T Nation

32 Y/O High SHBG, Potential E Dominance?


#1

Age: 32
Height: 166cm / 5'5"
Waist: 78cm / 31"
Weight: 74kg / 164lbs
Body and facial hair: Light facial hair, have trouble growing a convincing beard. Light body hair around chest & stomach (not much else), average arms/legs.
Carry fat: Love handles/hips, thighs, butt.
Health conditions, symptoms: A lot of trouble losing weight. Brain fog, fatigue, low libido, unrefreshed sleep.
Rx and OTC drugs etc: Nothing...
Diet: Low carb, moderate protein, high fat. Moderate calorie overall & pretty stable staying on the wagon, some cheats Fri or Sat night.
Training: Lower rep heavy compound lifts, 3-4 times a week. HIIT or Tabata 2 times a week.
Testes ache, ever, with a fever?: No aches etc...
Morning wood: I have no memory of of morning wood in the last few years.

Recent bloods - July 2016 (8:20am):
FSH: 8 U/L (1-11)
LH: 6 U/L (1-8)
Estradiol: 130 pmol/L (0-190)
Prolactin: 120 mU/L (45-375)

DHT: 2.43 nmol/L (0.35-2.50)
Total Test: 34.2 nmol/L (8-27.8) *high
Free Test: 0.468 nmol/L (0.091-0.579)
SHBG: 73.6 nmol/L (10-70) *high
DHEA-S: 4.6 umol/L (2.2-15.2)

Fasting Insulin: 4 mU/L (<12)
Fasting Glucose: 4.3 nmol/L (2.5-5.4)
ACTH: 5.9 pmol/L (2-10)

Cortisol: 493 nmol/L (140-600)

TSH: 1.6 mU/L (0.5-5)
Free T3: 5.2 pmol/L (3.2-6.4)

CRP: 1 mg/L (<5)

Morning temp was 96.6

I've been tracking my bloods for about 3 years now, looking into hormones due to the usual stuff; unexpected weight gain that's hard to shift, low energy, low libido, motivation, concentration/memory etc.... The bloods vary year to year, usually the SHBG & Total Test are on the high end, regardless of the other variations the symptoms remain the same.

My background; I was previously obese going back a decade (2006), as a teenager I was overweight but not to this extent. Partying caught up with me around the age of 21, but as I turned 22 I cleaned up everything... Committed throughout 2007 with sensible diet and exercise principles (following a lot of T-Nation CT/Poliquin/Berardi stuff at the time) and by early 2008 I had dropped 40kg/90lbs heading down to approx 62kg/136lbs, maybe around 10% bodyfat (abs, vascularity etc) ... I maintained my weight within a few kg's no issues for the next few years but it crept up a bit heading into my late 20's, though if I worked out whatever was happening (diet/lifestyle etc) and cut for a few weeks I'd get it back down at will.

Mid-2013 I started feeling fatigued and had a lot of trouble with both seeming to gain weight without a lot to account for, and not being able to shed any of the excess - I could probably drop 15-20lbs at the moment, it shouldn't be too hard to get things moving. Lifting and nutrition have played a part of most of my adult life... I have what seems to be an Estrogen dominant fat distribution - no gyno & the top half of my body looks ok, but my love handles are more prominent than my gut, a lot of fat on my thighs, butt and some cellulite and overall retention. More subcutaneous akin to my sister, rather than that visceral gut like my Dad if that makes sense.

Mid-2013 again, I started getting symptoms associated to Intracranial Hypertension (pseudotumor cerebri) - pressure behind my ears and eyes, ringing in the ears, some blurred vision and floaters... Basically pressure from excess CSF hitting cranial nerves, it's 10-1 more common in women triggered by hormonal shifts (obesity, pregnancy, PCOS, contraceptives); in men usually sleep apnoea or androgen deficiency. I have had some TMJ dysfunction (teeth grinding while sleeping) in the past which might trigger apnoea, but I had a septoplasty for a deviated septum 18 months ago so I'm breathing fine (and otherwise don't fit the lifestyle factors)... The concept is the dynamics of Estrogen, even if plasma levels are within range they can be elevated in CSF or on a cellular level - most of the pubmed documents go through a lot of hormone related info. Strong diuretics (risking kidney stones) or weight loss are the only prescription.

I'm in Australia, as I've seen with others on the forum there isn't a lot of open-mindedness in the medical community regarding hormones here. I've seen an Endocrinologist which was useless, I went through a sexual health specialist a few weeks ago who was open minded with the clinical symptoms (wrote "strong clinical indication of androgen deficiency" on the pathology request) but 'legally' couldn't offer any advice based on the 'perfectly fine' blood results.

There isn't a lot I can clean up in my life from here; I've been sober all year (wasn't a big drinker prior), following a low-inflammation diet. My life is busy, but not stressful and despite how shitty I feel I don't have much trouble with willpower. I've gone through the supplemental protocols for estrogen dominance, adrenal fatigue, gut health, heavy metal detox etc. My vitamin D has always been good, for a long time have supplemented zinc, magnesium, fish oil, probiotics, B's, curcumin, ubiquinol (coq10) and cycle through things like selenium, iodone, adaptogens, melatonin/or theanine, alpha lipoic, thistle/silymarin, occasionally some binders (charcoal, EDTA). Detox stuff like infrared sauna, dry skin brushing... Eating meats, eggs, vegatables, fat (coconut oil, butter etc) and always functioned fine low carb. Shorter workouts of heavy lifting, or some intervals - nothing that will lead to burnout. I've been cleared of allergies, autoimmune conditions etc. I've been mindful about xenoestrogens the last few years. My sleep hygiene is pretty good, 8 hours a night, getting to bed early, blue blockers, supps, EMF etc - takes 5 minutes to crash, but wake up feeling unrefreshed... No alcohol at all or cigarettes, most of the year no coffee (maybe a single cup on the weekend), a little weed on a Saturday night.

I have felt colder over the last few years (my ex would comment how cold my feet were in bed), but it's getting better this year. The surgery for my deviated septum 18 months ago noticeably fucked with my adrenals, it took me a while to bounce back but I'm better than I was... Sex drive isn't great for my age, no morning wood. No ED, but erections aren't so 'inspiring'... I've tracked my weight/measurements, workouts and diet logs on/off over the years, the last 4 months my weight hasn't shifted more than 1kg regardless of the periods where my diet and routine has been immaculate. I don't feel like I can throw much else at it without taxing my CNS/adrenals.

That was more long winded than anticipated, my main concern is the aromatase/estrogen situation on a clinical level (if the bloods aren't painting a clear picture). Following the "adipose tissue as an endocrine organ" model, there being 10 times the aromatase activity in the hips/thighs/butt etc. If my total T is high and bound, Estrogen less bound, and adipose tissue in sites to cause more aromatase activity. Being previously obese, the Intracranial Hypertension and it's ties to hormone function. The feedback loop of more fat = more estrogen, more estrogen = more fat.. I'm not too sure where to go from here; I looked into AI monotherapy if my body still functions fine producing Test. Maybe taking something to blunt down SHBG a bit. With the more I read, even if I start to understand things clearer than before, I come to realise how complicated it is to apply any protocol.

I've attached the salivary hormone panel I did in 2014, all doctors or specialists don't take it seriously but maybe it adds to the puzzle.


#2

In my experience keto really elevated SHBG. Insulin decreases SHBG apparently. You might consider experimenting with carbs, and see how you feel.

The concept of cellular (vs serum) estrogen is interesting. Any merit in that idea?


#3

Morning temp (Saturday) = 97

I've considered the insulin / SHBG idea and experimented in the past but symptom-wise nothing changes. I'm following low carb to keep the inflammation down, mananging brain fog, sleep, the diuretic effect is beneficial for Intracranial Hypertension & I'm able to handle my appetite well. But, I'm fine with trying anything, no issues switching it up.

Not hard pressed on the concept, I'm trying to be open minded with a lot of the information but might not be on the right track?... Pseudotumor Cerebri = Intracranial Hypertension.

An integrated mechanism of pediatric pseudotumor cerebri syndrome: evidence of bioenergetic and hormonal regulation of cerebrospinal fluid dynamics
ncbi.nlm.nih.gov/pmc/articles/PMC4641240/

Hypothalamic-Pituitary-Gonadal Axis
Androgens and estrogens have diverse metabolic, influences on the CNS. In patients with PTCS, characteristic changes in sex hormones may occur. In the CSF of both male and female adult patients with PTCS, estrogen levels are increased while androstenedione levels are decreased (ref. (55,56) but see (57), differences not seen in plasma (55) and suggestive of a localized increase in aromatase activity.

Estradiol in elderly men (Department of Endocrinology, Ghent University Hospital)
ncbi.nlm.nih.gov/pubmed/12198740
In males, testosterone is the major source of plasma estradiol, the main biologically active estrogen, only 20% of which is secreted by the testes. Plasma estrone, 5% of which is converted to plasma estradiol, originates from tissue aromatization of, mainly adrenal, androstenedione.... Plasma levels of estradiol do not necessarily reflect tissue-level activity as peripherally formed estradiol is partially metabolized in situ; thus, not all enters the general circulation.... Increasing aromatase activity increase in fat mass, significantly related to body fat mass and more specifically to subcutaneous fat, but not to visceral fat. Indeed, aromatase activity in abdominal fat is only one-tenth of the activity in gluteal fat.