Skip to main content
Your session has expired. Reloading...
Hormones

SHBG: the protein that binds testosterone and oestradiol and what an abnormal level means

SHBG, short for sex hormone binding globulin, is according to the NVKC, the Dutch society of clinical chemists, a protein that the liver produces and that can bind testosterone and oestradiol strongly. According to the NVKC, SHBG carries those hormones in an inactive form through the blood around the body, and according to MedlinePlus sex hormones bound to a protein such as SHBG cannot work with the tissues.

According to the NVKC, with a high SHBG less testosterone is probably freely available than the total testosterone level suggests, and with a low SHBG probably more. Only a blood test shows how much SHBG is in the blood.

Star-SHL uses 18.3 to 54.1 nmol/l for men aged 20 to 49 and 32.4 to 128 nmol/l for women aged 20 to 49.

Doctor's Assessment Included

SHBG is a protein from the liver that binds testosterone and oestradiol and carries them in an inactive form through the blood. According to the NVKC, with a raised SHBG less testosterone is probably freely available than the total testosterone level suggests.

  • For SHBG, Star-SHL uses 18.3 to 54.1 nmol/l for men aged 20 to 49 and 32.4 to 128 nmol/l for women aged 20 to 49; Certe and Diagnostiek voor U give, for ages 19 to 49, 18 to 54 nmol/L for men and 32 to 128 nmol/L for women.
  • According to the NVKC, SHBG reference values depend on the test method, and a result should be compared with the reference values of the laboratory that performed the test.
  • According to MedlinePlus, a low SHBG may be related to an underactive thyroid, type 2 diabetes or insulin resistance and obesity, among others, and a high SHBG to liver disease and an overactive thyroid, among others.

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

Package-insert value: 5th-95th percentile per subgroup (n = 241 men 20-49 years; 174 men 50 years and older; 166 women 20-49 years; 177 women 50 years and older), with fasting blood drawn between 06:30 and 14:00. The reference cohort consisted of non-pregnant adults with a BMI of 30 or lower who used no contraception or relevant medication. A hormone reference value is assay-specific; these values apply to the Roche Elecsys method (CE package insert). Important for interpretation: SHBG is linked to body composition. Weight, BMI and waist-to-hip ratio are inversely related to SHBG, and a lowered SHBG is seen with overweight, insulin resistance and hypothyroidism. The pill, pregnancy and hyperthyroidism raise SHBG instead, and hormone therapy after menopause changes SHBG depending on how it is given. If you use contraception or hormone therapy, or are pregnant, this reference value does not apply to you.

Source: Roche Diagnostics Reference population: Roche reference cohort (Elecsys SHBG package insert CE, study CIM 000669; fasting, BMI 30 or lower, not pregnant, no contraception)

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 Dutch laboratories use

Reference ranges by group, in nmol/l
Star-shl · Male · 20–49 years 18.3–54.1 nmol/l
18.3 54.1
Star-shl · Male · 50 years and older 20.6–76.7 nmol/l
20.6 76.7
Star-shl · Female · 20–49 years 32.4–128.0 nmol/l
32.4 128
Star-shl · Female · 50 years and older 27.1–128.0 nmol/l
27.1 128
Unilabs · Female · 17 years and older 20–155 nmol/l
20 155
Unilabs · Male · 19 years and older 14–71 nmol/l
14 71
Certe · Female · 19–49 years 32–128 nmol/L
32 128
Certe · Female · 49 years and older 27–128 nmol/L
27 128
Certe · Male · 19–49 years 18–54 nmol/L
18 54
Certe · Male · 49 years and older 21–77 nmol/L
21 77
Diagnostiek voor U · Female · 19–49 years 32–128 nmol/L
32 128
Diagnostiek voor U · Female · 50 years and older 27–128 nmol/L
27 128
Diagnostiek voor U · Male · 19–49 years 18–54 nmol/L
18 54
Diagnostiek voor U · Male · 50 years and older 21–77 nmol/L
21 77
0 170.5 nmol/l

Source: Star-shl

Source: Unilabs

Source: Certe

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

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

According to the NVKC, the SHBG test measures the amount of SHBG in the blood, and the laboratories give the result in nanomoles per litre (nmol/l or nmol/L). According to the NVKC, the reference values depend on the test method used, which can differ between laboratories: Star-SHL measures with an electrochemiluminescence immunoassay, Certe with an ECLIA based on the sandwich principle and Unilabs with a two-step immunometric immunoassay.

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

According to the NVKC, SHBG is measured to determine the amount of free, biologically available testosterone. According to the NVKC, normally about 50% of testosterone in men and about 75% in women is bound to SHBG; the rest is weakly bound to albumin, another blood protein, or unbound, and according to the NVKC those two forms are the rapidly available forms. According to the NVKC, testosterone inhibits the production of SHBG, while oestradiol stimulates it.

SHBG (Sex Hormone Binding Globulin): how the blood test works

Referral
No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw
A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Which test
Hormone checkup for men · €169,- · Hormone checkup for women · €169,-
Where
650+ draw sites run by independent laboratories across the Netherlands. Draw sites

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?

According to the NVKC, SHBG is measured when looking at the balance of the sex hormones, with complaints of infertility and reduced libido in men and women, and with menstrual cycle disorders or excessive hair growth in women. According to the NVKC, the doctor usually requests SHBG together with total testosterone, among others, because the combination gives an estimate of the active, free testosterone.

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

Low Levels

According to the NVKC, with a lowered SHBG more testosterone is probably freely available than expected from the total testosterone level. According to MedlinePlus, a low SHBG may be related to, among others, an underactive thyroid, type 2 diabetes or insulin resistance, obesity, overuse of steroid medicines or anabolic steroids and, in women, polycystic ovary syndrome (PCOS), a condition of the female reproductive system.

High Levels

According to the NVKC, with a raised SHBG less testosterone is probably freely available than expected from the total testosterone level. According to MedlinePlus, a high SHBG may be related to liver disease, an overactive thyroid, certain eating disorders, oestrogen-containing medicines such as the contraceptive pill or menopausal hormone therapy in women, and reduced production of sex hormones in men.

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

What lowers the value

  • Underactive thyroid

    An underactive thyroid may be related to a low SHBG.

  • Type 2 diabetes or insulin resistance

    Type 2 diabetes or insulin resistance may be related to a low SHBG.

  • Obesity

    Obesity or being very overweight may be related to a low SHBG.

  • Overuse of steroid medicines or anabolic steroids

    Overuse of steroid medicines and/or anabolic steroids may be related to a low SHBG.

  • PCOS in women

    In women, polycystic ovary syndrome (PCOS) may be related to a low SHBG.

What raises the value

  • Liver disease

    Liver disease may be related to a high SHBG.

  • Overactive thyroid

    An overactive thyroid may be related to a high SHBG.

  • Certain eating disorders

    Certain eating disorders may be related to a high SHBG.

  • Oestrogen-containing medicines in women

    In women, oestrogen-containing medicines such as the contraceptive pill or menopausal hormone therapy may be related to a high SHBG.

  • Reduced sex-hormone production in men

    In men, reduced production of sex hormones may be related to a high SHBG.

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

Discuss an abnormal SHBG with your GP. According to the NVKC, the SHBG result should be compared with the reference values of the laboratory that performed the test. According to MedlinePlus, medicines containing hormones, such as the contraceptive pill, oestrogen therapy or anabolic steroids, can affect SHBG, and MedlinePlus advises not to stop any medicine unless the doctor says so.

SHBG (Sex Hormone Binding Globulin): frequently asked questions

What is the difference between SHBG and free testosterone?

According to the NVKC, SHBG is the protein that binds testosterone and carries it in an inactive form, and free testosterone is the part that is not bound to anything. According to the NVKC, free testosterone and testosterone weakly bound to albumin, another blood protein, together form the rapidly available, bioactive forms.

Why do SHBG reference values differ between laboratories?

According to the NVKC, SHBG reference values depend on the test method used, which can differ between laboratories. Unilabs uses 20 to 155 nmol/l for women older than 17 and 14 to 71 nmol/l for men older than 19, and Certe and Diagnostiek voor U give 32 to 128 nmol/L for women aged 19 to 49.

Can the pill be related to a high SHBG?

Yes, according to MedlinePlus oestrogen-containing medicines such as the contraceptive pill or menopausal hormone therapy may be related to a high SHBG in women.

SHBG (Sex Hormone Binding Globulin): sources

  1. Roche Diagnostics. Elecsys SHBG, Method Sheet 03052001500 V 15.0, 2024-11 (CE). Material 03052001190 (cobas e 411 / e 601 / e 602). Verwachte waarden: 5e-95e percentiel, studie CIM 000669 (415 mannen, 343 vrouwen; nuchter, BMI <= 30, niet zwanger, geen anticonceptie). (retrieved 2026) elabdoc-prod.roche.com
  2. Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
  3. Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
  4. Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
  5. Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
  6. MedlinePlus, SHBG Blood Test, U.S. National Library of Medicine, last updated 2026-01-12, geraadpleegd 2026-10-15 (retrieved 2026) medlineplus.gov

Test Products

This marker is included in the following test panels.

Medical reviewer

Medical standards

Dr. Naimi oversees the medical standards behind our content and assessments.

Medical policy
CIBG Ministerie van Volksgezondheid,
Welzijn en Sport Official BIG registration BIG 49928676701 Opens in a new tab

SHBG (Sex Hormone Binding Globulin)

€44,-