Nobody attempts to move their SHBG levels by manipulating their E2 levels, each hormone has its own sweet spot and you’ll never be able to balance all your hormones in this manner. Only large weekly doses will bring down SHBG.
TRT is for life, you lose the benefits when you stop TRT. SHBG will return to previous levels.
It does seem that trt is the best option to lower shbg. Would the weekly doses be something I would have to continue for life or would I be able to stop once shbg returned to normal? It seems I am able to produce enough testosterone on my own.
You need to read the following a few times, a lot to digest.
Your remaining teste is not working very well. Your pituitary is pounding your teste with very high LH/FSH. So it looks like secondary hypogonadism except for the fact that your T levels are not low. The teste may be having LH receptor down regulation from high LH.
With LH so high, testicular T–>E2 is very high and then serum E2 is high. So the T competitive AI anastrozole is not expected to work well. If you take 0.5mg anastrozole twice a week and E2 stays high, that hypothesis is confirmed. The only way to fix that is to get on TRT with higher T valves that should LH/FSH–>~zero allowing anastrozole to manage peripheral T–>E2.
On TRT if LH/FSH does not -->~zero, again there is a H-P problem as I suspected, but worse that anticipated.
High E2:
This case is very unusual and I suspect a problem in hypothalamus-pituitary function. MRI any one?
Diagnostic: So get started on TRT with 0.5mg anastrozole twice a week taken at same time as 50mg T injections twice a week. Do labs after three weeks: TT, FT, LH/FSH, prolactin, E2. Then if LH/FSH go down you can keep on TRT, if LH/FSH does not go down, there is an HP problem. If E2 goes down, great. If LH/FSH stays high, E2 probably will too. If an HP problem, get an MRI of these areas.
If on TRT with LH/FSH–>~zero, you will need 250iu hCG SC EOD to preserve size and fertility.
Please read the stickies found here: About the T Replacement Category - #2 by KSman
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 numbers 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.
Thank you for all that information. I am scheduled to go in for an MRI soon. Before I do so my GP wants me to talk to my oncologist about it and that appointment is tomorrow 3/21. Once I have my MRI results I’ll go back to my endocrinologist and I will ask her about your recommendations. Hopefully she agrees with you. I just got the results today for new labs I took 3/14 here they are
LD: 143 (100-200 U/L)
AFP (tumor marker): 4.3 (<6.1 ng/mL)
FSH: 24.6 (1.6 - 8 mIU/mL) High
LH: 20.4 (1.5 - 9.3 mIU/mL) High
E2: 41 ( < or = 39 pg/mL) High
HCG, TOTAL, QN: <2 ( <5 mIU/mL)
SHBG: 84 (10 - 40 nmol/L) High
I’m not sure why things are going down. Nothing has changed. I will provide further updates once I have my MRI and go to my appointments. Thanks again for the reply.
Your doctor probably does not take my engineering approach to this problem, but might like some aspects of it.
Finally an update. I really need some input here.
I had the MRI on my pituitary and it came back normal.
After that I went to see my endocrinologist and she thought we should try an estrogen blocker to lower estradiol and that was the end of her plan. I asked what she planned to do to lower the sbgh and she tells me that she didn’t really think that was a problem. I explained to her why it was important and she tells me she doesn’t know how to lower it. I tell her about @KSman recommendation for t-injections along with an AI and she tells me she will consult another endocrinologist who knows more about the topic than she does.
Her colleague let’s her know that he also doesn’t know what is going on with me. So they agree that we should try an estrogen blocker and see what happens. I’m not happy and I explain that I would like the t-injections but that I would still give the AI a chance on its own.
So now I have a bottle of Anastrozole. The dosage is supposed to be 1mg tablet per day. Per day!! There is no way I’m taking that much. I was thinking about .5mg twice a week but the tablets are really small so I might have to do 1mg twice a week. I took my first 1mg tablet today.
Does anybody think that and AI on it’s own will be able to lower shbg by lowering estrogen? Is it even safe to take on it’s own like this? Any recommendations on dosage.
I know I should find another doctor but through work health insurance this is extremely cheap.
Others can help that read your log. But this I do know. Run fast from this Dr. If she prescribed 1 mg a day she is causing you great harm.
You’re dealing with incompetence doctors, as long as you continue to see these doctors you will be the guinea pig and guinea pigs always suffer until such time the doctors start to understand where mistakes were made.
Is this what you want? Insurance is typically useless for TRT as doctors have no clue what their doing, it isn’t cover at all in medical school. It’s all trial and error and there are those who have osteoporosis from taking 3mg of arimidex weekly over years, the usual complaint to doctors is, “why do my bones hurt”.
I saw my third endo on Monday who is knowledgeable in everything but TRT, he told me he will run whatever labs I want, when I want and for me to find the correct dosage and injection frequency and report back to him and he will change my prescription to match but refuses an AI.
I have no intention to going that route, sure it’s cheap with a $10 copay twice yearly. I’m saving up for Defy Medical with a yearly cost of $1300-2000 yearly. I’d rather foot the bill than suffer at the hands of these doctors. If an AI was provided I’d have the keys to the kingdom.
FSH: 24.6 (1.6 - 8 mIU/mL) High
LH: 20.4 (1.5 - 9.3 mIU/mL) High
E2: 41 ( < or = 39 pg/mL) High
You have secondary hypogonadism.
TT is strong and is low, was
With high SHBG, non-bioavailable SHBG+T is very high, inflating TT and TT overstates T status, while FT is reduced - TT ,FR ???free??? (DIALYSIS): 54.5 ( 35 - 155 pg/mL)
High E2 is promoting more SHBG production.
E2 is high because high LH/FSH is overstimulating the testes and testicular T–>E2 is high, doctors do not understand this and they also do not understand that anastrozole is very ineffective inside the testes because T levels there are higher than serum and the competitive drug cannot compete against the T levels there.
To lower E2 you need TRT to lower LH/FSH, then testicular T–>E2 will be resolved. With lower E2 and high FT/Bio-T SHBG should be reduced, but some guys systems do not know about those rules. If you then cannot get SHBG lower, you will need higher T dosing to get higher FT levels and will need to have quite high TT levels ignored.
Update: The source of high E2 also needs to be considered against the backdrop of lower FT which means that FT–>E2 in peripheral tissue is then low. Then higher testicular E2 seems the obvious source.
Update. I decided to give the anastrazole a chance. I only took it 3 weeks due to side effects. My joints, hip, wrists, fingers, and back were hurting and I felt sick and tired all the time. The first week I did 1mg twice a week then I lowered it to .5mg twice a week the last two weeks before I stopped.
Here are my labs I took 5/15
FSH: 25.9 (1.6 - 8 mIU/mL) high
LH: 12.5 (1.5 - 9.3 mIU/mL) high
Estradiol: 36 (< or = 39 pg/mL)
SHBG: 97 (10 - 50 nmol/L) High
TT: 935 (250 - 1100 ng/dL)
FT: 66.3 (35 - 155 pg/mL)
FSH has been constant while LH seems to be going down. E2 did go down with the AI but SHBG spiked back up. TT is increasing a lot and FT is still lower than I’d like. (There are 2 labs I took before this that I didn’t post)
Lately I’ve felt worse than usual. I’ve been unable to lose fat and I haven’t been able to finish my workouts anymore. Plus my anxiety and depression seem to be worse. I still dont get morning or spontaneous erections.
@KSman I trust your assessment of my situation but I am struggling to find a knowledgeable doctor. I’ve been turned away from trt clinics due to my high TT, TCancer history, or the fact that I’m 25. Nobody seems to know what SHBG is. I’m hoping my endo will be willing to work with me the next time I see her.
You’ve recommended test injections 50mg twice a week along with AI .5mg and hcg. I will push for this.
You’ve been a member here long enough to know typical dosing won’t work for you, your high SHBG requires large weekly doses of testosterone and you’ll be lucky to get SHBG suppressed enough to create more free T.
Your TT is flooded with non-bioavailable SHBG+T.
TT needs to be ignored.
FT varies a lot and a single lab is not representative.
Bio-T might be the best lab for this situation.
With lower FT/Bio-T, E2=36 can easily kick your butt. I had E2=37 11-12 years ago while in TRT with high TT and FT and it made life miserable.
If you were on 0.5mg anastrozole twice a week for those labs; increase to 0.5mg X 36/22 which will move you closer to E2=22pg/ml. That would be 0.81mg twice a week, 0.75mg could be tried. Dispensing from a solution of 1mg/ml anastrozole in vodka allows for arbitrary dose amounts
Those aren’t side effects from anastrazole. Those are side effects from low E2.
Joint pain, fatigue. Literally getting sick because your immune system relies on e2.
Is that E2 test the sensitive?
You need to tread lightly here. I agree something needs to be done with your e2. But if you keep accepting the “side effects” of the anastrazole. Those joint problems will only get worse.
Recovering from AI induced musculoskeletal syndrome takes anywhere from 6 months to 1.5 years. If you are lucky enough to stop soon, you might not have any issues past a few weeks.
That explains the situation. Not current issue.
I was expecting my estradiol levels to be too low based on the side effects as well. I dont think I took enough to cause low E2 though.
This is not the sensitive test. It’s only the regular estradiol test at quest.
I stopped taking the anastrazole 5/12 and it only took 3-4 days for the side effects to go away.
So from what I understand, that is not the test you want to go off of if you are having e2 issues.
You need the sensitive test.
Just to clarify: What exactly was your anastrozole dosing for those labs and for how long prior?
I will ask for Bio-t in my future labs as well as the sensitive E2 test.
I started taking the anastrazole 4/25 and stopped 5/12 (3 weeks). I had never taken it before this. The first week I took 1mg twice and the next two weeks I lowered it to .5mg twice. I had these labs taken 5/15.
I think I would want to wait until I am able to start trt before I take anastrazole again.
My endocrinologist finally decided to give trt a chance. I owe you a big thanks @KSman! I explained your analysis and diagnostic and she was willing to give it a shot.
I’m starting 50mg T injections twice a week taken with .5mg of anastrazole next week.
I’ll be taking labs in 6 weeks to see how fsh, lh, tt, ft, shbg, E2, and prolactin react. We will also discuss hcg at this time.
@systemlord You said typical dosing wouldn’t work for me because I have very high shbg (97 nmol/L). Now that I finally received my prescription for T-injections I wanted to ask what dosing schedule you think will be most effective. My endo is letting me control my dosage so I can make adjustments.