T Nation

Can I Use an AI & SERM Together?

Based on my 6 week lab results my SHBG is really bad

Protocol 20mg subq Propionate / daily

Testosterone 25.5 nmol
Free Testosterone 1.1nmol
E2 145 pmol
SHBG 5.35 nmol

Labs before TRT

SHBG 9 nmol flagged low (16-55nmol)
Free T 351 pmol
T 11.1 nmol
Albumin 46 g/l

I’m wondering if I can take an AI at a low dose to bring my e2 down to 30 & a SERM to increase my SHBG level? Just unsure if that is ok to do?

Ksman - We need details of your protocol. Are you on a SERM?

No, I do have adex here 0.05mg volumetric doses

You asked about protocol

At this time im soley using test p @ 20mg subq daily

Do you still recommend adex 3 times a week?

Careful lower E2 too much could lower SHBG a little, get E2 in ranges. There isn’t much you can do to increase SHBG unless your hyperthyroid which would explain low SHBG. You ned to get to the gym and workout, this temporarily raises SHBG.

KETO raises SHBG. Intermittent Fasting raises SHBG. Almonds and pistachios raise SHBG.

is there no drugs that can increase it? I was told I’m basically wasting my time with injections with a SHBG that low, I have had thyroid checked several times and I’m low normal range, I’m not overweight either, in fact I could do with putting some on, 5ft 11, 12stone, I feel like shit I am willing to try anything

Thyroid meds do.

You need to research Keto and IF.

Women who have PCOS, which is caused by an abundance of free testosterone (low shbg) , are advised to go on KETO to raise their SHBG.

“I feel like shit I am willing to try anything” - I just gave you 3 options that are proven to increase SHBG.

Thanks I will look into the KETO & Fasting diet

Almost all need T+hCG+AI.

SERMs increase E2, many get that wrong.

You should be near E2=80 pmol/L

If SERM dose is too high, or too high for you, too much LH leads to high testicular T–>E2 and serum E2 gets high. Anastrozole can fail to help because it really only can work on T–>E2 in peripheral tissues and not inside the testes. SERMs are not always viable.

We need details of your protocol. Are you on a SERM?

Directly edit your post above, look for pencil icon and add lab ranges. Also add any other lab data that you have. Do not skip because it states normal.

Low SHBG sometimes just happens. But there is an association with diabetes. So we have interest in fasting glucose and A1C.

SERMs do not have any direct effect on SHBG! More E2 would but E2 already is too high.

What other health issues and medications?

Is fertility a concern?

Suggest .5mg anastrozole 3 times per week.
Should notice changes in 5-7 days.
If you feel crashed in 2-3 days or sooner, stop and then resume after 6 days at 1/4th of the above dosing. So .25 or .2mg twice a week would be a good re-attempt.

If E2 levels do not come down near E2=80pmol/L target, the problem is the SERM with LH too high. You can test LH/FSH on a SERM to see what is happening. An acceptable SERM dose from an E2 point of view might not be able to sustain good T levels. So a SERM sometimes?often does not work.


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.