How can one increase SHBG when it is too low?

[AbsoluteZ3R0]

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

https://www.ncbi.nlm.nih.gov/pubmed/17412336

RESULT(S):

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.

As far as I know, all SERMs raise SHBG. I believe this is due to the E2-agonizing qualities they exhibit on specific receptors. Of course, the issue with SERMs is that the varying interactions they exhibit on E2 receptors can often make their effects unpredictable. I would imagine that using any of them effectively in conjunction with a standard TRT protocol would be disastrously convoluted. The most commonly used one is tamoxifen, but only temporarily to combat gynecomastia. I can't imagine staying on a SERM throughout the entirety of a trt regimen, and I would imagine that SHBG would return to baseline after discontinuation. Incidentally, I used clomid for a few months and my SHBG didn't budge (it was actually a few decimals lower on clomid than it was pre-clomid, not a significant difference).

 

[Dr Justin Saya MD]

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

https://www.ncbi.nlm.nih.gov/pubmed/17412336

[h=4]RESULT(S):[/b]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.

Be mindful that toremifene carries a small, yet substantial, risk of a potentially fatal cardiac arrhythmia ("Torsades de Pointes"), especially in folks with QT segment prolongation on EKG. There is a blackbox warning for this reason. To be safe, get an EKG performed before considering this SERM.

 

[Vestpocket]

As far as I know, all SERMs raise SHBG. I believe this is due to the E2-agonizing qualities they exhibit on specific receptors. Of course, the issue with SERMs is that the varying interactions they exhibit on E2 receptors can often make their effects unpredictable. I would imagine that using any of them effectively in conjunction with a standard TRT protocol would be disastrously convoluted. The most commonly used one is tamoxifen, but only temporarily to combat gynecomastia. I can't imagine staying on a SERM throughout the entirety of a trt regimen, and I would imagine that SHBG would return to baseline after discontinuation. Incidentally, I used clomid for a few months and my SHBG didn't budge (it was actually a few decimals lower on clomid than it was pre-clomid, not a significant difference).

The problem with SERMs is that the current offerings (tamoxifen/clomiphene) only increase SHBG by up to 30% in studies. For a guy suffering with SHBG between 8-13 nmol/L, we're talking about a difference of a paltry +3 nmol/L. That's essentially irrelevant.

The kind of increase we're looking for is 100% — minimum. We want to bring that guy at 13 nmol/L to a more normal 26 nmol/L.

Also, if a male isn't seeing SHBG elevation as his E2 increases, he isn't likely to see any movement whatsoever with SHBG just because of a medication that might be a slight estrogen agonist. If estradiol itself didn't work, neither will a SERM.

So, we toss SERMs out the window for the sake of this discussion.

 

[HealthMan]

10mg of tamoxifen for me increased my SHBG by 60-70% (and i tested this a few times)

 

[Vince Carter]

10mg of tamoxifen for me increased my SHBG by 60-70% (and i tested this a few times)

How did this benefit...any negatives? Why...did you use Tamoxifen for something else and noticed the SHBG or did you go with it purely for the SHBG?

 

[CoastWatcher]

10mg of tamoxifen for me increased my SHBG by 60-70% (and i tested this a few times)

May I ask a question on this, too? How long did you maintain the tamoxifen as part of your protocol?

 

[HealthMan]

How did this benefit...any negatives? Why...did you use Tamoxifen for something else and noticed the SHBG or did you go with it purely for the SHBG?

Hi Vince. I added tamoxifen because of gyno i had during TRT a few times. Every single time I had blood work done before and after this is why i know the impact of tamoxifen to my SHBG levels. My total testosterone levels end up increasing because of that. Overall i felt worse than before. My body doesn’t really like tamoxifen for whatver reason. It makes me feel like s....

 

[HealthMan]

May I ask a question on this, too? How long did you maintain the tamoxifen as part of your protocol?

2-4 months at a time. Until the gyno cleared up. The effects on SHBG was very quick to manifest though.

 

[HealthMan]

Just as a reference last time i used tamoxifen my SHBG went from 21.7 to 36.5 nmol/l

 

[Vestpocket]

Just as a reference last time i used tamoxifen my SHBG went from 21.7 to 36.5 nmol/l

Right, but your T and E2 both increased.

SHBG is supposed to increase along with other hormones. There's no way it would just stay the same. So, the effect is not necessarily from tamoxifen. SHBG would have increased no matter how you increased T/E2.

 

[Nelson Vergel]

Click here for more posts on low SHBG

 

[Dr. John Crisler]

Like a cork bobbing on top of the water, I just play SHBG where it settles in my patients.

Having said that, the most common cause of SHBG that is low(er) I have found is INFLAMMATION. This has actually been found to be the cause of low(er) SHBG in DMII patients--not the actual elevated insulin.

On a more personal note, after my heart attack a couple years ago, I went on a very high anti-inflammatory supplement regimen. As Dr. Saya saw, my SHBG went to over 90! The supplements (and better diet no doubt LOL) were the only change that took me from mid-range to super high SHBG. I could tell, because I just wasn't feeling the benefits of the same dose of Test cyp any longer.

 

[Vince Carter]

I can't imagine that any one would want high SHBG and suffer thru subterranean Free T with it all bound up.

 

[AbsoluteZ3R0]

Like a cork bobbing on top of the water, I just play SHBG where it settles in my patients.

Having said that, the most common cause of SHBG that is low(er) I have found is INFLAMMATION. This has actually been found to be the cause of low(er) SHBG in DMII patients--not the actual elevated insulin.

On a more personal note, after my heart attack a couple years ago, I went on a very high anti-inflammatory supplement regimen. As Dr. Saya saw, my SHBG went to over 90! The supplements (and better diet no doubt LOL) were the only change that took me from mid-range to super high SHBG. I could tell, because I just wasn't feeling the benefits of the same dose of Test cyp any longer.

What supplements did you take?

 

[Jason Sypolt]

On a more personal note, after my heart attack a couple years ago, I went on a very high anti-inflammatory supplement regimen.

Dr. Crisler, could you elaborate on what your anti-inflammatory regimen was/is?

Discounted Labs has an inflammation panel:
https://www.discountedlabs.com/inflammation-panel

- C-Reactive Protein (CRP)
- CK- Creatine Kinase (or Creatine Phosphokinase – CPK)
- Ferritin
- Homocysteine
- Lactic Acid Dehydrogenase (LDH)
- Erythrocyte Sedimentation Rate (by Westergren) (ESR)

Is there anything more/less that you would recommend as far as testing for someone interested in seeing a comprehensive view of their current state of inflammation?

 

[Dr. John Crisler]

The most usual cause of low(er) SHBG is inflammation.

This has been shown as the actual cause with Type II Diabetes.

An anti-inflammatory diet is first. Then fish oil, curcurmin, mixed Vit E's etc should help.

 

[BillyJ03z]

The Thyroid also has direct effect on SHBG.... Thyroid supplementation can raise SHBG, as well as correcting a Thyroid imbalance will raise SHBG... Exogenous TRT will lower SHBG (how low is dose dependent....)

 

[ERO]

Thyroid supplementation raises SHBG for many guys, but for some of us with super low SHBG, it seems to have no effect. I have raised my T3/T4 dose 4 times (per my doc at Defy Medical with no effect whatsoever. Not only doesn't it raise my SHBG, it seems to have no effect on my thyroid, either. I still feel borderline hypothyroid at seemingly any dose of T3/T4.

 

[BillyJ03z]

Thyroid supplementation raises SHBG for many guys, but for some of us with super low SHBG, it seems to have no effect. I have raised my T3/T4 dose 4 times (per my doc at Defy Medical with no effect whatsoever. Not only doesn't it raise my SHBG, it seems to have no effect on my thyroid, either. I still feel borderline hypothyroid at seemingly any dose of T3/T4.

Have you tried adjusting/lowering your Test dosage? Also, from what I have researched is that SHBG is also an indicator of Thyroid health/functioning.... you could very well have Hypo issues... I have very low Shbg and I too am suffering from Hypo symptoms (low energy, low motivation, brain fog, sleep issues, etc..)

 

[ERO]

Yes, I have tried it all over the last 6 years. Daily doses, bi weekly, topical, injections, combination topical and injections, Test Prop, Test Cyp. It all feels like I am injecting water. Same with thyroid meds - they all feel like I am taking a placebo instead of any type of actual medication.