question from a user
How would you treat someone with very low SHBG and high estrogen symptoms? Assume patient is taking a large amount of AI already.
AlphaMD's Answer
Generally adjust their dosing frequency to be more frequent to reduce overall spikes which may cause aromatization, switch from IM to subq because it helps create a more even absorption for the same reason as the first option, examine other medications they are on like HCG in addition to their TRT, and finally if already at a high dose of AI look at potentially reducing overall dose. Those are pretty general & it may vary with the patient, but normal steps.
With that information, the first consideration would be to consider lowering the TRT dose. Simply put, all estrogen was once testosterone. If you have high estrogen despite large AI dosing, it would suggest that this person’s testosterone is also high. Adjusting dosage frequency would be another method to manage SHBG. Lowering dosage frequency typically will help someone who has very low SHBG.
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