Hack my SHBG results

[SusanJ]

Okay, so I have another clue to what might be happening to the estrogen I'm on. My hormone panel results show a high SHGB (sex hormone binding globulin). 175 nmol/L. Reference range is 18-144.

Here's a quick skinny on SHBG for those of you who might not know what it is.

Hormone levels in the blood must be just right. Steroid hormones include testosterone, estrogens, DHEA, and progesterone, among others. Steroid hormones are fat soluble, but our blood is mostly water. Therefore, hormones and the blood do not mix very well. The body's solution to this problem is sex hormone binding globulin (SHBG), a protein created by the liver which connects with the fat-loving hormones. The resulting complex becomes water soluble and can move freely in the blood stream.

SHBG carries these hormones throughout the body. SHBG also acts as a reservoir for the hormones it carries and protects the hormones from hyperactive liver metabolism and kidney excretion.

SHBG combines with hormones to different degrees of affinity or attraction. The most strongly bound hormone is dihydrotestosterone (DHT), the active form of testosterone, followed by testosterone itself. SHBG also shows affinity, although considerably less, for estrogens, DHEA and even progesterone.

Estrogens increase SHBG production in the liver if the liver is functioning correctly. Adiponectin, a hormone released by the fat cells is also involved.

If SHBG levels are too high, both testosterone and estrogens are bound. High levels of SHBG increase one's risk for osteoporosis because the testosterone and estrogens needed to assist with bone formation are not available for use. Birth control pills can increase SHBG greatly and high SHBG can be predictive of blood clot formation while on these drugs. High SHBG can also be predictive for cardiovascular disease.

https://www.womensinternational.com/new ... rmone.html

I don't care to see CVD and blood clots mentioned but this might also help to explain my wrestling with osteopenia.

Here's the last two hormone panels.

Estradiol
Dec = <10 pg/mL
July = 33
Reference = menopause <10, but Bredesen wants it closer to 80

DHEA
Dec = 115 mcg/dL
July = 102
Refenence = 23-266

Testosterone (free)
Dec = <0.30 ng/dL
July = 0.14
Reference = <0.30-0.83 (the results from 2 different labs, so lost December detail)

Testosterone (total)
Dec = 32 ng/dL
July = 39
Reference = 2-45

Progesterone
Dec = 0.86 ng/mL
July = 2.5
Reference = menopause <0.15-0.80

Upped Biest to 3mg in October in compounded cream. I thought maybe I wasn't absorbing it well (and was ready to go to a patch), but while SHBG went down some, the estradiol went way down suggesting estradiol is still being bound up.

Thyroids are all normal. My doc wants to test cortisol (24 hour) - a risk factor for high SHBG, and good place to start since the HPA axis can be out of whack with RA. Other possible factors are undernourishment (protein and fiber are two mentioned), so he suggests I try some betaine Hcl in case my stomach acid is not up to digestion par. But, my GI seems to be the best it's been in quite a while, and I've managed to get my BMI to 19 (increased calories and more weight lifting) in the past 2 months.

Anyone had to wrestle with SHBG and if so, what worked?

[TheBrain]

Susan,

I don't have any help to offer regarding how to lower SHBG, at least not yet. But I can commiserate with you. In May 2015, my SHBG was 156 nmol/L (reference range 18-114). As far as I know, it's the only time my SHBG has ever been tested. Checking into this matter has been on my long To Do list.

My progesterone and DHEA are abysmally low, unless I supplement accordingly. My free testosterone is in the low end of the reference range (1.6 pg/mL within a range of .6-6.8); I suspect that's not optimal. In May of last year, my estradiol was 42.6 pg/mL, significantly higher than yours but below Bredesen's recommended level. (My recent progesterone and estradiol levels were off because I was taking too much progesterone—I'm still working on getting those optimized.)

I'm 55 and was diagnosed with osteoporosis of the total hip four years ago. Now I'm wondering if I've had high SHBG for a long while, which then contributed to the osteoporosis.

So far, no doctor who has seen my SHBG level has said anything about it, but I will bring it up at my next endocrinology appointment, as well as my next PCP appointment. If I learn anything useful, I'll post it here.

But per a Life Extension article, low SHBG is associated with cardiovascular disease. So this contradicts the article you posted.

http://www.lifeextension.com/magazine/2 ... us/page-01

Low SHBG Is a Key Marker of Cardiovascular Disease
SHBG levels have an important relationship with nearly every biomarker of cardiovascular disease, from C-reactive protein (CRP) to arterial calcification.38,39 Low SHBG is also associated with elevated triglycerides and low-density lipoprotein (LDL).40

Calcification of blood vessels, an early finding in cardiovascular disease, is also associated with lower SHBG levels, especially in women.10,38 Low SHBG in women is associated with higher levels of C-reactive protein (CRP), an important marker of inflammation and cardiovascular risk.39 In men, low SHBG indicated an increased risk of death from cardiovascular disease.35 In both men and women, low SHBG levels are strongly correlated with obesity.41

SHBG, alone and in the context of specific sex hormone levels, thus constitutes an integral predictor of a major chronic age-related condition. Some experts are now recommending SHBG measurements as another means of evaluating cardiovascular and metabolic risk.42

References noted in the quoted text are listed on page 2 of the article.

[Gilgamesh]

Susan, SHBG levels are typically very high on CR, and testosterone is low. If you're on CR, even a bit, that might be part of the cause. It's consistent with the theories by which CR slows the aging process. There's no evidence of problems resulting from this in Luigi Fontana's human CR studies. It's a bit of a paradox: like lower lymphocytes on CR, yet no sign of increased rate of infections (if anything, the opposite).

[SusanJ]

Thanks A & G.

A, I know, my July test was the first time I ever saw it. At the time my doc didn't say much. This time, because the focus was hormones, he was all over that number.

This study suggests that they didn't find a consistent relationship, but they say there was an inverse relationship for baseline CVD. http://www.ncbi.nlm.nih.gov/pubmed/26385535

An older one suggested that there was a relationship to lower levels, but not independent from obesity or other CVD risk factors.
http://citeseerx.ist.psu.edu/viewdoc/do ... 1&type=pdf

Bottom line for me, the high levels suggest my hormones are being bound up and maybe not available to do what they need to...

I'm thinking it is all inter-related for me: estrogen level, osteopenia and high SHGB, so it's high on my research list (if I only had a few more hours in the day!) Promise to post when new info pops up.

[Tincup]

Hi Susan,

Not sure a male's experience applies to a female's. However my SHBG was high and free testostrone low on my first Gundry test.
test dates: 5/15, 12/15
DHEA 124, 226 (μg/dL)
Estradiol 19.7, 19.8 (pg/mL)
SHBG 119, 128 (nmol/L)
Testosterone 276, 497 (ng/dL)
Free Testosterone 2.05, 3.63 (ng/dL)

In July, Gundry put me on 25 mg/day of DHEA along with 240 mg/day of Ginko Biloba to inhibit conversion of testosterone to estrogen. In Januaray, he doubled the DHEA to 50/day without changing the Ginko. Said he likes to keep Estradiol under 30 for men and I had room to play with.

In keeping with G's comment about CR & SHBG, the first test I had was in July, however 9-10 months before that I'd switched something more like Gundry's Matrix program, from a meat/fat HFLC diet. I've read that vegans can have issues with high SHBG, and while Matrix isn't completely vegan, it is close and it is low carb and modest protein. I'd noticed the lower free testosterone in my sexual performance after starting it. Almost immediately after adding the DHEA in, I could tell the difference the other way, again without testing.

The difference going from 25 to 50 mg/day of DHEA is hardly noticeable. I'm guessing coming off the bottom of the range makes the most noticeable difference.

[SusanJ]

George, interesting about the protein, testosterone and DHEA.

I actually cut back protein a bit by cutting out red meat in the last few months, and the SHGB actually dropped. I supplement DHEA and my values fall in the upper mid range of normal so not sure there is much to gain there.

Testosterone total is on the high end, but free is on the low end, presumably from the SHBG since SHBG binds preferentially to testosterone. So maybe I need to look at that pathway more and why it might be out of whack.

And CR - I know I need more calories to gain a little weight.

[Tincup]

From Carruthers’s Androgen Deficiency in the Adult Male: Causes, Diagnosis, and Treatment: Strict low cholesterol diets have been shown to lower total and free testosterone levels by 14%. Vegetarian diets, especially if low in protein, can increase SHBG, further reducing FT [free testosterone]. However, men put on a low-fat, high-fiber, vegetarian diet have a 18% reduction in both total testosterone and FT, which is reversed when they go back on a normal diet.… Conversely, high-protein, low-carbohydrate diets, such as the fashionable weight-reduction Atkins diet, may partly exert their slimming action by raising total testosterone and lowering SHBG.

Ferriss, Timothy (2010-12-14). The 4-Hour Body: An Uncommon Guide to Rapid Fat-Loss, Incredible Sex, and Becoming Superhuman (Kindle Locations 4640-4645). Potter/TenSpeed/Harmony. Kindle Edition.

Ferriss is not a doc, but he is an experimenter. He is exacting in his n=1 experiments. Again, not sure if any of this applies to females.

The simple solution was found in eggs. I wanted to isolate cholesterol as a variable because of its potential dose-dependent SHBG-lowering effect, and a single large egg yolk provides more than two-thirds of the USRDA cholesterol limit of 300 milligrams, meaning 200 milligrams per yolk. The minimum threshold for a very noticeable effect appeared to be 800 milligrams of cholesterol, or four whole eggs.

Ferriss, Timothy (2010-12-14). The 4-Hour Body: An Uncommon Guide to Rapid Fat-Loss, Incredible Sex, and Becoming Superhuman (Kindle Locations 8783-8786). Potter/TenSpeed/Harmony. Kindle Edition.

[Gilgamesh]

Susan, from a CR standpoint, if your total testosterone is high (esp. if your IGF-1 is high, or simply not low), I'm not sure adding more calories would be optimal for health and longevity, but that would partly depend on how you feel, of course!

G

[SusanJ]

Complicated, ain't it. I never cease to be amazed at the complexity of the human body.

Thanks for all the ideas so far.