T Nation

Low E2 & SHBG with High Total T

E2 is 16 SHBG is <15 total T is 937. Protocol : 100mg test/cyp split into two doses per week, .5 Anastrozole and 60 units HCG.
Symtoms: low energy, low libido, achy joints, sexual dysfunction, moody

Doc wants to increase AI stating low SHBG is masking a high E2. Meaning E2 is actually higher than 16. Also wants to test Prolactin level. Not sure I buy what he’s telling me! Any help appreciated.

Your doctor is an idiot, do not listen to him. You need to stop taking any AI. It will take weeks to feel better probably but more is absolutely not the answer.

The “old school” optimal e2 level people used to say was something like 20-30 and in hindsight is too low for most, and you’re even lower than that already… more AI isn’t the answer.

The fact that you’re below that and literally have textbook symptoms of low e2 and your doc is saying more AI tells me your doc is an idiot, or misinformed, or behind the times… whatever you want to call him, he’s wrong and you’re not going to feel better until you stop taking the AI.

No more AI!

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Thanks for the reply. This is my second clinic! The first one combined the AI with the test. Just started with this one and already not very impressed! Almost fell off my chair when he said he wanted to increase the AI!!:face_with_symbols_over_mouth: Any suggestion on a clinic. I’ve read Defy is good

Yeah that’s crazy. I just don’t understand where docs come up with this garbage. Like, do they get told once that all issues are e2 and just assume that’s a fact for the next 30 years of their career? I don’t understand.

I use Dr. Saya @ Defy and he is good. It usually takes a few weeks to get in with him though, his schedule stays pretty full. There may be others that are good too, not sure. The first nurse I tried there tried to put me on Boron because my SHBG was 160, lol.

The good thing (at least for me) with Defy is I’ve been able to get insurance to pay for all my labs. They send me a prescription pad with the labs written on it and I take it to Labcorp and bill insurance for the tests. So far they’ve paid all of them. That may not work for your situation but it may at least be worth trying at some point.

Have you ever heard of low SHBG masking a low E2 number, as in, the lab result number shows lower E2 than what you actually have. That was his basis for saying I needed more AI !

It sounds made up. You are crushing your estrogen metabolism using that much AI and are more than likely lower within several hours of taking it.

Defy can prescribe AI .125mg doses, but .5mg anastrozole is usually way to much.

If you schedule a consultation with Dr. Saya it’s about a 15 day waiting period right now.

The HCG is one of those things that either make you feel great or makes your feel bad, so it’s not for everyone.

What he was probably thinking is “free e2” would be higher because of the low shbg. Much like free T is higher (given the same levels of total T) for someone with lower shbg. SHBG impacts the relationship between E2 and free E2, kind of like total T and free T, though you don’t hear a lot about free e2 because it’s quite expensive to measure and my understanding the measurement isn’t very accurate. There’s a thread on excel male that talks about it more and there are some spreadsheets that help estimate it given a few knowns.

For a long time I always wondered if that’s why people with high E2 did better if they had high shbg (meaning lower free e2) also but I’ve found plenty of cases that go both ways on that one so I never really got anywhere on that idea.

But yeah, that’s my guess on what he’s thinking but explaining poorly.

I still think it’s way too low no matter how you look at it though.

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I thought the same thing! I’m also type 2 diabetic so not sure if that could be playing into the mix!

I have low SHBG (18) and last week my E2 came in at 62 pg/mL and I’m doing good. I have type 2 diabetes as well and this new protocol of mine has dropped my fasting glucose more than 100 points in only 8 weeks.

TRT should increase your SHBG a little.

How much test are u on? What ester? Injection schedule? I’ve heard more frequent doses and an ester with a longer half life is best for diabetics because of the low SHBG factor. Do u use Defy as your clinic?

“achy joints”

No, ur e2 is too low. Do not listen to this doc.

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I’m on 80mg test weekly split up every other day, I’m on cypionate.

Yes, I have a consultation with Dr. Saya on the 18th.

I have heard it postulated that low SHBG can allow more free e2 to circulate, and therefore you’d have symptoms of higher e2 while the measured estradiol was relatively low. Not sure if that’s what he’s talking about or not.

Either way, I think he’s wrong, and your symptoms align with low e2. I’d dial back the AI

Edit: I see @ncsugrad2002 already explained this and I think he’s correct

So no AI or HCG? I’m thinking of just staying on the test and getting rid of the AI and HCG to see if I can get my E2 back and my ratio of T/E2 corrected. Not sure of my free T. This doc also said didn’t need to check that either!! I’m learning a lot for sure.

Sounds like that doc is stuck in 1999. I’d go with T only and see where you end up.

He’s stuck somewhere!!! Common sense not so common these days!!

It’s up there with docs who insist on 1 injection every 2 weeks despite it taking 30 seconds to google a graph of how bad T levels crash after 7-8 days, but they still insist on it. I don’t understand it.

Yes but it’s not their bodies getting messed up soooo! Just because they have MD after their name doesn’t mean they know what their talking about

Do I need to ween off AI and HCG or can I just stop? Currently .5 AI and 60 IU HCG

Just stop