If secondary,i.e, low LH/FSH, SERM should be given a shot for a restart as it can work well and avoid life long TRT. However, i advise everything to be always done under the care of a medical advisor, this is because SERMs can do a lot of funny stuff. It can raise TT but also SHBG which leaves FT still low enough to not get symptomatic relief, some don’t feel well with even good improvements in numbers on all counts, for reasons not understood. So it’s good that you have a doctor knowing your baseline and symptoms so that when there is not a symptomatic response it can be traced back to the original problem.
IGF-1=200 is quite decent. Depends on age which I cannot find in this thread.
T+SHBG is tightly bound and not bio-available. In the trash can by the road waiting for pickup [by the liver] would be a better analogy.
Body builders will take some DHT like drugs that have a higher affinity for SHBG and SHBG gets saturated and that increases FT. So in that case, we see these guys making an effort to duplicate your condition. So, again, I do not understand the problems with this which may simply be the limits of what I have learned.
http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/9285
There are some issues with low SHBG which people suggest makes it very difficult to dial in their TRT. I don’t know the mechanism of these problems as i have been too saturated with information pertaining to my case itself-high SHBG. You can try learning more in Crisler’s book, i vaguely remember some details about this in his TRT book.
@KSman my age is 23, nearing 24. I do not understand the problems either, which frustrates me because it should seem that the ONLY function of SHBG would be “in the trash can by the road waiting for pickup,” but this does not seem to be the case, for whatever reason.
There are a lot of serious implications to having low SHBG as well; heart disease, insulin resistance, things of that nature.
I am young and healthy enough (in appearance and weight) that the insulin resistance theory likely does not apply to me, but I could always get a stim test of sorts. You never know.
@equalo212 if the most well-known side is an increase in SHBG, count me in! Why not use both a SERM and testosterone shots? Seems like a decent method of treatment for someone like me, actually. Just that I may need less testosterone and potentially an AI.
How is Crissler’s book? Worth the purchase? To be frank, I’ve read about him on the web and his patient satisfaction is relatively low. That’s not to say his knowledge on the subject is minimal, but to me it is a red flag.
It’s not a certainty, it happens to few people for reasons unknown as clomid is an estrogen itself, low T and adding actual estrogen can do that. IF secondary, SERM should be tried and seen if making a symptomatic response, if yes, then you’re good.
Still ripping my hair out here.
@KSman what do you think about my glucose level? It was 110 mg/dL (65-100 mg/dL) and taken at 8am. I didn’t have anything to eat before except for some coffee with sugar in it.
Is that indicative of metabolic syndrome? It could explain my SHBG levels. Should I look into additional testing?
I asked about A1C because it reflects average glucose levels and cut through a lot of uncertainties[quote=“needsdoctor, post:46, topic:217006”]
what do you think about my glucose level? It was 110 mg/dL (65-100 mg/dL) and taken at 8am. I didn’t have anything to eat before except for some coffee with sugar in it.
[/quote]
That been the case, insulin resistance is a definite possibility. A1C clears the fog.
Suggest 500-1000mg metformin per day with meals. What you read about risks seem to apply to those with other imparements. Metformin seems to have other age extension effects as well as anti-cancer benefits.
Menwhile, be looking at the insulin sensitivity improvement of TRT done right with E2 management.
It is almost impossible to drop into a thread this long and put latest posts into perspective. It is your job to be your expert and fix everything together. I can’t do everything following hundreds of cases. I have not reviewed your thread in total for this post. You metabolic balance involves T, E2, thyroid and cortisol - if everything else is functional. There are confounding factors to each. Sorry if too deep - mood that I am in.
Insulin resistance/diabetes seems to involve low SHBG or low SHBG predicts the reverse. Focus on the issues referred to in the prior paragraph. Metabolic balance is the key to all of this.
Metabolic syndrome, aka syndrome X involves low T, elevated T, fat gain in central areas, increased blood pressure, elevate cholesterol, presumed to be from estrogen dominance, perhaps low DHEA. Thyroid problems can make it all worse or cause the most of the mess.
I don’t expect you to “be my doctor,” I only ask because I’m suffering and you have a lot of knowledge on endocrine. I do appreciate your help, along with everyone else in the thread. I understand you look through a lot of posts each day. Would you recommend I start a new thread?
I’m going to get A1C tested, along with true fasting glucose and see what the results show. When I first was diagnosed with low T, at a young age, my free T / SHBG was never measured, but my total T was in the 200’s. From what I’ve been reading online, it is rather common in younger men for low total T to be accompanied by low SHBG. I’ll never know, but I know it’s low now and it’s difficult to treat.
What would optimal values be for fasting glucose and A1C? When I was first experiencing symptoms, I lived a rather active lifestyle, played sports in high school. Is it possible, however unlikely, for someone so young and active to develop metabolic syndrome?
FWIW, both of my maternal grandparents had type 2 diabetes. My father’s family history is unknown.
And do you think switching to Clomid for the time being would be a good idea? T lowers SHBG and I feel that, being a SERM, Clomid may help to elevate SHBG levels. My doctor is unfamiliar with that specific form of treatment, but he’s reasonable when provided with the necessary medical studies.
@KSman fasting glucose was 87 and A1C was 4.9%. Both values normal. Is there any way at all to raise my stupid SHBG level? Can I buy synthetic SHBG and eat it or something? I’m desperate here.
Please contact me. I have the following. I am completely lost with this and im not on trt. My symptoms are very similar. No libido, numb genitals, lack of sweat from armpits, genital area. dry tired eyes. low semen volume and force.
elevated DHEA-s.
Low e2
low DHT
normal total T
elevated ggt+alt+ billirubin
elevated uric acid
endo also claimed my “carriers” (SHBG) was low at 20…