Low T, high SHBG as a 'standard' outcome of HT, ERT, HRT...

[AbraCadabra]

Well, SHBG (Sex Hormone Binding Globulin) binds sex hormones i.e. prevent them to be 'Free' as e.g. in Free Testosterone.

It seems the inevitable outcome of HRT, HT = Hormone Therapy, ERT = Estrogen Replacement Therapy...

The higher the SHBG the lower the Free T as it will have more binding going on.

This initially quite favoured outcome of HRT for MtF starts to become an issue of sorts, after some time resulting in too little T, resulting in lack of energy, dry skin, brittle hair/nails, NO libido, the list goes on.

It all comes about by the liver being stimulated to produce more SHBG due to the intake of hormones; I'm only looking at Estradiol (the main HRT hormone) for M2F.

Someone in another thread here, had mentioned that Estrogen dominance does not exist as excess Estrogen would be aromatise into Testosterone... that was not correct... it works the other way around as Testosterone being the precursor to Estrogen rather than the other way around.

This according to:
Philip M. Sarrel, M.D. is founder of the Yale Menopause Program and the Yale Sex Counseling Service. He completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital.

So far I only figured two ways to deal with this.

1.   The use of estrogen/androgen combination as e.g. "Estratest" and similar, yet not available in SA

2.   Having 3 cups of sting-nettle-root infusion a day... which at least is supposed to lower SHBG.

Has anyone got a clue what this is all about, and has had some results in lowering SHBG, or at least has had this brought to their attention by their Endo?

Axélle

[Flan]

What I know about estrogen and shbg interaction mostly relates to how the body processes estrogen with oral form having the highest correlation with increase in shbg versus other routes that are processed less by the body.

[Asfsd4214]

I don't see what basis you have for your premise that SHBG will inevitably rise as a result of HRT.

My SHBG levels are significantly lower post-HRT than pre.

[AbraCadabra]

I don't see what basis you have for your premise that SHBG will inevitably rise as a result of HRT.

My SHBG levels are significantly lower post-HRT than pre.

The premise I learned, and the case with me also... HRT causes higher liver stimulation which in turn produces higher SHBG output.
I mentioned my values. Almost twice the top of range level.
I did mention this, didn't I?

If it does not apply in your case, you're lucky I guess – and as always we are all different... at least to some degree.

Loss of libido is also quite an issue that had been widely ignored by MDs with FAAB on the pill (BCP) reducing libido after about a year or so.
The reasons are the same, elevated SHBG resulting in less Free T.
Axélle
PS: one more misconception that only oral HRT goes by (loads) the liver... Hormones are in the blood stream and therefor ALWAYS go by the liver. The only difference being that there will be only one pass rather than second pass as for oral E2, and in the case of EE multiple passes... in order to metabolize it.
Therefor the liver is ALWAYS involved in HRT.
Please correct me it this is wrong.

For further interest see:
http://www.empowher.com/menopause/content/what-should-woman-know-she-talks-her-doctor-about-hormone-replacement-therapy-dr-s

[Flan]

I don't see what basis you have for your premise that SHBG will inevitably rise as a result of HRT.

My SHBG levels are significantly lower post-HRT than pre.

It's just what I know, if there's something better, please point it out.
http://ukpmc.ac.uk/abstract/MED/10914617/

[kelly_aus]

My SHBG levels have not changed up or down. My LFT's do always come back slightly elevated, but not by much and my gyno has decided that's probably going to be my 'regular' level from now on.

[AbraCadabra]

My SHBG levels have not changed up or down. My LFT's do always come back slightly elevated, but not by much and my gyno has decided that's probably going to be my 'regular' level from now on.

My LFT (Liver Function Test) so far always comes back normal... with SHBG on the rise.
Are you on oral HRT?
I am, and mostly sublingual.

My E actually is in the lower range at 255 nmol/L... it could be up to 400 nmol/L - meaning to double my daily E intake.
This does not feel good to me - most of the time when I tried.

In fairness one's SHBG level is ALSO an age related thing... going up with age.
Say no more 

Axélle

[Asfsd4214]

The premise I learned, and the case with me also... HRT causes higher liver stimulation which in turn produces higher SHBG output.
I mentioned my values. Almost twice the top of range level.
I did mention this, didn't I?

If it does not apply in your case, you're lucky I guess – and as always we are all different... at least to some degree.

Loss of libido is also quite an issue that had been widely ignored by MDs with FAAB on the pill (BCP) reducing libido after about a year or so.
The reasons are the same, elevated SHBG resulting in less Free T.
Axélle
PS: one more misconception that only oral HRT goes by (loads) the liver... Hormones are in the blood stream and therefor ALWAYS go by the liver. The only difference being that there will be only one pass rather than second pass as for oral E2, and in the case of EE multiple passes... in order to metabolize it.
Therefor the liver is ALWAYS involved in HRT.
Please correct me it this is wrong.

For further interest see:
http://www.empowher.com/menopause/content/what-should-woman-know-she-talks-her-doctor-about-hormone-replacement-therapy-dr-s

Well you're certainly correct that hormones will interact with the liver regardless, first pass effect happens when you swallow medications which can alter their structure and/or reduce their quantity.

I think the problem I'm having with this thread is me not understanding what you're actually getting at.

Yes your SHBG levels may rise as a result of taking estradiol, or lower by being overweight, or a myriad of other factors. But ultimately it seems like your concern is about insufficient androgen levels causing fatigue, loss of libido, etc.

I understand that concern, but not why you're focusing on SHBG specifically in regards to it.

If your levels of SHBG are abnormal, it's something to look into as to why, but ultimately I think it's a somewhat separate issue.

Now yes, obviously SHBG has to be used in calculation of your free testosterone levels, but ultimately it's that final number, the result of total testosterone vs bound testosterone, that is insufficient. The solution is not automatically to lower your SHBG levels specifically.

I think you may be better off consulting with your doctor about reducing your dosage slightly of anti-androgen or estradiol until the symptoms subside or your levels become abnormal.

Your free androgen levels should be somewhere inside the normal female range, if your symptoms are still causing trouble at the upper side of that limit, you may be better trying to manage the symptoms.

What I don't understand about this thread is the focus on manipulating your SHBG levels in particular.

Sorry if my previous post was unclear.

[AbraCadabra]

[clipped]
... But ultimately it seems like your concern is about insufficient androgen levels causing fatigue, loss of libido, etc.

Correct.
Also I do not like the situation (if it can be helped) of too high a SHBG... as little I would have like too high E, or e.g. Prolactin etc.

I understand that concern, but not why you're focusing on SHBG specifically in regards to it.

Since my S-Total T is VERY low at 0.1 nmol/L from 0.52 nine months back... shooting T be one thing to do now?
Something I think being a bit drastic, right? All I can see therefore to figure out to lower SHBG. Simple as that really.
There ARE estrogen/androgen combination drugs on the markets, I also mentioned - yet NOT available to me. So now shooting T (my son does at 42... for loss of libido and energy!) after having long gone off anti-androgens over a year or longer?!?

If your levels of SHBG are abnormal, it's something to look into as to why, but ultimately I think it's a somewhat separate issue.

Separate from no libido? I don't think so, really don't.

Now yes, obviously SHBG has to be used in calculation of your free testosterone levels, but ultimately it's that final number, the result of total testosterone vs bound testosterone, that is insufficient. The solution is not automatically to lower your SHBG levels specifically.

Well, than since I asked the question, what then is the solution? Shooting T?!?

I think you may be better off consulting with your doctor about reducing your dosage slightly of anti-androgen or estradiol until the symptoms subside or your levels become abnormal.

I'm post-op 1 year... see next to avatar. Reducing anti-androgens... hello?!?  ;P
Reducing E...? It is on the low side as it stands also.

Your free androgen levels should be somewhere inside the normal female range,

Therefore my question/post ... as they are NOT.
Not at an FAI (Free Androgen Index) of 0.1... with lowest female range = 0.2 and up to 3.6! Hum.

if your symptoms are still causing trouble at the upper side of that limit, you may be better trying to manage the symptoms.

"manage the symptoms"...  Like?

What I don't understand about this thread is the focus on manipulating your SHBG levels in particular.

Sorry if my previous post was unclear.

I hope this interchange made that now clearer... unless shooting T is what you would suggest... the only alternative I currently see to lowering SHBG...
Quite straight forward then, init?

Axélle
PS: started with nettle root infusion (tea) but all I experience this far is mild depression...
AND what is mentioned also, that this stuff might be hogging E receptors...?!
I noticed some contradictory information about it --- saying it would 'lower' E, that was for male BPH... were it's use is also recommended...
Am I getting too old for such experiments? (reducing SHBG) ...
Could well be.