Nak,
Just to be clear.. the new neuro didn't claim that Dilantin binds to SHBG, only that it is a strong protein binder. Though, he did say that perhaps that was part of the issue with why sexual issues didn't appear till ending Dilantin.. Either that, or it is a problem with the Keppra. He basically is recommending to go back to Dilantin.
My endocrinologist says my hormone numbers are all normal, although my free testosterone is in the lower end of normal. My total testosterone has always been on the higher end of normal (high enough that he says that my number is what he shoots for when he has other patients on testosterone therapy), so he is reluctant to recommend any kind of testosterone therapy for me. Unfortunately, no one bothered to do detailed Free testosterone numbers prior to ending Dilantin, since I never complained of sexual issues. However, my total testosterone was tested a few times while I took the Dilantin and that number was very high, sometimes higher than the normal reference range. Today, toal testosterone numbers are still on the high end of the refernce range, but not as high as when I took Dilantin..
I did a phone consult with a "nuero-endocrinologist" out of New York who said I should take testosterone shots to boost my free testosterone and take arimidex to control any estradiol issues, all while continuing with keppra. But, to me that just sounds like more drugs (and therefore side effects to deal with) that I am not interested in going through.
Also, the local endocrinologist and local neuro do not agree, he says just go back to dilantin (since I felt fine when I took that back in the day) and that my hormone numbers are good enough. (they both smirked as if it was dumb to consider testosterone shots given how high my total testosterone numbers already are)
Again, until ending Dilantin and going alone on Neurontin (and now Keppra alone) I had no sexual issues regardless of TLE or Dilantin, so all of this is very confusing. I certainly don't want to make it worse by going back to Dilantin, but I want to have a full life again..