Blood test results

[Break60]

Recently had my umpteenth blood test and had some out of range results other than T which is expected . I'm on Trelstar and Estradiol patches and was on cabergoline to lower prolactin which I stopped a couple weeks ago.

Test/Result / Normal range /Flag

Testosterone, total/ 9.0 / 264-916 / (low)

Bioavailable testosterone /1.2 / 60-240 / (low)

SHBG/ 102.5 / 19.3-76.4 / (high)

prolactin/ .2 / 4.0-15.2 / (low)

Alk phosphatase, bone specific/ 7.4 /7.6-24.8/ (low)

My biggest concern is SHBG which had been in normal range. Any thoughts?

Bob

[Tall_Allen]

Why are you concerned about that? If you're on ADT, you should be happy about that.

[Break60 in reply to Tall_Allen]

TA

My previous SHBG result in May 2018 when on trelstar, casodex and Avodart was 67.4. Would it have increased due to going off casodex and Avodart?

[Tall_Allen in reply to Break60]

Why are you concerned?

[Break60 in reply to Tall_Allen]

I’ve been having dizzy spells and fatigue.

[Tall_Allen in reply to Break60]

It's not from SBBG

[pjoshea13]

What is your estradiol [E2] patch dose? Do you monitor E2?

Hard to imaging that your E2 is >30 pg/mL, but high E2 in men can cause SHBG to be elevated. (SHBG preferentially binds testosterone - the putative source of the excess E2 - though not in your case, of course.)

-Patrick

[Break60 in reply to pjoshea13]

Patrick

The dose is .1mg/day and although I get blood tests every two months I don’t believe E2 is one of them.

Bob

[pjoshea13 in reply to Break60]

Bob,

I know that the Vivelle-Dot patch comes in 5 doses ranging from 0.025 to 0.1 mg per day, and the lowest dose was used by Dr. Myers for patients on ADT.

-Patrick

[Break60 in reply to pjoshea13]

Well I changed them about every 4 days to control hot flushes. They work well

[pjoshea13 in reply to Break60]

Bob,

Probably a good idea to check your estradiol blood level.

-Patrick

[Break60 in reply to pjoshea13]

I’ll mention it at my next visit . Really surprised my RO who is very diligent didn’t request it.

Thanks

[dave2 in reply to Break60]

Bob, my SHBG has been quite high ever since Myers asked me to start monitoring it in 2013. It's currently 165 (19.3-76.4); in the past six years it's been in the range of about 140-220. Myers told me it's high because of all of my PCa treatments, but he wasn't more specific (doubt that had more specifics).

Note that SHBG will affect bioavailability of most/all sex hormones, including T, DHT, and E2. In other words, measuring total serum level of these won't give you a good idea of the serum unbound (free) level of the hormone. To get that you need to either measure the free level directly (separate blood test) or adjust the total level based on measured SHBG. Your bioavailable E2 (estradiol) would drop with a sizable increase in SHBG.

I agree with Patrick that E2 monitoring is prudent if using E2 transdermal. I'm currently using E2 patches 0.025 mg/day that I cut in half (with scissors--not advised by the manufacturer but lots of women do this). So my effective dose is 0.013 mg/day (~1/10 of your dose). This is maintaining my total E2 at roughly 25 pg/mL. But everyone is different; my T is running 100-200 ng/dL, so I'm producing some endogenous E2. When I was on full ADT incl Xtandi I needed higher patch dose.