Jump to content
RemedySpot.com

Re: Low SHBG and Estradiol by Dr. nco.

Rate this topic


Guest guest

Recommended Posts

i thought the SBHG was needed to confirm hypogonadism secondary is this not the

case,i had been told its one i need to get done?

and again i cant see how you can tell if someone is hypogonadsm secondary or

partial andrrogen deficiency??

its all extremly confuisng i go to my doctor in a few hours time and i still

dont really know what to ask for,i have all those blood tests said about other

day,though i personally doubt if my local doctro will get all those done,will

just getting the shbg and free testosteron be enough

what is in real figures is diagnostic criteriav for hypogonadsm secondarry,i

need yto convince her to diagnose me and not endo as i dont intend ever to see

that guy again ,all i want is my doc to see the figures after getting blood

tests and say yes paul i agree not parital adnrogen deficiency but hypogonadsm

secondary.

i have also emailed a private company to see how much all these blood test and

diagnosis may cost me in uk to gwet done,i doubt i could afford it b ut may have

no other options if to get diagnosied

regards paul

Low SHBG and Estradiol by Dr. nco.

The most common cause of low SHBG is excessive insulin - i.e. insulin

resistance. Insulin resistance in turn leads to a cascade of events

which results other hormone imbalances such as low testosterone

production, suboptimal thyroid hormone activity, adrenal fatigue, etc.

Factors which together in a balance determine SHBG are:

1. Anabolic hormones generally reduce SHBG. These include

testosterone, DHEA, insulin, DHT, and growth hormone.

2. Thyroid hormone, Estrogens, and Progesterone (by increasing

estrogen receptors/sensitivi ty), increase SHBG.

In the absence of insulin resistance, the most common other cause of

low SHBG is a very high level of other anabolic hormones - most

frequency high testosterone from TRT. Those who use anabolic steroids

at high doses often drive their SHBG to near zero.

When total testosterone is between 650 to 1000 ng/dl, and a person

still has zero sex drive, I would look for other causes for sexual

dysfunction - e.g. other hormone, neurotransmitter, or immune system

problems.

Raising SHBG does not necessarily increase the risk for Alzheimer's

disease. It is important to keep in mind the factors which lead to

the risk of Alzheimer's disease.

Insulin resistance (i.e. excessive insulin levels) causes low SHBG.

It also greatly increases the risk of Alzheimer's disease because it

results in a higher level of inflammatory cytokine production

(Cytokines are the chemical messengers of the immune system). It is

the inflammation which is one of the underlying factors which leads

to Alzheimer's disease.

SHBG level is most often a signal of the overall status of multiple

hormone levels. The balance may give an indication of whether one is

in an pro-inflammatory state or anti-inflammatory state - with

inflammation leading to disease such as Alzheimer's disease, heart

disease, strokes, cancer, etc. Some hormones such as some estrogens

and insulin can lead to inflammation leading to illness. And other

hormones such as the androgens (except DHT), growth hormone, and

thyroid hormone, can lead to an antiinflammatory state, reducing the

risk for illness. The balance determines the person's risk for

illness.

What estradiol level is best for any individual often needs to be

determined by trial and error. It is unique for each individual. Most

do best around 30 pg/ml. But some do best at lower and higher levels.

For example, I have a 65 y.o. patient with a total testosterone of

840 ng/dl and an estradiol of 47 pg/ml. He's having the time of his

life - able to make love numerous times each night - after more than

a decade of having no sex. The estradiol level works for him without

side effects. Some may do better with much loser levels of estradiol -

the response is highly individualistic.

Even with low SHBG - which is difficult to correct since it depends

on the balance of so many hormones - when the other hormones and

neurotransmitters are optimized, sex drive and the ability to have an

erection can often return.

When total testosterone is supraphysiologic - i.e. over 1000 ng/dl -

problems with libido and erections may occur. Testosterone increases

dopamine in the brain in order to increase sex drive, reduce

depression, give pleasure to activities. The problem is that dopamine

is a very fragile neurotransmitter/ hormone in its effects. Too high a

dopamine level can cause tolerance to dopamine. This is similar to

how one can develop tolerance to drugs such as cocaine and

amphetamines which increase dopamine levels in the brain to cause

their high. This can lead to the loss of libido when high

testosterone levels are maintained for long periods of time.

Conversely, when one is deprived of testosterone (and hence dopamine)

for long periods of time due to hypogonadism, one can get a high

during the first few weeks of testosterone treatment since the brain

becomes supersensitive to dopamine when it has been deprived of it

(e.g. making more dopamine receptors to pick up the weaker dopamine

signals). Unfortunately, as the brain then gets use to the higher

dopamine levels, it will develop some tolerance, and libido will drop

off - though we often wish that hopefully a good amount remains.

____________ ______

Any statement I make on this site is for educational purposes only

and is subject to change. It does not constitute medical advice, does

not substitute for proper medical evaluation from physician, does not

create a doctor/patient relationship or liability. If you would like

medical advice, you will have to make an appointment. Thank you.

Phil

Link to comment
Share on other sites

that was posted at Meso to a guy that has problems with ED it was not about

being Secondary or Primary. If you need to know about this read this link.

http://www.aace.com/pub/pdf/guidelines/hypogonadism.pdf

To tell if one is Primary or Secondary you do a test on Total and Free T with

the LH and FSH. If total and free T are low and LH and FSH are high the man is

Primary his testis are not working good. If one tests low and LH and FSH are

low he is secondary not getting the LH and FSH messages from the Pituitary

Gland. If one is near the mid range then a Clomid or HCG stim test is needed to

tell.

Phil

paul wey <promachief@...> wrote:

i thought the SBHG was needed to confirm hypogonadism secondary is this not

the case,i had been told its one i need to get done?

and again i cant see how you can tell if someone is hypogonadsm secondary or

partial andrrogen deficiency??

its all extremly confuisng i go to my doctor in a few hours time and i still

dont really know what to ask for,i have all those blood tests said about other

day,though i personally doubt if my local doctro will get all those done,will

just getting the shbg and free testosteron be enough

what is in real figures is diagnostic criteriav for hypogonadsm secondarry,i

need yto convince her to diagnose me and not endo as i dont intend ever to see

that guy again ,all i want is my doc to see the figures after getting blood

tests and say yes paul i agree not parital adnrogen deficiency but hypogonadsm

secondary.

i have also emailed a private company to see how much all these blood test and

diagnosis may cost me in uk to gwet done,i doubt i could afford it b ut may have

no other options if to get diagnosied

regards paul

Low SHBG and Estradiol by Dr. nco.

The most common cause of low SHBG is excessive insulin - i.e. insulin

resistance. Insulin resistance in turn leads to a cascade of events

which results other hormone imbalances such as low testosterone

production, suboptimal thyroid hormone activity, adrenal fatigue, etc.

Factors which together in a balance determine SHBG are:

1. Anabolic hormones generally reduce SHBG. These include

testosterone, DHEA, insulin, DHT, and growth hormone.

2. Thyroid hormone, Estrogens, and Progesterone (by increasing

estrogen receptors/sensitivi ty), increase SHBG.

In the absence of insulin resistance, the most common other cause of

low SHBG is a very high level of other anabolic hormones - most

frequency high testosterone from TRT. Those who use anabolic steroids

at high doses often drive their SHBG to near zero.

When total testosterone is between 650 to 1000 ng/dl, and a person

still has zero sex drive, I would look for other causes for sexual

dysfunction - e.g. other hormone, neurotransmitter, or immune system

problems.

Raising SHBG does not necessarily increase the risk for Alzheimer's

disease. It is important to keep in mind the factors which lead to

the risk of Alzheimer's disease.

Insulin resistance (i.e. excessive insulin levels) causes low SHBG.

It also greatly increases the risk of Alzheimer's disease because it

results in a higher level of inflammatory cytokine production

(Cytokines are the chemical messengers of the immune system). It is

the inflammation which is one of the underlying factors which leads

to Alzheimer's disease.

SHBG level is most often a signal of the overall status of multiple

hormone levels. The balance may give an indication of whether one is

in an pro-inflammatory state or anti-inflammatory state - with

inflammation leading to disease such as Alzheimer's disease, heart

disease, strokes, cancer, etc. Some hormones such as some estrogens

and insulin can lead to inflammation leading to illness. And other

hormones such as the androgens (except DHT), growth hormone, and

thyroid hormone, can lead to an antiinflammatory state, reducing the

risk for illness. The balance determines the person's risk for

illness.

What estradiol level is best for any individual often needs to be

determined by trial and error. It is unique for each individual. Most

do best around 30 pg/ml. But some do best at lower and higher levels.

For example, I have a 65 y.o. patient with a total testosterone of

840 ng/dl and an estradiol of 47 pg/ml. He's having the time of his

life - able to make love numerous times each night - after more than

a decade of having no sex. The estradiol level works for him without

side effects. Some may do better with much loser levels of estradiol -

the response is highly individualistic.

Even with low SHBG - which is difficult to correct since it depends

on the balance of so many hormones - when the other hormones and

neurotransmitters are optimized, sex drive and the ability to have an

erection can often return.

When total testosterone is supraphysiologic - i.e. over 1000 ng/dl -

problems with libido and erections may occur. Testosterone increases

dopamine in the brain in order to increase sex drive, reduce

depression, give pleasure to activities. The problem is that dopamine

is a very fragile neurotransmitter/ hormone in its effects. Too high a

dopamine level can cause tolerance to dopamine. This is similar to

how one can develop tolerance to drugs such as cocaine and

amphetamines which increase dopamine levels in the brain to cause

their high. This can lead to the loss of libido when high

testosterone levels are maintained for long periods of time.

Conversely, when one is deprived of testosterone (and hence dopamine)

for long periods of time due to hypogonadism, one can get a high

during the first few weeks of testosterone treatment since the brain

becomes supersensitive to dopamine when it has been deprived of it

(e.g. making more dopamine receptors to pick up the weaker dopamine

signals). Unfortunately, as the brain then gets use to the higher

dopamine levels, it will develop some tolerance, and libido will drop

off - though we often wish that hopefully a good amount remains.

____________ ______

Any statement I make on this site is for educational purposes only

and is subject to change. It does not constitute medical advice, does

not substitute for proper medical evaluation from physician, does not

create a doctor/patient relationship or liability. If you would like

medical advice, you will have to make an appointment. Thank you.

Phil

Link to comment
Share on other sites

Hi

We said you needed to get SHBG done at the same time so as to try and diagnose

what is

wrong and to see what is OK. Nothing to do about Primary or Secondary as SHBG

means

Sex Hormone Binding Globulin and helps to understand how the Testosterone is

binding to

proteins and how available the T will be.

Hope that helps?

On 12 Sep 2006 at 21:36, paul wey wrote:

> i thought the SBHG was needed to confirm hypogonadism secondary is this not

the case,i had been told its one i need to get done?

>

> and again i cant see how you can tell if someone is hypogonadsm secondary or

partial andrrogen deficiency??

>

> its all extremly confuisng i go to my doctor in a few hours time and i still

dont really know what to ask for,i have all those blood tests said about other

day,though i personally doubt if my local doctro will get all those done,will

just getting the shbg and free testosteron be enough

>

> what is in real figures is diagnostic criteriav for hypogonadsm secondarry,i

need yto convince her to diagnose me and not endo as i dont intend ever to see

that guy again ,all i want is my doc to see the figures after getting blood

tests and say yes paul i agree not parital adnrogen deficiency but hypogonadsm

secondary.

>

> i have also emailed a private company to see how much all these blood test and

diagnosis may cost me in uk to gwet done,i doubt i could afford it b ut may have

no other options if to get diagnosied

>

>

> regards paul

>

>

> Low SHBG and Estradiol by Dr. nco.

>

> The most common cause of low SHBG is excessive insulin - i.e. insulin

> resistance. Insulin resistance in turn leads to a cascade of events

> which results other hormone imbalances such as low testosterone

> production, suboptimal thyroid hormone activity, adrenal fatigue, etc.

>

> Factors which together in a balance determine SHBG are:

> 1. Anabolic hormones generally reduce SHBG. These include

> testosterone, DHEA, insulin, DHT, and growth hormone.

> 2. Thyroid hormone, Estrogens, and Progesterone (by increasing

> estrogen receptors/sensitivi ty), increase SHBG.

>

> In the absence of insulin resistance, the most common other cause of

> low SHBG is a very high level of other anabolic hormones - most

> frequency high testosterone from TRT. Those who use anabolic steroids

> at high doses often drive their SHBG to near zero.

>

> When total testosterone is between 650 to 1000 ng/dl, and a person

> still has zero sex drive, I would look for other causes for sexual

> dysfunction - e.g. other hormone, neurotransmitter, or immune system

> problems.

Link to comment
Share on other sites

Hi

If you are able to afford the blood tests privately then just get those that are

mentioned in

our Library here and get a set which you can then send to any medic for

diagnostics and

prescribing, including your own GP. There is nothing to stop you have a private

GP as well

as an NHS GP. So you could visit one of those recommended on Nick's site for

London or

age and that information can go to your NHS GP for prescribing NHS

prescriptions

and related hospital referrals. You just need to say the Private GP is a 2nd

Opinion. With

the blood test work completed you can refer to this for the hospital to repeat

and discuss in

the future as well. Quite a large number of patients find themselves doing

things this way for

many different reasons.

On 12 Sep 2006 at 21:36, paul wey wrote:

> i thought the SBHG was needed to confirm hypogonadism secondary is this not

the case,i had been told its one i need to get done?

>

> and again i cant see how you can tell if someone is hypogonadsm secondary or

partial andrrogen deficiency??

>

> its all extremly confuisng i go to my doctor in a few hours time and i still

dont really know what to ask for,i have all those blood tests said about other

day,though i personally doubt if my local doctro will get all those done,will

just getting the shbg and free testosteron be enough

>

> what is in real figures is diagnostic criteriav for hypogonadsm secondarry,i

need yto convince her to diagnose me and not endo as i dont intend ever to see

that guy again ,all i want is my doc to see the figures after getting blood

tests and say yes paul i agree not parital adnrogen deficiency but hypogonadsm

secondary.

>

> i have also emailed a private company to see how much all these blood test and

diagnosis may cost me in uk to gwet done,i doubt i could afford it b ut may have

no other options if to get diagnosied

>

>

> regards paul

>

>

> Low SHBG and Estradiol by Dr. nco.

>

> The most common cause of low SHBG is excessive insulin - i.e. insulin

> resistance. Insulin resistance in turn leads to a cascade of events

> which results other hormone imbalances such as low testosterone

> production, suboptimal thyroid hormone activity, adrenal fatigue, etc.

>

> Factors which together in a balance determine SHBG are:

> 1. Anabolic hormones generally reduce SHBG. These include

> testosterone, DHEA, insulin, DHT, and growth hormone.

> 2. Thyroid hormone, Estrogens, and Progesterone (by increasing

> estrogen receptors/sensitivi ty), increase SHBG.

>

> In the absence of insulin resistance, the most common other cause of

> low SHBG is a very high level of other anabolic hormones - most

> frequency high testosterone from TRT. Those who use anabolic steroids

> at high doses often drive their SHBG to near zero.

>

> When total testosterone is between 650 to 1000 ng/dl, and a person

> still has zero sex drive, I would look for other causes for sexual

> dysfunction - e.g. other hormone, neurotransmitter, or immune system

> problems.

Link to comment
Share on other sites

-Hey Thanks phil this is a good read and I am gaining some info as to

what to ask the doc next week. I guess I wanted to know what kind

test to take inorder to find out why I am so low on testosterone even

though looks slightly okay on the free testosterone for now again my

lh and FSH are going down the hill so what could that mean anyone

relates. Thanks Jack.

In , philip georgian <pmgamer18@...>

wrote:

>

> that was posted at Meso to a guy that has problems with ED it

was not about being Secondary or Primary. If you need to know about

this read this link.

> http://www.aace.com/pub/pdf/guidelines/hypogonadism.pdf

> To tell if one is Primary or Secondary you do a test on Total and

Free T with the LH and FSH. If total and free T are low and LH and

FSH are high the man is Primary his testis are not working good. If

one tests low and LH and FSH are low he is secondary not getting the

LH and FSH messages from the Pituitary Gland. If one is near the mid

range then a Clomid or HCG stim test is needed to tell.

> Phil

>

> paul wey <promachief@...> wrote:

> i thought the SBHG was needed to confirm hypogonadism secondary

is this not the case,i had been told its one i need to get done?

>

> and again i cant see how you can tell if someone is hypogonadsm

secondary or partial andrrogen deficiency??

>

> its all extremly confuisng i go to my doctor in a few hours time

and i still dont really know what to ask for,i have all those blood

tests said about other day,though i personally doubt if my local

doctro will get all those done,will just getting the shbg and free

testosteron be enough

>

> what is in real figures is diagnostic criteriav for hypogonadsm

secondarry,i need yto convince her to diagnose me and not endo as i

dont intend ever to see that guy again ,all i want is my doc to see

the figures after getting blood tests and say yes paul i agree not

parital adnrogen deficiency but hypogonadsm secondary.

>

> i have also emailed a private company to see how much all these

blood test and diagnosis may cost me in uk to gwet done,i doubt i

could afford it b ut may have no other options if to get diagnosied

>

>

> regards paul

>

>

> Low SHBG and Estradiol by Dr. nco.

>

> The most common cause of low SHBG is excessive insulin - i.e.

insulin

> resistance. Insulin resistance in turn leads to a cascade of events

> which results other hormone imbalances such as low testosterone

> production, suboptimal thyroid hormone activity, adrenal fatigue,

etc.

>

> Factors which together in a balance determine SHBG are:

> 1. Anabolic hormones generally reduce SHBG. These include

> testosterone, DHEA, insulin, DHT, and growth hormone.

> 2. Thyroid hormone, Estrogens, and Progesterone (by increasing

> estrogen receptors/sensitivi ty), increase SHBG.

>

> In the absence of insulin resistance, the most common other cause

of

> low SHBG is a very high level of other anabolic hormones - most

> frequency high testosterone from TRT. Those who use anabolic

steroids

> at high doses often drive their SHBG to near zero.

>

> When total testosterone is between 650 to 1000 ng/dl, and a person

> still has zero sex drive, I would look for other causes for sexual

> dysfunction - e.g. other hormone, neurotransmitter, or immune

system

> problems.

>

> Raising SHBG does not necessarily increase the risk for Alzheimer's

> disease. It is important to keep in mind the factors which lead to

> the risk of Alzheimer's disease.

>

> Insulin resistance (i.e. excessive insulin levels) causes low SHBG.

> It also greatly increases the risk of Alzheimer's disease because

it

> results in a higher level of inflammatory cytokine production

> (Cytokines are the chemical messengers of the immune system). It is

> the inflammation which is one of the underlying factors which leads

> to Alzheimer's disease.

>

> SHBG level is most often a signal of the overall status of multiple

> hormone levels. The balance may give an indication of whether one

is

> in an pro-inflammatory state or anti-inflammatory state - with

> inflammation leading to disease such as Alzheimer's disease, heart

> disease, strokes, cancer, etc. Some hormones such as some estrogens

> and insulin can lead to inflammation leading to illness. And other

> hormones such as the androgens (except DHT), growth hormone, and

> thyroid hormone, can lead to an antiinflammatory state, reducing

the

> risk for illness. The balance determines the person's risk for

> illness.

>

> What estradiol level is best for any individual often needs to be

> determined by trial and error. It is unique for each individual.

Most

> do best around 30 pg/ml. But some do best at lower and higher

levels.

> For example, I have a 65 y.o. patient with a total testosterone of

> 840 ng/dl and an estradiol of 47 pg/ml. He's having the time of his

> life - able to make love numerous times each night - after more

than

> a decade of having no sex. The estradiol level works for him

without

> side effects. Some may do better with much loser levels of

estradiol -

> the response is highly individualistic.

>

> Even with low SHBG - which is difficult to correct since it depends

> on the balance of so many hormones - when the other hormones and

> neurotransmitters are optimized, sex drive and the ability to have

an

> erection can often return.

>

> When total testosterone is supraphysiologic - i.e. over 1000 ng/dl -

> problems with libido and erections may occur. Testosterone

increases

> dopamine in the brain in order to increase sex drive, reduce

> depression, give pleasure to activities. The problem is that

dopamine

> is a very fragile neurotransmitter/ hormone in its effects. Too

high a

> dopamine level can cause tolerance to dopamine. This is similar to

> how one can develop tolerance to drugs such as cocaine and

> amphetamines which increase dopamine levels in the brain to cause

> their high. This can lead to the loss of libido when high

> testosterone levels are maintained for long periods of time.

>

> Conversely, when one is deprived of testosterone (and hence

dopamine)

> for long periods of time due to hypogonadism, one can get a high

> during the first few weeks of testosterone treatment since the

brain

> becomes supersensitive to dopamine when it has been deprived of it

> (e.g. making more dopamine receptors to pick up the weaker dopamine

> signals). Unfortunately, as the brain then gets use to the higher

> dopamine levels, it will develop some tolerance, and libido will

drop

> off - though we often wish that hopefully a good amount remains.

> ____________ ______

> Any statement I make on this site is for educational purposes only

> and is subject to change. It does not constitute medical advice,

does

> not substitute for proper medical evaluation from physician, does

not

> create a doctor/patient relationship or liability. If you would

like

> medical advice, you will have to make an appointment. Thank you.

> Phil

>

>

>

>

>

Link to comment
Share on other sites

hi yes i thought that was so on hypogonadism two ,i could not understand then

about all the otherr blood tests ,if lh/fsh and total testorone are low then to

me thats hypogonadism secondary,or am i wrong

all i want is recognition of that ,if i dont need the otherr blood tests then i

wont asl for them i will tell gp today,endo made and error and i am secondary

hypogonadism and want my doctor to just rubber stamp the diagnosis i wil then

ask for those lh/fsh and total t tests again with sbhg and free testosterone and

whatever of those other tests she allows me to have

so yto get back to myu docotor

lh 2 iu/l range 1-9

fsh 2 iu/l range 1-19

ttotal t 7.6 nmo/l range 6-27

am i correct in telling my docotor thst there is no sdoubt destpie the crrap the

endo said that this is hypogonadism secondary?

the biggest problems seems to be deciding on wehat is low, all those officially

fall in normal range but low end and that may mean still my doc will say that

too.

i dont want to get carried away with loads of bllod test that are not

indicative of hypogonadism two,yes i accept some may be needed in future but for

now the only thing i am establishing is am i or am i not based on the figures i

have hypogonadsm secondary,some times i am sure i am and then i see something

else that confuses me

i know you are all trying to help but its very confusing and made harder by our

health system in UK

as said i dont have an endo i trust,i certainly wont go back to the last one and

he is only one in local hopsital so not much choice.

and any new person would take 4 months or so to even see

so are the figures i give officially ok to diagnose hypogonadism secondary[not

just persnal beliefs] but actuall oficially ,as all i ever see is referance to

low figures above being hypogonadism secondary but no actual classification of

what is officially low or not.

my figures i guess are low side of normal ansd thats the problem,as its not

being recognised officialy

anyway i will hopefully get my doc to say she agrees that iam hypgogonadism

seciondary then at least i will have that diagnoses.

regards paul

Low SHBG and Estradiol by Dr. nco.

The most common cause of low SHBG is excessive insulin - i.e. insulin

resistance. Insulin resistance in turn leads to a cascade of events

which results other hormone imbalances such as low testosterone

production, suboptimal thyroid hormone activity, adrenal fatigue, etc.

Factors which together in a balance determine SHBG are:

1. Anabolic hormones generally reduce SHBG. These include

testosterone, DHEA, insulin, DHT, and growth hormone.

2. Thyroid hormone, Estrogens, and Progesterone (by increasing

estrogen receptors/sensitivi ty), increase SHBG.

In the absence of insulin resistance, the most common other cause of

low SHBG is a very high level of other anabolic hormones - most

frequency high testosterone from TRT. Those who use anabolic steroids

at high doses often drive their SHBG to near zero.

When total testosterone is between 650 to 1000 ng/dl, and a person

still has zero sex drive, I would look for other causes for sexual

dysfunction - e.g. other hormone, neurotransmitter, or immune system

problems.

Raising SHBG does not necessarily increase the risk for Alzheimer's

disease. It is important to keep in mind the factors which lead to

the risk of Alzheimer's disease.

Insulin resistance (i.e. excessive insulin levels) causes low SHBG.

It also greatly increases the risk of Alzheimer's disease because it

results in a higher level of inflammatory cytokine production

(Cytokines are the chemical messengers of the immune system). It is

the inflammation which is one of the underlying factors which leads

to Alzheimer's disease.

SHBG level is most often a signal of the overall status of multiple

hormone levels. The balance may give an indication of whether one is

in an pro-inflammatory state or anti-inflammatory state - with

inflammation leading to disease such as Alzheimer's disease, heart

disease, strokes, cancer, etc. Some hormones such as some estrogens

and insulin can lead to inflammation leading to illness. And other

hormones such as the androgens (except DHT), growth hormone, and

thyroid hormone, can lead to an antiinflammatory state, reducing the

risk for illness. The balance determines the person's risk for

illness.

What estradiol level is best for any individual often needs to be

determined by trial and error. It is unique for each individual. Most

do best around 30 pg/ml. But some do best at lower and higher levels.

For example, I have a 65 y.o. patient with a total testosterone of

840 ng/dl and an estradiol of 47 pg/ml. He's having the time of his

life - able to make love numerous times each night - after more than

a decade of having no sex. The estradiol level works for him without

side effects. Some may do better with much loser levels of estradiol -

the response is highly individualistic.

Even with low SHBG - which is difficult to correct since it depends

on the balance of so many hormones - when the other hormones and

neurotransmitters are optimized, sex drive and the ability to have an

erection can often return.

When total testosterone is supraphysiologic - i.e. over 1000 ng/dl -

problems with libido and erections may occur. Testosterone increases

dopamine in the brain in order to increase sex drive, reduce

depression, give pleasure to activities. The problem is that dopamine

is a very fragile neurotransmitter/ hormone in its effects. Too high a

dopamine level can cause tolerance to dopamine. This is similar to

how one can develop tolerance to drugs such as cocaine and

amphetamines which increase dopamine levels in the brain to cause

their high. This can lead to the loss of libido when high

testosterone levels are maintained for long periods of time.

Conversely, when one is deprived of testosterone (and hence dopamine)

for long periods of time due to hypogonadism, one can get a high

during the first few weeks of testosterone treatment since the brain

becomes supersensitive to dopamine when it has been deprived of it

(e.g. making more dopamine receptors to pick up the weaker dopamine

signals). Unfortunately, as the brain then gets use to the higher

dopamine levels, it will develop some tolerance, and libido will drop

off - though we often wish that hopefully a good amount remains.

____________ ______

Any statement I make on this site is for educational purposes only

and is subject to change. It does not constitute medical advice, does

not substitute for proper medical evaluation from physician, does not

create a doctor/patient relationship or liability. If you would like

medical advice, you will have to make an appointment. Thank you.

Phil

Link to comment
Share on other sites

On Wed, 13 Sep 2006 06:12:44 +0000 (GMT), you wrote:

>hi yes i thought that was so on hypogonadism two ,i could not understand then

about all the otherr blood tests ,if lh/fsh and total testorone are low then to

me thats hypogonadism secondary,or am i wrong

>

>all i want is recognition of that ,if i dont need the otherr blood tests then i

wont asl for them i will tell gp today,endo made and error and i am secondary

hypogonadism and want my doctor to just rubber stamp the diagnosis i wil then

ask for those lh/fsh and total t tests again with sbhg and free testosterone and

whatever of those other tests she allows me to have

>

>so yto get back to myu docotor

>

>lh 2 iu/l range 1-9

>fsh 2 iu/l range 1-19

>ttotal t 7.6 nmo/l range 6-27

>

>

>am i correct in telling my docotor thst there is no sdoubt destpie the crrap

the endo said that this is hypogonadism secondary?

>

>the biggest problems seems to be deciding on wehat is low, all those officially

fall in normal range but low end and that may mean still my doc will say that

too.

>

>i dont want to get carried away with loads of bllod test that are not

indicative of hypogonadism two,yes i accept some may be needed in future but for

now the only thing i am establishing is am i or am i not based on the figures i

have hypogonadsm secondary,some times i am sure i am and then i see something

else that confuses me

>

>i know you are all trying to help but its very confusing and made harder by our

health system in UK

>

>

>as said i dont have an endo i trust,i certainly wont go back to the last one

and he is only one in local hopsital so not much choice.

>

>and any new person would take 4 months or so to even see

>

>so are the figures i give officially ok to diagnose hypogonadism secondary[not

just persnal beliefs] but actuall oficially ,as all i ever see is referance to

low figures above being hypogonadism secondary but no actual classification of

what is officially low or not.

>

>my figures i guess are low side of normal ansd thats the problem,as its not

being recognised officialy

>

>

>anyway i will hopefully get my doc to say she agrees that iam hypgogonadism

seciondary then at least i will have that diagnoses.

>

>regards paul

In my opinion before you go on Testosterone replacement you should

have an E2 test. And a prolactin test. Read the AAACE guidelines to

understand why. Take the guidelines to your doctor for a complete list

of all tests.

http://www.aace.com/pub/pdf/guidelines/hypogonadism.pdf

It would seem you are most likely secondary - but high E2 or high

prolactin could lay at the root and these two causes can sometimes be

resolved without Testosterone therapy. Also secondary cases usually

require an MRI to make sure the cause is not pituitary lesions or

tumors. Once those tests are done it and those causes ruled out it

makes sense to start T.

Once you start they need to follow your E2 levels for a time. You

should aim to keep them in the 20 to 30 range in my opinion. Much

higher or lower negates the testosterone benefits and causes problems.

Also before they start they are supposed to do a prostate exam. Most

of this is spelled out in the guidelines.

Good luck! keep asking questions here and posting results.

________________

I am human; nothing in humanity is alien to me.

Terence

Link to comment
Share on other sites

Join the conversation

You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...
×
×
  • Create New...