I’m afraid I do not know about the ins and outs of liver function enough to know the mechanisms that cause drugs to cause metabolic hormonal issues.
In terms of treating poor metabolisation of estrogen- DIM is something that some people claim helps effectively remove estradiol from the liver. The claim remains unproven to my knowledge, but some people believe it has helped them.
If estradiol is overtly high or even relatively high then lowering it via a prescribed and monitored course of an aromatase inhibitor can help prevent the negative feedback cycle and the cascade of negative effects. If SHBG is overtly high or relatively high then Danazol can help prevent the negative feedback cycle and the cascade of negative effects.
There can also be a place for TRT in combination with either or both of the above depending upon the individual situation.
If there is no other hormonal cause for elevated SHBG and metabolic hypogonadism appears to be the cause if testosterone is increased and estradiol kept in check then SHBG might also be lowered
But when SHBG is high or low adverse endocrine metabolic effects can be present and other causative conditions should be considered and ruled out or treated.
e.g
Low SHBG can be a sign of hypothyroidism for instance, high SHBG can conversely be caused by hyperthyroidism.
Underlying causative conditions must also therefore be considered and ruled out or treated. Naturally treating an underlying condition can also help correct sex hormones based issues by bringing SHBG to a more acceptable level.
Low levels of Zinc, excessive alcohol intake and obesity can also cause problems relating to SHBG. Of course the latter of the three can be part and parcel of the problem and obesity can in the first place be caused by a hormonal imbalance so that can be a little bit of a chicken and egg scenario.
Questions like that are impossible for me to answer and might be impossible for anyone to answer at this time. I very much doubt that there is one answer.
That said I will do my best to offer and answer.
Some people are affected by finasteride while others are not. The degree of problems/symptoms found between individuals vary greatly based upon the extent of the problem incurred and the form of the problem incurred. As we have seen finasteride causes a multitude of differing endocrine problems. Even just considering the sex hormonal effects that are proven we have seen men with;
Elevated SHBG and low free testosterone levels, men with acceptable levels of SHBG but low LH and low total and free testosterone levels, men with elevated estradiol levels etc.
A wide variety of adverse effects then.
The dose and duration of use of finasteride is almost certainly a factor and it is probable that many people are to differing degrees predisposed to a variety of problems.
Some people are probably predisposed to adverse effects via boarderline hormonal status be that via the sex hormones or potentially other hormonal effects, some people may have had little predisposition but took sufficient doses of finasteride to cause adverse effects. Others could potentially have a predisposition to or undiagnosed poor liver function. Some people have suggested or theorized about other potential effects or predispositions.
As you can see that isn’t an acceptable answer, it is just the best one that I can offer and I think this is something that Dr Shippen, Dr Crisler and other doctors treating these conditions are also somewhat flummoxed by. Of course they may be able to supply a better and more detailed answer that can be evidenced; you would have to ask them.
I think the plain fact of the matter is that no product containing finasteride should have been licensed for anything other than the most serious of conditions, that finasteride is a poison to the endocrine system at the least and that it simply should not be licensed in the manner that it is.
It might seem strange that a drug can cause such wide ranging side-effects and problems. But one look at the side-effects found on any medication does give you an idea of the wide variety of differing physiological response that different people have with even the most mild and safe medications
It is an assay where the equipment is calibrated around low estradiol levels that are more typical of that found in the male body as opposed to the usual and FAR more common assay, where equipment is calibrated around the much high levels found in the female body. The latter is often unhelpful when trying to consider low levels of estradiol as the reference range can completely exclude the levels that one wishes to look at or can result in a questionable result because of a lack of sensitivity.
