Hormone Panel test results...What to do? low SHBG

[ello]

Hi

Recently ie last 3 months or so noticed rapid receding hairline. I was very concerned and so went to the Doctor (as my knuckles also started hurting) who carried out a full blood panel test with hormones included.

Now apparently the concerns were: 1. Nuclear antibody test showed "slightly" higher level but the 2nd test showed it was alright

2. Cholesterol and LDL slightly high

3. Slightly higher homocysteine

4. SHBG level was very low around 9 and free testosterone was very high around 180 or so. Apparently the estrogens panel(which he will chase up) was missing BUT all my other hormones were normal LH, FSH, TSH etc

He was saying my sudden hairloss etc is probably from all that excess free testosterone floating around and unbinded to SHBG which is very very low. He will chase up the estrogens (cant remember if he had the progesterone levels) but he couldnt understand it...... He felt that I was undergoing an aggravated hairloss situation because of all the excess rather than genetic predisposition and IF WE CAN BRING THINGS UNDERCONTROL we can FIX it and reverse things.

He did say a couple of factors would affect it such as insulin resistance, liver disease, major body trauma etc. Also said obesity can affect it and though I agree that im overweight he also said it cant affect it THAT much considering im only 28. Also said that since I have suddenly ie last 3 weeks changed to low carbs, high proteins, low cal and exercise that my SHBG should have in fact gone up.

Can anyone please help and explain as to why this may be happening?

 

[TheGrayMan2001]

finasteride sounds like the answer to me. Someone with more knowledge on hormones might have a different opinion.

 

[DIYtony]

The SHBG and Insulin Resistance links are something that also interest me very much. I don't like the way Propecia just tries to deal with the last link in the chain, it's like having a dislocated shoulder but just using pain killers to mask the problem rather than actually solving it.

 

[123000123]

I also agree low SHBG/high free test is the issue, as this is exactly what my blood tests revealed, and I have the same issue as the OP as in a rapidly receding hairline which seemed to come out of nowhere.

The question is, how the hell do you raise SHBG? I know insulin is a factor but how much is diet/exercise REALLY going to raise SHBG and lower test to the extent where it will have a significant effect?

 

[ello]

I also agree low SHBG/high free test is the issue, as this is exactly what my blood tests revealed, and I have the same issue as the OP as in a rapidly receding hairline which seemed to come out of nowhere.

The question is, how the hell do you raise SHBG? I know insulin is a factor but how much is diet/exercise REALLY going to raise SHBG and lower test to the extent where it will have a significant effect?

Yep suddenly out of nowhere and rapid loss.

Atleast he thinks that If we sort it out then like normal people and like myself previously most of my testosterone would be bound and not free floating and that I should be able to regain all the hair back.

What did you do about yours?


The Doctor doesnt think its the finasteride that would have caused that and since all my liver, kidney, thyroid etc stats are normal including glucose and insulin levels etc doesnt think I have any insulin issues.


We will investigate more but rough research indicates that estrogen will increase SHBG dramatically e2 specifically. T3/T4 supplementation would increase it dramatically as well as other hormones such as HGH.

Diet and exercise will help but wont be able to increase it to that extent.
Coffee, Green Tea and MAYBE lignans or phytoestrogens though the little evidence available sort of points both ways eg flaxseed contains the most lignans and soy may contain the most phtoestrogens (caffeine and phytoestrogens). Beta sterols like in saw palmetto may help.

The single biggest boost would come from the estrogen apparently followed by t3/t4, hgh, overall diet (supposedly HIGH fibre, low GI, low protein, low fat, low cal, higher lignans/phytoestrogens, beta sterols), and lots of exercise(assuming healthy body fat).

 

[123000123]

The Doctor doesnt think its the finasteride that would have caused that

Sorry could you please just clarify what you mean by this? Have you been on finasteride (finasteride) because I didn't think you mentioned it in your first post. And caused what?




From what I understand there is no direct way to raise SHBG in the sense that if you have low testosterone you can raise it by endogenous test, low estrogen you can take estrogen, etc.

I think if you have low SHBG it's because of mainly two reasons: insulin resistance and hypothyroidism. So because of that the best (only?) way to raise it is to improve insulin resistance or take thyroid meds (like you mentioned, T3). The problem with this is if you take thyroid meds you can go to far and end up hyperthyroid which has its own host of problems. Likewise, I'm not sure of the extent to which diet/exercise would have a significant impact on SHBG levels (enough to improve hair).
The other option would be to take insulin-improving anti-diabetic meds like Metformin, however from what I gather this can be quite dangerous if you're not careful.

Please look in to PCOS (Polycystic Ovarian SYndrome) in females and its comparison to male pattern baldness. It has been described as the female version of male pattern baldness, where women suffer excessive body hair growth, acne and hair loss in the typical male pattern baldness pattern. Further, they have LOW SHBG AND HIGH FREE TEST and they are given anti-diabetic meds like Metformin to treat it, as their is often insulin resistance present.




What am I doing?

I started finasteride but I started getting sides pretty much straight away. So I really don't know, I'm at a loss. The only thing I know is I wish I had your doctor who seems like he knows something and is willing to give you tests and actually try to figure out your problem. Please please please keep me updated on anything you figure out with him.

 

[ello]

@123000123


Sorry should have stated that. My previous regiment was(over course of 3years and more because I just wanted to prevent any loss):

*folligen initially consistently and then stopped and then started last couple of months EOD E3d etc

*2% Nizoral shampoo which I have kept using fairly consistently as I had dandaruff issues

*Initially 1mg finasteride ED and slowly moved towards E2D or E3D etc.



Now I have blood panel and hormone results from before that show everything was fine including SHBG etc.



I stopped finasteride because I got injured and I started to gain fat and started getting gyno.


Fast forward ~8months ago or so I had another blood panel and again results were fairly normal(though admittedly it was not intensive hormone panel).



I understand that one cant get exogenous SHBG like you could with test, estrogen, t3 etc.

However there are things 1 can do that does affect it inversely (im leaving sides out of this as im sure you know them too):
1. Taking exogenous estrogen (specifically e2) or increasing the balance within you in its favour will increase SHBG. A few ways to do this.

2. Take T3/T4 which in turn would increase SHBG

3. Take insulin resistance lower drugs like metformin to improve insulin sensitivity and drop actual insulin count reducing inflammation and increasing SHBG.

4. Take other medications such as antiandrogens etc that would also affect it


Now in my case I have full panels from 3yrs ago no real issues. 2 years ago or so no real issues. ~8 months ago and no issues (though wasnt comprehensive hormone panel).

Then suddenly I start losing hair, itch, etc with aches in knuckles and thereafter a full test shows that out of nowhere my SHBG is low and have lots of free test....and the other minor issues.


The stranger thing here is I am not diabetic and have once again turned things around and getting healthy etc. Also I am not insulin resistant and so far NO OTHER HORMONES are out of whack though still waiting on results of estrogens prog andro.

I have a sneaking suspicion....but I wont know until i get my damned results in full. I might infact get retested tomorrow to see if within a week anything has changed.....


Well the doctor works with me (most have) because I am reasonable and I guess I come across to them as quite informed and educated relating to medical matters and medicine. I doubt I would have otherwise gotten the tests I wanted had I not known this much about the field and able to elaborate and prove my point to them.
ALL DOCTORS should work with their patients and take their concerns and requests seriously though sadly some are up themselves or just stubborn morons.



May I ask what sides you experienced? What dosage were you on? How long did you stay on? What else were you taking or doing?

 

[123000123]

I see..

Well I had a blood test about a year ago and it showed very low SHBG and high free test. My doctor actually commented on this (at the time I hadn't even thought about balding). A few months later I started to lose hair really fast.

I started 1.25mg finasteride and about 6 weeks later I noticed sensitive/slightly enlarged nipples/chest, mainly on the left side. The thing is, after I looked in to gyno (again, I didn't even know what gyno was before all this), and looked at some older photos, I realised I've always had a slightly larger left nipple/chest, at least since puberty. Also, although I'm quite a skinny guy overall, the fat I do have is concentrated around chest, thighs, ***. This leads me to believe I've had slightly elevated estrogen for a while, which probably explains my sensitivity to finasteride sides.

But then, estrogen is supposed to be protective of hair, and normally equates with high SHBG (like you mentioned) so I'm really at a bit of a loss. Unfortunately I never actually got my estrogen levels tested.

ANYWAY,

Any ideas you have? What is your suspicion that caused your low SHBG levels?? I'm interested to hear what you're thinking and also what you and your Doctor come up with.

I honestly think (and have thought for a while now) that one of the best things we could do would be to take anti-diabetic medication. It would improve insulin sensitivity, raise SHBG as well as reduce overall inflammation. As young balding men, this could almost be a long-term solution (in theory), perhaps along with a small dose of finasteride. Unfortunately, I can't really find much info on what would happen if a non-diabetic person took anti-diabetic medication. Also, I have no idea on dosing/sides/etc. Do you have any thoughts?

Also, look at the medication "diazoxide". From what I understand, it seems to do all of the above plus its a potassium channel opener (same as minoxidil). Just some ideas...

 

[ello]

So the Doctor pointed out you have low SHBG and high free test yet did nothing? Slap him! :box:
lol

Now here is the problem. You havent tested recently and perhaps dont accurately remember your figures and most likely have not had a full spectrum test.

BEFORE YOU DO ANYTHING I WOULD HIGHLY ADVISE DOING THAT FIRST.


Now considering the limited info given, I doubt the finasteride was giving you gyno that early in the game ESPECIALLY if you consider that your free test was high and your SHBG was low. You may have started feeling a slight puffiness etc which is fairly normal other than in really fit healthy and lean low muscular low body fat people.
But then again, I dont know the rest of your stats of your other hormones etc and im assuming that if all else was fine that you would have had a large amount of DHT. DHT would not have allowed for gyno to develop as its highly androgenic.

But then you point out another factor. From your description it sounds like your left side has an enlarged gland or atleast susceptible tissue.. If this is true then it would explain your sensitivity inspite of your large amounts of potential dht. So what can you do given that your breast tissue might be sensitive?
1. Take a SERM specifically Raloxifene which would stop any gyno taking hold. Ralox increases SHBG and reduces IGF-1/ whilst increasing IGFBP-3.

If a condition had already taken hold and you felt the full effects of estrogen abundance and had not started ralox then stronger Aromotase Inhibitors could be used. 1 that is known for reversing even existing gyno is called Letrozole and its very potent stuff(@2.5mg CAN block off 90+% estrogen). The side with letro? You guessed it lowers SHBG

2. You could have surgery to remove the susceptible tissue. Question then is: is it fatty tissue? or is it actual breast gland tissue?
The techniques applicable for surgically and permanently fixing the problem would depend on what type of gyno it is.



Your body composition unfortunately is genetics at work. Yes having high estrogen levels COULD lead to a more feminine distribution of fat on your body BUT not necessarily, if your not genetically predisposed to distributing fat in a certain genetically defined way. So you cant say youve always had elevated estrogens unless youve got test results to back it up and your symptoms and test results indicate otherwise (if u did have high or more normal SHBG you wouldnt have lost hair to start with )

Puberty is a turbulent time, hormonally speaking, like PMS is for women
Many many men get gyno or lumps or enlargement etc which MAY ease down as their body stabilizes eventually or it MAY NEVER go away. There are many factors at play during puberty and your hormones would be all over the place eg you could have high test yet also high estro or just high proge or WORSE high prolactin and start producing milk!


You can recontour your genetic overlay by 1st drop your bodyfat and increase your muscles and exercise. Once you have SLOWLY (too fast and ull have flabby skin that would then need to be excised) lost your bodyfat to an acceptable level and bulked up ~10-14% bodyfat. Then what you could do is go PHYSICALLY remove your fat cells. Hence liposuction. That is the only way you will PERMANENTLY change the contour of your body.


Regarding diabetic meds they would help on one hand whilst hurt on the other....Take metformin for instance:
it would potentially reduce your insulin resistance and thereby potentially increase your SHBG BUT it may reduce your TSH and will reduce your LH and Test and inadvertently reduce your estrogen.
If you were to take this option or any other again I would recommend full testing before and during. Typical doses with metformin is 500mg-750 in XR but perhaps you could get away with much lower dose to reduce your risks of acidosis, hypoglycaemia etc.

However if it were me I would most likely, once I have all the facts and figures and know exactly whats going on inside me, start with some e2 and or ralox, and test if still a bit low, maybe take a small dose of t3/t4 combo.
T3/t4 combo is often prescribed even in healthy people with normal TSH values and is fairly safe so long as you dont abuse it and take just enough. Once your body balances out you could start tapering off slowly and test again to see what the levels are. And its effects overall when slightly increased are good.

I wouldnt touch Diazoxide too systemic and potential for issues. You first need to investigate your levels etc and whether you are indeed insulin resistant before you miss around with insulin.

The point here would be to increase SHBG with minimal damage, sides or health risks.

Also there are much more effective treatments on the horizon such as CB, PTH(7,34), cloning etc.


I will know what to do once I get the full picture and full lab results back and will ask for a retest (if i can get away with it) tomorrow as its been a week later and id like to know if any changes have occurred...

 

[DIYtony]

The single biggest boost would come from the estrogen apparently followed by t3/t4, hgh, overall diet (supposedly HIGH fibre, low GI, low protein, low fat, low cal, higher lignans/phytoestrogens, beta sterols), and lots of exercise(assuming healthy body fat).

That diet is basically impossible.... You can't have low everything

 

[123000123]

ello,

Thanks for your ideas. I will look in to them.

In a bit of a rush so just a short reply for now:

T3 interests me. My thyroid results showed borderline hypo. Also, it's used as a fat burning tool. Lastly, it will raise SHBG. hmm sounds good.

 

[ello]

The single biggest boost would come from the estrogen apparently followed by t3/t4, hgh, overall diet (supposedly HIGH fibre, low GI, low protein, low fat, low cal, higher lignans/phytoestrogens, beta sterols), and lots of exercise(assuming healthy body fat).

That diet is basically impossible.... You can't have low everything

Its NEAR impossible and probably unrealistic long term not to mention most would probably abandon it. but can be done.

 

[ello]

ello,

Thanks for your ideas. I will look in to them.

In a bit of a rush so just a short reply for now:

T3 interests me. My thyroid results showed borderline hypo. Also, it's used as a fat burning tool. Lastly, it will raise SHBG. hmm sounds good.

Yep it would increase your metabolism etc.

BUT make sure you take BOTH T3 and T4 and in the right ratio to reduce any hormonal impact. The ratio is important.




QUICK UPDATE:

Really pissed! Came back from the Doctor and got printout of all my results.

Found out that my prog, andro, estro, t3/t4, igf-1, insulin and dht hadnt actually been tested. Apparently, according to the Doctor, though he had written it, the lab hadnt tested it since as a guy estrogen, prog and andro shouldnt be an issue unlike for a woman.

So after debating(pushing) with him again he agreed to re-test some results and specifically wrote estrogen, dht, c-peptide, t3/t4 and IGF-1, as well as free test and SHBG again. He hopes the lab will do the test this time and didnt write prog and andro since unless my estro is out of whack those shouldnt be and my prolactin is normal(according to the LAB GUY but then again lab guy also told him I wouldnt need estro's tested since im male).

According to this lab guy, in men, shbg is typically affected by:
steroids
medications
obesity
insulin
thyroids
IGF-1



So looks like I will retest again.......

 

[Bryan]

Here's something I just posted on another hairloss site:

(Posted by another person) "eg though ur total test is normal range, your free test could be abnormally high, perhaps due to lowish SHBG count. (Low SHBG is a common trait amongst balding men)"

I've always been curious about why some people seem to be so interested in SHBG (I could mention a couple of individuals on another hairloss site who seem to talk about it quite a bit! ). I really don't understand EITHER of those statements you made about it: I don't know why free testosterone would be abnormally high, due to lowish SHBG; and I'm not sure why low SHBG would be a common trait among balding men.

Our bodies keep a close watch over levels of androgenic stimulation; there's no doubt in my mind that if you were able to inject significant amounts of extra SHBG into your bloodstream on a regular basis, your body would react to that by making more testosterone! The opposite of that would happen, I believe, if you were able to remove SHBG (like through dialysis or something), or suppress its synthesis in the liver: the production of testosterone would automatically be lowered by the body. In other words, our bodies synthesize and use testosterone on a basis which is probably pretty much independent of other factors like SHBG.

 

[Mens Rea]

Here's something I just posted on another hairloss site:

(Posted by another person) "eg though ur total test is normal range, your free test could be abnormally high, perhaps due to lowish SHBG count. (Low SHBG is a common trait amongst balding men)"

I've always been curious about why some people seem to be so interested in SHBG (I could mention a couple of individuals on another hairloss site who seem to talk about it quite a bit! ). I really don't understand EITHER of those statements you made about it: I don't know why free testosterone would be abnormally high, due to lowish SHBG; and I'm not sure why low SHBG would be a common trait among balding men.

Our bodies keep a close watch over levels of androgenic stimulation; there's no doubt in my mind that if you were able to inject significant amounts of extra SHBG into your bloodstream on a regular basis, your body would react to that by making more testosterone! The opposite of that would happen, I believe, if you were able to remove SHBG (like through dialysis or something), or suppress its synthesis in the liver: the production of testosterone would automatically be lowered by the body. In other words, our bodies synthesize and use testosterone on a basis which is probably pretty much independent of other factors like SHBG.

So what's your point there Bryan?

That doesn't really have any relevance to the effects of someone's very low ratio of SHBG.....

And even on your first point. If more free testosterone was being converted to SHBG then there's bound to be less free T unless that free T is being used up elsewhere anyway.

I've no idea about any direct effect of low SHBG on hairloss but its very logicial that a person with a lower SHBG ratio might well have higher DHT levels or other androgen's, or simply free T, as a result. This would potentially attribute to hair loss but only to a man already predisposed to male pattern baldness (it would only serve to help accelerate the inevitable process).

Alot of people for instance, who are using or have used finasteride, find their SHBG levels greatly elevated due to the surpression on DHT - some of the additional free testosterone converted to SHBG. The reverse isn't that hard to envisage either, in fact it could very well be expected.

 

[123000123]

Bryan,

I've never heard of increased testosterone (say, for example, exogenous test) increasing SHBG (granted, these are only anecdotal reports). Further, the following are the views of a well respected "doctor" on a bodybuilding website:

1. Increasing Testosterone reduces SHBG
2. Increasing DHT lowers SHBG
3. Increasing DHEA lowers SHBG
4. Increasing Growth Hormone lowers SHBG
5. Increasing Insulin lowers SHBG
6. Increasing Estrogen increases SHBG
7. Increasing Thyroid Hormone increases SHBG


What are your thoughts on the potential benefits of increased SHBG leading to less "free" testosterone circulating which would of course lead to less DHT and therefore decreased hair loss? Of course, this works in theory, but realistically...?

This would potentially attribute to hair loss but only to a man already predisposed to male pattern baldness (it would only serve to help accelerate the inevitable process).

Exactly.

 

[Mens Rea]

What are your thoughts on the potential benefits of increased SHBG leading to less "free" testosterone circulating which would of course lead to less DHT and therefore decreased hair loss? Of course, this works in theory, but realistically...?

There's no real opinion to be had....this is how finasteride works. The additiional free T usually ends up as E2 or SHBG over time.

Obviously not in the same chain but that is semantics.

 

[Bryan]

So what's your point there Bryan?

My point is that I think it's useless to talk anywhere nearly as much about SHBG as people have been doing. I think it's irrelevant.

That doesn't really have any relevance to the effects of someone's very low ratio of SHBG.....

As I explained in my first post, I don't see any relevance that someone would have an unusually low amount of SHBG. I think the body's ability to control testosterone production would easily make up for that.

And even on your first point. If more free testosterone was being converted to SHBG...

You mean bound to SHBG?

...then there's bound to be less free T unless that free T is being used up elsewhere anyway.

Why would you say that?? Are you unaware of how the body regulates the production of testosterone?

I've no idea about any direct effect of low SHBG on hairloss but its very logicial that a person with a lower SHBG ratio might well have higher DHT levels or other androgen's, or simply free T, as a result. This would potentially attribute to hair loss but only to a man already predisposed to male pattern baldness (it would only serve to help accelerate the inevitable process).

I'll repeat what I've said before: aren't you aware of what a pretty tight grip the body maintains over the amount of androgenic stimulation going on in the body?

Alot of people for instance, who are using or have used finasteride, find their SHBG levels greatly elevated due to the surpression on DHT - some of the additional free testosterone converted to SHBG.

Testosterone isn't converted into SHBG!

 

[Bryan]

Bryan,

I've never heard of increased testosterone (say, for example, exogenous test) increasing SHBG (granted, these are only anecdotal reports). Further, the following are the views of a well respected "doctor" on a bodybuilding website:

1. Increasing Testosterone reduces SHBG
2. Increasing DHT lowers SHBG
3. Increasing DHEA lowers SHBG
4. Increasing Growth Hormone lowers SHBG
5. Increasing Insulin lowers SHBG
6. Increasing Estrogen increases SHBG
7. Increasing Thyroid Hormone increases SHBG

Okay. I don't have any particular reason not to accept what he says.

What are your thoughts on the potential benefits of increased SHBG leading to less "free" testosterone circulating which would of course lead to less DHT and therefore decreased hair loss? Of course, this works in theory, but realistically...?

In general, I doubt that there would be much benefit, because the body tries to maintain a homeostasis of androgenic stimulation. That's why testosterone production goes UP, when you take systemic antiandrogens; that's why testosterone production goes DOWN, when you take body-building steroids.

 

[ello]

Having done tons of research on the matter and spoken to an endocrinologist, a dermatologist and a hair specialist:

SHBG definately has a strong relationship with hairloss.

People with low SHBG (for whatever reason) and high free(or more specifically bio available) testosterone will get aggravated hairloss. THEY WILL EXPERIENCE HAIRLOSS EVEN IF THEY ARE NOT SUSCEPTIBLE TO IT AND HAVE NO FAMILY HISTORY and most of these people will experience it (atleast to start with) in their temple area/hairline area.

SHBG has the strongest affinity for DHT followed by testosterone followed by a much lower affinity for estrogen. There are circumstances where your body simply cant maintain homeostatis.

The endo stated that shbg's mechanisms are not the be it all and end it all but it stands to reason that if your shbg is extremely low and youve got high free test with a corresponding high DHT value that it would aggravate your scalp. He said irrespective of whether your susceptible or not EXCESS DHT causes follicular and scalp irritation via a few modalities. Also the extra test + dht would cause increase sebum production which is also not good.

Unfortunately you cant inject it. The endo stated the only ways to increase it (in his views) are:
1. Reduce IGF-1 levels
2. Reduce Insulin levels
3. Reduce Test levels
4. Reduce DHT levels
5. Reduce body fat drastically and increase fitness
6. Increase e2
7. Increase T3/T4
8. Change Diet



I told all 3 of them my initial results and they all stated that is way too low and definately would be the root cause of my sudden loss. They also thought that perhaps the letro may have caused it by massive estrogenic reduction and hence sorish joints and sudden hairloss but more testing is needed to establish what my complete panel looks like.
Also stated that I should be cautious of a rebound effect due to estrogen but again more testing is needed.