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Hormones

SHBG: normal values, high and low

SHBG stands for sex hormone binding globulin. It is a protein made by the liver. SHBG binds testosterone tightly and oestradiol somewhat more loosely.

Hormone bound to SHBG cannot act in the tissues. SHBG therefore determines how much of your total testosterone is genuinely available. SHBG is not itself a sex hormone but a transport protein.

Results are reported in nmol/l. Normal values differ by sex and by age, and in men SHBG rises as they get older. An SHBG should therefore be assessed alongside total testosterone, never on its own.

Doctor's Assessment Included

Reference Ranges

See the value that applies to you:

Choose male or female — this range differs by sex.

Enter your age — this range changes with age.

This range also depends on context such as cycle phase or sample material; the highlighted rows apply to your group.

Your reference range
nmol/l
18,3 128 nmol/l
Reference ranges by group, in nmol/l
Male · 20–49 years 18,3–54,1 nmol/l
18,3 54,1
Male · 50 years and older 20,6–76,7 nmol/l
20,6 76,7
Female · 20–49 years 32,4–128 nmol/l
32,4 128
Female · 50 years and older 27,1–128 nmol/l
27,1 128
18,3 128 nmol/l

Bijsluiterwaarde: 5e-95e percentiel per subgroep (n = 241 mannen 20-49 jaar; 174 mannen 50 jaar en ouder; 166 vrouwen 20-49 jaar; 177 vrouwen 50 jaar en ouder), bij nuchtere bloedafname tussen 06.30 en 14.00 uur. Het referentiecohort bestond uit niet-zwangere volwassenen met een BMI van 30 of lager die geen anticonceptie of relevante medicatie gebruikten. Een hormoonreferentiewaarde is assay-specifiek; deze waarden gelden voor de Roche Elecsys-methode (CE-bijsluiter). Belangrijk bij de interpretatie: SHBG hangt samen met de lichaamssamenstelling — gewicht, BMI en middel-heupratio hangen omgekeerd samen met SHBG, en een verlaagd SHBG wordt gezien bij overgewicht, insulineresistentie en hypothyreoidie. De pil, zwangerschap en hyperthyreoidie verhogen SHBG juist, en hormoontherapie na de menopauze verandert SHBG afhankelijk van de toedieningsvorm. Gebruikt u anticonceptie of hormoontherapie, of bent u zwanger, dan is deze referentiewaarde niet op u van toepassing.

Source: Roche Diagnostics Reference population: Roche referentiecohort (Elecsys SHBG bijsluiter CE, studie CIM 000669; nuchter, BMI 30 of lager, niet zwanger, geen anticonceptie)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Check your own value

SHBG (Sex Hormone Binding Globulin): what this test measures

SHBG is a protein made in the liver. Its full name is sex hormone binding globulin, and that name describes exactly what it does. It binds sex hormones and carries them through the blood.

SHBG does not bind every hormone equally tightly. Testosterone is bound firmly, oestradiol distinctly more loosely. Hormone attached to SHBG is not active.

It cannot enter the cell and does nothing while bound. Only the free fraction, plus the portion loosely bound to albumin, is available to the tissues.

An SHBG test therefore does not measure a hormone. It measures the transport capacity around it. That distinction matters.

SHBG is not itself a sex hormone and causes no symptoms of its own. It does determine how a hormone result must be read.

Results are expressed in nanomoles per litre (nmol/l). The reference values below come from the manufacturer of the Roche Elecsys assay. They derive from 415 men and 343 women. The cohort consisted of healthy adults without obesity, not pregnant, and taking no contraceptives or relevant medication.

GroupReference value
Men, 20-49 years18.3 – 54.1 nmol/l
Men, 50 years and older20.6 – 76.7 nmol/l
Women, 20-49 years32.4 – 128 nmol/l
Women, 50 years and older27.1 – 128 nmol/l

Note the age boundary in both columns. SHBG is age-banded in both sexes, and in men the value rises over the years. The upper limit for men therefore moves from 54.1 to 76.7 nmol/l. Read an older man against the younger band and a normal value looks raised.

Reference values also differ between laboratories and analyser platforms. With SHBG that is not a detail: different laboratories use noticeably different bands. Always go by the reference values printed on your own report.

SHBG (Sex Hormone Binding Globulin): why this value matters

The main reason to measure SHBG is that a total testosterone without it can mislead in two directions. That is not an edge case. It is the core of this test.

With a low SHBG there is less transport protein. Total testosterone falls with it, while free testosterone can stay normal. The result looks low, though the available hormone supply need not be.

With a high SHBG the opposite happens. Total testosterone is propped up artificially, while the free fraction falls. The result looks reassuring while less active hormone is present.

What lowers SHBG? Excess weight and insulin resistance are the main causes, acting through a raised insulin level. Then type 2 diabetes, an underactive thyroid, glucocorticoids, androgens and anabolic steroids, and fatty liver disease.

What raises SHBG? It rises with age and with an overactive thyroid. Oral oestrogens raise SHBG markedly, so the combined pill and oral hormone therapy.

Delivery through the skin does not, and that difference is large. Then liver cirrhosis, anorexia, prolonged severe energy restriction, and some anti-epileptic drugs.

SHBG is also a metabolic value in its own right. In large population studies a low SHBG is associated with a higher risk of developing type 2 diabetes. That holds in both sexes, and it has also been found in genetic research.

This is an association within groups. It is expressly not a prediction about one person, and a low SHBG diagnoses nothing.

SHBG (Sex Hormone Binding Globulin): how to prepare

  1. Preferably in the morning

    Recommended

    A morning draw makes this value easiest to compare with its reference range. Plan the draw before 10:00 if you can.

  • Water is always fine. Drink as usual beforehand, it makes the draw easier.
  • Take your usual medication, unless your own doctor told you otherwise.

SHBG (Sex Hormone Binding Globulin): when is testing worthwhile?

SHBG is useful when a testosterone result does not match the symptoms. That is the most common reason. A man with fatigue, low sex drive or loss of muscle strength may have a total testosterone inside the normal range. Without SHBG there is no way to tell whether free testosterone is normal too.

The test is also useful with excess weight, insulin resistance or type 2 diabetes. In those conditions SHBG is often reduced, which drags total testosterone down structurally.

In women there is a second reason. Anyone using the pill or oral hormone therapy usually has a clearly raised SHBG. A testosterone result taken during that use is hard to interpret without it.

So request SHBG together with total testosterone as a rule. Free testosterone can be calculated from that pair, and only then is the picture complete. An SHBG on its own rarely answers the question someone actually has.

The draw itself carries no strict condition, since SHBG has no strong daily rhythm. Total testosterone does. That belongs in the morning, roughly between 07:00 and 10:00. Because the two are requested together, the morning is the practical moment.

SHBG (Sex Hormone Binding Globulin): symptoms of a high or low value

Low Levels

By itself a reduced SHBG produces no complaints whatsoever. SHBG is a transport protein rather than a hormone, so it acts on nothing directly. Its meaning lies in what sits underneath it and in what it does to the testosterone result.

A low SHBG usually points to a metabolic cause. Excess weight, insulin resistance, type 2 diabetes and fatty liver disease come first. An underactive thyroid can lower it too, as can glucocorticoids and androgens.

Any symptoms therefore come from that underlying situation. In men there is a further reason to take a low SHBG seriously. Because total testosterone falls with it, a clinician may judge that result as low while free testosterone is normal.

In older men the age band matters as well: their lower limit is 20.6 nmol/l, not 18.3. A value of 19 in a man of sixty is therefore reduced, though against the wrong band it looks normal.

High Levels

A high SHBG likewise causes no symptoms by itself. What counts is its effect on free hormone and the cause behind it. With a high SHBG a larger share of testosterone sits bound.

Free testosterone falls as a result, while the total value looks normal or even high. Someone can therefore have symptoms consistent with little active testosterone, alongside a reassuring total on paper. The most common causes are readily traced.

Oral oestrogens raise SHBG markedly, so the combined pill and oral hormone therapy; delivery through the skin does not. An overactive thyroid raises it as well. Then liver cirrhosis, anorexia and prolonged severe energy restriction.

And SHBG rises with age, particularly in men. A raised SHBG is therefore rarely the conclusion. It is the signal that free testosterone must be calculated before anything meaningful can be said about hormone status.

SHBG (Sex Hormone Binding Globulin): what to do about an abnormal value

Male

If Low

Low SHBG may indicate metabolic syndrome, obesity, or insulin resistance. Focus on weight loss, exercise, and metabolic health optimization.

If High

High SHBG may cause symptoms despite normal testosterone. Consider hyperthyroidism evaluation and consultation with an endocrinologist.

Female

If Low

Low SHBG may indicate PCOS, insulin resistance, or metabolic syndrome. Consider weight management, low-glycemic diet, and PCOS evaluation.

If High

High SHBG may reduce free hormone availability. Consider thyroid evaluation and nutritional assessment.

SHBG (Sex Hormone Binding Globulin): lifestyle and this value

SHBG is not a value you steer directly. It reflects your metabolism, your thyroid function, your liver function and your medication. Anyone wanting to see SHBG change has to change that underlying situation.

The strongest levers sit with a reduced SHBG. A low SHBG is associated above all with excess weight and insulin resistance, acting through a chronically raised insulin level. Improving insulin sensitivity generally goes together with a rising SHBG. Weight loss, more movement and more muscle mass all work along that same route.

Alcohol and fatty liver disease are a second lever. SHBG is made in the liver, so liver function matters.

On the other side sit factors you should not treat as lifestyle. A raised SHBG caused by the pill or by oral hormone therapy is a normal, expected effect of that medicine. It is not a problem to be solved.

Never change a prescribed medicine yourself in order to influence a blood value. Always discuss that with your doctor first.

A single SHBG result also says less than the direction across several measurements. If you change something, measure again after a few months, under the same conditions and preferably at the same laboratory.

SHBG (Sex Hormone Binding Globulin): frequently asked questions

Is SHBG itself a sex hormone?

No. SHBG is a protein made by the liver, not a sex hormone. In full it is called sex hormone binding globulin.

It binds testosterone and oestradiol and carries them through the blood. Bound hormone is inactive. SHBG therefore determines how much hormone is genuinely available, while doing nothing itself in the tissues.

Why is SHBG measured together with testosterone?

Because total testosterone without it can mislead in two directions. A low SHBG pulls the total down while the free fraction stays normal. A high SHBG lifts the total while the free fraction falls. Free testosterone is calculated from the pair, and that figure is the actual question being asked.

Why does the normal value differ by age?

SHBG is age-banded in both sexes, and in men it rises over the years. For men under 50 the range is 18.3 to 54.1 nmol/l, and above that 20.6 to 76.7 nmol/l. In women the lower limit moves down instead, from 32.4 to 27.1 nmol/l. A single band per sex is therefore wrong.

Does the pill raise SHBG?

Yes, and often substantially. Oral oestrogens raise SHBG markedly, so the combined pill and oral hormone therapy. Free androgen levels fall as a result.

Delivery through the skin, such as a patch or gel, does not have that effect or has far less. A testosterone result taken while on the pill should be read with the SHBG alongside it.

What does a low SHBG mean?

Usually it points to a metabolic cause. Excess weight and insulin resistance are the main ones, acting through a raised insulin level. Type 2 diabetes, fatty liver disease, an underactive thyroid, glucocorticoids and androgens also lower SHBG.

A low SHBG diagnoses nothing by itself. It signals that the rest of the picture belongs with it.

Can SHBG predict diabetes?

No. In large population studies a low SHBG is associated with a higher risk of type 2 diabetes, in both sexes. That is an association within groups, not a prediction about one person.

An SHBG result diagnoses nothing and does not tell you whether you will develop diabetes. Always discuss an abnormal value with your doctor.

Do you need to fast for an SHBG test?

Not for SHBG itself, since the value has no strong daily rhythm. Total testosterone does, and it is almost always measured from the same tube. That belongs between roughly 07:00 and 10:00. In practice the morning is therefore the best moment for both.

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SHBG (Sex Hormone Binding Globulin)

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