Chris: All right.
Let's go to Brendan Hannigan.
Brendan Hannigan is a 30-year-old male withhigh SHBG and low free testosterone.
Total testosterone is normal, 700 nanogramsper deciliter or higher, but SHBG ranges from 50 to 80 nanomoles per liter.
As a result, free testosterone sits at thebottom of the range and sometimes below it.
Symptoms of poor testosterone status, sexualdysfunction, low libido, trouble building muscle mass without gaining a lot of fat, low mood and motivation.
Background: Hypothyroidism that's currentlywell managed to treat T4 and T3.
No major weight issues.
No sign of metabolic dysfunction and liverproblems.
Very low progesterone and high estrogen, anothercase of high estrogen, due to very low progesterone and high estrogen to progesterone ratio, butabsolute estradiol levels are below range.
Normal prolactin, DHEA, LH, FSH, et cetera.
Very low blood lipids.
Total cholesterol around 100 to 140, prettylow.
Over-the-counter supplements to lower SHBGand increased free T, boron, zinc, various herbs Chris: Things that didn't work: Over-the-countersupplements to lower SHBG and increased free T, boron, zinc, various herbs like TongkatAli, et cetera, and even course of sermorelin, an injectable GH secretagogue.
Raising total cholesterol to 160 to 170 throughcholesterol supplementation.
Looking for ideas.
What am I missing? Any thoughts on this? Carrie: I have no idea.
SHBG is like bane of my existence.
I have no idea how to get SBHG down once it'sup.
Boy, I actually talk to practitioners aboutthis all the time to figure that out.
I would agree that supplements that for SHBG, it's very hit or miss, Tongkat being one of them, DHEA being the other.
There are two other ones, stinging nettlesand Avena oats.
There's like very mild, very weak researchabout lowering SHBG with nettles and then with Avena.
Again, it's like hit or miss.
How to get that SHBG down? Well, also remember, SHBG binds estrogen aswell.
Although he said his estrogen is low.
Actually low, but relative.
Chris: His total estradiol, yes, absoluteestradiol is low.
Carrie: His SHBG is not going up because ofa low absolute estradiol.
Low progesterone gives men the same symptomsas low testosterone.
I don't actually worry that much about progesteronebecause if the other things improve, generally progesterone improves as well generally, yeah.
Chris: I'm curious how an increase in bodyfat might affect this because he said he had no weight problems.
He said no major weight issues, no sign ofmetabolic dysfunction or liver problems.
I don't know.
It seems to me logically that a high SHBGis a bad thing, and that seems supported by his symptoms.
But if you look at the literature, SHBG goesdown with an increase in liver fat.
Carrie: And insulin.
Chris: And it seems like a high SHBG is correlatedwith a lower disease risk for a variety of things.
I think sometimes it might be counterintuitive, but something like maybe you need to wait a little bit more sometimes is an issue there, even though that's not a good answer if the person is not underweight.
Carrie: I'm not an expert in this at all, but I have heard from some other practitioners, mycotoxin will raise SHBG.
What was the other one that does? I have not done any other research into that.
I've just had a few mycotoxin experts say, “I see it all the time.
When we address their mycotoxin, their SHBGgoes back to normal.
” I'm like, “Well, that would make sense.
” All your binding globulins are going to goup to try to protect.
You may, Brendan, want to look into otherthings: viruses, Epstein-Barr, cytomegalovirus, mycotoxin, just things like that.
Run some inflammatory markers, see what'sup, and just see if you're missing.
You're looking at the hormones, you've runa lot of great stuff, but maybe it's just the next layer down in the onion.
Chris: Yeah, I think it's worth noting thathis cholesterol still isn't very high.
Carrie: That's not good, 100 to 140? Chris: Yeah.
He says he used cholesterol supplementationto get it up to 160 to 170.
Carrie: I wonder if that's familial.
Does everyone in his family have low cholesterolor is it just him? Chris: Yeah.
Brendan, if you're able to comment on that, that would be an interesting question to answer whether your family members have those issuesor have the cholesterol issue specifically.
Anyhow, when I was a vegan, my cholesterolwas 106, my total cholesterol.
But I was also borderline psychotic when Iwas a vegan.
I don't think it was a good thing.
But even on a high animal fat diet, my cholesterolis around 160 or so, although it might be higher now.
I haven't check in a while.
Carrie: Oh, Brendan answered.
Dad and grandpa have low total cholesteroltoo, but not as extreme.
I don't think you should completely excludethat you might want to raise your cholesterol higher than that.
I know 160 and 170 would be looked at as really, really good from a cardiovascular person's perspective.
Your cardiologist isn't going to tell youyou need it higher, but cholesterol is a precursor to the sex hormones and is going to be a factorin your body's perception of how much abundance you have.
The fact that you needed cholesterol supplementsto bring it up to 160 to 170 makes me think that the general state of cholesterol in yourbody is very, very low by default and is still pretty low.
I don't know.
170 should be okay, but I think given thespecific problems that you're looking at, pushing it up to 200 and seeing if you feelany better should be one of the tools in the kit is my advice.
Carrie: It's interesting that some of hishormones are low and some are high.
His total testosterone is high or in range, I apologize, in rage.
So he can make testosterone.
He has the testicular ability to pull in cholesteroland make it, but his progesterone and estrogen aren't absolutely high.
Those two are low, but testosterone is something.
His free is low, but we know that's boundup.
Chris: Well, we don't know what the cholesterolcontent of his liver is, but the liver lipids — obviously, you don't want fatty liver, but there might be a threshold where the cholesterol content in the liver and the triglyceridecontent in the liver are influencing the SHBG expression.
My thought is, yeah, clearly it's not likethe limiting precursor to the production of sex hormones.
No one is going to give him a liver biopsyto figure that out.
Chris: But it's a reasonable thought thatthey might be influencing the SHBG expression.
Neither of us have good answers, but there'ssome brainstorming.
Carrie: Sorry, Brendan.
Chris: All right, thanks, Brendan.