Hormones

SHBG — The Gatekeeper of Your Sex Hormones

Here's something most people don't know: having 'normal' testosterone doesn't mean your body can use it. Enter SHBG — a protein made by your liver that grabs onto testosterone, DHT, and estradiol and holds them in an inactive state. When SHBG is high, your hormones are locked up. When it's low, they're running loose. Either way, it changes how you feel — even if your total hormone levels look fine on paper.

Why Test SHBG?

SHBG testing fills in the gaps when symptoms don't match your total testosterone result. It's especially useful for women with suspected excess androgens (think PCOS) and men who feel low-T but have normal numbers. If something doesn't add up, SHBG is often the answer.

What Do High SHBG Levels Mean?

High SHBG locks up testosterone, potentially making you feel testosterone-deficient even with normal total levels. Causes include liver conditions, hyperthyroidism, eating disorders, HRT, pregnancy, decreased sex hormone production, growth hormone deficiency, alcohol, smoking, and ageing in men.

What Do Low SHBG Levels Mean?

Low SHBG lets more testosterone roam free. In men, this can mean fluid retention, acne, weight gain, and mood swings. In women, it can lead to excess available testosterone — weight gain, unwanted hair, acne, and cycle changes. Common culprits: high insulin, obesity, elevated prolactin, inflammation, hypothyroidism, Cushing's, and PCOS.

Symptoms to Watch For

  • Acne or oily skin
  • Excess facial or body hair in women
  • Decreased sex drive
  • Erectile dysfunction in men
  • Menstrual irregularities
  • Weight gain or difficulty losing weight

Who Should Get Tested?

  • Men with low-T symptoms but normal total testosterone
  • Women with signs of excess androgens (unwanted hair, acne)
  • Those being evaluated for PCOS
  • People with unexplained changes in libido or body composition
  • Anyone on hormone therapy who needs monitoring

How to Prepare for Your Test

No advance preparation needed. Don't exercise before the test. Arrive early and sit quietly before the blood draw. Bring valid ID. If you take a supplement containing biotin (often sold for hair and nails), pause it for two days before the test, as high doses can distort the result.

Order Your Blood Test

Test your SHBG levels with an accredited Swedish laboratory. Results within days, reviewed by Wellth.

SHBG (Sex Hormone-Binding Globulin) →

Frequently Asked Questions

Why does SHBG matter if my testosterone is normal?
Because 'normal' total testosterone includes bound hormone you can't use. If SHBG is abnormally high, most of your testosterone may be locked up and inactive — explaining symptoms despite a normal number.
Can insulin resistance affect SHBG?
Yes. High insulin pushes SHBG down, freeing up more testosterone. This is a common finding in women with PCOS and men with metabolic syndrome.
Does SHBG change with age?
In men, SHBG generally rises with age as testosterone falls. In women, it fluctuates with menstrual status, pregnancy, and menopause.
NW

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Wellth Team

Wellth

Our content is written and reviewed by Wellth, and fact-checked against peer-reviewed research and current Swedish clinical guidelines.

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Medical Disclaimer

The information on this page is provided for informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Wellth provides health information and testing services but is not a substitute for clinical care. Always consult a qualified healthcare provider if you have questions about a medical condition. If you are experiencing severe or urgent symptoms, contact your doctor or call 1177 Vårdguiden. Blood test results should be interpreted by a qualified healthcare professional in the context of your complete medical history.