An important protein is sex hormone binding globulin. SHBG - sex hormone binding globulin

Sex hormone binding globulin (SHBG) is a special protein produced in the liver that is responsible for combining with androgens and transporting them throughout the body in an inactive form. The glycoprotein molecule has a special site for binding the following:

• Testosterone.
• 5-dihydrotestosterone.
• Estradiol.

The remaining biologically active substances are fixed to the protein albumin.

SHBG is responsible for binding and transporting biologically active substances produced in the gonads. Its amount in the body depends on a person’s age, gender, liver condition, functional activity of the endocrine system and the presence of concomitant diseases. Most androgens (from 40% to 60%) are in close relationship with sex hormone-binding globulin. The remaining half is fixed to albumin and only 1-2% of testosterone remains in free form, exerting a corresponding effect on the human body.

Estrogens and androgens in bound form have virtually no effect on metabolism. Therefore, with pathological changes in the level of the corresponding protein, a number of clinical symptoms are observed that require laboratory diagnostics to establish the root cause of the problem.

Fluctuations in the amount of protein

The synthesis of sex hormone binding globulin occurs in the liver. The main factor that affects its amount in the blood is the activity of the gonads in women and men. An increase in estrogen levels leads to an increase in protein concentration in the body, and androgens, on the contrary, reduce its activity. This causes different functioning of the substance in the body of representatives of both sexes.

Therefore, if for certain reasons women experience a sharp decrease, then the globulin will decrease in the blood equivalent to it. At the same time, in a similar situation with male androgen, protein levels will increase. With a generally normal amount of testosterone in the blood, it will be significantly reduced. The result is characteristic clinical symptoms.

In addition to the effect on the concentration of SHBG hormones that protein binds them, there are other important factors responsible for the amount of globulin in the blood:

• Functional and morphological state of the liver. The pathology of this organ leads to a weakening of its protein-synthesizing capacity, which acts as a reducing factor in the amount of corresponding globulin.
• Functional activity (pituitary gland, thyroid gland, adrenal glands). For example, in a state of hypothyroidism, a drop in the concentration of sex hormone-binding globulin is observed.
• Age. Over time (after 60 years), the amount of protein increases by an average of 1.2% per year.
• Floor. The concentration of globulin in women is on average 1.5-2 times higher than that in men. In the fair sex, ovarian activity is a factor that increases the amount of protein.
• Obesity and hormonal therapy.

Any of the above factors can affect the concentration of the corresponding protein in the body of representatives of both sexes, which will manifest itself in corresponding symptoms.

There are a number of conditions for which SHBG analysis is prescribed. If we talk about men, then they are advised to undergo this test if there is a severe clinical lack of testosterone (presence of symptoms), but with normal levels of this hormone in the blood. A standard androgen test records the total amount of biologically active substance, without dividing it into bound and free.

There may be a situation where the concentration of the active fraction of testosterone is too low to ensure normal activity of the reproductive system, but the total amount remains standard. Establishing the concentration of globulin in this case will help clarify the situation.

Venous blood is taken for examination. No special preparation is required for submitting biological material. The main thing is to avoid vigorous physical activity and smoking 30 minutes before the test. Electrochemiluminescent analysis is used to measure protein concentration in plasma.

Indications for its implementation in representatives of both sexes remain:

• Clinical signs of increased or decreased amount of testosterone in the blood. In this case, the steroid may be within the normal range with a routine hormonal study, which takes into account its total concentration.
• Alopecia.
• Oily seborrhea.
• Acne.

For the fair sex:

• Menstrual irregularities by type.
• Male pattern hair growth ().
• Anovulatory cycle.
• Polycystic ovary syndrome.

It is necessary to study the amount of SHBG in men when:

• Erectile dysfunction.
• Male menopause.
• Chronic inflammation of the prostate gland.
• Decreased sexual desire.

After taking blood, the laboratory takes on average 1 day to calculate the amount of the hormone and provide the finished result. Units of measurement are nmol/L. Normal values ​​for women over 14 years of age range from 28-112 nmol/l, for men of the same age - 13-71 nmol/l, respectively.

Often, for a more accurate diagnosis of the cause of the pathology, an additional determination of the free testosterone index (FTI), which is the ratio of the concentration of the total amount of androgen to the corresponding globulin as a percentage (%). Normal values ​​of this indicator for representatives of the fair sex over the age of 14 years are 0.8-11%. In men it is relatively high, which is due to the physiology of the body and amounts to 14.8-95%, respectively.

Situations in which the amount of globulin in the blood changes

Under normal conditions, the body's hormonal balance remains relatively stable. But when concomitant pathology or dysfunction of the endocrine system organs occurs, a change in the amount of globulin responsible for binding sex hormones is often recorded.

SHBG is elevated in women in the following situations:

• Excessive amounts of estrogen in the blood (hyperestrogenism). The most common reasons for which this pathology develops are hormonally active ovarian tumors or uncontrolled use of oral contraceptives. Considering the relationship between sex hormone binding globulin and estrogens, the percentage of protein in the blood is increased.
• with an increase in the amount of iodine-containing hormones (T 3, T 4).
• Cirrhosis of the liver.
• Hereditary factor.

It is very important to understand that an increase in protein concentration in the blood is not always a sign of a pathological condition. Sometimes this may be a variant of the norm for a particular person, which is due to his individual metabolic characteristics. The main criterion for assessing the activity of a biological substance remains the relationship between test data and the clinical picture.

In order to reduce the amount of globulin in the body, doctors first determine the root cause of the pathology and use appropriate medical or surgical interventions (if there is a tumor process).

Levels of a specific protein may be decreased in the following situations:

• Increasing the amount of androgens.
• .

  Bibliography

  1. Makarov V.M. Kylbanova E.S., Khorunov A.N., Argunova A.N., Palshina A.M., Pharmacotherapy of nonspecific lung diseases. Toolkit. Yakutsk, YSU Publishing House, 2008.
  2. Guide for emergency doctors. help. Edited by V.A. Mikhailovich, A.G. Miroshnichenko. 3rd edition. St. Petersburg, 2005.
  3. Bessonov P.P., Bessonova N.G. Syndromic diagnosis of chronic liver diseases.

1 year ago

Most people, who rarely encounter examinations of the endocrine system, only have to check the levels of androgens, estrogens, testosterone, and prolactin. The state of other hormones needs to be assessed very rarely, so their names, especially with abbreviations, sound like foreign speech. For example, the hormone SHBG - what it is in women, what it is responsible for, why it can increase or decrease - few people know.

The deciphering of the abbreviation “SHBG,” which is unfamiliar to most, sounds like “sex hormone binding globulin.” This substance is a blood plasma protein that takes on the role of a transporter for a pair of female and male sex hormones - androgen and testosterone, allowing them to travel through the bloodstream. In addition, it is thanks to it that these 2 hormones become available to most tissues of the body, since SHBG regulates their entry into individual areas, as well as their distribution. A few key points:

• The importance of SHBG is emphasized by the fact that under the influence of proteases, sex hormones in both women and men disintegrate, and therefore cannot be independently transported through the bloodstream. Only 2% retain their original state and reach their destination. And SHBG helps them remain in an inert form.
• SHBG transports not only pure estradiol and testosterone, but also estriol, dihydrotestosterone, estrone, and dihydroepiandrosterone. Due to the fact that they are devoid of biological activity, they cannot do without binding substances.
• The synthesis of the hormone SHBG occurs in the liver, but it is also present in the testicles, uterus, placenta and brain. And thyroxine, somatropin and estrogens are responsible for its appearance.

It is noteworthy that male hormones generally have an inhibitory effect on the synthesis of globulins: testosterone, dihydrotestosterone, as well as insulin and IGF-1, therefore the level of SHBG is inextricably linked with the amount of testosterone and estrogen, as well as with their fluctuations.

In modern endocrinology, a referral for testing directly for GSPD is rarely issued - doctors mainly assess the level of free testosterone and total: based on the results, we can talk about the state of binding globulin. However, if the indicators are higher than the norm, you have to additionally check SHBG separately. The main reasons for this are:

• acne;
• seborrhea;
• alopecia;
• menstrual irregularities;
• lack of ovulation;
• phenomena of hirsutism in women;
• polycystic ovary syndrome;
• deviations in the level of steroid hormones (in the absence of problems with testosterone);
• menopause in men;
• decreased libido;
• deterioration of erectile function;
• chronic prostatitis.

Also, doctors do not deny the possible need to check the status of binding globulin in men who are faced with the growth of mammary glands, and in women with gestosis. In some cases, it is necessary to take a SHBG test during a comprehensive examination of the reproductive system in order to monitor the balance of sex hormones.

The synthesis of binding globulin is influenced by several factors, including primarily the gender and age of the person (the latter due to the state of the reproductive system), as well as:

• work of the thyroid gland and adrenal glands;
• general level of sex hormones;
• body weight (obesity causes disruption of the endocrine system and disrupts hormonal levels);
• liver condition (presence or absence of pathological problems).

It is noteworthy that a high level of SHBG is by no means a normal condition, since the more it is, the worse the transport of male and female sex hormones is, and the less of them becomes available to the tissues. In addition, elevated SHBG is fraught with cardiovascular diseases.

If we talk about standard indicators, then for persons over 15 years of age (the approximate age of formation of the reproductive system), the figures are as follows:

• 28-112 nmol/l for women (in menopause – 14-69 nmol/l);
• 13-71 nmol/men.

In some cases, doctors additionally monitor the proportion between total testosterone and binding globulin (this is mainly relevant for monitoring the state of male sexual health). Here the indicators (total after division) can vary between 14.8-95%. For women, the normative figures are lower – less than 11%. However, unlike men, the level of binding globulin itself varies greatly depending on age.

At the same time, in order to obtain correct test results, 3 days before the SHBG test, you should stop taking hormonal medications, protect yourself from sexual intercourse, and also not eat food in the morning before donating blood. Women come for a SHBG test at the beginning of the menstrual cycle (no later than the 7th day). Additionally, glucose, insulin, and albumin can be checked.

Since, as already mentioned, the level of binding globulin is influenced by a whole list of various factors, situations of excess or deficiency of standard values ​​must be considered separately. In women, the SHBG hormone is often elevated due to improper functioning of the thyroid gland, mainly its hyperfunction (which leads to excessive production of its hormones, thyrotoxicosis). In addition, doctors do not exclude the influence of:

• anorexia;
• somatotropin deficiency;
• the use of drugs that include female steroids (mostly such therapy is prescribed during menopause).

It is also possible to have a syndrome of insensitivity to male sex hormones, which creates an imbalance in the body, cirrhosis or hepatitis of the liver, and autoimmune diseases. Often, elevated SHBG occurs during long-term use of oral contraceptives with a high content of estrogen. The physiological growth of this indicator occurs in the last trimester of pregnancy.

Men and women encounter a decrease in the level of binding globulin much less frequently, although, again, in women this situation can be observed while taking hormonal drugs that increase prolactin. In most cases, hypoglobulinemia is a consequence of the influence of:

• subclinical hypothyroidism;
• hirsutism (in women);
• obesity;
• long-term use of glucocorticosteroids or somatotropins;
• too active activity of the adrenal cortex;
• nephrotic syndrome;
• Impaired insulin sensitivity (often associated with diabetes);
• prolactinomas;
• polycystic ovary syndrome.

In this article we will look at why sex hormones must bind to globulin, what this protein is, where it is formed and how it is determined. We will also highlight the main reasons for changes in this indicator in women and provide brief information on methods of treating identified pathologies.

Introduction

Most of the biologically active substances are contained in the blood in a form associated with transport proteins in order to affect not the body as a whole, but only the cells of target organs that have corresponding receptors on their surface. In a similar way, sex steroid hormones - testosterone and estrogens - are transported in the blood.

The protein in connection with which they are transported is produced by liver cells and is called testosterone-estradiol-binding globulin (TESG). Synonyms are also female sex hormone-binding globulin (SHBG), sex steroid-binding globulin.
According to its chemical structure, it is a glycoprotein with a molecular weight of approximately 86,000. SHBG binds and transports hormones such as testosterone, estradiol, progesterone, dihydrotestosterone, androstenedione. This type of globulin has a greater affinity for male sex hormones, that is, in the presence of estradiol and androgens, it is more likely to bind to the latter.

Factors affecting SHBG levels

· age of the patient;

· concentration of estrogens and androgens;

· state of adrenal and kidney function;

· presence or absence of obesity;

· functional state of the liver;

· concentration of hormones produced by the thyroid gland;

· therapy with androgen drugs;

· presence or absence of pregnancy.

The activity of sex hormones depends on the amount of SHBG in the blood. The susceptibility of target organ tissues is lower with a high globulin content, and vice versa. Normally, approximately half of all sex hormones contained in the blood are associated with SHBG. The remaining 50% is attached to another protein - albumin, but the connection with it is weaker, so the hormones are more easily detached and affect the reproductive and other organs sensitive to them. Thus, only 1-2% of the sex hormones produced influence the sexual functions of the body. The norm of globulin that binds to sex hormones in women ranges from 7.2 to 100.0 nmol/l.

In children, SHBG levels can be much higher than 100.0 nmol/L. With the onset of puberty, the concentration of SHBG in the blood decreases, and in the postmenopausal period, on the contrary, it increases. Upon reaching the age of 60 years, the TESH content increases by an average of 1-1.5% annually.

The amount of globulin in the blood largely depends on the level of sex hormones. Estrogens contribute to an increase in the indicator, androgens reduce it. This explains the fact that women have twice as much globulin in their blood as men. With insufficient estrogen synthesis, not only the content of SHBG decreases, but also free estradiol.

However, the main factor influencing the concentration of SHBG is the functional activity of the liver, where this substance is produced. In liver failure, the synthesis of SHBG is significantly reduced; accordingly, the biological activity of sex hormones increases, especially estradiol, which already has a reduced affinity for SHBG.

These circumstances explain the fact that with liver failure in men, manifestations of gynecomastia develop; in women, this leads to cycle disorders and cancer (benign or malignant) of the uterus and mammary glands.

Determination methods and indications

The study of the concentration of globulin that binds steroid sex hormones is carried out in the laboratory using immunochemiluminescent technology. 10 ml of blood is taken from the patient from a vein. Blood for analysis is taken in the morning on an empty stomach. 30-60 minutes before the analysis, it is necessary to refrain from smoking, emotional and physical stress, a day from sexual intercourse, and three days to stop taking hormonal medications (if possible).

To diagnose some diseases, an indicator such as the free testosterone index is used. This is the ratio of total testosterone to SHBG. In women, this index is usually about 0.8-11%.

Indications

The purpose of determining SHBG levels is to assess the hormonal balance of the reproductive system. Such an examination may be necessary in the following cases:

· infertility;

· decreased sexual desire;

· signs of increased androgen levels in women (endocrine tumors, cysts, pathologies of the adrenal glands, etc.);

· suspicion of polycystic ovary syndrome;

· irregular menstruation;

· the need to determine the risk of developing severe gestosis during pregnancy.

In most cases, analysis of globulin levels is carried out in conjunction with determination of the content of various sex hormones, for example, prolactin, estrogens, luteinizing hormone, gestagens, etc. You may also need to study the hormones of the thyroid gland, pituitary gland, adrenal glands, ultrasound of the internal genital organs, liver, adrenal glands. To determine the condition of the liver, biochemical indicators such as alanine aminotransferase, asparagine aminotransferase, alkaline phosphatase, bilirubin are often determined, and a thymol test is performed.

The essence of the method

The immunochemiluminescent method for determining SHBG is based on an immunological reaction between an antigen and an antibody, resulting in the formation of immune complexes. The antigen in this case is globulin, and antibodies to it are contained in special tubes included in the test kit. Antibodies labeled with a radioactive isotope are also added to them. The tubes with the reaction mixture are incubated for 2 hours and then their radioactivity is measured using a gamma counter. Based on the intensity of radiation, the device determines the concentration of the hormone in the blood. For quality control, special calibrators are used.

The determination of the indicator is carried out in serological laboratories by experienced clinical and laboratory diagnostic doctors strictly according to the instructions for the reagent kit. All tubes are labeled and numbered according to their intended purpose to eliminate error. The results of the analysis are assessed by the attending physician (endocrinologist or gynecologist).

Causes of low globulin levels

Insufficient SHBG levels in women occur in the following conditions:

· diseases characterized by disruption of metabolic processes in connective tissue (rheumatism, lupus erythematosus, scleroderma, periarteritis nodosa and other so-called collagenoses);

· PCOS (polycystic ovary syndrome);

· nephrotic syndrome, accompanied by renal failure and increased loss of protein in the urine (with glomerulonephritis, chronic kidney disease);

· hyperandrogenism (one of the signs is hirsutism, i.e. the appearance of hair in places atypical for women - on the stomach, back, in the face);

· pathologies of the thyroid gland, characterized by a violation of its hormonal function (hypothyroidism, hyperthyroidism);

acromegaly and gigantism (observed with excessive synthesis of growth hormone - somatotropin in adults and children, respectively);

· diabetes;

prolactinoma - a tumor of the pituitary gland that secretes excess levels of the hormone prolactin in women;

· liver diseases accompanied by a violation of its protein-synthesizing function (chronic hepatitis, cirrhosis, tumors);

· incorrectly selected dosages of hormonal drugs;

· adrenogenital syndrome (a hereditary disease associated with excessive production of androgens in the adrenal cortex and accompanied by hirsutism and other symptoms of virilization of a woman);

If the reason for the change in SHBG levels is due to the use of hormonal drugs, then their dose is adjusted under laboratory control, if possible, canceled or replaced with other drugs.

Correction of thyroid function is determined by the level of its hormonal activity. If the patient has hypothyroidism, replacement therapy with iodine-containing hormones and iodine preparations is used. In case of hyperthyroidism, drugs are used that reduce the production of gland hormones. Thus, treatment should directly affect the underlying disease that led to the disruption of globulin production.

Conclusion

The level of sex steroid binding globulin is a diagnostically valuable indicator hormones and hormonal status in women when identifying a number of reproductive diseases in women. But when assessing the result, it is necessary to take into account the general condition of the body, existing chronic diseases, ongoing therapy and other factors that may affect the level of SHBG. For a more accurate diagnosis of pathologies, additional laboratory and instrumental studies are required to determine the original cause.

Many people do not understand the abbreviation “SHBG” when taking hormone tests. This is a protein produced by the liver, and the name stands for “sex hormone-binding globulin.” The structure of globulin resembles plasma protein. This hormone is present in the body of both men and women, but women should have more of it, since androgens reduce its synthesis. High or, conversely, low indicators can indicate various pathological changes in the body, but in no case should you immediately panic. It is necessary to undergo a full examination; perhaps these are just minor hormonal imbalances.

Functions of SHBG in the body

What is this globulin responsible for in general? The SHBG hormone plays a huge role in a woman’s life and health. The correct and timely transportation of nutrients through the blood in the body, protection against infectious and viral diseases, and the speed of blood clotting depend on it. Thus, steroid binding globulin affects synthesis processes in the body, but these are different indicators for men and women.

SHBG in women is almost twice as much as SHBG in men. In general, sex hormone binding globulin is increased by female hormones and decreased by male hormones. If the indicators are not normal, this can lead to the predominance of certain hormones in the body.

SHBG norm

The norm for men and women is determined based on the following factors:

• age;
• the presence of serious diseases - endocrine liver diseases, oncology, HIV, AIDS and others;
• production of testosterone and androgens in the body.

The concentration of this hormone in human blood is not constant; when deciphering, it is necessary to take into account numerous individual factors. Sometimes only an experienced specialist can make a correct diagnosis and determine the globulin norm. The norm is different for women and men, but it also depends not only on gender. Before the analysis is taken, other studies and additional examinations may be carried out. It is simply impossible to say unequivocally about the norm; there are some average statistical data (values ​​in nmol/l):

An analysis of the level of such a hormone in the blood is rarely prescribed. It is required in the following cases:

• loss of sexual desire, decreased libido;
• impotence in men;
• infertility in women;
• alopecia (baldness);
• enlargement of the mammary glands in men;
• the need to determine the level of female and male hormones and their balance;
• gestosis during pregnancy.

The most common reason for prescribing this analysis is still a lack of libido and sexual desire. The causes of potency problems in men and hirsutism in women may be different, but it is the imbalance of hormones that plays a huge role here.

How to take the test correctly?

If a hormone test is prescribed, the doctor must explain to the patient all the rules for taking it. Otherwise, the result may be incorrect.

The basic rules for conducting this analysis are quite simple. Blood is donated from a vein and must be taken on an empty stomach (the last time food is taken is no less than 8 hours before the study). Three days before the analysis, it is necessary to completely exclude sexual contact, and it is not recommended to engage in strenuous physical exercise and sports. Alcohol and hormonal drugs are also excluded three days before the test. You must not smoke for one hour before donating blood. For women, the study is carried out no later than the seventh day of the menstrual cycle.

Usually, along with this study, a general and biochemical blood test is also prescribed. Results are usually known within 24 hours. The decoding must be done by a doctor; he must have good experience, since, otherwise, the decoding may be performed incorrectly.

Increasing the norm

If SHBG is elevated in the female body, this is associated with many factors. If a woman takes hormonal pills or oral contraceptives, then the analysis will definitely be high. Also, hormone levels inevitably increase with hepatitis, thyroid diseases, cancer, HIV and AIDS.

If the readings are elevated, you should never panic right away. It is necessary to undergo additional tests, identify the causes, reject or confirm suspicions. Thus, elevated sex hormone-binding globulin should not “become a death sentence.”

Indicators are below normal

Low levels of the hormone can also indicate a variety of diseases, but this analysis alone cannot speak of a final diagnosis. If hormonal levels are low, this may be due to:

• with diabetes mellitus;
• disorders of the kidneys;
• hyperadrogenism - increased levels of male hormones;
• acromegaly;
• polycystic ovary syndrome;
• increased prolactin;
• liver cirrhosis;
• Cushing's disease.

Also, globulin decreases when taking certain medications, for example, Somatostatin. If the medications you take contain substances such as glucocorticosteroids and androgens, then the analysis will also not be normal, but at a reduced level.

It is worth paying attention to lowering levels of the hormone in cases where dandruff appears for no reason, skin oiliness has increased, acne and pimples have appeared. All this indicates changes in hormonal levels, and if other tests do not produce results, then a globulin test may be prescribed. Such an analysis is also prescribed in controversial cases when it is simply impossible to identify another cause of a particular ailment. In any case, the decision must be made by the doctor.

Treatment and necessary measures

If the analysis reveals values ​​higher than normal, then steroid drugs are prescribed to help restore the normal SHBG level. It is definitely worth noting that there is simply no single treatment regimen. First of all, it is necessary to identify the causes of an increase or decrease in hormone levels, and only then treat and eliminate these causes.

In any case, you shouldn’t immediately panic and invent diseases. It is necessary to undergo additional tests and identify the causes of changes in hormonal levels, and only then take appropriate measures.

Sex hormone binding globulin (SHBG) is a special protein designed to transport sex hormones - testosterone, estrogen, dehydrotetosterone, estradiol. SHBG is produced in the liver, and its concentration in the body directly depends on the age and gender of the person. The process of SHBG metabolism consists of two phases: first, it is rapidly distributed into the intercellular space, and then a slower phase of degradation occurs. Increased levels of sex hormone binding globulin may be associated with symptoms and signs of hypogonadism in men, while decreases may lead to androgenization in women.

In pre-pubertal children, SHBG levels are slightly higher than in adults. As fat tissue increases during puberty, levels of this hormone begin to decline, a process that accelerates as androgen levels rise. In men, the level of globulin in the blood is lower than in women. The level of this hormone is also affected by the quality of nutrition and the body's resistance to insulin. Insulin resistance, even without obesity, leads to decreased SHBG levels, which is associated with intra-abdominal fat deposition and the risk of cardiovascular disease.

In postmenopausal women, SHBG levels may predict the risk of developing type 2 diabetes. Taking medications containing androgens, norethisterone and synthetic progesterone also reduces the production of this globulin in the body in women. In men, SHBG production increases with age, which is obviously associated with an age-related decrease in testosterone synthesis.

Increased levels of sex hormone binding globulin can result from increased production of endogenous or exogenous thyroid hormones.

Normal globulin levels in the blood. Explanation of the result (table)

A blood test for SHBG is prescribed for the diagnosis and follow-up of patients with signs of androgen excess in the body, for example, with polycystic ovary syndrome or idiopathic hirsutism. Can be used as an auxiliary test in monitoring treatment with sex steroids and antiandrogen therapy.

For men, a blood test for the level of sex hormone binding globulin is prescribed to determine the causes of erectile dysfunction, decreased libido and infertility, especially if the level of total testosterone remains normal. An analysis for SHBG levels can be prescribed to assess the patient’s general hormonal background - simultaneously with blood tests for luteinizing hormone, prolactin, testosterone, estradiol, and albumin.

This analysis can also be used:

• as an additional study in the diagnosis of puberty disorders,
• as an additional study in the diagnosis and subsequent treatment of anorexia,
• as an additional study in the diagnosis of thyrotoxicosis,
• as an additional study in the diagnosis and subsequent monitoring of insulin resistance, disorders of the cardiovascular system and assessing the risk of developing type 2 diabetes, especially in women.

Currently, a blood test for sex hormone binding globulin is used quite rarely. In most cases, it is believed that a test for total and free testosterone levels is sufficient to obtain the necessary information. SHBG levels may need to be determined if total testosterone test results are clearly inconsistent with clinical symptoms.

Blood is drawn from a vein in the morning, on an empty stomach.

If sex hormone binding globulin (SHBG) is elevated, what does this mean?

An elevated SHBG level means that there is a high probability that there is less free testosterone in the patient's body than the total testosterone test results indicate. This may be due to the following pathologies:

• liver diseases,
• increased function of the thyroid gland - hyperthyroidism,
• eating disorder - anorexia,
• decreased synthesis of sex hormones – hypogonadism.

Sometimes the level of globulin in the blood may decrease. Pregnancy and the use of certain medications: corticosteroids, estrogens and oral contraceptives lead to a decrease in SHBG levels.

If sex hormone binding globulin (SHBG) is low, what does this mean?

An increase in SHBG concentration indicates an increase in the level of total testosterone not bound by SHBG. This information can be important for diagnosing diseases associated with excess or insufficient synthesis of sex hormones, as well as for assessing the general condition of the patient.

The following pathologies can lead to an increase in the level of sex hormone binding globulin:

• obesity,
• decreased function of the thyroid gland - hypothyroidism,
• polycystic ovary syndrome,
• hyperandrogenism,
• hirsutism,
• Cushing's disease.

The use of medications based on androgens (steroids) and glucocorticoids leads to the same result.