Changes in SHBG levels can be influenced by several health conditions and hormonal factors. Low SHBG levels are often associated with polycystic ovary syndrome, insulin resistance, metabolic syndrome, hypothyroidism, and Cushing’s syndrome. They can also occur with high androgen activity, obesity, or glucocorticoid use. Lifestyle factors such as a sedentary routine or a high-sugar diet that raises insulin levels may further lower SHBG.
In contrast, high SHBG levels may result from hyperthyroidism, liver disease, pregnancy, or estrogen therapy, including oral contraceptive use. Certain medications — like anticonvulsants and selective estrogen receptor modulators (SERMs) — can also elevate SHBG. Improved insulin sensitivity, weight management, and even moderate alcohol intake have been linked to higher SHBG levels. Because SHBG affects the amount of free, active testosterone and estrogen in the body, understanding what raises or lowers it can help guide the evaluation and treatment of hormonal imbalances.
The typical normal reference range for females is 24.6–125 nmol/L (ranges vary by lab).
No. Fasting is not typically required, but you should always check in with your provider for special instructions.
Yes, some hormone testing kits include SHBG.
Yes. Oral contraceptives and estrogen therapy increase SHBG, which lowers free testosterone levels.
