Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: MIS71MUM on March 08, 2019, 01:59:18 PM
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Hello
Can anyone explain what the relevance of SHBG tests are? What do they show? Are they meant to be read alongside Testosterone Test results?
I've read somewhere about freeing up other hormones but I don't really understand it.
Thanks
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SHBG - Sex Hormone Binding Globulins - are chemicals which the body produces to regulate the level of hormone available in the blood. If you have a very high level of SHBG it doesn't matter how much oestrogen or testosterone you put into your body, it won't be available for use because the SHBG had bound it up and made it inert. I think what's important is your serum hormone level, not the total level - the former is the available amount, the latter is the total amount. But I could be wrong about that - this is the sort of thing Hurdity is best at! What's annoying is that Gps seem to have no idea about SHBG and whether there's anything that can be done if you have a very high level. Sorry I can't be more helpful - I know there are things that will raise your SHBG and others that will lower it, hopefully someone with a bit more sense than me will come along soon and fill in the gaps!
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Hi there - yes racjen is right. There are some threads on this but it is very complex - the role of SHBG and what it binds to and how it is controlled and with all the hormones floating about and feeding back on each other impossible to sort out - in fact it's not fully understood I don't think.
However as racjen says -in terms of SHBG and testosterone - the most important thing is that it binds testosterone making it unavailable for the body to use (oestrogen binds to it too but T more readily).
Most blood tests do not measure free testosterone, just the total T so on its own it can't tell you muich because of the amount bound up to SHBG so if a doc measures serum T they need to measure SHBG too and then you can work out the Free Androgen Index. The Royal College of Obstetricians and Gynaecologists have a formula for this. I posted on another thread somewhere - will link to it if I can find it! If your SHBG is very high then you probably need more T to enable you to have enough free T because lots of it will be bound up - if you see what I mean?
Hurdity x
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Here is one thread where I gave the calculation (for the FAI) and the link:
https://www.menopausematters.co.uk/forum/index.php/topic,41130.msg648779.html#msg648779
Hurdity x
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Mis7. Interesting thread. I found the links useful too hurdity. i Hope you dont mind me asking a further question MIS7
If SHBG is high would it also follow that as with T more eastrogen would be needed to obtain higher blood levels?
Can SHBG be lowered?
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That's what I've been wondering tc but haven't been able to find an answer. Mine is very high and i needed a high level of oestrogen before I started feeling any benefit
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Robin I was on eastrogen patch 3months and then 4 pumps gel for 3 months and my blood estradiol didnt increase at all over that time. Still very low.
It does make you wonder
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My levels did increase quite quickly once I was on appropriate treatment but it needed to be a high level before I started feeling any benefit which makes be wonder if some of that 'high level ' is bound to SHBG. But might also be because it was too low for too long so took a while for oestrogen receptors to wake up and start responding. I'm completely guessing of course. Probably way off beam but would be really interested to know more about it as mine is so high.
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Robin. What amount eastrogen did you have to take before e level went up?
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700 ish
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What is yours at?
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Sorry tc misread your post. 100 patch. 700 patch would be enormous size 😆. I think my levels did rise on the lower dose but I didn't benefit until it reached a high level in my system (700ish) which is why I wondered if that was because some might bind to my SHBG which is very high in the same way testosterone does. I would be interested to know if other women who need a high level to feel well have high SHBG
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Thanx. My bloods were 129pmol on 4 pumps.
I am very interested too.
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I'm not sure if I need a particularly high level of oestrogen to feel well or whether the missing link is the testosterone as my specialist suspects. I feel exhausted and brain foggy and achey at the level I'm at but there doesn't seem to be any way for me to get levels high enough to find out if I would feel better ::). I am now taking 2x100 Estradot patches twice a week and my oestrogen has risen to the stunning heights of 257 pmol/l ;D.
My SHBG has risen further as my oestrogen levels have gone up - now over 200 (so high I wasn't given an actual level :o). I find it strange that some of us have low measured oestrogen levels with very high SHBG while others have quite high levels of oestrogen.
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I think I'm in range then having followed the calculation method.
SHBG - 77
Total test - 0.4
Oestradiol - 91
Just never had the shbg done before so wanted to know why.
Just need to increase the gel for the time being it seems.
Thank you for your help.
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Sorry I missed the other replies.
I take 4 pumps - split twice a day and my oestrogen levels are lower now than when not on hrt!
I need to increase to 6 pumps but I don't think it's goung to make much of a difference. Been on 100 patch before and still had with flushes the following day after application.
I'd be interested to know how to change your shbg levels to allow the oestrogel to work more effectively.
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So would I. I realy hope someone can help us on this.
MIs7 I was beginning to think i might be a rare case but it seems I have had the same experience as you. My doc said my levels are as though I'm not on HRT at all. I couldn't understand it.
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Yes its true my levels didnt increase at all on eastrogel.or on the femseven patch and symptoms were not controlled
but what I'm now wondering is if it might not actually be an absorption problem after all. I'm wondering whether it might be how the body is metabolizing the easteogen it's getting. Whether If its binding to SHBG in the same way T does and having the same effect I.e.the low serum levels in blood which is showing in the tests and leading to symptoms not being controlled.
Mis7 has had Shbg test but I haven't yet. Just this experience seems so similar to mine. So I suspect it very heavily that shbg might be an issue.. My next blood test is for the T I have been started on but just T and not SHBG. So I need to ask for it.
if this is the case how can it be tackled. Higher levels of E which my doc will not go above 100 patch and as mis7 says how high do you have to go or can we lower SHBG levels in some way.
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Hi ladies
I'll reply more later but wanted to say to TC, I had my blood tests done by a gynaecologist at a NHS menopause clinic. I asked, no begged, my GP to refer me and she did.
Despite being told that the waiting list was ridiculous and I'd be waiting 6 months, I think I was seen in 2 months.
The gynaecologist was amazing - wasn't to disturbed by my high blood pressure. When I described that my mind howled sometimes and wouldn't stop, she said that's a marvellous way on putting it! Rather than telling me I was depressed.
I think Gynaecologist can increase doses beyond what your GP can, so maybe you could ask for a referral to your local nhs menopause clinic.
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Sorry I missed the other replies.
I take 4 pumps - split twice a day and my oestrogen levels are lower now than when not on hrt!
I need to increase to 6 pumps but I don't think it's goung to make much of a difference. Been on 100 patch before and still had with flushes the following day after application.
I'd be interested to know how to change your shbg levels to allow the oestrogel to work more effectively.
Hi MIS71MUM - I don't think the effectiveness of oestrogen is affected by SHBG levels. However I don't fully understand it and it is not fully understood anyway - especially with respect to T replacement. Your SHBG levels from that test are low anyway - as well as your oestrogen. Yes your FAI is within range but at the lower end. I wonder if these levels vary daily too just like estradiol ie only prvodie a snapshot eg i wonder what they would be if you had more done tomorrow for example?
One thing I'm not clear about is whether the oestrogen measured by serum tests is total oestrogen (as with testosterone) or just the biologically free estradiol. I haven;t considered this - or rather it has flitted through my mind now and again and gone away again. I have always presumed that because so much emphasis (well sometimes) is placed on serum estradiol levels - that whatever is measured must have biological significance. However estradiol exists in dynamic equilibrium (interconverts from one to the other) with another oestrogen called estrone and various metabolic states ( like estrone sulphate) and all this is subject to hormonal/enzyme control - so it's so complex that I don't think it's as simple as increase one therefore decrease the other if you see what I mean?
In the case of testosterone it does seem to be more clear cut and I think that's because testosterone has a very high affinity for SHBG - but I dont understand whether it will therefore displace oestrogen and then make it (oestrogen) more available for the body.....I wish a bit more was known. There are various studies done at cellular level with animal tissues eg mice or rats but....can you tell I'm flannelling??!!!
I understood that only oral oestrogen has a direct effect on SHBG (increasing it) which binds free testosterone and that transdermal HRT does not have this effect. It's all very confusing!
... and sorry my ramble is probably no help at all!!
Hurdity x