Dr. Mary Claire Haver

Yep, you just answered your own question.

So SHBG is steroid hormone binding globulin.

It is a protein that is made in the liver.

And those of you on oral estrogen, you're going to have a little bit higher levels of SHBG versus transdermal because of that first pass effect of the liver.

SHBG binds our sex hormones, binds estrogen, progesterone, and testosterone.

And when they're bound to that protein, they're not active.

So you need the hormones that are floating free in the bloodstream that are going to be active in the tissues rather than bound.

So if you can lower your SHBG, and we can do that a number of ways, you will increase the activity of your hormone levels because we're unbinding them from the protein.

Let's see.

What are optimal hormone ranges for bone, brain, heart, and symptom control?

All we know.

is bone.

That's the only thing people have measured.

This is what just pisses me off about how we don't study women.

We know everything about testosterone and men and different organ systems and how it may be affected.

But like simple things like how much estradiol in the serum, where did we see the best cardiovascular protection benefit?

When you're only measuring the presence or absence of a hot flash as therapeutic endpoint, we're not going to know that data.

So

what studies would Mary Claire want done?

I would want to see serum estradiol levels, you know, starting people at baseline, checking with their estradiol level, starting them on therapy, then watching the markers of heart disease, like their insulin resistance, like their blood pressure, like their triglyceride level.