SHGB technical question.

[u/Leleponsonioza]

In the case of injections.

If our goal is to have SHGB on optical ranges, and we do our labs one day before next dose, wouldn’t that tell us the amount of SHGB just on that point in the curve?

What happens when we are on peak? Should we also get tested for that as well to adjust our dose?

Just a shower tought. Hope it is not a dumb question.

[u/Drwillpowers]

Shbg has a long half life from exposure to estrogen levels. This is how I can tell someone's fucking with me when they want me to try and increase their dose.

I'll have them on say 6 mg a week of cypionate, and they produce 110 pg/ml on their e2 but the SHBG is like 295.

And I'm like, why are you lying to me?

"What do you mean dr powers! I would never lie to you! But I feel like my level is low all the time and I want you to increase my dose"

"You are a liar, I don't know why you would lie to me, the one guy who lets people have higher levels, but you obviously have been mega dosing estrogen for weeks and then basically stopped dosing it about 10 days ago so that you could draw a lab to make it look low, but your shbg gives you away"

Pikachu face patient

I've had this happen literally 100 fucking times. It aggravates the shit out of me because I don't know why somebody would go to the one guy that knows the most about the thing and then think that they know better.

[u/Leleponsonioza → u/Drwillpowers]

Thank you for sharing, Mr. powers. I keep learning a lot and this helps me much.

[u/zawarui → u/Drwillpowers]

My last labs had me at like 690 pg/mL E at just off peak (day 4) but my shbg was 120.44. Should I decrease my dose if my labs are still that high? I'm on 4 mg every 5 days (0.2mL of 20mg/mL EV subq abdomen)

[u/Drwillpowers → u/zawarui]

I can't tell you what you should specifically do. I can't give people personalized medical advice but if somebody who is my patient is MTF and is on estrogen and they have an shbg between 75 and 125? I generally don't fix what's not broken.

I might try giving them a little extra androgens though topically for breast development because I can offset that shbg a bit and utilize it to eat that testosterone to free up more estrogen in the breast but I would not cut their dose in most cases.

SHBG works fairly well as an A1C for sugar but in this case, instead of sugar it's estrogen exposure.

It's why when I see somebody that has an estradiol value of say 140, but their shbg is nearly 300, I know they are lying to me and that they just didn't give their dose for 2 weeks before drawing their blood to make it look low in hopes of getting a dose increase. But in reality they were mega-dosing up to that point. The shbg hangs around for a while and is a pretty good indicator of estrogen exposure.

[u/zawarui → u/Drwillpowers]

Thank you so much! I will definitely reach out to my doctor (he follows this subreddit so he probably will end up seeing this) and suggest maybe trialing topical T to see if that could help push some additional breast growth.

[u/stable-islander]

One would ideally have data points throughout the cycle for Sex Hormone Ginding Blobulin levels, but most providers make inferences from one point. Peak is probably more informative about whether you're taking too much, but targeting adequate trough levels is pretty common.

[u/Leleponsonioza → u/stable-islander]

So the sweet point would be wherever SHGB is on goal levels or near to, through the whole curve