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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
What is the reason low shbg needs ED injections?
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<blockquote data-quote="Cataceous" data-source="post: 189857" data-attributes="member: 38109"><p>One of the problems with low SHBG may be the ratio of free estradiol (fE2) to free testosterone (fT). Without TRT, the normal HPTA uses free estradiol as its primary regulator. With a fixed free estradiol, the lower the SHBG the lower the free testosterone. This means low SHBG provides a built-in propensity towards hypogonadism.</p><p></p><p>So the symptomatic low-SHBG guy goes on TRT. What happens? Now the exogenous testosterone is directly controlling free testosterone. With a fixed free testosterone, the lower the SHBG the higher the free estradiol. What this means in practice is that the low-SHBG guy starts with a higher fE2/FT ratio than in normal guys, and increasing testosterone via large, infrequent injections pushes the ratio even higher.</p><p></p><p>If we posit that there is a tolerable normal range for the fE2/fT ratio then it's clearly safer for the low-SHBG guy to avoid large peaks in his serum testosterone and estradiol. This is accomplished with smaller and more frequent injections.</p><p></p><p>Here are some numbers calculated using the multi-ligand model:</p><p>[ATTACH=full]11341[/ATTACH]</p><p>In this thought experiment there are two guys on TRT who are identical except for SHBG. They are on the same E5D doses of testosterone cypionate. In the last line of the table the peak fE2/fT ratio of the guy with normal SHBG is chosen as the reference point. The normal guy is operating in a range of 93-100%. The low-SHBG guy starts out at 106% and then climbs to 111%. Suppose symptoms occur at over 109%. In this case daily injections would probably help. But if symptoms occur at a lower figure, such as 107%, then a dose reduction would also be necessary, and this would risk sending free testosterone too low, which might cause other symptoms. It's easy to see why TRT can be a struggle for guys with low SHBG.</p><p></p><p><strong>Edit</strong>: The premise of free estradiol increasing relative to free testosterone at low SHBG is based on an assumption of total estradiol being driven directly by free testosterone. But it seems more likely that free estradiol follows free testosterone, making total estradiol the dependent variable. In other words, neither free estradiol nor free testosterone changes much when SHBG is reduced in isolation. It's still plausible that lower SHBG leads to reduced androgenic activity relative to estrogenic activity—without a dependence on the free hormone levels.</p></blockquote><p></p>
[QUOTE="Cataceous, post: 189857, member: 38109"] One of the problems with low SHBG may be the ratio of free estradiol (fE2) to free testosterone (fT). Without TRT, the normal HPTA uses free estradiol as its primary regulator. With a fixed free estradiol, the lower the SHBG the lower the free testosterone. This means low SHBG provides a built-in propensity towards hypogonadism. So the symptomatic low-SHBG guy goes on TRT. What happens? Now the exogenous testosterone is directly controlling free testosterone. With a fixed free testosterone, the lower the SHBG the higher the free estradiol. What this means in practice is that the low-SHBG guy starts with a higher fE2/FT ratio than in normal guys, and increasing testosterone via large, infrequent injections pushes the ratio even higher. If we posit that there is a tolerable normal range for the fE2/fT ratio then it's clearly safer for the low-SHBG guy to avoid large peaks in his serum testosterone and estradiol. This is accomplished with smaller and more frequent injections. Here are some numbers calculated using the multi-ligand model: [ATTACH type="full" alt="1603987233357.png"]11341[/ATTACH] In this thought experiment there are two guys on TRT who are identical except for SHBG. They are on the same E5D doses of testosterone cypionate. In the last line of the table the peak fE2/fT ratio of the guy with normal SHBG is chosen as the reference point. The normal guy is operating in a range of 93-100%. The low-SHBG guy starts out at 106% and then climbs to 111%. Suppose symptoms occur at over 109%. In this case daily injections would probably help. But if symptoms occur at a lower figure, such as 107%, then a dose reduction would also be necessary, and this would risk sending free testosterone too low, which might cause other symptoms. It's easy to see why TRT can be a struggle for guys with low SHBG. [B]Edit[/B]: The premise of free estradiol increasing relative to free testosterone at low SHBG is based on an assumption of total estradiol being driven directly by free testosterone. But it seems more likely that free estradiol follows free testosterone, making total estradiol the dependent variable. In other words, neither free estradiol nor free testosterone changes much when SHBG is reduced in isolation. It's still plausible that lower SHBG leads to reduced androgenic activity relative to estrogenic activity—without a dependence on the free hormone levels. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
What is the reason low shbg needs ED injections?
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