How can one increase SHBG when it is too low?

[Vince Carter]

I'm going to refute everything from vestpocket on SHBG. I've never read that theory any where before and I've done A LOT of reading on low SHBG. But don't care for a pissing match on it. I'll disagree and have a nice day

I live it, as low as 12 at my last test. Simply: the only way that I got better and started to enjoy TRT was when I put myself on EOD injections and cut to a minimum, the HcG.
Through testing I saw the results of SHBG, I had a 24hr "high" of 1450. Yep...very very high Total T, on just 50mg. At 72hrs post injection I was down to 800.

This makes for what I call a very bumpy ride through the week.

Its my experience and belief that low SHBG dictates smaller, more frequent injection. Do I use a lot of T in the context of a weeks time? Sure, ~200mg is what many would call a lot. But its small(er) doses close together. I never, ever, had a smooth ride until EOD. I was up, I was down, I was up, I was down, all very quickly and was always miserable and saying that TRT wasn't working for me. I was basically going Low T symptons as I approached 72hrs post. Once per week was no good for me, and E3.5D was no good. I would inject Thurs and be bottomed out on Sunday, feeling miserable.

You have to recognize this is a simple matter, low SHBG is not anything to fret over, if you accept that you're different and it requires a slightly different protocol.

Now, I do concur with Dr Crisler new book that with high Free T, comes higher Free E. As another aspect of why low SHBG guys have a tough time, E2 is tough to control. One way I did that was the smaller more frequent T injections, less likely for (over) aromatization. Also, less HcG which frankly, I don't care for as it never did anything for me besides keep my nuts from shriveling up; cosmetic. The E2 produced in the testes isn't via the aromataze enzyme and isn't controlled by an AI so I try to heavliy moderate that route for E2.

That's my theory and what I directly experience and back up with frequent self testing. For the last 6 months I have felt dialed up and getting better especially the last three when I started to get fully adjusted to it. I no longer feel like I need to monkey around with dosing or frequency or that I'm chasing something more or that I'm not doing well.

Short of a minor cortisol issue that needs retested, I am as well as I can be where TRT is concerned.

 

[RoneTone]

Thanks for sharing your story, Vince.

Do you manage E2 at the moment with an AI? If so, what's your dosing? I do EOD injections too so I'm curious.

 

[Vince Carter]

No, no AI at this time. This EOD dosing of 50mg helps me with that and I subscribe to Nelson's T:E ratio theory and I feel better than I have otherwise to this point.

 

[Vestpocket]

There's a big difference between your experience, Vince, and the experiences of the majority of men with low SHBG. For the majority of men, there is no cure. Just ask ERO, or a number of members of Dr. John's own messageboard.

Your case is interesting because you "feel it" and then you bottom out a few days later. That's not what is happening with me. I've never heard of a case like that before, but I certainly believe that yours is true.

I inject 200mg per week, split into two doses. I never feel it. Ever. There's no day where I'm "feeling" low, even if I miss a shot. The whole week feels low. Day of. Day after... whenever.

This is what men with low SHBG usually experience. I know of two other men, one who goes by a handle beginning with XKS, and another that begins with PNKY, who are like you. One was born with ultra high SHBG and cut it down to very low levels to feel better (a very unique case.) Another had to switch to daily injections.

Vince, you never mentioned whether or not your SHBG was actually naturally low or you just suppressed it by overshooting with TRT. In my case, my hypogonadism is because of the elevated FT/FE2 from low SHBG that fed back on my hypothalamus and kept my TT naturally low. I'll bet your SHBG response is perfectly normal, and you're just high on the scale in terms of TT. That's a whole different story, and of course you feel alright.

Low SHBG does not "just require a slightly different protocol." It did for you.

Most men in my situation have tried innumerable protocol variations with no good response. Ever. Not even slight improvements. It's like the T isn't even present.

 

[ERO]

Vestpocket- Yes, this is the last 5 years of my TRT life described exactly! The entire week feels low and innumerable protocols all feel the same - like the T isn't even present. FWIW, I am currently injecting Test Prop (not Cyp) 20 mg daily and it feels exactly the same as every other protocol, which basically feels like I am injecting saline.

 

[Vince Carter]

I started off not having great labs, even with Low T Center for a few months it was hard to get them to divulge my numbers so I can't say where I started at with SHBG but I've never seen it over 17, which is my latest number two weeks ago. I've seen 15 and 12, too.
I was miserable on once a week shots at that clinic so I stopped going, for many reasons, but I'd say it wasn't working, not 100-105mg once per week and we know weekly doesnt even cover the half life of Cyp let alone one's SHBG.
Changing providers to self inject wasn't working for me either. IIRC 97mg E3.5D. I'd inject on Thurs and by Sunday I was just struggling to make it back to Monday. I was low T, again...unmotivated, tired, bored, mildly depressed, disinterested...miserable. I went to a M/W/F schedule @ 60mg per and I felt more balanced after 4 weeks...moods were up, moods were more stable and consistent and I felt quasi-normal.

In these times I really found that I do not like HCG. That is one that I will say I never felt a thing with it...205iu EOD, 400iu EOD, 100iu daily...never "felt" a thing.

I went round and round with Anastrozole... .25mg daily, .5mg 2x week, hell I was dissolving tabs in Vodka and reducing it down to where I could dose .15mg 2x week. I developed a real loathing for Anastrozole and E2. And there was monthly E2 testing I'd get on my own thru Discountlabs.

I did A LOT of my own TT/FT/E2 testing, monthly was typical, but I purposely drew blood at 24 post injection to see a "peak" number and then a 72 hr to get a trough, this let me see how wildly my TT fluctuated in that time. For the record I'd have a high of 1475 (24hrs) and a trough of 814 (72hrs).

This makes a wild ride of instability when over 3 days time you halve your TT. Makes your E2 a real bitch to control, too.

At that time I moved to Defy for cheaper meds and better care. Dr Saya consented to change me to 50mg EOD and .15mg Anastrozole, ONLY if I felt I needed it. We're doing 100iu HCG 2x week. I only use HCG for keeping my nuts alive; cosmetic appearance primarily.

But I tell ya, I've never felt "high", if that's an appropriate word, I know what low is like, but it's not a high or something I can "feel" in so many tangible ways, I just feel normal and balanced. But I know low and what that feels like and can recognize it. I think I have a high state of self awareness, I'm rather in tune with myself and I think that that helps me with TRT.

I just had my 3 month bloods for Defy and waiting on my consult. Since the EOD change, reducing the HCG and getting off Anastrozole, I no longer have felt I'm tweaking and tuning my doses and regimen. I need some work with my DHEA and welcome a little more energy after 12 noon, but ya...I'm pretty straight here.

Something else I bought in too, heavily, is Nelson's T:E ratio, which by my latest tests I could use MORE Estrogen...believe it or not. Studying and talking to Nelson about it got me off Anastrozole completely.

My low T days...were pretty bad. I was checking my insurance for mental health coverages, I was chronically fatigued, unmotivated, disinterested in most everything I used to enjoy, I was getting in to fights at work like I was on a hair trigger with anger and aggression. Making all sorts of silly little mistakes at work, being forgetful...I was NOT in a good place when I started on Androgel 1.62.

But now I'm nothing like that. I'm still a moody short-tempered *******, but that's just me, and that's NOTHING like I was ~18 months ago.

And this, too, Thyroid all those are normal/optimal and in-range, same with my cortisol which maybe needs a little tweak it's "normal".

I really wish itd work for you like it did me. Key was I went Rogue...I looked at like this, I only need you to prescribe the meds, I'll handle the rest, and I did.

Lucked out.

 

[James]

Good post Vince Carter.

 

[Vestpocket]

I'm rogue, too. My 200 mg/wk is not prescribed.

You say Dr. Saya consents to anastrozole only when you feel you need it. What exactly to do you feel that lets you know that your estrogen is too high?

At 200 mg/wk, I feel nothing from T. Not even a single boner. So, toying with anastrozole would be a bit difficult. I play with the number of days in between 0.25mg doses, but I don't notice any difference in anything from sleep to mental clarity to sex drive to physique, so there's nothing to note that would let me know E2 is in the wrong place.

 

[Vince Carter]

I don't know what all you've tried but I read twice per week @ 100mg per and that's just not something that I agree with given you continue to state that it does nothing. What do you mean "does nothing"...no alleviating the class low T symptoms, not sex related. What is your total T? I just don't agree with that your protocol, 100mg at one-time is too much. It just is. Common HRT thinking has yet to progress past the two week threshold but it should. I'm sure you get an E2 spike with that much at one-time, it's logical.

My numbers last week: TT: 1031, (Standard Test) E2: 42, and no anastrozole. No DIM, no Estrogen management at all.

I had a straight convo with Dr Saya, that I was taking very little AI, I was in fact crushing tablets in vodka to be able to dose it <.25mg. I've been OD'd on AI before, by a another Dr and then by my own hand as I experimented. At one-time I was taking a .25mg daily so I'm aware of what its like being tanked out. Dr Saya had me some capsules compounded, they're just .15mg.

Im keen to high E2 symptoms, for me I see it as nite sweats, never had a nipple issue though, never been puffy but I have felt bloated but I'm iffy about on that one. But no swollen ankles or puffy face. If I have an E2 moment or feeling, lately its with my HCG injection.

Part of my perceived success has been minimizing HCG use. I jsut don;t like it and I think it made my E2 tougher to control. You may or may not know that the E produced in the testes isn't via the Aromatase Enzyme and this AI isn't effective there. I only use 100iu 2x week. I have no fertility issue and use a minimal amount for the cosmetics of not having my nuts shriveled up. And I tried it all on that too, 250iu EOD, 400iu EOD, 100iu daily...I never saw an improvement in my symptoms, only complications.

In closing, I departed from this obligatory HCG and Anastrozole and I'm feeling my best having adopted Nelson's T:E ratio theory, in the last 90days since I did that. Only lingering issue I have to complain about is ED but Tadalafil is reliable and effective with my T and E2 numbers as they are now. With low E2 you may have heard its tough to get it up even with a PDE5 inhibitor.

 

[ERO]

I'm rogue, too. My 200 mg/wk is not prescribed.

You say Dr. Saya consents to anastrozole only when you feel you need it. What exactly to do you feel that lets you know that your estrogen is too high?

At 200 mg/wk, I feel nothing from T. Not even a single boner. So, toying with anastrozole would be a bit difficult. I play with the number of days in between 0.25mg doses, but I don't notice any difference in anything from sleep to mental clarity to sex drive to physique, so there's nothing to note that would let me know E2 is in the wrong place.

No AI is the way to go for me as well. I can relate to your situation Vestpocket, as I have low SHBG as well and in general I don't really feel anything from TRT either. I am currently on daily injections of 20mg of Test Prop, but to me it "feels" the same as when I was at 200/week divided into two doses of 100mg every 3.5 days. I am also a low converter to E2 as even at 200/week I found that I did not need an AI, at all - with 0.15 mg twice a week being way too much. I stopped using an an AI about 4 months ago now and I do notice that I feel a bit better overall. I still don't feel any of the classic things one expects from TRT like a strong libido, less or no ED, and good results in the gym, but not having tanked E2 on top of everything is a definite improvement overall. It is subtle, but definitely there.

 

[Nelson Vergel]

[h=4]Oleic acid increases hepatic sex hormone binding globulin production in men[/b][h=2]Molecular Nutrition & Food Research[/b][h=4]Volume 58, Issue 4, pages 760–767, April 2014

Scope[/b]Low circulating sex hormone-binding globulin (SHBG) is an independent risk factor for cardiovascular disease. Mediterranean diet has been associated with a decreased risk of cardiovascular disease. We aimed to test the hypothesis that the increase of circulating MUFA associated with olive oil consumption (primary fat source in Mediterranean diet) increases SHBG serum levels.


[h=4]Methods and results[/b]A total of 315 men were included. In these patients, nutrition data and plasma samples for SHBG assessment were obtained. In vitro studies to examine the effects of oleic and linoleic acid on SHBG production using HepG2 cells were performed. We provided evidence that SHBG serum levels were significantly higher in subjects using olive oil for cooking in comparison with subjects using sunflower oil. The SHBG levels correlated positively with MUFA (p < 0.001) and negatively with saturated fatty acids (p = 0.003). In the multiple regression analysis, MUFA were independently associated with SHBG levels and accounted for the 20.4% of SHBG variance. In vitro studies revealed that oleoyl-CoA increases SHBG production by downregulating PPAR-γ levels in HepG2 cells.


[h=4]Conclusion[/b]Olive oil consumption is associated with elevated SHBG serum levels. PPAR-γ downregulation induced by oleoyl-CoA is an important underlying mechanism of such regulation.

 

[ERO]

Great post, Nelson! I am going to start using more olive oil and keep my fingers crossed that it helps me raise my SHBG to a useful level. Mine is so low (varies between 7 and 14 on a scale where 20-60 is normal) that I really need to double it to get a good number if that is possible.

 

[LowT2014]

So any updates to this low SHBG issues, My endo told me if you got fatty liver or fatty liver caused by HEP B then it can also cause low shbg issues, being overweight, high E2 are all work in similar fashion to reduce SHBG.

 

[ipi]

Vince, excellent points. I am new in TRT and my FT are 29.5 , TT =708, e2=55.8 after 27 hours of 60 mg TestCYp and 57 hours of HCG (day before TestCYp).

BUT

48 more hours later of the above results:

FT=35 (strangely higher than 27 hour result).
TT=660
E2= 48.9
SHBG=12.8 (low)
Prolactin= 31.7 (high) range=(4-15.2)...
LDL=109 a (a little high)
HDL = 36 (a little low)

I feel pains, cracking, popping of bones. Low energy and mood, lbido is OK.

Am I low on SHBG because I have high E2 and are my FT increasing even after 3 days of TestCYp becuase I have low SHBG?

 

[LowT2014]

Vince, excellent points. I am new in TRT and my FT are 29.5 , TT =708, e2=55.8 after 27 hours of 60 mg TestCYp and 57 hours of HCG (day before TestCYp).

BUT

48 more hours later of the above results:

FT=35 (strangely higher than 27 hour result).
TT=660
E2= 48.9
SHBG=12.8 (low)
Prolactin= 31.7 (high) range=(4-15.2)...
LDL=109 a (a little high)
HDL = 36 (a little low)

I feel pains, cracking, popping of bones. Low energy and mood, lbido is OK.

Am I low on SHBG because I have high E2 and are my FT increasing even after 3 days of TestCYp becuase I have low SHBG?

Your prolactin is too high get your MRI SCAN done on your skull to check for any masses.

 

[ipi]

Isn't high prolactin also due to high E2? I read it somewhere.

 

[LowT2014]

His level are double than the top value something else going on better get looked at instead of guess work...

 

[CoastWatcher]

His level are double than the top value something else going on better get looked at instead of guess work...

That has been suggested elsewhere, as well as on this thread.

 

[Vestpocket]

What is your training and diet like? There are rare people that can't build any muscle with the correct diet/training. That being said, a natural lifter will gain 5-10 lbs of lean body mass a year, in the beginning, and only 1-2 lbs a year after 8-10 years of training. So you may just not notice.

That sounds insane to me.

5-10 lbs. of muscle in a single year? Jesus. It would take me 5-10 years to build 5-10 lbs. of muscle.

I once had a trainer tell me that we were going to lose an inch off of my waist (not even starting out large) per week. Man, I've never laughed so hard in my early 30s.

But, seriously. I started working out at age 24. After a year, I don't think I put on a single lb. of muscle. I was on TRT at the time, with FT higher than any natural/TRT person on this board. Nothing happened.

I got fatter over time from the 2,800-3,500 cal diet. Muscle growth was slow and unnoticeable. I was completely new to it, but following all of the dietary macros and workout advice that was popular at the time and should have worked for a newbie.

 

[Elnico50]

I keep hearing people say that there are medications that can increase SHBG. When questioned, they back down.

Are there actually any medications that reliably increase SHBG?

- Estrogen is out of the question, because all of us with low SHBG already have high estrogen to begin with. The liver doesn't care.
- T3 is supposed to increase it, but if you believe the studies, you need to achieve hyperthyroid doses ~50 mcg per day to see a boost. Also, the studies are in people that start with normal SHBG, not impaired SHBG.

Capesaris is on the way as a drug to increase SHBG. It's a SERM that works at the liver.

Has anyone heard of anything else that might work?

I see this is an old thread.... but anyway, have been looking at Toremifene.... this study:



Toremifene administration resulted in a significant increase in FSH, testosterone, SHBG, and inhibin B levels, as well as in sperm concentration, percentage motility and normal sperm forms.