years.
Something that should be pointed out is that there are limitations to how high you can go with TT before other problems occur. Doc, correct me if I am wrong, but I believe that the T-SHBG complex has peripheral receptors and is active in exerting androgenic effects, even though the complex it too large to cross the blood-brain barrier where we need the T. One of those peripheral T-SHBG receptors must be located in the bone marrow because I consistently run at the upper end of hematocrit. This effectively limits my T dose to where I am at now.
I do a double red blood donation every 16 weeks like clockwork. My hemoglobin at the time of donation is usually at the upper end of the range (and what they will accept) at around 17. After the donation, it drops down to the lower end of the normal range at around 13.5 and slowly creeps to the upper end of the range over the next 16 weeks to donation time.
I don't recognize that E1 range. Do you happen to know the laboratory methodology employed? I do not believe it was the appropriate LC/MS.
The range (12-72) is used in LabCorp
Estrone Test Number: 004564 CPT: 82679
Methodology Radioimmunoassay (RIA)
LabCorp have another estrone test:
Estrone, LC/MS (Endocrine Sciences) Test Number: 500634 CPT: 82679
Liquid chromatography tandem mass spectrometry (LC/MS-MS)
It may be worth while to do this test rather than the test you have done (and dr John have misgivings about it, and would prefer LC/MS).
There is good likelyhood that you will also find your estrone very high, just the results will be more accurate.
It would be good idea to test as many estrogens as possible.
You can test E1, E2, E3 and total estrogens using blood testing,
and other estrogens in 24hr urine.
High testosterone lowers SHBG and tend to raise Hgb, HCT, RBC, iron related indicators.
May create need for phlebotomies.
High estrogens raise SHBG.
Keeping testosterone and estrogens in their proper range should somewhat optimize SHBG.
E1 is produced from androstenedione with assistance of aromatase.
E2 is produced from testosterone with assistance of aromatase.
Both E1 and E2 convert both ways with assistance of enzyme 17B-HSD
We can influence this process by suppressing or killing aromatase, that results with less E1, E2 being produced.
We can influence this process by increasing metabolization rate that disposes them more quickly.
All above is within normal process.
There is also abnormal process related to cancer, large quantities of estrone are being produced by backdoor process.
Dr John I have an exact copy of the lab report that my doctor got. It does not have the test number on it. All it says is Estrone serum. It lists ranges for both sexes and different ranges for age groupings.
0-5 yrs 18-53 pg/mL
6-7 yrs 17-48
8-9 yrs 20-54
10-11 yrs 21-49
12-14 yrs 17-44
I have read up a bit on the Rhein 24 hr urine test. As soon as I get my tax refund I will be getting that test done and also scheduling a AOC with you once I have the results as that is the test you recommend.
I was taking HCG at the time. A dose of 200IU every other day injected IM as I didn't feel anything from it injecting sub-Q. Could that be responsible for the high estrogens? I was bloated big time and had horrible ED, sore nipples, breasts seemed to be getting larger and no sex drive at all. I didn't do any HCG for 5 days and took .5 mg Anstazole that day I got my results which got rid of the bloat within 2 days. Took 2 more .5mg doses and now have low E symptoms and have stopped the AI. Now doing only two 200IU HCG shots per week.
Adex nor letro lowered my high e1. Let us know what the rhein test says.
You just have to check the laboratory methodology. Liquid Chromatography/Mass Spectroscopy (LC/MS) is what it takes to most accurately measure estrogens in men.
Usually you can go online, to the lab's website, to find out how they run a given test.
...from what I got, the test was this --> LabCorp -- Unit Code: 904564
From that link --> Methodology: Radioimmunassay
*edit* -- just noticed that JanSz has already provided us with this information above
The NEW "Sensitive Estradiol", which has the same code as the old one, but is the appropriate LC/MS (and is quite inexpensive) is #140244.
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