Nelson Vergel
Founder, ExcelMale.com
This is part II of: Role of Estradiol and Sex Hormone Binding Globulin in Men
HOW TO TREAT ELEVATED SHBG
1.Remove any of the agents or treat the condition, which lead to elevated SHBG. In some cases it may be difficult to identify the cause of elevated SHBG.
2.Use anti-aromatase meds such as Anastrazole, Letrazol, if E2 is elevated,
3.Stop smoking and/or abusing alcohol,
4.Increase protein intake, if low. Avoid soy, which is an incomplete protein,
5.Avoid plant estrogenic herbs and foods,
6.Use androgens like natural T if medically indicated,
7.Increase intake of Omega-3 fish oils (EPA/DHA) consumption to about EPA=1.2 to 1.4 gram and DHA= 1.0 to 2 gram
8.Nettle root (Ulrica urens) in highly concentrated extracts can be effective in binding to SHBG and thereby displacing T and DHT from SHBG and into the free form for cell use. Potent Nettle root concentrates also can act as a 5-alpha reluctance inhibitor, which can partially inhibit the conversion of T to DHT and overall decrease SHBG levels.
9.Artificial progesterones like Norgestrol, Noresthisterone can reduce SHBG. That is bad idea since these androgenic like progestin's can lower the good HDL cholesterol and produce negative mood effects in men.
Note from Nelson: Danazol is also prescribed off label by some doctors to lower SHBG.
Some of the conditions that can lead to increased SHBG, include:
1.Testicular cancer is the most common cancer of young men. This is the cancer cyclist Lance Armstrong had.
2.Breast cancer. Even men can get it, if they have gynecomastia (gyno) – male breast growth. It is estimated that maybe 3 % of men with gyno develop breast cancer. A male with gyno and elevated SHBG should have mammographic and other evaluation for possible breast cancer. Mild gyno can often be treated with meds such as Tamoxifen and Aromatase Inhibitors. If gyno persists and gets larger then surgical removal is my suggestion. I have seen too many men suffer mentally and physically for too long from gyno.
3.Elevated Estradiol levels from various causes such as increased body fat, excess alcohol usage, liver damage, exposure to Estrogen, medications and other agents.
4.Extremely elevated thyroid levels such as in Grave's disease. This can be treated medically usually and occasionally surgically.
5.Aging. It is not clear why aging causes elevation of SHBG and lower free Testosterone, but likely causes can be inflammatory signals along with age associated disregulated physiological events. Aging is associated with lower androgens (Testosterone) in men even with normal physiologic aging, which can lead to increased SHBG. Administration of Testosterone decreases SHBG levels.
6.Extreme weight loss such as seen in anorexia nervosa.
7.Low protein diets. SHBG is increased in vegans usually from a plant based low whole protein diets. Not many pure vegans are very muscular.
CAUSES AND FACTORS FOR LOW SHBG
SHBG binds up to 98 % of the sex steroid hormones in the blood including Dihydrotestosterone (DHT), Testosterone, Androstenediol, and Estrogen and Estrone (but with lower affinity) than the Androgens.
Conditions with low SHBG:
1.High Testosterone (Androgen) levels. Women who are “hirsuite” (exhibit male characteristics) often have excessive body hair, balding, facial hair, acne, and obesity. This is commonly seen in a metabolic disorder of women called the polycystic ovarian syndrome (PCOS). These women have high risk for many diseases such as diabetes, cardio-vascular disease and other conditions. Men on Testosterone therapy have low SHBG.
2.Low Estrogen levels can lead to low SHBG. Estrogens have the effect to stimulate liver synthesis of SHBG and raise SHBG. Women in menopause with low Estrogen will have low SHBG.
3.Hypothyroidism can lower SHBG. Having low thyroid is not a good idea since it leads to low metabolism and fat gain can be a consequence. Classic Hypothyroidism is easily diagnosed and treated. However there are many who have subclinical hypothyroidism. They may have low morning body temperatures, lethargy and sometimes a fat gain despite normal thyroid lab numbers. A number of thyroid studies have shown that if the TSH value climbs to above 2 to 2.5 it may be an indication of the early start of onset hypothyroidism. Some endocrinologist feel the TSH should be kept around 2.0 for best health. TSH is the brain's (pituitary) output of this hormone in greater amounts than usual when the hypothalamus – the brain sensor-reads low thyroid levels in the circulation. TSH is often the first clue of a thyroid and/or sometimes a pituitary disorder.
Some suffer from the controversial Wilson's Syndrome when hypothyroidism may occur because T4 is not converted properly to T3. Since T3 is “engine for cell metabolism” in the same way that Free Testosterone is the “engine portion” for the effects of Total Testosterone. Occasionally some have a syndrome called “Reverse T3 dominance”. An inert form of T3 called Reverse T3 is made from T4 in greater amounts than usually made for a variety reasons. In this scenario the Reverse T3 ties up the T3 receptors in cells and normal T3 can't activate cell metabolism and the person may suffers from a number of low thyroid symptoms. One treatment is to use slow release T3 (a sustained release of the medicine called Cytomel) to displace the bad Reverse T3 molecule. There is a whole treatment protocol for this process, which is to long to discuss.
4.Hyperprolactinemia: Prolactin is produced in the pituitary gland. Elevated blood levels of prolactin can decrease SHBG. However increased blood levels of prolactin also usually produces low Testosterone levels and you would expect elevated SHBG. In all men prolactin elevations need to be investigated since pituitary gland tumors can produce elevated prolactin leading to low Testosterone. Pituitary gland tumors need to be treated medically and sometimes surgically.
5.Elevated cortisol levels. Sometimes persistent elevations of cortisol levels as seen with Cushing's syndrome and other disorders, can keep SHBG low. Cushing's often is a result of pituitary gland tumors causing adrenal gland cortisol overproduction. Sometimes the adrenal becomes overactive resulting in chronically elevated cortisol (a secondary form of Cushing's).
6.Obesity and elevated insulin levels. Extremely obese people often can have low SHBG. There is an inverse relation of SHBG to abdominal fat and subcutaneous fat. The causation mechanisms are multifactorial such as high insulin levels, insulin resistance, Type 2 diabetes, and others. Low SHBG levels contribute or can be a result of low Testosterone levels.
7.Drug side effects such as a result of using cortisone preparations like Prednisone can lower SHBG.
TREATMENTS TO KEEP SHBG AT NORMAL PHYSIOLOGICAL LEVELS.
1.Treat the female PCOS with variety of agents. You should consult an endocrinologist for proper therapy.
2.Lower Estrogen levels. Treat by balancing E/T ratios. Add Estrogen if you are a female and have medical indications for it's use.
3.Low thyroid. Treat with thyroid medications and the underlying causes of it.
4.Elevated prolactin. Treatment discussed already.
5.Elevated cortisol. Treat the medical causes and remove drugs like Prednisone, if indicated.
6.Obesity and high insulin levels. Treat by loosing weight. Gluten free and vegan diets can help with weight loss. I recommend “partial vegan diets” since for muscle mass you need whole animal proteins. Diets high in vegetables can decrease certain cancer risks.
7.Drug side effects. Consult your doctor.
SUMMARY
It has been traditionally thought by many those in the world of the muscle building and body building, that low SHBG is always good thing. It has also been believed that SHBG has only one role and function – to transport and regulate in the blood the amount of bound and free or cell-bio-available Testosterone and other Androgens that can be incorporated into the cell and turn the cells anabolic machinery to promote new muscle and other tissue growth (the anabolic effect).
The new science of Testosterone and SHBG reveals that the traditional thinking about SHBG is that SHBG is more than sex hormone transport. It has its own “independent actions” such as related to development of Type 2 diabetes mellitus, cardio-vascular disease and other conditions. There are sexual differences how SHBG affects men and women in its androgen / sex hormone: independent role.
It has been recently shown that low SHBG independently predicts the onset of and risk for Type 2 diabetes. Free Testosterone levels were not associated with Type 2 diabetes. Decreased total Testosterone was associated with increased risk for Type 2 diabetes [Araujo, A et al J Gerontol A Biol Med Sci 2010; 65A: 503-509]
HOW TO TREAT ELEVATED SHBG
1.Remove any of the agents or treat the condition, which lead to elevated SHBG. In some cases it may be difficult to identify the cause of elevated SHBG.
2.Use anti-aromatase meds such as Anastrazole, Letrazol, if E2 is elevated,
3.Stop smoking and/or abusing alcohol,
4.Increase protein intake, if low. Avoid soy, which is an incomplete protein,
5.Avoid plant estrogenic herbs and foods,
6.Use androgens like natural T if medically indicated,
7.Increase intake of Omega-3 fish oils (EPA/DHA) consumption to about EPA=1.2 to 1.4 gram and DHA= 1.0 to 2 gram
8.Nettle root (Ulrica urens) in highly concentrated extracts can be effective in binding to SHBG and thereby displacing T and DHT from SHBG and into the free form for cell use. Potent Nettle root concentrates also can act as a 5-alpha reluctance inhibitor, which can partially inhibit the conversion of T to DHT and overall decrease SHBG levels.
9.Artificial progesterones like Norgestrol, Noresthisterone can reduce SHBG. That is bad idea since these androgenic like progestin's can lower the good HDL cholesterol and produce negative mood effects in men.
Note from Nelson: Danazol is also prescribed off label by some doctors to lower SHBG.
Some of the conditions that can lead to increased SHBG, include:
1.Testicular cancer is the most common cancer of young men. This is the cancer cyclist Lance Armstrong had.
2.Breast cancer. Even men can get it, if they have gynecomastia (gyno) – male breast growth. It is estimated that maybe 3 % of men with gyno develop breast cancer. A male with gyno and elevated SHBG should have mammographic and other evaluation for possible breast cancer. Mild gyno can often be treated with meds such as Tamoxifen and Aromatase Inhibitors. If gyno persists and gets larger then surgical removal is my suggestion. I have seen too many men suffer mentally and physically for too long from gyno.
3.Elevated Estradiol levels from various causes such as increased body fat, excess alcohol usage, liver damage, exposure to Estrogen, medications and other agents.
4.Extremely elevated thyroid levels such as in Grave's disease. This can be treated medically usually and occasionally surgically.
5.Aging. It is not clear why aging causes elevation of SHBG and lower free Testosterone, but likely causes can be inflammatory signals along with age associated disregulated physiological events. Aging is associated with lower androgens (Testosterone) in men even with normal physiologic aging, which can lead to increased SHBG. Administration of Testosterone decreases SHBG levels.
6.Extreme weight loss such as seen in anorexia nervosa.
7.Low protein diets. SHBG is increased in vegans usually from a plant based low whole protein diets. Not many pure vegans are very muscular.
CAUSES AND FACTORS FOR LOW SHBG
SHBG binds up to 98 % of the sex steroid hormones in the blood including Dihydrotestosterone (DHT), Testosterone, Androstenediol, and Estrogen and Estrone (but with lower affinity) than the Androgens.
Conditions with low SHBG:
1.High Testosterone (Androgen) levels. Women who are “hirsuite” (exhibit male characteristics) often have excessive body hair, balding, facial hair, acne, and obesity. This is commonly seen in a metabolic disorder of women called the polycystic ovarian syndrome (PCOS). These women have high risk for many diseases such as diabetes, cardio-vascular disease and other conditions. Men on Testosterone therapy have low SHBG.
2.Low Estrogen levels can lead to low SHBG. Estrogens have the effect to stimulate liver synthesis of SHBG and raise SHBG. Women in menopause with low Estrogen will have low SHBG.
3.Hypothyroidism can lower SHBG. Having low thyroid is not a good idea since it leads to low metabolism and fat gain can be a consequence. Classic Hypothyroidism is easily diagnosed and treated. However there are many who have subclinical hypothyroidism. They may have low morning body temperatures, lethargy and sometimes a fat gain despite normal thyroid lab numbers. A number of thyroid studies have shown that if the TSH value climbs to above 2 to 2.5 it may be an indication of the early start of onset hypothyroidism. Some endocrinologist feel the TSH should be kept around 2.0 for best health. TSH is the brain's (pituitary) output of this hormone in greater amounts than usual when the hypothalamus – the brain sensor-reads low thyroid levels in the circulation. TSH is often the first clue of a thyroid and/or sometimes a pituitary disorder.
Some suffer from the controversial Wilson's Syndrome when hypothyroidism may occur because T4 is not converted properly to T3. Since T3 is “engine for cell metabolism” in the same way that Free Testosterone is the “engine portion” for the effects of Total Testosterone. Occasionally some have a syndrome called “Reverse T3 dominance”. An inert form of T3 called Reverse T3 is made from T4 in greater amounts than usually made for a variety reasons. In this scenario the Reverse T3 ties up the T3 receptors in cells and normal T3 can't activate cell metabolism and the person may suffers from a number of low thyroid symptoms. One treatment is to use slow release T3 (a sustained release of the medicine called Cytomel) to displace the bad Reverse T3 molecule. There is a whole treatment protocol for this process, which is to long to discuss.
4.Hyperprolactinemia: Prolactin is produced in the pituitary gland. Elevated blood levels of prolactin can decrease SHBG. However increased blood levels of prolactin also usually produces low Testosterone levels and you would expect elevated SHBG. In all men prolactin elevations need to be investigated since pituitary gland tumors can produce elevated prolactin leading to low Testosterone. Pituitary gland tumors need to be treated medically and sometimes surgically.
5.Elevated cortisol levels. Sometimes persistent elevations of cortisol levels as seen with Cushing's syndrome and other disorders, can keep SHBG low. Cushing's often is a result of pituitary gland tumors causing adrenal gland cortisol overproduction. Sometimes the adrenal becomes overactive resulting in chronically elevated cortisol (a secondary form of Cushing's).
6.Obesity and elevated insulin levels. Extremely obese people often can have low SHBG. There is an inverse relation of SHBG to abdominal fat and subcutaneous fat. The causation mechanisms are multifactorial such as high insulin levels, insulin resistance, Type 2 diabetes, and others. Low SHBG levels contribute or can be a result of low Testosterone levels.
7.Drug side effects such as a result of using cortisone preparations like Prednisone can lower SHBG.
TREATMENTS TO KEEP SHBG AT NORMAL PHYSIOLOGICAL LEVELS.
1.Treat the female PCOS with variety of agents. You should consult an endocrinologist for proper therapy.
2.Lower Estrogen levels. Treat by balancing E/T ratios. Add Estrogen if you are a female and have medical indications for it's use.
3.Low thyroid. Treat with thyroid medications and the underlying causes of it.
4.Elevated prolactin. Treatment discussed already.
5.Elevated cortisol. Treat the medical causes and remove drugs like Prednisone, if indicated.
6.Obesity and high insulin levels. Treat by loosing weight. Gluten free and vegan diets can help with weight loss. I recommend “partial vegan diets” since for muscle mass you need whole animal proteins. Diets high in vegetables can decrease certain cancer risks.
7.Drug side effects. Consult your doctor.
SUMMARY
It has been traditionally thought by many those in the world of the muscle building and body building, that low SHBG is always good thing. It has also been believed that SHBG has only one role and function – to transport and regulate in the blood the amount of bound and free or cell-bio-available Testosterone and other Androgens that can be incorporated into the cell and turn the cells anabolic machinery to promote new muscle and other tissue growth (the anabolic effect).
The new science of Testosterone and SHBG reveals that the traditional thinking about SHBG is that SHBG is more than sex hormone transport. It has its own “independent actions” such as related to development of Type 2 diabetes mellitus, cardio-vascular disease and other conditions. There are sexual differences how SHBG affects men and women in its androgen / sex hormone: independent role.
It has been recently shown that low SHBG independently predicts the onset of and risk for Type 2 diabetes. Free Testosterone levels were not associated with Type 2 diabetes. Decreased total Testosterone was associated with increased risk for Type 2 diabetes [Araujo, A et al J Gerontol A Biol Med Sci 2010; 65A: 503-509]
