SHBG Lab Test Guide – High Levels, Low Levels & More (2023)

SHBG is short for sex hormone binding globulin and it is a serum blood test that can give you valuable insight about your hormones!

Low levels of SHBG may be associated with low thyroid function and low estrogen status while high levels may bind up testosterone leading to weight gain, depression, and other symptoms.

Most physicians don't put a lot of emphasis on this lab test but it is critical to understanding what is happening with the hormones in your body.

Learn how to understand your lab results, but more importantly what to do about changes to your SHBG.

We will discuss high levels, low levels and what to do about both:

More...

Quick Navigation

What Causes Increased SHBG?

Symptoms of High SHBG

What Causes Low SHBG?

Symptoms of Low SHBG

Using SHBG for Assessing Thyroid Function During Thyroid Hormone Replacement Therapy

How to Treat High SHBG (how to lower it when it's high)

#1. Check serum estrogen levels

#2. Check free thyroid hormones (consider altering your thyroid hormone dose)

#3. Consider alternatives to OCP if you are taking birth control medication

How to Treat Low SHBG (how to increase it when it's low)

#1. Get a complete thyroid lab panel

#2. Assess your estrogen/progesterone ratio (especially if menopausal)

#3. Check free testosterone levels

Back to you

(Video) SHBG - Sex Hormone Binding Globulin Effects on Testosterone Levels - Doctor's Analysis

References (Click to Expand)

Sex Hormone Binding Globulin - Why it is important

So what is SHBG?

SHBG stands for Sex Hormone Binding Globulin.

And it does exactly what it sounds like it does - binds up sex hormones.

But why is this important?

In order to understand we need to talk about some basic physiology.

First, you need to know that hormones float around in your serum in 2 major forms:

#1. Bound to proteins(1) -> the binding of hormones to certain proteins leaves them INACTIVE.

If a hormone is bound to a protein it is NOT available for use.

Consider this like hormones that your body "stores" for later use, similar to you putting food in a deep freezer.

#2. Free and active -> if a hormone is not bound to a protein it is considered "free" and can actually enter into cells and do its job.

Free hormones (such as "free t4" or "free testosterone") can turn on cellular function and promote genetic changes.

*Side note: this reasoning is why it's so important to check your free thyroid hormones if you have hypothyroidism. Checking "total t3" or "total t4" has less clinical utility than the free hormones!

SHBG Lab Test Guide – High Levels, Low Levels & More (1)

You can consider the free hormones as the ACTIVE hormones and the more clinically useful measurement of almost all hormones.

The amount of "free" hormone is usually a VERY small percentage when compared to the "bound" hormone in your blood.

Your body uses this binding system as a way to regulate certain hormones and keep everything in balance or in check.

So where does SHBG fit in?

Sex hormone binding globulin acts as a binding hormone which means that it may be helpful to think of SHBG as a way to inactive hormones floating around in your serum.

For this reason, you can consider SHBG to be a "Goldilocks" type of protein, meaning you don't want too much but you also don't want too little - you need just enough.

Small changes to SHBG levels can bind up free hormones and result in serious symptoms.

It also has a strong affinity (meaning it likes to bind) to certain sex hormones.

It will preferentially bind to hormones in this way:

Preference on dihydrotestosterone or DHT(2) (this is the most potent androgen), then testosterone, then androstenediol, then estradiol, then estrone.

You will notice that SHBG prefers to bind to and inactivate the various androgens in the body.

This is very important because of how this impacts androgens and therefore symptoms in both women and men.

High SHBG will bind up and INACTIVATE both testosterone and DHT meaning that both men and women may start to experience the symptoms of low testosterone (weight gain, depression, loss of muscle mass, irritability, etc.).

While low levels will leave more testosterone ACTIVE meaning that women may start to experience the symptoms of high testosterone (facial hair growth, weight gain, PCOS, irritability, acne, etc.).

What's worse is that most physicians don't even test for SHBG even though they understand the difference between "free" and "total" hormone concentration in the blood.

This makes SHBG a VERY important test to ask for if you are experiencing hormone any hormone imbalance as it may shed light on your current problem.

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Foods to Avoid if you have Thyroid Problems:

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type.

(Video) Why "How To Lower SHBG Levels?" is NOT the Right Question - SHBG Testosterone

The Complete List of Thyroid Lab Tests:

This list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose thyroid hypothyroidism correctly!

Download more free resources on this page.

What Causes Increased SHBG?

SHBG is influenced by 2 major hormone systems in the body:

#1. Thyroid hormone(3) and...

#2. Estrogen levels(4).

Both of these hormones may stimulate or INCREASE the circulating amount of sex hormone binding globulin in the serum.

So what does that mean for you if you have high SHBG?

If you are a woman and you have high SHBG the most likely cause is due to excessive estrogen use.

This can be either from a condition known as estrogen dominance - meaning you have too much estrogen in your serum.

Or because you are taking birth control(5) or some other form of exogenous hormones.

If you are taking OCP or other hormones and it is causing excessively high levels of SHBG you should take caution!

Increasing your SHBG will influence the amount of free testosterone in your serum and may be one of the reasons that women on OCP tend to gain weight and experience mood changes (6).

Another cause of high SHBG is due to excessive thyroid hormone replacement therapy.

This is most often seen in those who are taking T3 containing medications (T3 has a direct influence on hepatic SHBG production) like natural desiccated thyroid hormone or liothyronine/cytomel.

It can also occur in those taking T4 medication such as Levothyroxine, but this is less common.

Assessing SHBG accurately in menstruating women can be difficult, though, as women may commonly present with both excess estrogen and hypothyroidism.

If you are taking thyroid hormone replacement and your SHBG is high you should look at both estrogen levels and your current thyroid dose.

But how do we "define" a high SHBG?

Like other hormones, we need to look at "optimal ranges" and not just the reference range.

If you are a woman you want your SHBG to be in the 60-80 nmol/L range.

Anything higher is considered "too much" and anything lower is considered "insufficient".

You can see an example of high SHBG below with relevant laboratory reference ranges:

SHBG Lab Test Guide – High Levels, Low Levels & More (2)

Symptoms of High SHBG

It's important to realize that high SHBG doesn't necessarily cause negative symptoms by itself. Instead, symptoms related to your SHBG may be due to an indirect effect that SHBG has on other hormones in your body.

If you have high SHBG you are more likely to experience negative symptoms related to excess estrogen and/or low testosterone:

  • Menstrual irregularities
  • Weight gain (pear shape weight gain)
  • Mood changes (depression or anxiety)
  • Breast tenderness, breast fullness
  • Fatigue
  • Bloating and/or water retention
  • Decreased muscle mass (inability to gain muscle mass even while lifting weights)
(Video) CRUSHED Sex Hormone-Binding Globulin Into The SINGLE DIGITS? Restoring SHBG For Libido & Anabolism!

Rarely, high SHBG may also be caused by excessive thyroid dosing which may lead to the symptoms of hyperthyroidism as well.

What Causes Low SHBG?

In my experience low SHBG is often ignored (more so than high levels) because it's more sinister and difficult to spot.

Low SHBG is most often seen in women who are hypothyroid (meaning they have low thyroid function) and women who are menopausal.

We know that both thyroid hormone and estrogen stimulate SHBG(7) release, so low levels are often associated with low hormone levels.

This in turns causes an effect where free testosterone levels rise giving way to the symptoms of PCOS.

If you are experiencing the symptoms of hypothyroidism then it's VERY important to evaluate your SHBG.

This is also true if you are taking thyroid hormone replacement medication.

SHBG is considered "suboptimal" if it is lower than 60 nmol/L:

SHBG Lab Test Guide – High Levels, Low Levels & More (3)

If you are a menstruating woman (and have a normal cycle) then the most common cause of suboptimal SHBG is low thyroid function.

It's also worth pointing out that lowSHBG is associated with an increased risk of developing type II diabetes(8) - another important reason why you want to normalize your level if it is low.

Symptoms of Low SHBG

The symptoms of low SHBG tend to be tied to thyroid function and low estrogen.

In addition, women with low SHBG may also experience the side effects of excess free testosterone:

  • Weight gain
  • Fatigue or low energy
  • Menstrual irregularities
  • Facial hair growth
  • Hair loss
  • Acne
  • Depression/anxiety

Please note that the symptoms associated with low SHBG can vary widely from individual to individual.

For this reason, it's always best to assess SHBG in the context of other circulating hormones (testosterone, estrogen/progesterone, and thyroid hormone).

Using SHBG for Assessing Thyroid Function During Thyroid Hormone Replacement Therapy

Another very important clinical utility of SHBG is in its ability to assess thyroid function.

With up to 20% of the population suffering from subclinical hypothyroidism or overt hypothyroidism, this hormone imbalance is incredibly common.

Furthermore, SHBG is a tool that can help evaluate thyroid function at the cellular level.

In states of low thyroid function, the SHBG tends to drop.

When thyroid hormone is replaced, SHBG tends to rise.

This allows for the SHBG to be used as a marker to assess thyroid hormone absorption and thyroid hormone cellular action.

If you have low SHBG AND hypothyroidism then testing your SHBG at baseline is very important for assessing if you are taking the right type and dose of thyroid hormone.

In some cases, taking T4 only thyroid medication such as Levothyroxine or Synthroid may not actually increase the SHBG (9).

This may be a sign that the body is having difficulty with the conversion of T4 to T3 in peripheral tissues.

Remember:

T3 tends to increase SHBG more so than T4 levels.

SHBG can also be used to assess if your thyroid dosing is too high.

If your SHBG is elevated AFTER you take thyroid hormone then this may indicate that your thyroid dosing is excessive and should be reduced.

It's very important to keep SHBG in the "Goldilocks" range of 60-80 nmol/L.

How to Treat High SHBG (how to lower it when it's high)

Treating high SHBG has more to do with finding out the CAUSE of high SHBG in your body, rather than treating the SHBG level itself.

With that in mind if you have high SHBG you will want to take the following steps to find the root cause:

#1. Check serum estrogen levels

The first step is to assess both estrogen and progesterone levels.

This means assessing estradiol (the most potent estrogen in your serum) as well as progesterone.

Estradiol levels vary from woman to woman so the absolute value is not as important as the difference in the ratio between progesterone and estradiol.

(Video) Best Approach For Someone With Low SHBG? TRT Q+A

It's best to assess the estradiol/progesterone ratio mid-luteal phase of the menstrual cycle (if menstruating).

Look for a ratio that is 10:1 (estrogen:progesterone).

SHBG Lab Test Guide – High Levels, Low Levels & More (4)

If you have high levels of estrogens in your body (or low progesterone) you can find more information about treating both here.

#2. Check free thyroid hormones (consider altering your thyroid hormone dose)

If your estrogen:progesterone ratio is not an issue then your high levels may be related to thyroid function.

At a minimum, make sure to assess both free T3 and free T4 levels (but really you should check a complete thyroid panel).

Excessively high free T3 and/or free T4 may be the cause of high SHBG in individuals taking thyroid hormone replacement medication (especially if it contains T3).

#3. Consider alternatives to OCP if you are taking birth control medication

One of the most common causes of high SHBG is the use of oral contraceptives or birth control medications.

The only way to lower SHBG if it's related to these medications is to discontinue their use.

You should discuss this option with your physician and talk about other options (depending on why you are using them in the first place).

If you are using OCP medications for birth control then you may find better results switching to a form of birth control that does not include hormones such as the copper IUD.

How to Treat Low SHBG (how to increase it when it's low)

Low SHBG tends to be more difficult to treat than high SHBG.

If you know that you have "suboptimal" SHBG then you will need to look at the following areas:

#1. Get a complete thyroid lab panel

If you are a menstruating woman with low SHBG then this is the most important first step to take.

To get a full thyroid panel you will need the following tests:

  • Thyroid stimulating hormone or TSH
  • Free T3
  • Free T4
  • Reverse T3
  • Thyroid antibodies

Once you get all of these tests you can compare your set of labs to optimal thyroid lab tests and determine if your thyroid is contributing to your SHBG level.

If it is, then you will need to take steps to increase thyroid function in your body either by taking thyroid hormone replacement therapy or by increasing thyroid function naturally.

#2. Assess your estrogen/progesterone ratio (especially if menopausal)

This is really only important if you are menopausal.

After menopause estrogen levels fall which can cause SHBG to drop.

Some menopausal women are sensitive to this small drop and therefore may benefit from bio-identical hormone replacement therapy.

#3. Check free testosterone levels

Low SHBG may indirectly leave more testosterone in the free and active state.

You can determine if this is happening in your body by assessing free testosterone in the serum.

The combination of low thyroid function and low SHBG causes many of the symptoms seen in PCOS.

If you think this might be happening to you, then the best treatment is to get on the right thyroid hormone replacement medication which is often enough to normalize SHBG and help alleviate many of the symptoms of PCOS.

There are many other causes of PCOS, however, so this may not work for everyone.

Back to you

The bottom line?

This binding protein gives you important information about what is happening with various hormones in your body.

High SHBG is often caused by excessive estrogen levels while low SHBG is often the result of hypothyroidism (or low thyroid function).

The key to treating SHBG is to identify what is causing the abnormality and fixing that problem.

This will help normalize SHBG levels in your serum and should help to reduce your symptoms.

Now I want to hear from you:

Do you have abnormalities in your SHBG level?

Have you been able to identify what is causing the problem?

Why or why not?

Leave your comment below!

References (Click to Expand)

(Video) How to Handle Low or High SHGB (Sex Hormone Binding Globulin)

SHBG Lab Test Guide – High Levels, Low Levels & More (5)

FAQs

Is it better to have low or high SHBG? ›

Higher levels of SHBG may be beneficial because SHBG binds to estrogen, thus reducing the ability of estrogen to promote cancer growth (5,31). Also, SHBG may impact cancer growth directly (32).

What does a high SHBG level mean? ›

What does the test result mean? A high SHBG level means that it is likely that less free testosterone is available to your tissues than is indicated by the total testosterone test. A low SHBG level means that more of the total testosterone is bioavailable and not bound to SHBG.

What do low levels of SHBG mean? ›

If your SHBG levels are too low, it can be a sign of: Hypothyroidism, a condition in which your body doesn't make enough thyroid hormones. Type 2 diabetes. Overuse of steroid medications. Cushing's syndrome, a condition in which your body makes too much of a hormone called cortisol.

What are healthy SHBG levels? ›

What are normal SHBG levels? The normal ranges for SHBG concentrations in adults are: Males: 10 to 57 nanomoles per liter (nmol/L) Females (nonpregnant): 18 to 144 nmol/L.

Is it good to have high SHBG? ›

Excessively high SHBG is problematic especially for males and athletes because it decreases the amount of free testosterone. High levels of SHBG are associated with infertility, a decreased sex drive, and erectile dysfunction, especially when total testosterone levels are already low [4].

What are the symptoms of high SHBG? ›

Symptoms of High SHBG Levels
  • Arrested sexual development (in teenagers)
  • Infertility.
  • Decreased sperm concentration and motility.
  • Decreased sex drive.
  • Impotence.
  • Reduced testicle size.
  • Breast growth.
  • Decreased body hair.
2 Mar 2021

How do you fix low SHBG? ›

Low SHBG has been linked to metabolic diseases (like diabetes), breast cancer, heart disease, and PCOS. Physical exercise, caffeine, weight loss, certain dietary changes, and some pharmaceutical drugs may increase SHBG.

Does vitamin D lower SHBG? ›

Conclusions: Lower 25(OH)D concentrations were associated with lower SHBG levels and higher free testosterone levels in both men and women, and lower estradiol and higher DHEA levels in women, independent of adiposity and lifestyle. We observed no significant association of 25(OH)D with total testosterone in men.

Can low SHBG cause hair loss? ›

SHBG not only controls the transportation and balance of hormones, but it also influences your hair. If the SHBG level is not optimal, it may lead to hair loss. Yes, if you do not have optimal SHBG levels you can notice some changes to your hair, and you can experience hair loss as well.

Can low SHBG cause weight gain? ›

Because low SHBG levels free up more hormones for your body to use, the result is side effects such as fluid retention, acne, low sperm count, increased appetite and weight gain, increased muscle mass, and mood swings in men; and weight gain, excess facial and body hair, acne, mood changes, and menstrual changes in ...

Does SHBG increase with age? ›

SHBG is a major carrier of androgens. In men, SHBG levels increase with age, while in women data are scant. There is evidence that body mass index (BMI) and fasting insulin influence SHBG concentration.

What does SHBG do in the body? ›

Sex hormone-binding globulin (SHBG) transports androgens and estrogens in blood and regulates their access to target tissues. Hepatic production of SHBG fluctuates throughout the life cycle and is influenced primarily by metabolic and hormonal factors.

What increases SHBG in females? ›

The aging process, particularly for women, increases SHBG levels, which means younger women tend to have lower SHBG levels than postmenopausal women. Pregnancy increases SHBG even further, as SHBG is actually produced in the placenta tissue.

How long does it take to lower SHBG? ›

Six hours supplementation showed a significant decrease on sex hormone binding globulin (SHBG), high sensitive CRP (hsCRP) and TNF-α level. After one week (in samples taken at 8.00 A.M, only), the mean plasma free testosterone increased and the mean plasma estradiol decreased significantly.

What causes high SHBG in males? ›

Increased SHBG in men may be associated with symptoms of low testosterone levels (hypogonadism) because less testosterone is available to the body's tissues. Low testosterone leads to increased production of SHBG, further decreasing the amount of testosterone available to tissues.

Does zinc lower SHBG? ›

Conclusions. Higher dietary zinc intake was associated with lower serum concentrations of SHBG and possibly lower levels of T and E2 in healthy, young men, although we did not observe any association between zinc intake and calculated free T or any of the examined semen quality parameters.

Why is SHBG low in PCOS? ›

The concentration of SHBG in PCOS patients is typically low because these women have elevated androgen levels and usually present with compensatory HA and IR. In addition, the synthesis and secretion of SHBG in the liver are inhibited by androgens and insulin.

Can low SHBG cause infertility? ›

The metabolic phenotype (non-reproductive group) with insulin resistance and low SHBG levels is at a high risk for infertility.

What causes raised SHBG? ›

Increased SHBG levels can be seen in anorexia, pregnancy, ageing, growth hormone deficiency, androgen deficiency, hyperthyroidism, liver disease, hyperprolactinaemia, active porphyria and also with oestrogens.

What foods increase SHBG? ›

In regression analyses, after adjustments, the strongest predictors of SHBG concentrations were the dietary intake of rice (beta = 0.42, P < 0.01), fish (beta = 0.34, P < 0.05), millet (beta = -0.27, P < 0.01), and wheat (beta = -0.34, P < 0.01).

Does SHBG fluctuate? ›

No significant diurnal changes of SHBG binding capacity, total E2, free E2, percentage free E2 and percentage free T were found in female subjects in the mid-luteal phase of the menstrual cycle, although significant fluctuations of total T, free T and T/SHBG index were observed throughout the day.

Does caffeine increase SHBG? ›

Caffeinated coffee consumption has been found to be associated with higher SHBG levels in data from cross-sectional studies in women [2, 6–8].

How can I increase my testerone level? ›

Starke offers the following tips:
  1. Improve your diet. Adopting and maintaining a healthy diet benefits your testosterone levels in two primary ways: ...
  2. Mix cardio with strength training, and vice versa. ...
  3. Get plenty of sleep. ...
  4. Take steps to reduce stress. ...
  5. Address any underlying medical conditions.
9 Apr 2021

Does fasting increase SHBG? ›

Taking into account these data, it is worth considering the serum concentration of SHBG, whose level was increased after water-only fasting.

Does stress increase SHBG? ›

Manage Stress

A primary reason for SHBG levels to increase is from high cortisol levels. High cortisol levels occur from both a short term and long term stress response of any type (physical or emotional). The connection between SHBG and cortisol is a primary reason stress takes such a toll on hormone balance.

Does vitamin D increase SHBG? ›

Vitamin D and SHBG are also associated in previous studies. Two studies found that 25(OH)D and SHBG were significantly associated in men. Though no study has directly determined if vitamin D supplementation could increase SHBG levels, vitamin D supplementation may be helpful to men who have low testosterone levels.

Does vitamin d3 increase testosterone? ›

For most men, a higher vitamin D intake will probably not strongly influence the concentration of testosterone, but men with vitamin D deficiency might consider vitamin D supplements to boost the concentration of testosterone in the body and perhaps also fertility.

What liver disease causes high SHBG? ›

Sex hormone-binding globulin (SHBG), a glycoprotein synthesized by hepatocytes, has been linked to insulin resistance and hepatic lipid metabolism and is suggested to be associated with nonalcoholic fatty liver disease (NAFLD).

Does magnesium decrease SHBG? ›

Zinc lowers the binding affinity and magnesium has been found to decrease the affinity of SHBG to testosterone. Boron has also been found to lower SHBG and increase testosterone in an acute supplementation trail in healthy males.

How do you balance your hormones? ›

How to Naturally Balance Your Hormones
  1. Get enough protein. Proteins provide amino acids that your body cannot make on its own and are needed to produce peptide hormones. ...
  2. Exercise regularly. ...
  3. Maintain a moderate weight. ...
  4. Watch your gut health. ...
  5. Lower sugar intake. ...
  6. Reduce stress. ...
  7. Get enough sleep. ...
  8. Eat healthy fats.

Does low SHBG affect fertility? ›

We found a significant association between SHBG levels and infertility response to pharmacological treatment in PCOS women. This study suggests that assessment of SHBG levels before infertility treatment is a useful tool to identify the group of women who are more likely to respond to treatment.

Does high SHBG cause hair loss? ›

SHBG not only controls the transportation and balance of hormones, but it also influences your hair. If the SHBG level is not optimal, it may lead to hair loss. Yes, if you do not have optimal SHBG levels you can notice some changes to your hair, and you can experience hair loss as well.

What does SHBG do in the body? ›

Sex hormone-binding globulin (SHBG) transports androgens and estrogens in blood and regulates their access to target tissues. Hepatic production of SHBG fluctuates throughout the life cycle and is influenced primarily by metabolic and hormonal factors.

Why is SHBG low in PCOS? ›

The concentration of SHBG in PCOS patients is typically low because these women have elevated androgen levels and usually present with compensatory HA and IR. In addition, the synthesis and secretion of SHBG in the liver are inhibited by androgens and insulin.

What increases SHBG in females? ›

The aging process, particularly for women, increases SHBG levels, which means younger women tend to have lower SHBG levels than postmenopausal women. Pregnancy increases SHBG even further, as SHBG is actually produced in the placenta tissue.

Can low SHBG cause ED? ›

Conclusions: Patients had erectile dysfunction in association with low testosterone and SHBG, in spite of exogenous testosterone replacement.

How can I increase my testerone level? ›

Starke offers the following tips:
  1. Improve your diet. Adopting and maintaining a healthy diet benefits your testosterone levels in two primary ways: ...
  2. Mix cardio with strength training, and vice versa. ...
  3. Get plenty of sleep. ...
  4. Take steps to reduce stress. ...
  5. Address any underlying medical conditions.
9 Apr 2021

What liver disease causes high SHBG? ›

Sex hormone-binding globulin (SHBG), a glycoprotein synthesized by hepatocytes, has been linked to insulin resistance and hepatic lipid metabolism and is suggested to be associated with nonalcoholic fatty liver disease (NAFLD).

What foods increase SHBG? ›

Additionally, the following foods and beverages increased SHBG production.
...
4) Dietary Changes: Mediterranean Diet
  • Olive oil [139]
  • Almonds and walnuts [140]
  • Coffee and tea [136]
  • Alcoholic beverages [141]
  • Soy (rich in isoflavones) [142]
  • Cabbage, broccoli, and cauliflower [143]
13 Jan 2021

What hormone makes your hair grow? ›

Androgens, such as testosterone (T), dihydrotestosterone (DHT), and their prohormones dehydroepiandrosterone sulfate (DHEAS) and androstenedione (A) are the key factors in the growth of terminal hair.

Does SHBG increase with age? ›

SHBG is a major carrier of androgens. In men, SHBG levels increase with age, while in women data are scant. There is evidence that body mass index (BMI) and fasting insulin influence SHBG concentration.

What stimulates SHBG? ›

The levels of SHBG are controlled by a balance of hormonal influences on its synthesis in the liver. Testosterone and insulin inhibit and estrogen and thyroid hormone stimulate SHBG formation.

How long does it take to lower SHBG? ›

Six hours supplementation showed a significant decrease on sex hormone binding globulin (SHBG), high sensitive CRP (hsCRP) and TNF-α level. After one week (in samples taken at 8.00 A.M, only), the mean plasma free testosterone increased and the mean plasma estradiol decreased significantly.

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4. Sex Hormone Binding Globulin (SHBG) - The FACTS * Part 1 *
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