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Armour Thyroid is a good clinical test of Adrenal strength. Feelings of anxiety during a trial dose coupled with low Cortisol test is a sign of Adrenal issues. Given poor adrenals and low FT3 numbers, SHBG is the LEAST of your worries.
SHBG is a sign of issues, usually not the issue itself (stole that from Dr. M)
Get Adrenals treated for 2-4 weeks, then get Armour going and you will feel like a new man.
@InvestmentBanker 455 wrote:
No, I am not on anything right now. I was on Armour but the DO refused to treat my adrenals first. When I did the 4xcortisol/DHEA test I was low all day….10 (13-24) in the morning, dont have the #s in front of me but low the next two times as well. The 10 pm I was 1 (1-4) so I was in range. DHEA = 2 on (3-10). Cant remember cortisol burden but it was below the bottom. I showed her this info. but all she gave me was a product she sold. Even at 1/2 grain of Armour I started getting anxiety…but it was really strange. I was anxious and tired at the same time. Needless to say I stopped it. Now I dont take anything. I am supposed to have a consult with Crisler soon but for one reason or another it keeps getting pushed back. Unfortunately, I have already paid him. I think I talked to you about it. I was flying up on a Thursday, got a call five days before from Kim telling me he would be out of town and I needed to reschedule. Due to conflicts I couldnt. Lost almost all the money I paid on the flight, hotel and car. Wasnt happy.
@hardasnails1973 451 wrote:
That is extremely interesting because every one has been concerned about lower shbg to help increase bio T, but the lower the shbg the faster more frequent one will need T. So these people with lower shbg will result better more frequent shots. Higher the SHBG the more likely testosterone lingers around and is usable to the body. If that is true then higher shbg would be more likely to be more anabolic then having lower shbg. Please correct me if I am wrong in my thinking. To summerize higher shbg the more the testosterone functions in the body. The lower shbg the more the body will burn it up. Does this also imply to estrodial as well?
Yes.
The higher the SHBG, the longer testosterone functions in the body.
The lower the SHBG, the shorter testosterone functions in the body.
This applies to estradiol also.
The lower the SHBG, the more frequent testosterone dosing needs to be done to maintain a given testosterone level. The lower the SHBG, the more rollercoaster a person’s experience with testosterone.
Oh no, dont get me wrong…I am not upset with Dr. Crisler. Kim stated he would pay the difference on what I lost on canceling my trip when I could come up….so nothing against them. My issue is with everything that has gotten in the way. We are closing on our new house tomorrow so there is no way my wife is going to let to fly anywhere for at least a month or so. I will be taking a week’s vacation next week to move in and take care of all the “honey do” stuff. I am going to try and use the DO and consult from here, we will see how that goes. She wants to charge a $90+ fee for every 15 minutes but I think I talked her into just charging a regular office visit. She already ordered the full test of blood labs on Dr. John’s list. I did those on the 18th so they should be available in the next couple days. I hope to do the consult next week sometime while I am on vacation. We will see.
@hardasnails1973 457 wrote:
Crisler is very busy man with now running 2 office, giving seminars, flying all over the country at first notice. Again I am medical professional when people ask my opinon about other Dr’s I tell them go see for your self. One thing I will not do is talk bad about other medical professional. I am not a Dr and will not place judgement upon their mode of practice. When I go to seminars with my Dr I just keep my mouth shut until the end when it is time to ask questions then I will make my presence known. The number one rule to success is keeping the clients happy. Remember the patient is paying you to find out about them not to sit and listen to what the dr accomplished for 3/4 of the time. I have spent 1200 bucks between the test and the consultation to end up listening to her talk about her accomplishments, how she won this award, traveled to europe, BLAH BLAH. I almost walked out of her office but I needed the long waited test results I had been waiting for 3 months to get because she was out of the country. We spent a whole 15 minutes going over them that was it !!. Just be patient he will get back to you. I hate waiting as well so I understand completely because you are probably pulling your hair out waiting. In the past 4-5 years i blew over 50,000 on Dr’s and supplements. One treatment was $15,000 for 8 weeks.
I am at the mercy of the good Dr. I hope to consult next week. I hope the DO I use to consult with him will agree to his protocol. One can only hope!
@wondering 460 wrote:
Armour Thyroid is a good clinical test of Adrenal strength. Feelings of anxiety during a trial dose coupled with low Cortisol test is a sign of Adrenal issues. Given poor adrenals and low FT3 numbers, SHBG is the LEAST of your worries.
SHBG is a sign of issues, usually not the issue itself (stole that from Dr. M)
Get Adrenals treated for 2-4 weeks, then get Armour going and you will feel like a new man.
Dr. M, should I not be worried about the High SHBG then? I was told initially it was binding up the Testosterone and rendering it useless. I will say that I am fairly muscular…not so much as when I was younger. When I was in the military I was around 230 at 12%…6’2″, but when I hit my roadblock I actually started losing weight but BF % did not go down. I am not training right now but eat well, about 188 lbs at 10% BF.
@DrMariano 461 wrote:
Yes.
The higher the SHBG, the longer testosterone functions in the body.
The lower the SHBG, the shorter testosterone functions in the body.
This applies to estradiol also.
The lower the SHBG, the more frequent testosterone dosing needs to be done to maintain a given testosterone level. The lower the SHBG, the more rollercoaster a person’s experience with testosterone.
yeah but doesnt high SHBG cause one to have low BAT and free testsoterone which would cause symptoms of low T?
why do some men like myself have a high TT but low BAT
@DrMariano 461 wrote:
Yes.
The higher the SHBG, the longer testosterone functions in the body.
The lower the SHBG, the shorter testosterone functions in the body.
This applies to estradiol also.
The lower the SHBG, the more frequent testosterone dosing needs to be done to maintain a given testosterone level. The lower the SHBG, the more rollercoaster a person’s experience with testosterone.
So would more then bi weekly be over kill for a person that has low shbg <10?
Could doing EOD be possible route for this person to get the most optimal response from the testosterone.? The person is also using hcg with his bi weekly shots as well.When measuring T levels in a bi weekly phase with hcg taken day before the shot.
Should one discontinue the hcg the week prior the blood draw?Example
sunday hcg
monday shot
wed hcg
thursday shotIf that person was going to draw on a monday would hcg be totally cut out sunday and wed week before be sufficient enough for the hcg to clear the system? The reason I am asking this is because there is speculation that hcg can give false e2 reading since it causes an artificial spike in some people e2 levels. Alot of people including myself ride a bad e2 roller coaster ride and just want to smooth out the ridges so to speak and pitfalls.
Thank you for your time.
This is why probably athletes with low 300-400 testosterone levels can function better with lower levels because they tend to burn it up faster with lower shbg. I have seen studies done on boxers and their T levels where on 340 and they were beasts. I know of natural bodybuilders that are 450 and are walking freak shows. So I guess it is really how the body is handles the testosterone that will dictate functionality. Not every one needs to have 700 T to function. Lower T levels can be optimal as long as your adenals and thyroid are also optimal. Point being a guys T jumped almost 300 points when his thyroid was properly adjusted while TRT came down from 180 mgs a week to 130mgs. All other variables the same even day of testing. This was a welcome site as T levels with 180 mgs where only getting him 500 levels.
@InvestmentBanker 453 wrote:
I am confused because I am told that my high SHBG is NOT good either. Is Dr. M saying anything not considered low is okay? Mine hovers in the mid to high 60’s (nmol/L). What I did notice is when I took Danazol to drive it down my Total T went way down as well. When I got SHBG down 50% to around 30 nmol/L my Total T went down 65% to around 400 ng/dL. Why is that?
SHGB (Sex Hormone Binding Globulin):
Let’s look at what influences SHBG:
Increases SHBG:
Estrogens (particularly Estradiol)
Progesterone (by increasing Estrogen receptors)
Thyroid Hormone (particularly Hyperthyroidism)
Liver Disease
Anorexia, Starvation
Hypoglycemia (low insulin)Reduces SHBG:
Insulin (and insulin resistance)
Testosterone
Growth Hormone
DHEA
Other Androgens
Obesity
Hypothyroidism
Excessive Cortisol (Cushing’s Syndrome or Disease)
Progestins (such as by blocking progesterone’s effects)Excessively high SHBG may indicate factors increasing SHBG may be in excess in thus should be addressed. For example, an excess of Estrogen to testosterone may result in high SHBG.
Since SHBG is determined by several hormones, it is not generally a good component to address directly. Rather the influences affecting SHBG should be addressed independently of SHBG.
Testosterone replacement alone will drive down SHBG. Low SHBG, high free testosterone but LOW total testosterone is common in diabetes.
From my point of view, overly focusing on SHBG when trying to improve libido once total testosterone is raised to at least 650 ng/dL is a fairly narrow point of view.
Free Testosterone is only a fraction of Testosterone signaling. Free Testosterone too often does not determine libido.
One can use Bioavailable Testosterone as a measure of testosterone’s signaling strength. I, myself, consider total testosterone more important. Testosterone which isn’t free – but is bound to SHBG – also has signaling function on SHBG receptors. To take this function into account, I use total testosterone as a clearer measure of testosterone signaling.
If one focuses on the factors that determine SHBG and focus on optimizing them or treating the disease condition involved, then one hardly needs to measure SHBG at all.
High or low, SHBG indicates something is wrong but does not tell you what is wrong. Thus, alone, it is not a useful measure.
SHBG within the reference range also doesn’t tell if something is wrong. Factors that influence SHBG can cancel each other out, thus SHBG will be in the reference range.
Thus, one still has to optimize each factor that influences SHBG separately.
As a result of these considerations, SHBG is a minor player. I would look at the other issues that influence SHBG instead in their own right as more important considerations.
DANAZOL:Danazol is an androgen which lowers LH (Luteinizing hormone) and FSH (Follicle Stimulating Hormone) production. It is used in the treatment of endometriosis by driving estrogen production downwards. It is also indicated for fibrocystic breast disease and hereditary angioedema. Obviously, as an androgen, it can lower SHBG. Lowering SHGB and lowering LH would both reduce total testosterone. I would not use Danazol in a man or woman for that matter. There are better options for Fibrocystic breast disease (e.g. iodine) and endometriosis. However, its use in hereditary angioedema may have utility.
@BlackJack 465 wrote:
yeah but doesnt high SHBG cause one to have low BAT and free testsoterone which would cause symptoms of low T?
why do some men like myself have a high TT but low BAT
What symptoms of low testosterone are you referring to?
When total testosterone is high but libido is low, then the problem is other than testosterone, and unlikely to be SHGB.
I would look at the rest of the system (e.g. estrogen, adrenal function, thyroid, nervous system function, dopamine, insulin, nutrition, etc.) for causes of low libido.
Thank you for the insightful reply Dr. M. My estrodial on the sensative tests have always been in the 11 – 17 range, not sure about Progesterone, Hashi’s….so not sure about thyroid function even though Free #s always are at bottom of reference range, had my liver function checked and both enzymes were in the low 20s, i eat well………all of that said I do have hypoglycemia issues. I used to train hard but got to where I would get real dizzy and sick to my stomach. Days after I worked out I would almost black out when standing up. I have not been training at all recently and it seems to be getting a little better. I am also sleeping better as well.
My issues have been low libido, no spontaneous/morning erections…only through manual stimulation and even then not too strong, poor sleep, poor recover time from working out, overall fatigue. The things I have noticed is I am tired most of the time but temporarily feel better after I eat or work out lightly. Sex wise, I find I “perform” better in the morning after eating a breakfast high in sugar, such as a big bowl of sweet cereal. I wonder if that has to do with Insulin?
@DrMariano 470 wrote:
SHGB (Sex Hormone Binding Globulin):
Let’s look at what influences SHBG:
Increases SHBG:
Estrogens (particularly Estradiol)
Progesterone (by increasing Estrogen receptors)
Thyroid Hormone (particularly Hyperthyroidism)
Liver Disease
Anorexia, Starvation
Hypoglycemia (low insulin)Reduces SHBG:
Insulin (and insulin resistance)
Testosterone
Growth Hormone
DHEA
Other Androgens
Obesity
Hypothyroidism
Excessive Cortisol (Cushing’s Syndrome or Disease)
Progestins (such as by blocking progesterone’s effects)Excessively high SHBG may indicate factors increasing SHBG may be in excess in thus should be addressed. For example, an excess of Estrogen to testosterone may result in high SHBG.
Since SHBG is determined by several hormones, it is not generally a good component to address directly. Rather the influences affecting SHBG should be addressed independently of SHBG.
Testosterone replacement alone will drive down SHBG. Low SHBG, high free testosterone but LOW total testosterone is common in diabetes.
From my point of view, overly focusing on SHBG when trying to improve libido once total testosterone is raised to at least 650 ng/dL is a fairly narrow point of view.
Free Testosterone is only a fraction of Testosterone signaling. Free Testosterone too often does not determine libido.
One can use Bioavailable Testosterone as a measure of testosterone’s signaling strength. I, myself, consider total testosterone more important. Testosterone which isn’t free – but is bound to SHBG – also has signaling function on SHBG receptors. To take this function into account, I use total testosterone as a clearer measure of testosterone signaling.
If one focuses on the factors that determine SHBG and focus on optimizing them or treating the disease condition involved, then one hardly needs to measure SHBG at all.
High or low, SHBG indicates something is wrong but does not tell you what is wrong. Thus, alone, it is not a useful measure.
SHBG within the reference range also doesn’t tell if something is wrong. Factors that influence SHBG can cancel each other out, thus SHBG will be in the reference range.
Thus, one still has to optimize each factor that influences SHBG separately.
As a result of these considerations, SHBG is a minor player. I would look at the other issues that influence SHBG instead in their own right as more important considerations.
DANAZOL:Danazol is an androgen which lowers LH (Luteinizing hormone) and FSH (Follicle Stimulating Hormone) production. It is used in the treatment of endometriosis by driving estrogen production downwards. It is also indicated for fibrocystic breast disease and hereditary angioedema. Obviously, as an androgen, it can lower SHBG. Lowering SHGB and lowering LH would both reduce total testosterone. I would not use Danazol in a man or woman for that matter. There are better options for Fibrocystic breast disease (e.g. iodine) and endometriosis. However, its use in hereditary angioedema may have utility.
@InvestmentBanker 472 wrote:
Thank you for the insightful reply Dr. M. My estrodial on the sensative tests have always been in the 11 – 17 range, not sure about Progesterone, Hashi’s….so not sure about thyroid function even though Free #s always are at bottom of reference range, had my liver function checked and both enzymes were in the low 20s, i eat well………all of that said I do have hypoglycemia issues. I used to train hard but got to where I would get real dizzy and sick to my stomach. Days after I worked out I would almost black out when standing up. I have not been training at all recently and it seems to be getting a little better. I am also sleeping better as well.
My issues have been low libido, no spontaneous/morning erections…only through manual stimulation and even then not too strong, poor sleep, poor recover time from working out, overall fatigue. The things I have noticed is I am tired most of the time but temporarily feel better after I eat or work out lightly. Sex wise, I find I “perform” better in the morning after eating a breakfast high in sugar, such as a big bowl of sweet cereal. I wonder if that has to do with Insulin?
Hormonal optimization is only part of an evaluation and treatment. Evaluation of a person’s neurotransmitter and immune system status are also important. And, evaluation of nutritional status is highly important. Modern diets do not provide enough nutrition.
A good starting point for nutrition is the book, Nourishing Traditions: http://www.amazon.com/Nourishing-Traditions-Challenges-Politically-Dictocrats/dp/0967089735/ref=sr_1_1?ie=UTF8&s=books&qid=1246542997&sr=8-1
Dr M. If the culprit is constant low blood suger or hypoglycemia (not sure if they are the same thing), what could one due to raise it? As I mentioned I feel much better if a eat something high in sugar, such as a large sugary bowl of cereal. Thank you!
@DrMariano 478 wrote:
Hormonal optimization is only part of an evaluation and treatment. Evaluation of a person’s neurotransmitter and immune system status are also important. And, evaluation of nutritional status is highly important. Modern diets do not provide enough nutrition.
A good starting point for nutrition is the book, Nourishing Traditions: http://www.amazon.com/Nourishing-Traditions-Challenges-Politically-Dictocrats/dp/0967089735/ref=sr_1_1?ie=UTF8&s=books&qid=1246542997&sr=8-1
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