Print

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

[floraljo]

Hi, I've gained weight all in my midsection in the last year. I've gone on a strict diet and have increased exercise including x3 PT sessions per week. Yet I cannot shift this weight. I'm on 75 estradot and high oestrogen levels at my last test (around 900). I'm still waiting for my testosterone result but the last few have been low, and shbg is very high.

Did anyone find testsoterone replacement helped with weight loss?
Thanks

[Tulip256]

I am only 1 month in to using testosterone but if anything I am finding it is causing slight weight gain.  I think hormonal imbalances can lead to weight gain so it could help you.  High SHBG can be caused by too much oestrogen, have you considered reducing your patch?

For midsection weight gain the most effective thing for me has been reducing carbs and increasing protein.

[floraljo]

Thank you for your responses. My GP said transdermal hrt wouldn't affect shbg levels. My shbg was high before starting the patches. She said only oral hrt would affect it because it is processed in the liver. I'm very confused by the high shbg result most women in perimenopause on here appear to have results normal or lower. Thanks

[Hollyboll]

Sorry you’re concerned about weight. I fear it may be life stage/change.

Unfortunately all of this is a balance - you don’t mention other symptoms and personally i’d be wary of changing hrt just vis weight, if it was helping with other things.

If your e2 is consistently at 900, that’s high. But you need more than one test (consistent on 1st patch day) to know.

Your gp’s out of date even to look at shbg.  Show her this (bottom of p2):
https://thebms.org.uk/wp-content/uploads/2022/12/08-BMS-TfC-Testosterone-replacement-in-menopause-DEC2022-A.pdf

Many GPs will still give testosterone only if you complain libido low.

Hth x

[laszla]

If your SHBG is consistently high , it should certainly be taken into consideration even with the new BMS guidelines, see p 3:

“In certain circumstances, SHBG levels may be helpful as additional supportive information: Where SHBG levels are high […] Conversely, when SHBG levels are very low.”

Unfortunately, the BMS statement is inconsistent and downright contradictory here (p1):
“Oral estrogens, especially conjugated estrogens, can reduce the effectiveness of testosterone by increasing sex hormone binding globulin levels. Switching women with HSDD from oral to transdermal estrogen can be beneficial as this can increase the proportion of circulating free testosterone”.

In short, in that sentence they’re saying to consider SHBG and free T, only to go on to say on p 2 to give preference to total levels and ignore free T (but only sometimes).

Of course the reality is complex and an ‘either/or’ approach unhelpful, as is obvious in the paper on which they’ve based the new guidelines, A Reappraisal of Testosterone’s Binding in Circulation: Physiological and Clinical Implications (the paper also includes a list of possible causes of high SHBG Floraljo). If it’s not freely available online the BMS will send you a copy.

The paper is yet another illustration of how incredibly complex the endocrine sytem is and that even the so-called experts still have a very rudimentary understanding of the interactions.

Re high SHBG, mine has always been high but increases even more when my serum estradiol goes up, despite my never having touched oral estrogens. So, again, it's complicated.

[floraljo]

Thanks everyone for the responses and links x

[margherita]

If your SHBG is consistently high , it should certainly be taken into consideration even with the new BMS guidelines, see p 3:

“In certain circumstances, SHBG levels may be helpful as additional supportive information: Where SHBG levels are high […] Conversely, when SHBG levels are very low.”

Unfortunately, the BMS statement is inconsistent and downright contradictory here (p1):
“Oral estrogens, especially conjugated estrogens, can reduce the effectiveness of testosterone by increasing sex hormone binding globulin levels. Switching women with HSDD from oral to transdermal estrogen can be beneficial as this can increase the proportion of circulating free testosterone”.

In short, in that sentence they’re saying to consider SHBG and free T, only to go on to say on p 2 to give preference to total levels and ignore free T (but only sometimes).

Of course the reality is complex and an ‘either/or’ approach unhelpful, as is obvious in the paper on which they’ve based the new guidelines, A Reappraisal of Testosterone’s Binding in Circulation: Physiological and Clinical Implications (the paper also includes a list of possible causes of high SHBG Floraljo). If it’s not freely available online the BMS will send you a copy.

The paper is yet another illustration of how incredibly complex the endocrine sytem is and that even the so-called experts still have a very rudimentary understanding of the interactions.

Re high SHBG, mine has always been high but increases even more when my serum estradiol goes up, despite my never having touched oral estrogens. So, again, it's complicated.

Very helpful clarifications on the new guidelines Laszla, which indeed still suggest looking at the shbg/total T ratio in some cases. And yes, the statement - authored by Nick Panay I see - certainly could have been clearer.

[Hurdity]

Very interesting and would like to get hold of that paper you refer to laszia....

Re weight gain - I don't have any scientific data on this but as Tulip 256 - I feel I may have gained weight since starting T though I've been taking it for 9 years but admittedly I am aged. My intuitive view is that since T increases the ability to build muscle, for which you need to increase appropriate exercise, in the absence of the latter, whatever T does to the metabolism may well result in an increase in fat (rather than muscle) and especially round the middle. This is what I have found anyway.

The only way to prevent weight gain (or rather fat gain) as we age is to change our diet and take more exercise, irrespective of HRT, I would suggest.

Hurdity x

[Hollyboll]

Laszla - interesting stuff, thanks.  I should have read the whole thing - I was only directed to bottom of p2 (to show GP because consultant wondered why he kept on testing SHBG/FAI). 

I'm not going to parse the paper - even before Margharita pointed out the author, for which thanks! - but from a quick read it still suggests test total testosterone unless one is trying to understand either lack of therapeutic response (for libido) or excessive androgenic symptoms.  Unless weight gain counts as the latter, I still read it as floraljo's tests don't need SHBG ... obviously no harm beyond wasting resources, but it might be helpful to know it's a distraction.

Floraljo - having now skimmed more than just the bottom of p2, I see that although unusual when within range, the most common effects are hair growth (which I've had), acne and weight gain - I'm guessing you'd already seen this but in case not ... it says usually reversible with lowering dose or discontinuing ... of course one's then into the lesser of two evils if lose beneficial effects!

If your oestrogen is consistently that high, I'm no expert, but having suffered badly from too high oestrogen I'd think getting that down may be more of a priority than getting testn up ... it's so complicated/individual though.

xx

[Hurdity]

I've had a quick look at the paper - (well the abstract and the conclusions at the end - not the detail about side effects nor the biology of the binding proteins)  and I suggest this is an important point (re measurement of total vs free T):

"Total testosterone, which can be measured with
high accuracy using LC-MS/MS assays in CDCcertified
laboratories, and free testosterone are
highly correlated, and it is only in individuals with
altered binding-protein concentrations that the associations
begin to diverge. For the time being, we
therefore suggest continuing to follow the Endocrine
Society’s guidelines to measure total testosterone
level and, in circumstances of suspected alterations in
SHBG and albumin concentrations and/or binding,
checking free testosterone level by equilibrium dialysis."

In other words, amongst other things, I understand this to be saying that Total T can be used as a proxy for free T so no need to measure both, except in circumstances where SHBG might be altered, in which case they are not well correlated. Therefore surely especially when women are taking (oral) HRT - it would be useful to measure SHBG as well? Not sure where that leaves the FAI measurement though?

Nothing to do with weight gain though!

Hurdity x

[joziel]

Are you on any thyroid meds? Because they can also cause high SHBG....

You can reduce SHBG by taking 12mg of boron a day, by the way. There is research showing that boron reduces SHBG. (I am not sure if it works well when there is so much going against it in terms of all the hormones we are taking.) Boron is also good for bone density so no reason not to try anyways...