What is Sex Hormone-Binding Globulin?
SHBG is a carrier protein that binds tightly to sex hormones in circulation, regulating how much of them are available to your tissues.
While most circulating sex hormones are attached to carrier proteins, a small fraction remains free and biologically active. When hormones are tightly bound to SHBG, they can’t enter cells and exert their effects. Only unbound (“free”) and loosely bound hormones are biologically active and able to exert effect in tissue.
Why Does SHBG Matter?
- Acts as a surrogate marker of metabolic health, particularly insulin sensitivity
- Regulates how much testosterone and estradiol are available to tissues
- Helps identify the cause of symptoms when total testosterone levels appear normal
- Plays a central role in polycystic ovary syndrome (PCOS) in women by influencing free testosterone levels
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How to Interpret SHBG?
(Ranges may vary slightly by lab)
Standard reference ranges represent the middle 95% of healthy individuals but don’t necessarily reflect levels associated with longevity. Optimal ranges are derived from clinical guidelines, peer-reviewed research, and real-world outcomes data, with an emphasis on levels associated with peak functioning and reduced disease risk.
Benefits of Optimizing SHBG
- Lower risk of type 2 diabetes1
- Improved inflammatory markers
- Reduced PCOS severity in women2
- Improved cardiovascular health in men and women3
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Low SHBG Levels
Low SHBG is commonly seen in insulin resistance and polycystic ovary syndrome (PCOS) in women, where it contributes to higher free testosterone levels.
Symptoms:
- Acne and oily skin
- Excessive body/facial hair
- Irregular periods (in women)
- Weight gain
- Fatigue
- Irritability and mood swings
Causes:
- Insulin resistance
- Obesity
- Hypothyroidism
- Cushing’s syndrome
- PCOS (women)
- Hyperinsulinemia
Healthspan Impacts:
- Risk of insulin resistance and type 2 diabetes4
- Strongly associated with elevated triglycerides and C-reactive protein, a marker of inflammation associated with cardiovascular disease5
- Higher risk of heart disease
- Linked to non-alcoholic fatty liver disease
High SHBG Levels
Elevated SHBG is often associated with hyperthyroidism, liver disease, aging, or low insulin states.
Symptoms:
- Low libido
- Erectile dysfunction (men)
- Chronic fatigue
- Muscle loss
- Mood changes
- Absent or irregular menstrual periods (women)
Causes:
- Aging
- Hyperthyroidism
- Pregnancy
- Liver disease
- High alcohol consumption
- Low-calorie diets
- Oral estrogen therapy
Healthspan Impacts:
How Hone Treats Out of Range SHBG
Your Hone physician will evaluate SHBG as part of a full hormone panel including total testosterone, free testosterone, and estradiol. They will also consider your symptoms and overall health, then map out a treatment plan that optimal hormone balance.
- Metformin – to raise SHBG levels in those with insulin resistance
- Oral contraceptives* – to increase SHBG in women with PCOS
- Levothyroxine (T4) – to increase SHBG due to hypothyroidism
- Testosterone replacement therapy (TRT) – to boost testosterone levels by lowering elevated SHBG levels
*Your Hone Physician does not prescribe these treatments but will recommend further evaluation and help coordinate care with your primary care provider when medical treatment is indicated.
- Incorporate 2-4 resistance training sessions per week
- Avoid excessive training
- Get 7-8 hours of sleep per night with a consistent sleep schedule
- Avoid underfueling and severe caloric restriction
- Reduce alcohol consumption
- Improve insulin sensitivity through nutrition and body composition changes
Perry, J. R., et al. (2010). Genetic evidence that raised sex hormone binding globulin (SHBG) levels reduce the risk of type 2 diabetes. Human molecular genetics.
↑Xing, C., et al. (2022). Effect of Sex Hormone-Binding Globulin on Polycystic Ovary Syndrome: Mechanisms, Manifestations, Genetics, and Treatment. International Journal of Women’s Health.
↑Li, J., et al. (2023). Sex Hormone-Binding Globulin and Risk of Coronary Heart Disease in Men and Women. Clinical Chemistry.
↑Duric, L.F. et al. (2026). The Role of Sex Hormone-Binding Globulin (SHBG) as a Marker of Metabolic Dysfunction-Associated Steatotic Liver Disease, with an Extended Analysis in Both Men and Women. Journal of Clinical Medicine.
↑Aribas, E., et al. (2021). Aging, Cardiovascular Risk, and SHBG Levels in Men and Women From the General Population. The Journal of Clinical Endocrinology & Metabolism.
↑Hidayat, K., Du, X., & Shi, B.M. (2018). Sex hormone-binding globulin and risk of fracture in older adults: systematic review and meta-analysis of observational studies. Osteoporosis International.
↑Mellström, D., et al. (2008). Older men with low serum estradiol and high serum SHBG have an increased risk of fractures. Journal of Bone and Mineral Research.
↑Wang, A., et al. (2023). Sex hormone-binding globulin and heart failure hospitalizations in patients with dysglycemia: Experiences from the outcome reduction with an Initial Glargine Intervention trial. Diabetes Research and Clinical Practice.
↑Schederecker, F., et al. (2020). Sex hormone-binding globulin, androgens and mortality: The KORA-F4 cohort study. Endocrine Connections.
↑Unfer, V., et al. (2017). Myo-inositol effects in women with PCOS: A meta-analysis of randomized controlled trials. Endocrine Connections.
↑Xie, L., et al. (2019). The Effect of Berberine on Reproduction and Metabolism in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Control Trials. Evidence-Based Complementary and Alternative Medicine.
↑Naghii, M. R., et al. (2011). Comparative effects of daily and weekly boron supplementation on plasma steroid hormones and proinflammatory cytokines. J Trace Elem Med Biol.
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Reviewed for Accuracy by Our Medical Review Board
This biomarker information has been reviewed by a member of Hone’s medical review board. As part of the medical review team, physicians fact-check this content against the latest research and their own experience treating their patients.
Ashley Winter, M.D., is a board-certified urogynecologist trained at Weill Cornell and Cleveland Clinic. She specializes in female and male sexual dysfunction, urinary issues, genital pain, and hormone therapy.
James Staheli, D.O., is the Medical Director for Broad Health, Hone Health’s affiliated medical practice and a family medicine doctor in Atlanta, Georgia.
