Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Waterdaggers]

So i had my E and T tested after having a sudden break out in spots on my cheeks and also ongoing sleep issues. This is my result...

Pathology Investigations

HORMONE ANALYSIS COMMENTS
Serum testosterone level 0.5 nmol/L [0.22 - 2.9]
Serum sex hormone binding globulin level 112 nmol/L [26.1 - 110.0]
Outside reference range
Serum oestradiol level 419 pmol/L
Adult female reference range:
FOLLICULAR MID-CYCLE LUTEAL POST-MENOPAUSAL
E2 45-854 151-1461 85-1251 less than 50
Please Note: Change to oestradiol reference range
due to assay reformulation on 09/10/15
Free androgen index 0 % [0.5 - 6.5]
Outside reference range

I am taking testogel and estrodot for surgical menopause. I had been thinking my T might be too high but does this test show that its not? Not got a follow up docs appointment for over a week so if anyone can advise it would be appreicated. Thanks in advance

[Waterdaggers]

Also due to have pellets implanted 7th of june for both T and E. Bit worried now that this is a bad idea as once in they are in for 6 months.

[Tempest]

Waterdaggers, your E seems fine but your T is virtually non existent.  xxxx

[Waterdaggers]

Thats what I thought but I don't get that as I've been taking testogel since December. Does that mean it's not being absorbed? Confused! I thought it was going to say too high because of the acne I've suddenly started to get.

[Conolly]

Hello Waterdaggers,


I understand that your T levels are low because you have high levels of Serum Sex Hormone Binding Globulin. Your T molecules are mostly combined with these globulin molecules instead of free in the serum.


Maybe you should talk about it before the implant appt. Not that there's any danger in that but it would be pointless if the testosterone couldn't be available to your cells.

Have a look here
https://en.m.wikipedia.org/wiki/Sex_hormone-binding_globulin

Conolly X

[Tempest]

Conolly, you're absolutely right and I had to go back over Waterdagger's posts to see if she was on oral estrogen which might explain this but no - she's on gel. I must admit i'm scratching my head over this one, girls! 

Definitely needs checking by your Consultant, Waterdaggers - I think this is why testing is important to check how things are progressing on any regime. I also personally think us surgical ladies throw up some unique anomalies as we are literally replacing, not supplementing dwindling ovarian hormones.

I really, really wish we could have a member of the British Menopause Society who has a special interest in surgical menopause, especially as so many younger ladies are now having preventative surgery for BRCA (but then I spoke about this last time I was here)!

It's also amazing the difference in opinion amongst Consultant's that I have seen (and I've seen a few) over what function the post menopausal ovaries have. Some state that the amount of hormonal input is negligible, some say there is a significant production of post menopausal androgens from the ovaries. Some state this continues into relatively advanced age, some believe this tapers off after a few years post menopause. If you even Google this question, opinions and studies differ hugely. So who's right? I kinda think we need to know! (Sorry, Waterdaggers - going off topic a bit and thinking out loud here).

xxxx

[Waterdaggers]

That's interesting about the SHBG.... but why is my body doing that? And how is that likely to make me feel? Does that mean there is no point in me using TRT?

I definitely agree that there is a lack of awareness about surgical menopause. It's seems it's not understood at all and is just assumed to be the same as natural.

[Conolly]

Hello ladies,


It's a bit complicated. Another possible explanation is thyroid problems like hyperthyroidism or thyrotoxicosis.


I'm sorry I can't seem to be able to search for specific posts here, so forgive me for asking what may be obvious 🤭 Did you have a total hysterectomy/oophorectomy? When?


I ask this because depending on the time you had it, your body may be adjusting itself to the new hormonal environment, what biologists call homeostasis, and that could lead to a slight increase in SHBG levels.


Conolly X

[Waterdaggers]

Hello ladies,


It's a bit complicated. Another possible explanation is thyroid problems like hyperthyroidism or thyrotoxicosis.


I'm sorry I can't seem to be able to search for specific posts here, so forgive me for asking what may be obvious 🤭 Did you have a total hysterectomy/oophorectomy? When?


I ask this because depending on the time you had it, your body may be adjusting itself to the new hormonal environment, what biologists call homeostasis, and that could lead to a slight increase in SHBG levels.


Conolly X

Hi Conolly,

I had my thyroid checked about 3 months ago and that was all ok at that time.

I had a total hyst and removal of my last ovary in September last year. First ovary was removed 6 years ago and that sent me into early menopause.

So testosterone that is bound to SHBG cannot be used by the body at all, is that right? Just wondering why I don't have more symptoms of low T. I suffer with fatigue but I mainly put that down restless poor quality sleep.

xx

[Conolly]

Yes, the bioavailability of testosterone depends on the ratio between how many molecules are free and how many are bound to SHBG.


I think last September is relatively early days. Maybe that ovary was still very functional. Do you have blood tests results from that time? Why did you have just one ovary removed and 6 years later the total procedure? Sorry for asking so many questions but this can help explain what's going on.
 
Conolly X

[Saffy]

Waterdaggers, I have also had blood tests recently which shows a level of 0.5 for testosterone and a high SHBG of 182 ( ). My Oestrogen levels are rock bottom 'though, at  100, despite being on Estradot 100 for the last 5 months. My GP was puzzled as all my standard bloods, TSH etc. are fine.

Apparently the most likely explanation for high SHBG on HRT is due to 'too' high oestrogen levels - clearly doesn't apply to me but if I were you I would be wary of an oestrogen implant without further advice. I have, however, read that high SHBG is not unusual on people following a low carb diet - this could explain my readings.

My biggest symptoms are exhaustion, severe brain fog and poor concentration levels (I still have all my ovaries and uterus). We have decided to try and get my oestrogen levels up by switching to gel from patches before considering testosterone but yours seem a reasonable (but not excessive) level.

[Waterdaggers]

Yes, the bioavailability of testosterone depends on the ratio between how many molecules are free and how many are bound to SHBG.


I think last September is relatively early days. Maybe that ovary was still very functional. Do you have blood tests results from that time? Why did you have just one ovary removed and 6 years later the total procedure? Sorry for asking so many questions but this can help explain what's going on.
 
Conolly X

No I don't have blood tests from that time unfortunately, although I can tell you I was already using estrodot 75 patches.

I had the first ovary removed due to a large cyst that turned out to be borderline ovarian tumour. Consultant had wanted to take the whole lot out then but I was reluctant due to my age (38 at the time) and wanting to avoid menopause. So instead I had regular scans. All was fine and then I started having menopause symptoms about 3 years ago. I started on HRT but had big problems with the progesterone side of HRT, including vaginal utro. So I opted to have it all removed.

Estradot dose was increased to 100, then 125 and now 150. Started testogel in december. Although I don't feel 100% I feel considerably better than I did in december last year. My mood was rock bottom and I struggled with overwhelming tiredness. So I had really thought the improvement was due to the testogel. Maybe it was the increase in E? Now my tiredness is mainly due to bad sleep and I can fight through it.... end of last year I could not have done all the things I do now.

[Waterdaggers]

Waterdaggers, I have also had blood tests recently which shows a level of 0.5 for testosterone and a high SHBG of 182 ( ). My Oestrogen levels are rock bottom 'though, at  100, despite being on Estradot 100 for the last 5 months. My GP was puzzled as all my standard bloods, TSH etc. are fine.

Apparently the most likely explanation for high SHBG on HRT is due to 'too' high oestrogen levels - clearly doesn't apply to me but if I were you I would be wary of an oestrogen implant without further advice. I have, however, read that high SHBG is not unusual on people following a low carb diet - this could explain my readings.

My biggest symptoms are exhaustion, severe brain fog and poor concentration levels (I still have all my ovaries and uterus). We have decided to try and get my oestrogen levels up by switching to gel from patches before considering testosterone but yours seem a reasonable (but not excessive) level.

Hi Saffy,

I'm wondering if my relatively high estradiol reading is a false reading? My gp (one of them - see a different one every time) said before that this can happen and that high E readings should be ignored. I really have no idea if this is true. I had my E checked 3 months ago and it was 271. I am most concerned that my androgen index is 0% so that means I have no testosterone available at all. But then I had not really felt I had symptoms of low T so bit confused really. I dont have a low carb diet but its super healthy and I guess I am pretty skinny so maybe that has an impact? It's all so complicated!

[Hurdity]

Hi Waterdaggers - The gynae I saw said the tests for testosterone were somnewhat unreliable as the same test is used that is designed for men who have much higher levels and as our values are at the lower end of the scale, the subtle differences can be lost and they can be inaccurate. That being said most gynaes  say that T levels should be tested following T replacment for obvious reasons.

Certainly the break-out in spots does indicate higher T though!! Despite your results I would want to be wary of having an impnat based on the blood tests results alone.

What dose of T have you been using and I presume it is the sachets (1%)?

 If you had low libido (besides the fatigue and muscle pains etc after execrise - which is what I was getting) which has improved then it could be that you are absorbing it. Any effects of T would have become apparent by now.

To me the most important thing is to go by symptomns whatever blood tests say (as with thyroid for example - when some docs ignore the patient in front of them and rigidly adhere to their lab ref ranges to determine whether treatment is needed!).

If you are feeling generally well and pretty much happy with your current regime ( apart from the spots!) I am wondering why you are having an implant anyway? Personally I would be tempted to wait, see how you feel oveer the next couple of months, have another blood test and take it from there

It's not just surgical menopause that insufficient is known about - the whole area of T replacement in women is completely under-researched and in its infancy. When you think about it - we need to know about routes ( ie gel or patch), doses, the effect with different oestrogen levels, short and long term effects, effects on other parameters eg cardio-vascular system, cholesterol etc. if we are living longer and longer and more women are needing T replacement for better quality of life - there must be more research to benefit us all and society as well! Rant over!

Hurdity x

[Hurdity]

Also just seen your next post - the Free Androgen Index is calculated as follows:

FAI = Total Testosterone/SHBG expressed as percentage ie then x 100 (must be measured in same units)

Therefore yours based in this one result is:
0.5/112  x 100 = 0.45% so not actually zero. It was probably rounded down!

The RCOG ref range is given as 0.5 - 6.5 so yes yours is just outside the ref range but not zero!

Hurdity x