Low SHBG and Free Estrogen Impacts?

[riverside]

Yes I know..yet another low SHBG post. I have been googling and searching this forum and can't find anyone referencing lowish SHBG and the relationship to free estrogen. My Dr. says I am a hyper-metabolizer, hyper-excretor and hyper-converter to estrogen. Seems like a bad trifecta!

My Pre-T SHBG was 35nmol. Tests since TRT have been ranging from 14-20nmol over the last 8 months of my TRT experience. My E2 (ultra sensitive tests LC/MS) has ranged from 100pg/ml down to now what is between 22-32 BUT that is with .5mg Anastrazole EOD. My Dr. has me trying .5mg AI ED! He says that since I have low SHBG that my free estrogen is also too high therefore I would need a much lower E2. Has anyone else experienced this or had success? I have been on this protocol for 2 weeks now. I don't believe I have crashed E2 but I haven't experience benefits either. I haven't found anyone talking about free estrogen.

Yes for me libido is an issue and my primary issue which I believe is the sole reason for my ED issues.

 

[CoastWatcher]

Can you provide us with your full lab tests? Essentially, all that you have (with ranges)? And your protocol, details? There are hyper metabolizers - what caused this conclusion to be reached?

 

[riverside]

Sure - I have many blood labs over the last 8 months post TRT but the main pre-TRT lab that he requested was a 24 hour urine hormone test. This is what caused the diagnosis of a hyper-metabolizer. I want to emphasize that this lab was before TRT.

My current protocol is:

23mg Test-C ED
220IU HCG EOD
.5mg Anastrazole ED
6000IU Vitamin D ED
25mg DHEA ED
1000mg Metformin ED

I have had many different protocols, each with the same overall results as I have now. I'd be happy to post blood labs as well if that would be beneficial. There are no anomalies really, one interesting thing is my Total-T fluctuates between 650-950 on this regular of a dosage frequency regimen.

I have had surges in the last few months of libido which made me realize that I haven't had a libido for most of my adult life. I am 35, 6'2" and 210lbs with roughly 18% body fat. I do not know why I aromatize the way that I do.

 

[johndoesmith]

Sure - I have many blood labs over the last 8 months post TRT but the main pre-TRT lab that he requested was a 24 hour urine hormone test. This is what caused the diagnosis of a hyper-metabolizer. I want to emphasize that this lab was before TRT.

My current protocol is:

23mg Test-C ED
220IU HCG EOD
.5mg Anastrazole ED
6000IU Vitamin D ED
25mg DHEA ED
1000mg Metformin ED

I have had many different protocols, each with the same overall results as I have now. I'd be happy to post blood labs as well if that would be beneficial. There are no anomalies really, one interesting thing is my Total-T fluctuates between 650-950 on this regular of a dosage frequency regimen.

I have had surges in the last few months of libido which made me realize that I haven't had a libido for most of my adult life. I am 35, 6'2" and 210lbs with roughly 18% body fat. I do not know why I aromatize the way that I do.

Your doctor sounds incredibly informed with hormones due to the fact he's considering free estrogens, but the fact that he's using a urine test for hormones, is questionable.

I do not know that any real conclusions can be drawn from these tests. The gold standard is serum testing.

Do you have any labs from ON TRT?

 

[Vince Carter]

JDS is right, no one that knows anything (sorry) is using urine for hormone testing, serum is the gold standard here.

Dr Crisler has stated in one of his books, can't remember which but it was very recent, that low SHBG guys like me/us, while we can enjoy very high Free T numbers, we'll also suffer thru very high free Estrogens and this is going to become a test in the near future if not sooner, I've heard it discussed.
I too even on EOD and then daily inj was aromatizing like crazy, running 60-88 at one point and I eliminated methodically a number of things to find why to where I was only using Cyp. I was plagued with heavy night sweats/hot, easily angered/irritable as the main issues. I eventually had to get on AI @ .25mg MWF. AI EOD took me in to the high teens so we backed off a little bit.

I have felt in the last six months well enough that I haven't felt compelled for blood work or to tinker with my protocol any further.

28mg Cyp Daily
250iu HCG E3.5D
.25mg AI MWF

 

[Nelson Vergel]

I am confused.

Do you have current labs that reflect your current protocol? Do you really have access to sensitive estradiol testing in your country? Has your doctor ever measured free estradiol?

 

[Vince Carter]

I am confused.

Do you have current labs that reflect your current protocol? Do you really have access to sensitive estradiol testing in your country? Has your doctor ever measured free estradiol?

Good question...I noticed testing for every kind of "E" except the one that matters, as far as I know, (ultra) Sensitive Estradiol LC/MS/MS

 

[riverside]

Your doctor sounds incredibly informed with hormones due to the fact he's considering free estrogens, but the fact that he's using a urine test for hormones, is questionable.

I do not know that any real conclusions can be drawn from these tests. The gold standard is serum testing.

Do you have any labs from ON TRT?

Yes, the urine was just a one time thing before TRT. I have had many blood draws in my 8 months of TRT. Most recent results are on this protocol:

46mg Test-C EOD
220IU HCG EOD
.5mg AI EOD

E2: 20 (8-35) * I fluctuate here and this is my lowest ever. Normally around 26-35 range
Free T: 214 (46-224)
Total T: 663 (240-950) *this fluctuates for me between 650ish to 950 with no changes in protocol or days that I draw.
DHT: 590 (112-955)
SHBG: 15 (10-57)
Prolactin: 8 (2.1-17.7)

I am now on this protocol of:
23mg Test-C ED
220IU HCG EOD
.5 AI ED

I am going to get blood work after 3 weeks of this protocol next week. I will report back. I am concerned about needing this much AI...and of course not finding my libido yet.

 

[Nelson Vergel]

I bet if you run a sensitive E2 test, it will be under 10 micrograms per dl

I would just cut the AI dose to .5 per week.

Are you still on metformin?

 

[riverside]

I bet if you run a sensitive E2 test, it will be under 10 micrograms per dl

I would just cut the AI dose to .5 per week.

Are you still on metformin?

I should've clarified that all of my E2 tests have been ultra sensitive. I don't respond much to AI apparently as I've had 3 tests within 3 months on a .5mg EOD AI protocol that have been around 30. This 20 was the lowest for no apparent reason..but it was a new lab. My lab used to send my E2 to Mayo bu this time it went to Esoterix. I think my E2 will skyrocket on .5mg/week as it was around 100 before AI and in the 40-50 range on .25mg EOD. I just don't respond dramatically to AI and automatize like nobody I've seen in my countless hours of research. I've seen all the warning of AI crashing E2 but I seem to need more and more. Some day..

Yes - I purchased metformin outside of my doctor. I have been taking it for at least 5 weeks. Nothing notable from that to this point. My fasting BG was always over 100 but my A1C came back at 4.9% so I guess I'm not too concerned. I will see the impact on my SHBG from the labs I take next week.

I really think I am a rare case in how much I metabolize and excrete hormones. I...will...find and answer. Thanks

 

[Vince Carter]

I should've clarified that all of my E2 tests have been ultra sensitive. I don't respond much to AI apparently as I've had 3 tests within 3 months on a .5mg EOD AI protocol that have been around 30. This 20 was the lowest for no apparent reason..but it was a new lab. My lab used to send my E2 to Mayo bu this time it went to Esoterix. I think my E2 will skyrocket on .5mg/week as it was around 100 before AI and in the 40-50 range on .25mg EOD. I just don't respond dramatically to AI and automatize like nobody I've seen in my countless hours of research. I've seen all the warning of AI crashing E2 but I seem to need more and more. Some day..

Yes - I purchased metformin outside of my doctor. I have been taking it for at least 5 weeks. Nothing notable from that to this point. My fasting BG was always over 100 but my A1C came back at 4.9% so I guess I'm not too concerned. I will see the impact on my SHBG from the labs I take next week.

I really think I am a rare case in how much I metabolize and excrete hormones. I...will...find and answer. Thanks

That's not what you posted above as lab results. It can't be said much more clearly than this, anything but the (ultra)Sensitive Estradiol LC/MS/MS test is designed for women and will overestimate levels in men. You must have the for males test. Your posted labs contradict the tests you say you're getting.

 

[riverside]

I edited my OP to say ultra sensitive LCMS. Those are the only E2 labs I have ever drawn. Sorry for the confusion.

 

[Vince Carter]

Im not intending to beat a dead horse or rag on you but you can type and edit whatever you want things to say, we post labs here. Attachments, screenshots, and so forth, just as you did in #3.

 

[riverside]

Im not intending to beat a dead horse or rag on you but you can type and edit whatever you want things to say, we post labs here. Attachments, screenshots, and so forth, just as you did in #3.

I get it - my labs are all returned to me individually so that is a huge pain but I will take screen shots of them all and post soon. I see others that post a comprehensive list and I'm jealous. I do not live anywhere close to a Labcorp and have only used Quest on a rare occasion where I wanted to pull a sensitive LCMS E2 in between Dr labs and I ordered them myself online.

 

[riverside]

I get it - my labs are all returned to me individually so that is a huge pain but I will take screen shots of them all and post soon. I see others that post a comprehensive list and I'm jealous. I do not live anywhere close to a Labcorp and have only used Quest on a rare occasion where I wanted to pull a sensitive LCMS E2 in between Dr labs and I ordered them myself online.

Here are some labs from 2/28/2017 with a protocol of:

46mg Test C EOD
.5mg AI EOD
220IU EOD