T Nation

High SHBG/Est, What Actions?

T Replacement
#1

Hi T-people,

I had a blood panel done (It cost me 300 Euros just for this lot, so apologies if it seems insufficient) targeting a few areas that I had reason to believe are suspect.

I’m a 28 year old male, 5’10, 72kg body weight at 14% body fat. I’ve been lifting for 6 years, but dropped about 10kg lean mass over the last 12 months due to deficient caloric intake and high stress. I have taken a lot of steps to remedy both of these and consistent self-tracking is helping me improve.

Zinc: 15.7 umol/L [11-18]

Vit D-25 OH: 90 nmol/L [Deficient <25, Insufficient 25-50, Consider reducing >200]

Oestradiol 145.9 pmol/L [28-156]

Testosterone 27.7 nmol/L [9.9-27.8]

Free T 14.0 pg/mL [8.8-27]

SHBG 66 nmol/L [11-52]

Folate 12.8 nmol/L [7-39.7]

B12: 478.6 pmol/L [141-698]

I believe many here are U.S. based, so I think the T conversion is as follows:

Test 798 ng/dL

I’m open to any informed insights. To my eyes, the Oestradiol and SHBG results are through the roof!

I would appreciate assistance in getting those numbers down (and any references where I can understand the role they play as part of my endocrine system). I’m aware it’s not as simple as change number, problem solved.

Is there any possibility that if I had deficient iodine I could observe this pattern of high SHBG and Oestradiol? Can high levels of persistent stress and/or significant caloric deficiency cause this? Any other vitamin or dietary deficiencies leap out? Any more blood tests indicated that would clarify the problem? Are the Zinc/Folate/B12/D levels sufficient for someone with a very mentally and physically demanding lifestyle?

Thanks in advance for your insights. I would love to hear from anyone who has successfully improved a similar panel. On a final note, I’m not presently interested in a pharmaceutical approach. This by no means is me casting aspersions on those who do choose to improve their hormone profile in this way. My position is that there are still plenty of nutrition/lifestyle improvements that I can make before I look to that avenue.

Goldenchyld

#2

SHBG is made in the liver, primarily in response to estrogens. Higher T lowers SHBG.

Please use the [edit] function in the corner of your post above and add lab ranges to the data.

Your E2 appears to be 40 pg/ml. Should be near 1/2 of that. Suggest that you use 0.5 - 1.0 mg/week anastrozole in divided doses. I do not have any expectations that you will manage this with “nutrition/lifestyle improvements”. Unless we can find and eliminate something that might be affecting liver function.

Please read the advice for new guys sticky. Read carefully and fully. That is your best step right now. Note the other health issues discussed and consider. Note the opening notice. Check body temperatures and evaluate history of iodine intake.

Extreme diets, over training and low body fat can cause major problems for some.

Reduced clearance of E2 by liver can be from liver problems or the liver is too busy with drugs, Rx or OTC to get the job done. Alcohol, chemical exposure, even things applied to your skin can cause problems too.

Then E2 increases and liver produces more SHBG as a response.

If you lower E2, T levels should increase.

#3

Hi KSMan,

Thank you for your response.

I added lab recommended ranges as you suggest.

Folate is at the low end of the ‘normal’ range and so could be insufficient for me. Similarly, Vitamin D, although in the suggested range is low by ‘Vitamin D Council’ guidelines.

In terms of liver problems, should I have a liver function test? I had a full blood panel 5 years ago with high SHBG and the liver results came back normal (I could dig those out if they are relevant). I have never drunk alcohol, never smoked a cigarette and never used any recreational drugs. The closest I get to a pharmaceutical would be an Ibuprofen maybe twice a year. I believe (from the references) that Rx and OTC are steroids, and I haven’t used any of those.

I have likely been {over-training/under-eating} for about 6 years. I have just recently taken a complete handle on my dietary intake and it’s roughly doubled the amount of calories I eat per day (maybe even triple). Would letting that change cycle in be wise before pursuing a pharmaceutical route?

I read your sticky a couple of times before posting and have been tracking my body temperature for a couple of weeks every morning on waking. In that time it hasn’t gone above 97.2F and has been as low as 96.3F. I also purchased a dynamometer and on first measure my grip is that of a 14 year old boy! (31.1kg). Do those additional pieces of information help to find an explanatory narrative?

Thanks again for your help,

Goldenchyld

#4

Your E2 and SHBG are high and self-consistent. Your BF is low and liver is not clearing your estrogens. So it makes sense to check ALT/AST. 5 years ago may not be useful, did you feel different then?

Body temps are low, indicating functional hypothyroidism to some degree.

Can you get iodine supplements? As per the thyroid basics sticky.

I do not see how thyroid issues would increase E2.

What are your government provided health care options?

Anastrozole would be the best direct action to modulate your E2.

#5

Thanks again KSMan,

I’ll take your advice on getting a liver function test. I have felt like this for around 8 years and have only just had the right combination of {resources/mindset} to handle it.

I have ordered Iodine Supplements as you suggest. I’ll start on a relatively low dose and then increase gradually as recommended. I’m diligent about tracking, so I’ll be able to see if my body temperature responds over time.

There are some indications (sample source
http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/9285 and its references)
that severe caloric restriction increases SHBG and estradiol levels.

It’s hard to understand (not least because it’s so foolish) but there was a period of around 15 months when I was eating one sandwich a day when this all kicked off. Subsequent to that my diet has been a lot cleaner, but I have been eating the same amount as my 50kg girlfriend for most of the last 5 years (about two small meals plus a protein shake a day). As a result, I’ve not been used to feeling ‘hungry’ which accounts in part for me not just eating more earlier. In all that time I’ve been training hard in the gym on a regular basis. For this reason I’m going to track my increase in calories (and make sure I am getting sufficient essential nutrients) first before anything else.

I’m confident that your suggestion to use anastrozole would reduce my E2 and improve my quality of life overnight. Presently, however, I prefer to use my dissatisfaction as a tool to improve my overall health through dietary changes. If, after that point I still see no change then it shall be time for other options.

I hope this thread will be useful to somebody else in the future. If I fail to improve my results without Arimidex then at least others will see all the steps I took first and then be able to take your suggestion without wasting his time. If I succeed, then someone else who has deprived their body for a long period may be able to use my posting as a resource.

I’ll pitch back in with future bloodwork/changes. Thanks again for all the help you provide to people on this forum.

GC

#6

I had some more bloodwork done as per the recommendations. Does this provide any further evidence of thyroid trouble? The liver work and cholesterol tests all came back very healthy:

FT4 19.3 [12-22]
FT3 4.4 [2.8-7.1
TSH 0.83 [0.27-4.2]
PSA-Free 0.62 [<1.2]
PSA-Total 1.31 [<1.4]
FSH 3.2 [1.5-12.4]
LH 3.5 [1.7-8.6]
Prolactin 157.4 [98-456]
Testosterone 28.7 [9,9-27.8]

CRP 0.3 [<5.0]

Thanks again,

Goldenchyld

#7

Thyroid looks good… No problem there from what I see. Should be closer to 1 but ft3 and ft4 are ok so I’m not thinking thyroid…

As suggested liver markers

Next step is to check the adrenal function.

You need way more labs bud please post everything you have.

Your PSA seem high for a 28 year old I would see a urologist and get checked out with the old finger test.

This needs to be ruled out in my opinion

#8

Hi Iw84Aces,

Thanks for your comments, my other lab work (inc. liver) as requested:

Total Chol. 3.95 Low risk <5.2
HDL 1.65 No risk >1.45
LDL 2.13 No risk <3.37
Triglycerides 0.36 <2.3
Risk Factor 2.4 <4.9
Bilirubin-Total 10.9 <17.0
Bilirubin-Direct 2.6 [0-3.4]
Bilirubin-Indirect 8.3
Alkaline Phosphatase 80 [40-129]
Gamma Gt 11 [8-61]
AST/GOT 19 <38
ALT/GPT 19 <41
Total Protein:serum 72 [66-87]
Albumin 50 [34-48]*
Globulin 22 [19-35]

*Slightly high but this is usually from dehydration. It’s in the high 30s Celsius where I live (and the day of the test) and that’s the likely cause.

I believe these results are healthy. How would I go about checking adrenal function?

#9

ACTH
Insulin
C-peptide
Cortisol
Glucose
A1c
Rt3

4 point cortisol test is the only way to truly check cortisol. Most Likly would be a naturopath or homeopath doing this. Or at least in canada it’s like this or you can prolly order a kit online.

If your testing rt3 ft3 should be tested at the same time yes again lol

The blood work should be done fasting and within one hour of waking preferably 8 am.

I think you are correct to fix your E2 naturally, I have lowered mine and Ksman is a drugaholic lol