Hormone & Endocrine - Bloody Good
Hormone

Sex Hormone Binding Globulin

The Sex Hormone Binding Globulin (SHBG) Test measures the protein that binds to hormones like testosterone and oestrogen in the blood. SHBG levels affect how much free, active hormone is available, and this test may help assess hormone balance, fertility, and metabolic health.

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Sex Hormone Binding Globulin

Curious about why your hormone levels might appear normal on standard tests, yet you're still experiencing symptoms that suggest hormonal imbalance?

Overview

Think of SHBG (Sex Hormone Binding Globulin) as your body's hormone taxi service. Just like a taxi picks up passengers and controls where they can go, SHBG binds to your sex hormones—testosterone and estrogen—and determines how much of them are actually free to work in your body. When you have high SHBG levels, it's like having too many taxis picking up your hormones, leaving fewer available to do their important jobs of maintaining energy, mood, and sexual health. On the flip side, low SHBG means more hormones are running free, which might sound good but can actually cause symptoms of hormone overload.

This test is especially valuable because it explains why you might feel tired, moody, or experience other hormone-related symptoms even when standard hormone tests come back "normal." Your total hormone levels might look fine on paper, but if SHBG is throwing off the balance of what's actually usable, you'll still feel the effects. Since SHBG responds to factors like stress, weight changes, liver health, and insulin levels, testing it gives you and your healthcare provider a clearer picture of what's really happening with your hormonal health—helping you get to the root of symptoms that might otherwise remain a mystery.

Reviewed by Dr. Vu Tran
Bloody Good’s Chief Medical Officer

Symptoms

You may benefit from this test if you experience:
Low sex drive in women Low sex drive in men Excessive hair growth on face or body (women) Acne in adult women Insulin resistance

Purpose

Essential for anyone with unexplained symptoms despite normal hormone tests, particularly men and women with testosterone or oestrogen-related concerns. Valuable for individuals with metabolic syndrome, insulin resistance, thyroid disorders, or liver conditions. Important for women with PCOS, irregular periods, or fertility issues, and men with low energy despite normal testosterone. Also useful for monitoring hormone replacement therapy effectiveness.

How to prepare

No fasting required. Morning collection (between 7-10 AM) recommended for consistency. Avoid biotin supplements for 3 days before testing. Inform your healthcare provider about hormone medications, thyroid treatments, or liver medications as these can influence SHBG levels.

Understanding results

Normal ranges vary by age and gender. Adult men: 18-54 nmol/L; Adult women: 18-144 nmol/L (higher during pregnancy). Post-menopausal women typically have lower levels. High SHBG may indicate hyperthyroidism, liver disease, or anorexia. Low SHBG often suggests insulin resistance, hypothyroidism, or androgen excess. Optimal ranges depend on individual health goals and should be interpreted with other hormone markers.

After the test

Discuss results with a healthcare provider specialising in hormone health. Abnormal SHBG levels may require additional testing including comprehensive hormone panels, liver function tests, or thyroid studies. Lifestyle modifications such as weight management, regular exercise, and addressing insulin resistance can help optimise SHBG levels. Follow-up testing recommended every 3-6 months when monitoring treatment.

Frequently Asked Questions

  • High SHBG binds more of your sex hormones, potentially leaving less available for biological activity. This can lead to symptoms of hormone deficiency despite normal total hormone levels.
  • Yes, maintaining healthy weight, regular resistance exercise, adequate protein intake, and managing insulin levels can help optimise SHBG. Zinc supplementation may also be beneficial.
  • Oestrogen naturally increases SHBG production, while testosterone tends to lower it. This is why women typically have higher SHBG levels than men.
  • Oral contraceptives often increase SHBG significantly, which can reduce free testosterone and sometimes affect mood, libido, or energy levels.
  • Yes, SHBG should ideally be tested alongside total testosterone, free testosterone, and oestradiol for complete hormone assessment. The Free Androgen Index calculation also requires SHBG.
  • SHBG can change relatively quickly with significant diet or lifestyle changes, typically showing changes within 4-8 weeks of intervention.
Sex Hormone Binding Globulin

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