Low SHBG Cured with an AI? (not me)

[James]

On another board:

A young male presented with chronically elevated E2 and low SHBG.  Physicians prescribed testosterone, which only exacerbated the SHBG/E2 imbalance.  His problems persisted for years.  His entire youth, in fact.

I suggested that he try an AI-only mode of treatment.

This worked to bring his E2 within normal range, and ... surprisingly, his SHBG increased to from the single digits and low teens to 30!  SHBG has remained at 30, even though AI has been discontinued.   He claims that he is "85% cured."  His FT is now a bit low (FAI of 0.65) and I have suggested that with T supplementation, he might actually bring himself to a completely normal hormonal profile.

It seems like he was able to wake up dormant SHBG expression by simply starving E2.    I have no other explanation for this case.   I have never, in 10+ years of reading about these kinds of cases, seen a liver completely correct itself with regard to SHBG expression. Perhaps, like insulin receptors, receptors in the liver can become increasingly desensitized to estrogen?  In these cases, a course of AI over a 3 month period can completely resensitize them... or so it seems.

Does anyone have any theories?

[mrmagoo2010]

On another board:

A young male presented with chronically elevated E2 and SHBG.  Physicians prescribed testosterone, which only exacerbated the SHBG/E2 imbalance.  His problems persisted for years.  His entire youth, in fact.

I suggested that he try an AI-only mode of treatment.

This worked to bring his E2 within normal range, and ... surprisingly, his SHBG increased to from the single digits and low teens to 30!  SHBG has remained at 30, even though AI has been discontinued.   He claims that he is "85% cured."  His FT is now a bit low (FAI of 0.65) and I have suggested that with T supplementation, he might actually bring himself to a completely normal hormonal profile.

It seems like he was able to wake up dormant SHBG expression by simply starving E2.    I have no other explanation for this case.   I have never, in 10+ years of reading about these kinds of cases, seen a liver completely correct itself with regard to SHBG expression. Perhaps, like insulin receptors, receptors in the liver can become increasingly desensitized to estrogen?  In these cases, a course of AI over a 3 month period can completely resensitize them.

Does anyone have any theories?

did he have elevated shbg? you say elevated shbg and E2, and then you say it increased.. confused

[James]

did he have elevated shbg? you say elevated shbg and E2, and then you say it increased.. confused

Good catch.  I meant to say he had low SHBG and excessive estrogen. 

Fixed in the original post.

[PeakT]

On another board:

A young male presented with chronically elevated E2 and low SHBG.  Physicians prescribed testosterone, which only exacerbated the SHBG/E2 imbalance.  His problems persisted for years.  His entire youth, in fact.

I suggested that he try an AI-only mode of treatment.

This worked to bring his E2 within normal range, and ... surprisingly, his SHBG increased to from the single digits and low teens to 30!  SHBG has remained at 30, even though AI has been discontinued.   He claims that he is "85% cured."  His FT is now a bit low (FAI of 0.65) and I have suggested that with T supplementation, he might actually bring himself to a completely normal hormonal profile.

It seems like he was able to wake up dormant SHBG expression by simply starving E2.    I have no other explanation for this case.   I have never, in 10+ years of reading about these kinds of cases, seen a liver completely correct itself with regard to SHBG expression. Perhaps, like insulin receptors, receptors in the liver can become increasingly desensitized to estrogen?  In these cases, a course of AI over a 3 month period can completely resensitize them... or so it seems.

Does anyone have any theories?

Hey, thx for the story.  Sounds like he had a restart such as Clomid guys occasionally get.

So is this a one off thing?  Anyone else done it?

Also, when you say "normal range", do you mean 20-30 pg/ml? 

One comment:  most low SHBG guys do not have high estradiol though.  But still it's a interesting and cheap thing to try - can't see what it would hurt, right?

Also, was it Arimidex (anastrozole)?  No chance it was tamoxifen, right?

[James]

UPDATE:  This user is a member of this board.  His name is lxm.    He indeed does have a post on this board about AI monotherapy.  He has been posting about his  case on multiple messageboards, it seems, but has not updated us with the latest here at PeakT.


He used Arimidex, yes.

His units for estrogen are unusual, but his lab range lists 40-190 as the reference range.  I suspect they may be using the female range and test.

He reports the following, earliest to latest:

November 2014 (4 months after stopping AI)
Test: 18.7
LH: 3.5
FSH: 6.3
E2: 109
SHBG: 30.0
FAI: 62.33

August 2014 (AI THERAPY 4 MONTHS RESULTS)
Test: 20.6nmol
LH: 5.3
FSH: 12.9
E2: 46
SHBG: INVALID

April 2014 (baseline - HPTA restarted after 8 months TRT)
Test: 13.9nmol (8.6 - 28.8 )
LH: 4.3ul/l (1-8 )
FSH: 11.3ul/l (1-8 )
E2: 76pmol (40-150)
SHBG 18.2 (18-45)
FAI : 76%

[PeakT]

Thx.  As soon as I can, I'll update Sam's page.  Try to get him to post what has happened if you "see him around" and thx for the info...

[Okian]

Interesting , so if I understood right, this is a kind of PCT - a HPTA restart? only with A.I ? Is that possible ??

[PeakT]

Interesting , so if I understood right, this is a kind of PCT - a HPTA restart? only with A.I ? Is that possible ??

That's what it looks like.  The above really does not make sense as estradiol is supposed to stimulate SHBG.  But, if it works, it works.

Also, from what I have seen, a big percentage of low SHBG guys have low estradiol.  So they cannot take an AI, such as Arimidex, without hurting themselves.

[electrify]

Interesting--maybe this is something to consider for my low shbg of 14. But my estradiol is like 30 baseline and not elevated so wouldn't AI mono just crash it?

Also based on what I read it might just boost the levels but have minimal psychological effects....

[PeakT]

Interesting--maybe this is something to consider for my low shbg of 14. But my estradiol is like 30 baseline and not elevated so wouldn't AI mono just crash it?

Also based on what I read it might just boost the levels but have minimal psychological effects....

Yeah, that's risky.  You don't want osteopenia. 

[electrify]

Interesting--maybe this is something to consider for my low shbg of 14. But my estradiol is like 30 baseline and not elevated so wouldn't AI mono just crash it?

Also based on what I read it might just boost the levels but have minimal psychological effects....

Yeah, that's risky.  You don't want osteopenia.

Well in some places it says that if you use AI monotherapy, then you cannot crash estradiol due to the negative feedback. But either way it does seem risky and I would rather go a tried+tested route so I can defeat this anxiety instead of having the levels go up but not feel any symptomatic benefit psychologically.

[PeakT]

Well in some places it says that if you use AI monotherapy, then you cannot crash estradiol due to the negative feedback. But either way it does seem risky and I would rather go a tried+tested route so I can defeat this anxiety instead of having the levels go up but not feel any symptomatic benefit psychologically.

Well, and it could potentially negatively impact the clotting cascade.  In my opinion, that's the biggest reason to be cautious.