OK, I will get these done (May be a week or two before I can) but if you find something wrong the big question is how do I get it treated? My current Dr. is in Florida and I am in Tx. I guess I could talk to him but it's a long distance relationship and a strange one at that.
There are no "Open Minded" Dr's here that I can find.
Great post but my concern is some discussion I have read and some articles I have seen (Don't have them right now) that SHBG acts more like a reserve releasing T as needed.
There seems to be a correlation to men w/low SHBG having more issue w/anxiety etc.. (Not me at least right now) Also w/low SHBG dosage of T probably needs to be adjusted as not to spike Total T through the roof it would seem from what I have read. It also seems me w/low SHBG need more frequent dosing because of less SHBG to bind T. Another issues is there is more T to get coverted to metabolites such as E and DHT.
I am actually doing HCG monotherapy right now for fertility reasons but will start T therapy soon and am just researching and asking questions.
My SHBG is 9 and I am pretty sure I am insulin resistant. I am working on this w/diet and exercise though.
Why is there a concern with SHBG levels getting lower? Adex does not directly lower SHBG. The liver controls SHBG production levels, mostly in response to E levels. Increased T levels lower SHBG by interfering with the actions of E stimulated SHBG production. Lower SHBG should provide higher FT and Bio-T fractions. If E is maintained at a given level when T in increased, typically needed adex, SHBG goes lower.
SHBG production rates may be more a function of free estrogens and bio available estrogens. If SHBG+E is high and free estrogens are low, then there may not be any need.for higher SHBG levels. In this case, an imbalance in SHBG+E could be from liver problems or drugs that affect SHBG+T, SHBG+E clearance.
SHBG is how the body removes sex hormones from the blood. The liver removes SHBG+T and SHBG+E complexes and discharges metabolites in the liver bile into the gut. The level of SHBG, independent of hormone levels, is controlled by the liver's SHBG production rate and how fast the liver can remove hormone bound SHBG. The state of health of the liver can be involved, as well as individual variability. Drugs, Rx and OTC, also affect E clearance rates via P450 enzymes, probably affecting unbound SHBG as well. I do not know if SHBG lab results include SHBG and SHBG+E and SHBG+T.
When you read about SHBG serving as to transport T or E, remember that these SHBG bound hormones are not been transported anywhere to act on any receptors. The SHBG bound hormones are basically trash and the liver collects the trash and dumps it into the liver bile.
As with hormones, serum levels are a balance of production rates, sources, and removal rates, sinks. Ditto for SHBG. In the case of T is made in the testes, E is made in the testes and peripheral tissues [mostly fat]. SHBG is made in the liver and removed by the liver. So SHBG source and sink in the liver.
SHBG moves hormones to the liver for removal.
You need big guns to lower E2.
What are your TT and FT numbers?
E2 production in the testes is hCG dose responsive. But hCG dose requirements can vary greatly. If you are using a lot of hCG, that is a problem. If the testes on hCG will not deliver the T levels needed, one should not force the issue with high amounts of hCG. As long as one is injecting, adding T injections is not a big deal if normal hCG doses are not enough.
Your SHBG levels might be lower than typical, but as a result of something else that might need to be better understood. Are your liver markers normal? You need to consider the effects of Rx and OTC drugs as well.
Lower SHBG can be seen with hypothyroidism and insulin resistance, some times with elevated prolactin or from use of prednisone or elevated cortisol [Cushing's syndrome]. Hypothyroidism can increase SHBG. Check thyroid levels, fasting insulin and fasting serum glucose.
With shbg that low I would suspect hypothyroidism more so then insulin resistance..
Let me dig into your thyroid numbers I am sure I can find some thing out of balance. I usally do because dr's tend to over look alot of things. i would suggest getting following labs done
tsh 3rd generation
transthytretin or prealbumin
NOW THATS A THYROID PANEL !!