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[racjen]

How come no-one seems to take this into account, or even have very much knowledge of it ( and I'm talking specialists here, not just us normal women, although it seems to me these days that we ARE the specialists, but I for one ain't getting paid for the role...)

Sex hormone binding globulin is a chemical which your body makes when it's decided that the level of a particular hormone is too high in the blood - SHBG will then step in and bind some of that hormone to itself, making it unavailable for the body to use. Unfortunately routine blood tests don't show how much of a hormone is free (ie available) and how much is bound up, so you may appear to have high levels of circulating hormones but not actually be able to access them. This is the case with estrogen and testosterone, and a blood test can show if you have high levels of SHBG. I'm on a very high dose of estrogen, blood tests have shown that i am absorbing it, and yet I have none of the usual symptoms of high levels of estrogen eg painful breasts, bloating etc. Blood tests have also shown that I have high levels of SHBG, but at that point all the doctors just seem to lose interest, the message being there's nothing we can do about this. Does anyone have experience of this? - beginning to think I'm just a total freak....

[Conolly]

Hello racjen,


Very good point. I used to see a naturopath a couple of years ago and she always ordered SHBG tests. It seems that in the near future this will be the norm as low/high levels are also being implicated in other conditions.


https://onlinelibrary.wiley.com/doi/full/10.1111/1753-0407.12550


Conolly X

[Kathleen]

Hello ladies.

This is a very interesting point racjen and apologies for missing your post on the subject Robin.

Does this mean that high levels of SHBG prevent large quantities of oestrogen from being utilised? Given that the body always tries to maintain homeostasis that would make sense.  Also does this explain how a previously adequate level of HRT can suddenly 'stop working ' allowing symptoms to return?  Obviously it would be helpful if we could better understand this process and actually be able to do something about it!

Take care all.

K.

[Kathleen]

Hello Robin.

I didn't think you were complaining at all, like you I assumed your post was just overlooked. The SHBG mechanism could explain so much it would be great to learn more.

Wishing you well.

K.

[Conolly]

Hello Kathleen,

As I understand SHBG is synthesised primarily in the liver in response to androgens and, to a lesser extent, oestrogen levels. There are many other factors that can interfere with SHBG levels though, such as insulin (maybe the main factor), growth hormone, thyroid hormones, prolactin and diet (as the study linked above has shown), not to mention, age, sex, BMI, abdominal fat and chronic diseases.

The circulating androgen concentration affects SHBG synthesis. Elevated testosterone causes SHBG synthesis to decrease, while high oestrogen stimulates SHBG production. The regulation of SHBG synthesis, combined with SHBG's high affinity for testosterone compared to estrogen, results in SHBG effectively amplifying the oestrogen level.

I have read that transdermal estradiol doesn't affect SHBG levels but oral synthetic estradiol does. Here's one article https://academic.oup.com/jcem/article/90/6/3431/2870579

Conolly X

[Kathleen]

Hello ladies.

Me again lol! I've just looked at Conolly's link. Am I to understand that a diet high in natural fibre means higher SHBG and therefore less oestrogen absorption? Marilyn Glenville advocates dietary changes to treat menopausal symptoms and goes on to say  that  ' as dietary fibre increases so levels of oestrogen decreases.  This detoxification of 'old' oestrogen is important because it is effectively what your body has finished with and is aiming to excrete' so  how do we safely iincrease our oestrogen levels and alleviate symptoms I wonder? BTW I've just started reading her book so I'll keep reading and post any points of interest.

Take care everyone.

K.

[Conolly]

Hello Robin,

It's a fascinating subject. Do you think the festive season with all the extra carb/sugar have made any difference regarding menopausal symptoms? Please tell me you have noticed an improvement 

Conolly X


Hello Kathleen,

Now we're finally getting to the point that explains why SHBG is not routinely tested, it's VERY complex. First of all, SHBG binds to oestrogen but doesn't interfere with absorption, unless you are referring to cell absorption. The diet has primarily an effect on insulin levels that also affect SHBG levels, so oestrogen may be secondary.

I have no idea what she means by 'old' oestrogen... Oestrogen is metabolised by enzymes and its half-life is short (hours). Fat can store oestrogen though, so a diet high in fibre means less fat and less stored oestrogen.

Conolly X

[Kathleen]

Hello Conolly.

I acknowledge that Marilyn Glenville is not a scientist/ MD but since I was given her book as a Christmas present I thought I would read it! I would love to think that we can control our symptoms by diet as suggested by her but I have been eating a lot of fibre for years now as well as using HRT and I still have flushes etc. If there's a trick I'm missing I'd love to hear about it lol.

Wishing you all well.

K.

[Conolly]

Unfortunately not conolly. That would be fabulous. Eating all the Christmas goodies and getting rid of menopause symptoms into the bargain  . Maybe I need to give it a much longer trial for research purposes  . In reality eating rubbish very quickly makes me feel rubbish 

How's your weight, BMI? What do you mean by feel rubbish? Gut issues or menopause symptoms?

I understand that women who have problems maintaining a steady level of estradiol could theoretically be fast metabolisers, meaning their enzymes degrade oestrogen at a high rate in the liver. Slow and fast metabolisers are genetically determined so the only way to keep high levels of oestrogen would be increasing the dose or inhibiting specific enzymes. I don't know if this approach has ever been tried, but it would be interesting to investigate.

Another way of keeping some oestrogen storage is to be chubby  but then you would have to deal with other health issues, so... no easy way out.


Conolly x

[Conolly]

Hello Conolly.

I acknowledge that Marilyn Glenville is not a scientist/ MD but since I was given her book as a Christmas present I thought I would read it! I would love to think that we can control our symptoms by diet as suggested by her but I have been eating a lot of fibre for years now as well as using HRT and I still have flushes etc. If there's a trick I'm missing I'd love to hear about it lol.

Wishing you all well.

K.

Kathleen,

I think that maybe she is using an informal writing style so she can be understood by most readers.

Your case is very interesting, maybe we could investigate what's going on? I'd be glad to help.

Conolly X

[racjen]

I am pretty slim, usually between 8 and 8 and a half stone, 5'6" - not sure what bearing that has on all this as I haven't had time to read any of the material posted since my original post. Robin, your estrogen level is not high relatively speaking - mine was 991 pmol at last measurement in Nov, and I'm now on a higher dose (Evorel 150) and yet I have none of the negative effects of too much estrogen ie painful breasts, bloating, weight gain etc. so I question how much is actually getting utilised. My testosterone when tested way back last year was pretty much zero, and yet after a week of definite improvement on testosterone it just stopped,  and was replaced by depression. My SHBG level was then tested and found to be abnormally high, but no-one seems to have any solution to that or to be at all bothered to find one, and I can't help wondering if that's at the root of the problem. But if it is, what do í do about it?

[Conolly]

Racjen,

This article explains the relationship between BMI, insulin status and SHBG.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2648802/#!po=0.892857


This article is very interesting regarding hormones, SHBG and depression.


https://europepmc.org/articles/pmc3376685

We can discuss them if you are interested.

Conolly X

[Saffy]

I also have high SHBG (182) with Oestrogen levels of only 100 p/mol on 100 Estradot patches. My specialist said it 'gobbles' up all the Oestrogen and Testosterone before my body can use it but that was pretty much it. No info as to why it would be high. I have done my own investigations and the only explanation I can find for the SHBG level is also that I'm on a low carb diet.

She has put me on 2x100 patches with a view to getting me on testosterone as my free testosterone levels are also low. She did say that, despite my apparent lack of absorption (from gel too), she didn't want me on oral Oestrogen as this would raise the SHBG even higher.

I am nearly 3 months on the 2x100 patches and all I have to show for it is very sore breasts (worse on the Utro phase)  . My biggest symptoms are still exhaustion, severe brain fog and poor concentration. Flushes/adrenaline surges etc. ceased at much lower levels.

[Conolly]

Hello Saffy,

That's very interesting regarding the low carb diet. Food for thought (excuse the pun).

Your remaining symptoms are all brain related, considering that exhaustion comes from lack of energy and not from excessive exercise. Maybe high SHBG is more deleterious in the brain environment?

I wonder if you could benefit from a slightly high testosterone replacement therapy, since SHBG has more affinity for testosterone than for oestrogen.

Conolly X

[Saffy]

Definitely no excessive exercise involved  . I wonder too about the connection with brain-related symptoms. I have also suffered with low level anxiety, feelings of doom, apathy, lack of motivation etc. although not too bad ATM.

Yes, the specialist is keen to get me on testosterone. From my reading it would seem to be beneficial with my symptoms but I do have some misgivings as I already have quite a bit of facial hair and lost a lot of head hair (female pattern baldness) early in perimenopause. Prepared to give it a go 'though will have to pay privately as my GP practice doesn't allow it  .