can't believe this...after 7 yrs on Propecia...32 yrs old
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StoptheMadness
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had a follow up visit with my Endo today to discuss if I should take another blood test to see if SHBG levels would go down. She advised against another test because she's seen too many ppl get into this loop of testing and re testing, especially now that there is no difficulty now with ED. However she changed her tune immediately when I presented her my April 5th T and free T levels (for some reason I didn't have these with me on my first visit to her on May 6th and I forgot to mention to her that I had them back at home). Well, when I showed her that my free T was low, she immediately said that is usually one sign of hypogonadism. She then went to re-examine the T and free T results from my May 6th blood test and realized (!) the free T was relatively low compared to the total T (the latter shooting way up from my April 5th blood test). Again, a sign of hypogonadism. I could actually see the light bulb go on in her brain, making a connection 
Herewith are her notes from today:
"The patient is interested in learning whether he has experienced an adverse drug effect from prior use of Propecia. He probably is not will to rechallenge himself with Propecia, but might interpret an improvement of hormone levels as suggestive of a drug effect. A lingering effect after drug interruption would be likely to occur, if hormonal effects upon SHBG are observed, so that normalization might require some weeks. A reasonable hypothesis might be that high estrogen levels in the past could have driven the elevation of SHBG, such that, for a given testosterone level, the free testosterone would be low. However, areas of silence or uncertainty in the medical literature exist, such that we do not have evidence from controlled trials to support this interpretation as an expected consequence of treatment with Propecia. At the request of the patient, and to be assured as to whether he does or does not have abnormal endogenous estrogen production (which would require a search for cause), now that he has been off of Propecia since April 7, 2011, we are ordering: FSH, LH, estradiol, estrone, testosterone, fee testosterone, and SHBG. Endogenous estrogen overproduction could signify a medical illness or tumor. Therefore, the tests are medically indicated."
Herewith are her notes from today:
"The patient is interested in learning whether he has experienced an adverse drug effect from prior use of Propecia. He probably is not will to rechallenge himself with Propecia, but might interpret an improvement of hormone levels as suggestive of a drug effect. A lingering effect after drug interruption would be likely to occur, if hormonal effects upon SHBG are observed, so that normalization might require some weeks. A reasonable hypothesis might be that high estrogen levels in the past could have driven the elevation of SHBG, such that, for a given testosterone level, the free testosterone would be low. However, areas of silence or uncertainty in the medical literature exist, such that we do not have evidence from controlled trials to support this interpretation as an expected consequence of treatment with Propecia. At the request of the patient, and to be assured as to whether he does or does not have abnormal endogenous estrogen production (which would require a search for cause), now that he has been off of Propecia since April 7, 2011, we are ordering: FSH, LH, estradiol, estrone, testosterone, fee testosterone, and SHBG. Endogenous estrogen overproduction could signify a medical illness or tumor. Therefore, the tests are medically indicated."
StoptheMadness
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My Endo is open to the findings from other finasteride users
7/9/2011 blood test (3 months post finasteride)
LH 4.1
FSH 1.6
testosterone 856 (249-836 ng/dL)
free t, direct 13.0 (8.7-25.1 pg/mL)
SHBG 77.5 (14.5-48.4 nmol/L)
estradiol 37.0 (7.6-42.6 pg/mL)
estrone 45 (12-72 pg/mL)
letter from my endo dated july 2011
It would probably be worth having liver function tests done to be sure the high SHBG is not one manifestation of a more general problem with hyperglobulinemia due to hepatitis or chronic liver disease, but that explanation for the high SHBG seems highly unlikely. My previous speculation, that high estrogens might have explained the elevation of SHBG, was not supported by the current studies. There may be a relatively long timeframe for changes to be seen in the levels of circulation globulins, after revision of any influence that had been formerly exerting an effect upon their levels. A possibility is that we still could be seeing lingering effects from estrogen elevations of the past; the present estradiol level is in the high end of the normal range. However, given that estrogen elevation is not a recognized complication of treatment with Propecia, I now think the likeliest explanation might be that SHBG levels could be affected by the ratio of dihydrotestosterone to estrogen, such that a low ratio induces SHBG levels to be elevated. Once SHBG is elevated, the total testosterone is elevated, but not the free testosterone. With the passage of time, if there has been a temporary effect of this type, the effect should regress. Although I have tried to research these questions, I'm not finding clearcut answers. If I hear from you with your permission, I might like to share the de-identified data with an expert in the field of andrology or sex steroid metabolism. If you should learn anything further from your contacts who have similar concern, I would be interested to hear of your findings. (she means the hairloss community).
7/9/2011 blood test (3 months post finasteride)
LH 4.1
FSH 1.6
testosterone 856 (249-836 ng/dL)
free t, direct 13.0 (8.7-25.1 pg/mL)
SHBG 77.5 (14.5-48.4 nmol/L)
estradiol 37.0 (7.6-42.6 pg/mL)
estrone 45 (12-72 pg/mL)
letter from my endo dated july 2011
It would probably be worth having liver function tests done to be sure the high SHBG is not one manifestation of a more general problem with hyperglobulinemia due to hepatitis or chronic liver disease, but that explanation for the high SHBG seems highly unlikely. My previous speculation, that high estrogens might have explained the elevation of SHBG, was not supported by the current studies. There may be a relatively long timeframe for changes to be seen in the levels of circulation globulins, after revision of any influence that had been formerly exerting an effect upon their levels. A possibility is that we still could be seeing lingering effects from estrogen elevations of the past; the present estradiol level is in the high end of the normal range. However, given that estrogen elevation is not a recognized complication of treatment with Propecia, I now think the likeliest explanation might be that SHBG levels could be affected by the ratio of dihydrotestosterone to estrogen, such that a low ratio induces SHBG levels to be elevated. Once SHBG is elevated, the total testosterone is elevated, but not the free testosterone. With the passage of time, if there has been a temporary effect of this type, the effect should regress. Although I have tried to research these questions, I'm not finding clearcut answers. If I hear from you with your permission, I might like to share the de-identified data with an expert in the field of andrology or sex steroid metabolism. If you should learn anything further from your contacts who have similar concern, I would be interested to hear of your findings. (she means the hairloss community).
Re: My Endo is open to the findings from other finasteride users
ummmm WHAT?
Erroneous in its entirely. It's showcased in Merck's study. Given gyno is a known complication this should be obvious tbh. The link for this is in another thread: Enden should help you on this one.
That said, your endo seems very open and useful and indeed quite insightful given this is a rather unusual problem. Kudos.
My best advice though, is:
1) She doesn't even know your DHT. That could explain a high SHBG reading (low DHT). SHBG and DHT balance against each other. I'd love to see how you respond to small amounts of proviron. That said, id recommend needle root extract at this juncture.
2) She's looking at your key sex hormones only. She would be well advised to expland things to include your thyroids (TSH, Free T3, Free T4, Reverse T3) and adrenals (progesterone, cortisol readings, aldosterone etc). The elevated SHBG could very well be a red herring and not the key problem.
3) Going back to what you guys are looking into. If you haven't already did a full Liver function test that would be a good idea. A liver detox could help your SHBG level as should a good break from alcohol (a top Professor told me to stop alcohol for 6 weeks and retest my SHBG when it was high).
Hope this helps.
EDIT- Man i really wish i had an endo like yours. The sad thing is though, it's a crazy amount of trial and error and this problem - atleast for many of us - it far from straight forward. It will demand alot of time and effort. After a few failed attempts i can imagine that many endos - even good one's like this - could lose patience with the whole thing. Let's hope you guys nail it early on. I'd be very happy to help you avoid wasting time on silly stuff and cut straight to the useful stuff to avoid chasing the wind.
StoptheMadness said:
ummmm WHAT?
Erroneous in its entirely. It's showcased in Merck's study. Given gyno is a known complication this should be obvious tbh. The link for this is in another thread: Enden should help you on this one.
That said, your endo seems very open and useful and indeed quite insightful given this is a rather unusual problem. Kudos.
My best advice though, is:
1) She doesn't even know your DHT. That could explain a high SHBG reading (low DHT). SHBG and DHT balance against each other. I'd love to see how you respond to small amounts of proviron. That said, id recommend needle root extract at this juncture.
2) She's looking at your key sex hormones only. She would be well advised to expland things to include your thyroids (TSH, Free T3, Free T4, Reverse T3) and adrenals (progesterone, cortisol readings, aldosterone etc). The elevated SHBG could very well be a red herring and not the key problem.
3) Going back to what you guys are looking into. If you haven't already did a full Liver function test that would be a good idea. A liver detox could help your SHBG level as should a good break from alcohol (a top Professor told me to stop alcohol for 6 weeks and retest my SHBG when it was high).
Hope this helps.
EDIT- Man i really wish i had an endo like yours. The sad thing is though, it's a crazy amount of trial and error and this problem - atleast for many of us - it far from straight forward. It will demand alot of time and effort. After a few failed attempts i can imagine that many endos - even good one's like this - could lose patience with the whole thing. Let's hope you guys nail it early on. I'd be very happy to help you avoid wasting time on silly stuff and cut straight to the useful stuff to avoid chasing the wind.
StoptheMadness
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Re: My Endo is open to the findings from other finasteride users
you mentioned that estrogen elevation was observed in the merck study. Where can I view that particular study? (unless you are just referring to the merck leaflet?)
very very helpful. thank you. I'm sure to incorporate this into my plan of action with herMens Rea said:
you mentioned that estrogen elevation was observed in the merck study. Where can I view that particular study? (unless you are just referring to the merck leaflet?)
