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

[Bryan]

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.

Really? What are those circumstances?

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.

I would modify that statement in one small, but very important way. Instead of what he said, I would say this: It stands to reason that if you've got high free test with a correspondingly high DHT value that it would aggravate your scalp.

See the difference? Leave the SHBG out of it completely, as that introduces a secondary factor which appears to me to be mostly irrelevant. But we all know that too much androgen is bad for scalp hair! If a person has too much androgen (for whatever reason that doesn't appear to me to be particularly associated with SHBG), he's obviously got big problems.

 

[hhrock]

ok this thread got me really intrigued and here's the thing I'm wondering about.

considering ello is right and:
low SHBG --> high free T --> high(er) DHT

as a bottom line, the DHT is the root problem here not the high T correct?
when doctors speak of hair loss in this case, it is due to higher DHT because of higher free T, not necessarily higher T on its own?

why I'm asking is because I've started taking stinging nettle root extract daily. One of the reasons is that I self diagnosed myself with lower than average test and want to raise it slowly and naturally but another reason is that it may (not having high hopes but it's a "can't hurt" kind of attitude) help with hairloss due to its blocking of 5a-reductase and therefore lowering DHT. I already take 0.5mg of finasteride daily so it's clearly the better option for lowering DHT but I thought nettle can't hurt and I may experience the benefits of higher testosterone.

so should I panic or not? if ultimately it's all about DHT, then I guess I don't have any reasons to panic (because of both finasteride and nettle). but maybe i'm missing something here...

thanks.

 

[Bryan]

considering ello is right and:
low SHBG --> high free T --> high(er) DHT

Consider this for just a moment: what do you think would happen if you were to start taking some powerful new drug whose ONLY effect was to completely inhibit the liver's synthesis of SHBG? It doesn't do ANYTHING else, except completely stifle SHBG production? Would the level of free testosterone in the blood start to rise immediately? Would the part of the brain that monitors testosterone levels in the blood soon start to think, "Holy smoke!! We're getting waaaay too much free testosterone floating around here!", and then start cutting WAAAAY down on the release of LH (luteinizing hormone), which is the chemical signal that tells the testes to manufacture testosterone? Would the manufacture of testosterone by the testes be so sharply reduced that free testosterone (and DHT) levels go back to normal, even without the help of SHBG?

If your answer to the questions above is "yes", then you and I are in agreement. Now you know why I don't consider SHBG to be particularly relevant to this discussion.

 

[ello]

Really? What are those circumstances?


I would modify that statement in one small, but very important way. Instead of what he said, I would say this: It stands to reason that if you've got high free test with a correspondingly high DHT value that it would aggravate your scalp.

See the difference? Leave the SHBG out of it completely, as that introduces a secondary factor which appears to me to be mostly irrelevant. But we all know that too much androgen is bad for scalp hair! If a person has too much androgen (for whatever reason that doesn't appear to me to be particularly associated with SHBG), he's obviously got big problems.

Medications, exogenous hormones, corticosteroids, genetic issues, diseases.


Like he said too SHBG is not the BE it all and END it all BUT its a very important factor that has direct relevance.

I do completely agree with you that too much androgens is bad and agree with your logic from an overview. But IMO and those docs too, 1 reason why a person may have a high amount of a potent androgen such as DHT thats non binded and thereby free to influence the hair follicles etc is simply because there isnt enough SHBG for its primary hormone testosterone and its metabolite DHT to bind to.
The less free unbinded test present, the lower the dht levels likely to be.


Once I get my followup test results I will know what my levels of test/dht @ shbg is and what the new levels might be after increasing my shbg levels.

The inverse relationship that shbg plays with all the hormones is kind of like a see saw. SHBG being the centre point trying to balance the sides but moves in order to do so which may exacerbate the issues. The point here is the amount of free testosterone and correlating DHT that would affect your hair and scalp. Your body has other feedback methods such as the HPTA loop to adjust hormone levels (again assuming lack of medication, disease, etc).


Assuming all else is normal and a person still has high amount of test and corresponding dht then further investigation is warranted.

 

[ello]

considering ello is right and:
low SHBG --> high free T --> high(er) DHT

Consider this for just a moment: what do you think would happen if you were to start taking some powerful new drug whose ONLY effect was to completely inhibit the liver's synthesis of SHBG? It doesn't do ANYTHING else, except completely stifle SHBG production? Would the level of free testosterone in the blood start to rise immediately? Would the part of the brain that monitors testosterone levels in the blood soon start to think, "Holy smoke!! We're getting waaaay too much free testosterone floating around here!", and then start cutting WAAAAY down on the release of LH (luteinizing hormone), which is the chemical signal that tells the testes to manufacture testosterone? Would the manufacture of testosterone by the testes be so sharply reduced that free testosterone (and DHT) levels go back to normal, even without the help of SHBG?

If your answer to the questions above is "yes", then you and I are in agreement. Now you know why I don't consider SHBG to be particularly relevant to this discussion.

Not quite as simple. Sorry.

Your forgetting the other hormones that would also come into play such as FSH, estrogen, prolactin, tsh and more.

It would never be as simple as "high free test=reduce test production in order to also reduce dht" otherwise people with low shbg shouldnt have that much test present and therefore correlating dht since the body would already know there is excess levels of test and dht that arent even needed (assuming not a big muscular person with constant exercising etc).

 

[Bryan]

Medications, exogenous hormones, corticosteroids, genetic issues, diseases.

I was hoping for an answer that was a little bit more specific than that!

Like he said too SHBG is not the BE it all and END it all BUT its a very important factor that has direct relevance.

I do completely agree with you that too much androgens is bad and agree with your logic from an overview. But IMO and those docs too, 1 reason why a person may have a high amount of a potent androgen such as DHT thats non binded and thereby free to influence the hair follicles etc is simply because there isnt enough SHBG for its primary hormone testosterone and its metabolite DHT to bind to.
The less free unbinded test present, the lower the dht levels likely to be.

Well, any more I say on this issue, I'll simply be repeating what I've already said before. I'm baffled as to why you can't see that the purpose of SHBG isn't to control levels of androgens in the bloodstream. SHBG doesn't do that! It's the brain that does that, not SHBG!

 

[Bryan]

Not quite as simple. Sorry.

Your forgetting the other hormones that would also come into play such as FSH, estrogen, prolactin, tsh and more.

Remember, I made the specific condition that the effect of the hypothetical new drug I was talking about was ONLY to inhibit the synthesis of SHBG.

It would never be as simple as "high free test=reduce test production in order to also reduce dht" otherwise people with low shbg shouldnt have that much test present and therefore correlating dht since the body would already know there is excess levels of test and dht that arent even needed (assuming not a big muscular person with constant exercising etc).

Yes, but this _is_ a good example of the fact that there are numerous feedback loops, all of which have an effect on controlling the production of SHBG; not just sex hormones like androgens and estrogens, but also growth hormone, IGF-1, insulin, etc. My only point above was to emphasize that if you could somehow wave a magic wand and completely obliterate the total production of SHBG completely, I wouldn't expect much to come of that. The brain would still be operative after that, and continue doing its OWN regulation of testosterone production, as it always has.

 

[DIYtony]

So Ello, how are you planning to raise your SHBG?

 

[hhrock]

I guess I'll have to ask a very simple question in hopes of a very simple answer.

is it okay for me to take stinging nettle (which lowers SHBG hence possibly raises T but also has DHT blocking properties)?

again, I do use 0.5mg finasteride daily.

 

[ello]

@Bryan

Overall we agree where we disagree is how SHBG plays into it.

In your hypothetical situation just like in men with andropause or women with PCOS or other numerous scenarios, I dont think the body would be able to simply adjust and cope without SHBG. SHBG is 1 mechanism amongst others the body has and the primary one (next to albumin) that binds to the actual androgens.


In my situation (given that my SHBG counts have been normal before) letrozole most likely is the culprit and if my theory is correct then once my blood results come back I should be able to see an improvement in my shbg count and still a fairly low estrogen count.



@DIYTony

Well that depends tony. Today I had another blood sample taken for further testing and to see what my new shbg level (12days later or so) will be.
Once I know why it is low and whether my theory is correct then I would know what to do.

As of right now all I can really do is hang tight and wait for the results before missing with anything.


@hhrock
From what ive read around finasteride increases SHBG.

Why would u want to lower SHBG, raise T and try to block DHT at the same time?

 

[hhrock]

because healthy T levels help with a lot of stuff. I work out (naturally) and it helps for obvious reasons there but it is also good for mood, sex drive etc. just think of all the positives of higher T levels in men. I didn't say I *want* to lower SHBG, it's just that's what happens when taking stinging nettle (which I use primarily to raise T not to lower SHBG). so I guess I kinda want the best of both worlds, have healthy levels of testosterone while blocking as much DHT as possible at the same time because I'm also concerned about balding.

so my question stands, is it okay for me to be taking stinging nettle considering all its properties and would it be beneficial or harmful in my hair loss fight?

 

[Bryan]

@Bryan

Overall we agree where we disagree is how SHBG plays into it.

In your hypothetical situation just like in men with andropause or women with PCOS or other numerous scenarios, I dont think the body would be able to simply adjust and cope without SHBG.

Why don't you think the body would be able to cope, without SHBG? Haven't you heard stories about the TREMENDOUS increases in testosterone production just as a result of taking systemic antiandrogens (which is why they generally have to castrate prostate cancer patients, they can't just give them antiandrogens), or how bodybuilders who take anabolic steroids can get some serious shriveling-up of the testes? The body evidently has a LARGE ability to adjust the size of its testosterone production, from a whole lot, to nearly nothing; and yet you STILL think it's very limited in just how much it can decide to produce?? :dunno: :smack:

SHBG is 1 mechanism amongst others the body has and the primary one (next to albumin) that binds to the actual androgens.

I don't consider SHBG to be a "mechanism" that the body has to bind to androgens. I think it's there just because it's there, for whatever evolutionary reasons. I think as the level of SHBG goes up and down for various reasons (we know a great many things can influence that level), the brain keeps trying to maintain approximately the same level of androgenic stimulation in the body, REGARDLESS of how much SHBG happens to be floating around in the blood.

 

[ello]

Haven't you heard stories about the TREMENDOUS increases in testosterone production just as a result of taking systemic antiandrogens (which is why they generally have to castrate prostate cancer patients, they can't just give them antiandrogens), or how bodybuilders who take anabolic steroids can get some serious shriveling-up of the testes? The body evidently has a LARGE ability to adjust the size of its testosterone production, from a whole lot, to nearly nothing; and yet you STILL think it's very limited in just how much it can decide to produce?? :dunno: :smack:

Ofcourse Im well aware of those facts but your ignoring all the pathways relevant that cause those effects.

Like I said before its a seesaw effect.


Taking antiandrogens will ofcourse increase your test production because your body tries to make up for the lack of test and the EXCESS estrogen and a likely high SHBG which further aggravates the low test.

Just like taking dht blockers will INCREASE your test THOUGH reducing your DHT and increasing your SHBG as your T to E balance has been shifted and youd have more Estrogen than before.


In the case of BBers taking steroids specifically testosterone, you dont see their SHBG going high to try to bind with all that SHBG do you? Instead what happens?
Their aromotisation to estrogen or prog(depending on the steroids) increases, their LH reduces, and their natural test production decreases whilst their DHT increases astronomically.
But unlike the SHBG factor those BBers would take an AI perhaps anastrozole or cabergoline to reduce control and lower their estrogen/prolactin and most likely would be taking HCG to force their testes to stay active and not "shrivel up".

If we could somehow simply inject or take something to force our livers to create more SHBG Id be able to prove my point in terms of DHT reduction etc by posting blood test results etc. Unfortunately theirs nothing like that so far....

 

[ello]

@hhrock

I have not seen any conclusive studies done on stinging nettle (Urtica dioica).

The few studies I have seen on it seem to suggest that perhaps it does have a mild DHT inhibiting property but certainly no testosterone increasing property.

So considering youd like to increase your testosterone for increased protein synthesis and other benefits, id say itd be useless and money could be better spend elsewhere.


Have you had blood tests and hormone panel done? Your test should already be slightly higher and changing the ratio of Test to Estro is relatively easy.

 

[Bryan]

Ofcourse Im well aware of those facts but your ignoring all the pathways relevant that cause those effects.

Really? What am I "ignoring"?

Like I said before its a seesaw effect.

Taking antiandrogens will ofcourse increase your test production because your body tries to make up for the lack of test and the EXCESS estrogen and a likely high SHBG which further aggravates the low test.

I don't think the body tries to "make up" for estrogen by making more testosterone. Even if it did _try_ to do that, it would fail miserably, because estrogen has a powerful effect at decreasing LH and (as a result) suppressing the synthesis of testosterone. Estrogen is one of the main factors (along with DHT and testosterone itself) that tell the brain when it's made enough testosterone.

Just like taking dht blockers will INCREASE your test THOUGH reducing your DHT and increasing your SHBG as your T to E balance has been shifted and youd have more Estrogen than before.

I don't think the slight increase in estrogen that comes with the use of 5a-reductase inhibitors has anything at all to do with the small increase in testosterone that people usually get (as I said before, estrogen actually can help cause a DECREASE in LH, not an increase). The increase in testosterone almost certainly comes about because DHT is one of the players in the feedback loop (along with testosterone and estrogen) that determines how much testosterone is going to be made. Here is an exact quote from the PDR (Physician's Desk Reference). It's from the "Clinical Pharmacology" section on Proscar:

"...Increases of about 10% were observed in luteinizing hormone (LH), follicle-stimulating hormone (FSH) and testosterone levels in patients receiving Proscar, but levels remained within the normal range."

Do you understand the significance of that statement?? It's obvious that testosterone went up by 10% because LH also went up by 10%!! LH went up because the brain "saw" less DHT in the blood, and DHT is one of the factors (along with estrogen and testosterone itself) that it uses to determine if enough testosterone is being produced!

In the case of BBers taking steroids specifically testosterone, you dont see their SHBG going high to try to bind with all that SHBG do you?

Of course not. The body doesn't synthesize SHBG just to bind with androgens.

Instead what happens?
Their aromotisation to estrogen or prog(depending on the steroids) increases, their LH reduces, and their natural test production decreases whilst their DHT increases astronomically.
But unlike the SHBG factor those BBers would take an AI perhaps anastrozole or cabergoline to reduce control and lower their estrogen/prolactin and most likely would be taking HCG to force their testes to stay active and not "shrivel up".

I'm not sure about their DHT supposedly increasing "astronomically", but at least you got most of the other stuff in those two sentences correct!

If we could somehow simply inject or take something to force our livers to create more SHBG Id be able to prove my point in terms of DHT reduction etc by posting blood test results etc. Unfortunately theirs nothing like that so far....

I'm not sure what you think you'd be able to "prove" about DHT, but let's look on the bright side: I think you've learned some things today about the way the body produces and regulates sex hormones. It doesn't have NEARLY as much to do with SHBG as you thought it did.

 

[ello]

lol ur funny bryan.....


I never said that the body " "make up" for estrogen by making more testosterone." A bit counter intuitive if you actually know how things work.

And again I havent said that SHBG is the be it all and end it all but that it is an important factor that needs to be taken into account and one that adds to the equation of how much test/estro/dht etc you have free and how the body controls things.

Elaborating on my statement since apparently it wasnt clear enough or perhaps you would like me to post studies for each statement I make lol

"Taking antiandrogens will ofcourse increase your testosterone production because your body tries to make up for the lack of testosterone. What happens with testosterone after it undergoes aromatisation(unless ofcourse you block that)? Estrogen is produced.
Taking those doses of antiandrogens (and not merely dht inhibitors) will increase your testosterone BUT your ratio of test to estrogen will also shift in favour of higher amounts of estrogen present. Consequently your SHBG also increases which means youd have more androgens binded rather than free, further tipping the scales.

If the human body worked perfectly all the time then men wouldnt go through andropause, gynocomastia etc nor would women deal with hormonal imbalances, PCOS etc. This is ofcourse excluding any HPTA or HPGA issues eg diseases, tumors.
Its not as simple as reduce this and it will autoadjust on its own or adjust 1 single pathway and the body will autoadjust itself.

This detection and subsequent adjustment is not as simple as a single estrogenic pathway but multiple. Im SURE you know this but LH is not affected by estrogen only but by a large number of factors including diet, exercise, lifestyle and stress, dht, testosterone, androstenedione, progesterone, prostaglandins, FSH, gh, igf-1, nitric oxide, toxins/medications, and more.


Anyway its not as simple as if you could stop all ur SHBG your body would chug along just fine because it would adjust itself and that would be that with no sideeffects.

No shbg whatever scenario you paint would imply non binded testosterone and dht flowing around and if your body were to adjust by reducing your levels to bugger all levels.....well enjoy THAT life as you might as well get castrated and change sex.

 

[global]

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.......

What kind of a doctor lets a lab guy tell him what tests he needs????

WTF??

Your doctor needs to tell the lab guy that his job is to do the tests that the doctor thinks necessary, and when he has gone to med school for four years maybe his opinion will count for something.

 

[global]

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.

I'm not sure it's as simple as that Bryan.

Maybe in an ideal world the body would always be capable of reacting to changes in the amount of a free hormone (which may equate to SHBG and albumin levels) by up or down regulating total hormone output.

In that case it would never be necessary to test levels of free hormones since free hormone levels would always be proportional to bound hormone levels.

However we know that that is not the case and that for some conditions it is necessary to measure free hormone levels since the body does not function as effectively as you imply to regulate the total level up and down.

 

[Bryan]

lol ur funny bryan.....

I never said that the body " "make up" for estrogen by making more testosterone." A bit counter intuitive if you actually know how things work.

Really? Then what did you mean when you made this statement: "Taking antiandrogens will ofcourse increase your test production because your body tries to make up for the lack of test and the EXCESS estrogen and a likely high SHBG which further aggravates the low test." That's not _my_ putting words into your mouth, that's a direct quote (a simple copy/paste) of what you said in an earlier post. Are you trying to back away from what you said ealier?

And again I havent said that SHBG is the be it all and end it all but that it is an important factor that needs to be taken into account and one that adds to the equation of how much test/estro/dht etc you have free and how the body controls things.

I don't think it's an important factor at all. I don't even think the purpose of SHBG is to regulate the production of androgens. I don't really have any idea what it's evolutionarily-designed purpose actually IS, but it's almost certainly not to control androgens.

Anyway its not as simple as if you could stop all ur SHBG your body would chug along just fine because it would adjust itself and that would be that with no sideeffects.

I'm not necessarily saying that your body would "chug along just fine" if you were to completely eliminate all SHBG production. I'm saying that your body would certainly ATTEMPT to keep levels of testosterone normal, by adjusting the amount of the hormone that it produces. It's like the governor on a car or bus engine, which attempts to maintain a proper speed all the time. Does it maintain that speed perfectly, even when it finds itself going up (or down) a steep hill? No, but it makes an attempt to do that. The same thing happens with SHBG: the body obviously tries to maintain an even keel with it when it changes due to numerous other factors in the body which can affect SHBG. I'm sure the body does that pretty well, but not perfectly.

 

[Bryan]

I'm not sure it's as simple as that Bryan.

Maybe in an ideal world the body would always be capable of reacting to changes in the amount of a free hormone (which may equate to SHBG and albumin levels) by up or down regulating total hormone output.

In that case it would never be necessary to test levels of free hormones since free hormone levels would always be proportional to bound hormone levels.

However we know that that is not the case and that for some conditions it is necessary to measure free hormone levels since the body does not function as effectively as you imply to regulate the total level up and down.

I'm not saying this is an "ideal world", or that the brain will always maintain perfect control over androgen (testosterone) production, if SHBG were to suddenly change due to a myriad of reasons which can cause it to go up or down a little (see my analogy of the governor of a car or bus engine in my previous post). I'm just saying to stop talking about SHBG as if THAT is what is really controlling androgen production!