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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Does TRT reverse/improve sexual symptoms for most men with High Range SHBG / Lower Free T?
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<blockquote data-quote="Cataceous" data-source="post: 223381" data-attributes="member: 38109"><p>In accordance with this I think it's reasonable to argue that high SHBG can be disregarded in the context of hypogonadism. In practice SHBG has little influence on free testosterone, at least when it's not low. Free testosterone is likely controlled by the production rate in normal men or by the dose rate in men on TRT. Consider the analogy of a stream flowing into a reservoir. The inflow represent testosterone production. The outflow represents metabolism of free testosterone. The reservoir itself represents SHBG. It's clear that at equilibrium the size of the reservoir has no effect on the outflow; once the reservoir is full the outflow matches the inflow, regardless. </p><p></p><p>If you take a normal guy and suddenly increase his SHBG from 30 nMol/L to 100 nMol/L then what happens? There's a period of time during which the extra SHBG is absorbing testosterone, reducing free levels temporarily. But once saturation is achieved—the reservoir is full—then free testosterone returns to baseline. As you note, the body is regulating to attain its desired level of free testosterone. In secondary hypogonadism that regulation is broken, independent of SHBG.</p><p></p><p>In seeking treatment with incidental elevated SHBG, the main problem is having doctors who either don't know that free testosterone is the most important parameter, or who think that total testosterone is always an acceptable proxy. I encountered this firsthand, initially seeing a urologist who insisted that my total testosterone in the 300s ng/dL was normal. I then saw an endocrinologist who found that calculated free testosterone was low and initiated treatment.</p></blockquote><p></p>
[QUOTE="Cataceous, post: 223381, member: 38109"] In accordance with this I think it's reasonable to argue that high SHBG can be disregarded in the context of hypogonadism. In practice SHBG has little influence on free testosterone, at least when it's not low. Free testosterone is likely controlled by the production rate in normal men or by the dose rate in men on TRT. Consider the analogy of a stream flowing into a reservoir. The inflow represent testosterone production. The outflow represents metabolism of free testosterone. The reservoir itself represents SHBG. It's clear that at equilibrium the size of the reservoir has no effect on the outflow; once the reservoir is full the outflow matches the inflow, regardless. If you take a normal guy and suddenly increase his SHBG from 30 nMol/L to 100 nMol/L then what happens? There's a period of time during which the extra SHBG is absorbing testosterone, reducing free levels temporarily. But once saturation is achieved—the reservoir is full—then free testosterone returns to baseline. As you note, the body is regulating to attain its desired level of free testosterone. In secondary hypogonadism that regulation is broken, independent of SHBG. In seeking treatment with incidental elevated SHBG, the main problem is having doctors who either don't know that free testosterone is the most important parameter, or who think that total testosterone is always an acceptable proxy. I encountered this firsthand, initially seeing a urologist who insisted that my total testosterone in the 300s ng/dL was normal. I then saw an endocrinologist who found that calculated free testosterone was low and initiated treatment. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
Does TRT reverse/improve sexual symptoms for most men with High Range SHBG / Lower Free T?
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