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[Hurdity]

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....

Hi racjen - I have posted many times on this forum about SHBG but mainly in relation to testosterone. Because testosterone has greater affinity for SHBG than oestrogen the SHBG in your blood readily binds free testosterone making it unavailable to the body as has been discussed here. Because testosterone replacement is not licensed for women it seems that it is not routinely measured although it can be. When it is measured - tests only measure the total testosterone but by also testing SHBG  the Free Androgen Index can be calculated - which gives an estimate of free testosterone. It is not SHBG per se which is important in this context but this (SHBG) in relation to total testosterone.

Here is one recent thread where I gave the calculation: https://www.menopausematters.co.uk/forum/index.php/topic,41130.msg648779.html#msg648779

Oral oestrogens are well-known (by specialist gynaes) to reduce libido by comparison with transdermal oestrogens because of their effect on SHBG and the first suggested change women with low libido should make if they are taking oral oestrogens is to switch to transdermal. From what I recall ( this is all from memory - so hope it's correct!) conjugated equine oestrogens have an even more dramatic effect on (increasing ) SHBG.

From the very limited amount I've read about SHBG - it seem to be part of the complex and delicate balance between all our endocrine functions which are subject to feedback control involving many hormones and enzymes, so the effect of the addition of one exogenously may well be difficult to predict!

Interesting to read about SHBG synthesis. In fact I have no idea whether our current tests for estradiol measure total or bio-available estradiol and if the former why this does not seem to be a medical issue compared to testosterone measurement when discussing estradiol levels in women? However it is always the case that symptoms should be a guide - but in extreme cases and in surgical menopause - it is probably more difficult.

Connolly - thanks for the links - interesting. It is usual and helpful to put extracts of papers or articles into quotes so that readers can tell which are your own words and which come directly from another source.

Racjen - if you have high levels of SHBG and your total testosterone is low your FAI will also be very low - this could be a starting point although it doesn't help with your oestrogen levels and the effect on these.

Hurdity x

[racjen]

My testosterone level is practically zero, and when my SHBG level was tested a while back (at my request) it was abnormally high, so I'm pretty sure this is causing some of my problems - seems really weird that my estrogen level can get as high as 2000 pmol and I still don't feel any of the negative effects most others would suffer with this much estrogen. And when I tried testosterone it worked amazingly for a week and then just stopped, as if something had kicked in to 'gobble it all up'. The frustrating thing is, that may be what's going on, but is there anything that can be done about it? I feel like I'm having to tell my consultant all this stuff which he should be aware of - he said initially testosterone was irrelevant in my case as my ovaries would still be making it. I had to point out that blood tests had shown that my ovaries were completely clobbered by chemotherapy, and my testosterone level is on the floor. He looked kind of sheepish, but didn't really say a lot. When I next see him I'm going to be armed with questions about SHBG and what can be done, but I feel pretty pessimistic. Does anyone know of any doctor who has this level of expertise, private or NHS? I'm getting to the point where I'd spend my life savings to feel any semblance of normality again  .

[Conolly]

Hello racjen,

It has been shown that SHBG levels decrease after a diet high in fats https://academic.oup.com/jcem/article-abstract/64/5/1083/2653957

I guess you could try to add more good fats to your diet or take EPA/DHA supplements to see if it helps.

Have you ever thought that your daily dose of Diazepam could be the culprit of high SHBG? https://www.sciencedirect.com/science/article/pii/0278584684901313

Another possibility is high FSH, unfortunately only the abstract is available https://link.springer.com/article/10.1007/s12020-017-1272-y

Conolly X

[racjen]

Interesting about the diazepam - I had no idea and I don't expect that any doctor would either, will look into that further. FSH is produced by the ovaries isn't it? Since mine have been destroyed by chemo I think that's unlikely to be the culprit. Thanks for the info x

[Conolly]

Hello racjen, happy and healthy new year!

FSH is produced by the pituitary gland in the brain.

Here's another interesting article on diazepam  https://sites.ualberta.ca/~csps/JPPS6(2)/K.Dhawan/anxiolytic.htm
Conolly X

[Hurdity]

My testosterone level is practically zero, and when my SHBG level was tested a while back (at my request) it was abnormally high, so I'm pretty sure this is causing some of my problems - seems really weird that my estrogen level can get as high as 2000 pmol and I still don't feel any of the negative effects most others would suffer with this much estrogen. And when I tried testosterone it worked amazingly for a week and then just stopped, as if something had kicked in to 'gobble it all up'. The frustrating thing is, that may be what's going on, but is there anything that can be done about it? I feel like I'm having to tell my consultant all this stuff which he should be aware of - he said initially testosterone was irrelevant in my case as my ovaries would still be making it. I had to point out that blood tests had shown that my ovaries were completely clobbered by chemotherapy, and my testosterone level is on the floor. He looked kind of sheepish, but didn't really say a lot. When I next see him I'm going to be armed with questions about SHBG and what can be done, but I feel pretty pessimistic. Does anyone know of any doctor who has this level of expertise, private or NHS? I'm getting to the point where I'd spend my life savings to feel any semblance of normality again  .

Hi again racjen - Happy New Year!

Re your measurements of SHBG etc - do you have the actual measurement and was testosterone measrued at the same time? If you have the measurements of both in the right units then the Free Androgen Index can be determined - as I linked to in my earlier post. I do feel that irrespective of what is causing your high SHBG levels - this will probably be binding much of your testosterone and replacing this is worth pursuing if you can, because not only will you increase the T in your blood, but because T acts to decrease SHBG levels - this will also serve to further increase the bioavailable T. Without ovaries you only have your adrenal gland producing androgens and your symptoms will not be helped by such low levels.

I don't know about diazepam and whether it has an effect on sex hormones - although SSRIs (not bemzos?) may depress libido at least,  through other means than SHBG/testosterone.

There is an interesting ( and accessible) article (blog) about SHBG here https://www.zrtlab.com/blog/archive/shbg-modulator-01/ but not sure how much is opinion as it is not a paper, and only trials can determine cause and effect or the effect of a particular intervention - but might be worth thinking about? In your case though - if you need the high oestrogen levels to feel well generally then reducing this is not an option, although increasing and persevering with testosterone does remain a possibility hopefully?

I'm not sure where to find a doctor with this expertise although the general principle (of the effect of sex hormones on SHBG and therefore bioavailablity of these hormones) should be widely recognised by menopause specialists.

Hurdity x

[racjen]

Hi Hurdity,

yes, found these results dating back to MArch 2018:
 Serum sex hormone binding globulin level Report, Abnormal, Other (raised) (Patient Informed)   
   Free androgen index 0.3 % [0.6 - 4]   
   Serum sex hormone binding globulin level 176.1 nmol/L [40 - 120]   
   Serum testosterone level 0.49 nmol/L [0.2 - 1.65]

These were only taken at my request, and my GP had nothing to say about the results despite the fact they're clearly abnormal, but it felt a bit pointless really as it didn't lead to any progress. This testosterone level is after a couple of weeks of taking T, after which I stopped because it seemed to result in increased depression, but it maybe that I need to try again and stick with it for a lot longer.

Conolly, thanks I didn't know that about FSH - assumed all these hormones are produced by the ovaries. Bit irrelevant for me up till now since there hasn't been any doubt I'm post-menopausal - chemo does that to you instantly . Anyway, I found an FSH level taken in Nov 2018 - Serum follicle stimulating hormone level 8.9 IU/L. No idea if that's high or low, there are so many different ref ranges given for different times of the month, ages etc. I can't work it out.

[Conolly]

Hello racjen,

Thank you for answering. That FSH reading is actually low for postmenopause levels which are usually above 30 IU/L.
If you were already on HRT, it only means your oestrogen levels were doing the job, called negative feedback on the hypothalamus and pituitary, by decreasing FSH levels.

I was wondering if you are taking too much oestrogen and could be having tachyphylaxis. It's more common when using implants but each body is unique. Above a certain level, the oestrogen cell receptor synthesis is downregulated, so no matter how much oestrogen you have the molecules are not entering the cell nucleus where it is supposed to act.

I hope testosterone does the trick for you and don't exacerbate your anxiety/depression, but I keep thinking that maybe what you really need is a detox from all drugs (tapering of course) to let your brain biochemistry recover from the menopause and chemotherapy turmoil.

Conolly X

[racjen]

Yes, I wonder that too, and after my 3 month folllow up with NHS consultant (awaiting apptmt but prob Feb sometime) I may very well decide that's the best course of action. HRT doesn't seem to've done me any favours so far....

[Conolly]

Hello racjen,

I thought you might be interested in this article https://www.nursingcenter.com/journalarticle?Article_ID=643341&Journal_ID=54012&Issue_ID=643325

Conolly X

[Saffy]

That's an interesting article Connolly.

Just for info, as I still haven't found much further useful research on SHBG. I have been on 2x100 Estradot patches for just over 3 months now and my blood results are as follows (read out by receptionist):

Oestradiol 257 pmol/L (previously 100 on 100 patch)
Testosterone 0.5 nmol/L (unchanged)
SHBG >200 nmol (previously 182 on 100 patch)
Free Androgen Index (my calculation) 0.25 (previously 0.27 on 100 patch)

Ironically I was contemplating lowering the patches as pretty much all I have to show for those three months is really, really sore breasts  . Back to the specialist I guess...

[floraljo]

Hi,
I know this is an old thread but was wondering if you found anything further?
My shbg is high, oestrogen has been swinging high and low, testosterone and FAI low. I've just started testosterone replacement at 0.25mg initially to see if I have side effects. I'm low end of healthy bmi but have a naturally slim build.
My main worry is my bones so keen to ensure I'm absorbing the hrt. Concerned my high shbg is an issue and why it might be, but specialist didn't have any answers. Did anyone have shbg reduce on hrt? And any ideas on how I can see if hrt is being absorbed despite it? Thanks

[CLKD]

What type of specialist did U see?

To keep bones healthy we need a good mixed diet; a regular exercise regime with impact walking which helps bones throughout the body particularly the long bones, pelvis and hips [which is the best place to have a dexa scan]; as well as good dental care because the jaw bone requires teeth on which to 'chew' which encourages good jaw alignment and health.

[laszla]

floraljo like you I have high shbg, low fai and am underweight. Upping my oestrogel has not diminished my shbg in fact it has increased further and I'm convinced the low weight is the reason.

I don't have an eating disorder but anorexia is listed as one potential cause of high shbg. I understand your worry about bones, I've recently gone into osteoporosis following borderline osteopenia and it's disheartening considering the 5 pumps of oestrogel daily, lots of excercise, good diet etc...

[floraljo]

Laszla- what is your oestrogen level? My shbg has been high when my oestrogen is and it was high before hrt. I use estradot. I don't know if I'm absorbing it because my oestrogen has been swinging anyway. I've recently started Androfem so I don't know if/how that might affect my hormone results. I'm sorry to hear that your bone density hasn't improved- is there anything your doctor has suggested?