Having a low testosterone/SHBG is caused by a lot of things. In this video, a renowned urologist, Dr. Rena Malik explains ...

supercharge-your-testosterone-by-optimizing-this-1-blood-test-shbg-sex-hormone-binding-globulin

Supercharge your Testosterone by Optimizing this 1 Blood Test | SHBG  Sex hormone Binding Globulin

have you heard of shbg or sex hormone binding globulin well if you're interested in increasing your testosterone then listen up shbg is one of the things that we test for to get your free testosterone which is more indicative of the actual amount of testosterone that's available to you that can help improve symptoms of low testosterone I'm Dr Reena Malik urologist and pelvic surgeon and in today's video we're going to talk all about shbg and how changes at shbg can affect your free testosterone level and ultimately your symptoms testosterone is important for a lot of different things and we have receptors for testosterone all over the body including the brain so people who have low levels of testosterone will have symptoms like low libido erectile dysfunction poor sleep difficulty gaining muscle mass increased fat and even depression and each of these symptoms can vary from person to person so if someone presents with low testosterone some may have issues with erectile dysfunction and others may not somebody might present with symptoms of feeling fatigue and decreased interest in sex while others may have depression and have low energy when we think about testosterone in our bodies it lives in three forms tightly bound Loosely bound and free so it's tightly bound to something called sex hormone binding globulin which is what we're talking about today and that's about 45% of all of our testosterone is tightly bound to shbg that means it's not freely available for your body to use to activate all the receptors in our body to create those good symptoms of having a normal testosterone level and it's Loosely bound to albumin mostly about 50% and then corticotropin binding globulin which is a hormone from the hypothalamus that causes some Downstream effects and then about one to 2% is freely available while all the guidelines say total testosterone is the only standardized a available test that we should use to assess for hypogonadism or low testosterone a lot of us who practice sexual medicine will actually calculate a free testosterone and we calculate it because the free testosterone that you get on the blood work is not as reliable as one that's calculated so sometimes you'll see on your blood work that you get a total testosterone as well as a sex hormone binding globulin and there's freely available calculators to actually calculate your free testosterone and I'll link a couple down below there's even an iPhone app and if you remember from some of my prior videos the levels of testosterone and shbg will change throughout the day and this is because they rely on a circadian rhythm meaning testosterone peaks in the early morning and it decreases by the end of the day just like the sun does and similarly shbg will do the opposite it is lowest in the morning and highest later in the late afternoon or evening and so it's important to get these tests done early in the morning morning to assess how your true testosterone shb levels are because that's sort of where the reference values come from now in younger men these variations are much more significant however as men age this circadian rhythm actually tends to blunt a bit so generally speaking the testosterone levels are a little bit more stable throughout the day now they still have a bump in the early morning and a decrease later on in the day but overall generally speaking it's less of a difference so how much free testosterone do you actually need well there's a couple studies that have looked at this in a New England Journal study that was published in 2010 they found that symptoms were most often correlated with a free testosterone of less than 64 picogram per milliliter or 6.4 nanog per deciliter well what is the normal range well another study in 2015 looked at the ranges of free testosterone across multiple different studies that looked at a variety of men the European men's aging study the Framingham art study they found that the distribution of free testosterone in community dwelling men above 40 ranged anywhere from 38 PG per milliliter or 3.8 nanog per deciliter to all the way up to almost 400 PS per milliter or 40 nanog per deciliter so it can be quite a wide range generally we should be seeing that 1 to 2% of your testosterone is freely available for use by your body now as I mentioned shbg is the component that binds testosterone strongly and there are a number of conditions that can either increase shbg and therefore make less free testosterone available or decrease shbg now typically this the things where we see decreased shbg we're also seeing decreased testosterone our body tends to adapt to these changes so if your testosterone decreases then you will see your shbg decrease as well so interestingly the most common thing that decreases shbg is hyperinsulinemia so if you have diabetes your shbg will go down so people will sometimes say that oh if you do these diets like ketogenic diets you'll actually see your testosterone go down because it's actually creating a low insulin state but that's not exactly true in fact I reviewed a few studies on ketogenic diet and testosterone previously so check those out in fact what they found in these studies were that people on a ketogenic diet actually had higher testosterone levels other conditions that can decrease shbg are hypothyroidism which we know can decrease testosterone steroids progestins or any androgenic steroid therapy can decrease shbg which we know can also affect the ability of our body to produce testosterone and then obesity can also decrease shbg but again a lot of these things are because your body's natural production of testosterone goes down with these conditions now what about increased shbg if we have too much shbg G then our testosterone is getting bound up and it's not freely available for your body so what sort of conditions cause an increased shbg we know that shbg goes up with aging that is a known factor and unfortunately a part of aging we also see it in people have hyperthyroidism who have increased estrogen or who have Hib or hepatitis or hepatic ceros now if you have a thyroid condition or diabetes it's always valuable to optimize that but what are other ways that you can optimize your shbg level now before we get into that it's important to realize that shbg is very variable from person to person there are clearly variabilities in terms of how much shbg a person makes and it may be genetic in nature now interestingly the time that we find this most useful is when people have testostrone that's sort of on the borderline it's not very high it's not very low but they're having symptoms because then we may see that shbg is elevated and that their free testosterone is actually lower there's actually some interest in looking at shbg levels and type 2 diabetics because as I mentioned insulin actually suppresses shbg and so you would expect that people with diabetes have low shbg levels but in fact when they've studied men with diabetes they found that having diabetes as well as an elevated shbg and having a low testosterone combined with being over the age of 66 can significantly increase mortality so they found that men who were over the age of 66 with a total testosterone of less than 12 nanomoles per liter or 346 nanog per deiler and an shbg of greater than 35 nanomoles per liter put you at higher risk of mortality if you had two of those factors your risk was 22.5% and if you had all three your risk was 20 5% and this is why this is important because testosterone is so valuable for so many things it is not just for erect it is not just for libido it helps with cognition it helps with muscle mass it helps with reducing fat and these are all important for overall health and preventing mortality so it's super important to think about testosterone as a vital hormone and having good testosterone levels good Hormone Health is a surrogate of overall health and vitality so now let's get back to it what can we do so what about diet so we know that having too little fat in your diet will decrease testosterone if you don't know why check out my video on testosterone natural boosting where I talk about all the different things that can affect testosterone but essentially you need some amount of fat to create testosterone based on the pathways that create testosterone using cholesterol dietary data is somewhat conflicting and SBG in women is also a problem having elevated shbg can cause the same issues with decreased free testosterone and decrease libido although it's not studied quite as well so they've looked at different things in both women and men in some studies they've seen that fiber decreases shbg levels whereas vegetarians actually increase shbg levels and ultimately very low calorie diets actually significantly increase shbg so what is the best data that we have well there was a study looking at the Massachusetts male aging study and they assessed 1500 men between the age of 4 30 and 70 and they looked at a number of factors in these men but some of these included obviously getting blood work and assessing their hormone levels but also assessing their nutrition intake and these men were between the ages of 40 and 70 and they were 95% Caucasian and Were Meant to reflect the population of Boston so this is not reflective of every type of human being of every race and ethnicity but this is probably the best thinga we have at least at this point and so what they did was they took a food frequency questionnaire from them and they had them assess their food frequency over the course of a year as I mentioned they also assessed their hormone levels but they took it twice within 2 hours of waking so they were getting the best values possible for these men and the best part of this data is that they were able to control for a lot of confounding factors right they were able to control for BMI weight height other conditions that they may have to assess that does change es in diet actually affect shbg specifically or are other factors causing the change so after controlling for testosterone and estradi which again can affect shbg they found two things that increased shbg or were positively correlated with an increased shbg and that was age and dietary fiber that doesn't mean that you should stop eating fiber but that's what they found and then what negatively correlated with scpg meaning that higher levels of this decreased shbg or may decrease shbg was protein and body mass index so the higher your body mass index the lower your shbg which we already know obesity causes decreased shbg again not a desirable way to decrease your shbg we know that protein increases insulin levels and we know increase insulin decreases shbg and so that makes sense but interestingly carbohydrates did not see the same effect so we know that carbohydrates clearly increased insulin but they didn't show the same effect as protein so what would I recommend in terms of diet I do not think decreasing fiber intake is a good idea because fiber has other benefits particularly in preventing colon cancer and so I would strongly suggest increasing fiber intake it's also good for your gut microbiome as I've talked about in my podcast with both Dr Kum Kum Patel and Dr Amy Shaw so check those out if you want to learn more but I think fiber is really important but clearly protein is beneficial does that mean it has to be animal protein no does that mean it has to be fatty proteins no it needs to be protein that is generally healthy now you want to try to get ideally grass-fed meats you can also eat plant-based protein but generally increasing protein intake may be beneficial now what about supplements right are there supplements that can increase SBG so as I mentioned before obviously get your insulin checked your th roid hormones checked get your estrodial checked when you're getting evaluated for low testosterone because all of these things can affect shbg and ultimately how much testosterone is available for your body before you go and try any supplements now supplements a lot of people talk about supplements like Boron magnesium and zinc now the thought is that these supplements work by increasing the bioavailability of testosterone so that more of it is available to your body the Boron data however is only in one study on eight eight athletic young men eight eight men so there's never been a study after that initial study on eight men looking at the positive effects of boron so can you try Boron sure you could but there's not a ton of data presenting there's a lot of anecdotal data if you look on YouTube You're Going to find hundreds of videos on people talking about boron you're going to look on Reddit threads there's hundreds of people talking about it and it may help but it's not based on rigorous scientific data you can also consider eating foods high in boron like dates raisins plums those sorts of things could actually increase Boron levels if you are deficient in zinc or magnesium which you can easily check with a blood test these repleting these micronutrients can be helpful for a number of things including improving your hormone milu and decreasing shbg so the One supplement that I think does have some Merit in decreasing shbg is vitamin D now you know that a large portion of society is deficient in vitamin D and there was recently a systematic review published that look at the association of vitamin D with testosterone now what the systematic review found after looking at eight different articles and analyzing Thea they found that vitamin D was correlated with increasing testosterone in some studies but not in others and it wasn't strong enough to make a conclusion but they did see that increased vitamin D intake or normal vitamin D levels saw a decrease or at least stability in the levels of sa hbg and as I mentioned shbg increases with age so vitamin D particularly if you're deficient can be very helpful in improving your shbg levels ultimately what I would say is go to your doctor and get blood test done if you don't want to go to your doctor there's tons of services available online where you can check your vitamin D your zinc your magnesium your thyroid levels make sure you're not diabetic and assess all these factors as well as your shbg and your testosterone to see where things lie your blood work is just that blood work it is not how you're feeling it is not your symptoms your blood work is just that it is num it is not tell me how you're feeling if you're improving if your symptoms are getting better or if your symptoms are even bothering you at all at the end of the day the important thing is to treat you and your symptoms you should assess what is bothering you and then see how you can fix it many of these things including the symptoms with low testosterone are multifactorial in fact a lot of people think erectile function or dysfunction is caused primarily by low testosterone but in fact we know that only 3 to 6% of people who have erectile dysfunction is it caused by low testosterone the large majority of people have other causes of erectile dysfunction so it's important then to assess essentially what is the symptom you're trying to treat are there other things that are bothering that symptom or might be causing that symptom and attacking it from all angles and figuring out what the issue is and then tracking your improvement over time and realize realizing that sometimes the Improvement may take some time and may take some trial and error and that's where I think personalized medicine is super important we're not just treating numbers we're treating you and so it's really important to check that out so if you are looking for a urologist to evaluate your Hormone Health feel free to make an appointment to see me Reena Malik md/ appointments I see patients in person in Newport Beach California as well as online for seven different states and if you are not residing in those States I will also do an educational visit where we can talk about your issues but I cannot give you a diagnosis or prescribe you any treatment But ultimately allows me to review your health and discuss things that may be causing issues if you enjoyed this video make sure to check out my video on testosterone levels optimized by your age because a lot of people come see me and their testosterones are low normal but they're in their 40s and 50s so what exactly is normal for you and as always you were to take care of yourself because you are worth it

Dr.

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