SHBG Lab Test Guide - High Levels, Low Levels & More

SHBG Lab Test Guide – What to do About High Levels, Low levels & More

SHBG is short for sex hormone binding globulin and it is a serum blood test that can give you valuable insight into your hormones! 

Low levels of SHBG may be associated with low thyroid function and low estrogen status while high levels may bind up testosterone leading to weight gain, depression, and other symptoms. 

Most physicians don’t put a lot of emphasis on this lab test but it is critical to understanding what is happening with the hormones in your body. 

Learn how to understand your lab results, but more importantly what to do about changes to your SHBG. 

We will discuss high levels, and low levels, and what to do about both: 

Sex Hormone Binding Globulin – Why it is important

So what is SHBG?

SHBG stands for Sex Hormone Binding Globulin. 

And it does exactly what it sounds like it does – binds up sex hormones. 

But why is this important? 

In order to understand we need to talk about some basic physiology. 

First, you need to know that hormones float around in your serum in 2 major forms:

#1. Bound to proteins (1) -> the binding of hormones to certain proteins leaves them INACTIVE.

If a hormone is bound to a protein it is NOT available for use. 

Consider this like hormones that your body “stores” for later use, similar to you putting food in a deep freezer. 

#2. Free and active -> if a hormone is not bound to a protein it is considered “free” and can actually enter into cells and do its job. 

Free hormones (such as “free t4” or “free testosterone”) can turn on cellular function and promote genetic changes. 

*Side note: this reasoning is why it’s so important to check your free thyroid hormones if you have hypothyroidism. Checking “total t3” or “total t4” has less clinical utility than the free hormones!

SHBG over time in women

You can consider the free hormones as the ACTIVE hormones and the more clinically useful measurement of almost all hormones. 

The amount of “free” hormone is usually a VERY small percentage when compared to the “bound” hormone in your blood. 

Your body uses this binding system as a way to regulate certain hormones and keep everything in balance or in check. 

So where does SHBG fit in?

Sex hormone-binding globulin acts as a binding hormone which means that it may be helpful to think of SHBG as a way to inactive hormones floating around in your serum. 

For this reason, you can consider SHBG to be a “Goldilocks” type of protein, meaning you don’t want too much but you also don’t want too little – you need just enough. 

Small changes to SHBG levels can bind up free hormones and result in serious symptoms. 

It also has a strong affinity (meaning it likes to bind) to certain sex hormones. 

It will preferentially bind to hormones in this way:

Preference on dihydrotestosterone or DHT (2) (this is the most potent androgen), then testosterone, then androstenediol, then estradiol, then estrone. 

You will notice that SHBG prefers to bind to and inactivate the various androgens in the body. 

This is very important because of how this impacts androgens and therefore symptoms in both women and men. 

High SHBG will bind up and INACTIVATE both testosterone and DHT meaning that both men and women may start to experience the symptoms of low testosterone (weight gain, depression, loss of muscle mass, irritability, etc.). 

While low levels will leave more testosterone ACTIVE meaning that women may start to experience the symptoms of high testosterone (facial hair growth, weight gain, PCOS, irritability, acne, etc.). 

What’s worse is that most physicians don’t even test for SHBG even though they understand the difference between “free” and “total” hormone concentration in the blood. 

This makes SHBG a VERY important test to ask for if you are experiencing hormone any hormone imbalance as it may shed light on your current problem. 

What Causes Increased SHBG?

SHBG is influenced by 2 major hormone systems in the body:

#1. Thyroid hormone (3) and…

#2. Estrogen levels (4)

Both of these hormones may stimulate or INCREASE the circulating amount of sex hormone-binding globulin in the serum. 

So what does that mean for you if you have high SHBG?

If you are a woman and you have high SHBG the most likely cause is excessive estrogen use. 

This can be either from a condition known as estrogen dominance – meaning you have too much estrogen in your serum. 

Or because you are taking birth control (5) or some other form of exogenous hormones. 

If you are taking OCP or other hormones and it is causing excessively high levels of SHBG you should take caution! 

Increasing your SHBG will influence the amount of free testosterone in your serum and may be one of the reasons that women on OCP tend to gain weight and experience mood changes (6).

Another cause of high SHBG is excessive thyroid hormone replacement therapy. 

This is most often seen in those who are taking T3-containing medications (T3 has a direct influence on hepatic SHBG production) like natural desiccated thyroid hormone or liothyronine/cytomel. 

It can also occur in those taking T4 medication such as Levothyroxine, but this is less common. 

Assessing SHBG accurately in menstruating women can be difficult, though, as women may commonly present with both excess estrogen and hypothyroidism. 

If you are taking thyroid hormone replacement and your SHBG is high you should look at both estrogen levels and your current thyroid dose. 

But how do we “define” a high SHBG?

Like other hormones, we need to look at “optimal ranges” and not just the reference range. 

If you are a woman you want your SHBG to be in the 60-80 nmol/L range. 

Anything higher is considered “too much” and anything lower is considered “insufficient”. 

You can see an example of high SHBG below with relevant laboratory reference ranges: 

high SHBG example

Symptoms of High SHBG

It’s important to realize that high SHBG doesn’t necessarily cause negative symptoms by itself. Instead, symptoms related to your SHBG may be due to an indirect effect that SHBG has on other hormones in your body. 

If you have high SHBG you are more likely to experience negative symptoms related to excess estrogen and/or low testosterone: 

  • Menstrual irregularities
  • Weight gain (pear shape weight gain)
  • Mood changes (depression or anxiety)
  • Breast tenderness, breast fullness
  • Fatigue
  • Bloating and/or water retention
  • Decreased muscle mass (inability to gain muscle mass even while lifting weights)

Rarely, high SHBG may also be caused by excessive thyroid dosing which may lead to the symptoms of hyperthyroidism as well. 

What Causes Low SHBG?

In my experience low SHBG is often ignored (more so than high levels) because it’s more sinister and difficult to spot. 

Low SHBG is most often seen in women who are hypothyroid (meaning they have low thyroid function) and women who are menopausal. 

We know that both thyroid hormone and estrogen stimulate SHBG (7) release, so low levels are often associated with low hormone levels. 

This in turn causes an effect where free testosterone levels rise giving way to the symptoms of PCOS. 

If you are experiencing the symptoms of hypothyroidism then it’s VERY important to evaluate your SHBG. 

This is also true if you are taking thyroid hormone replacement medication. 

SHBG is considered “suboptimal” if it is lower than 60 nmol/L: 

SHBG and hypothyroidism

If you are a menstruating woman (and have a normal cycle) then the most common cause of suboptimal SHBG is low thyroid function. 

It’s also worth pointing out that low SHBG is associated with an increased risk of developing type II diabetes (8) – another important reason why you want to normalize your level if it is low. 

Symptoms of Low SHBG

The symptoms of low SHBG tend to be tied to thyroid function and low estrogen. 

In addition, women with low SHBG may also experience the side effects of excess free testosterone: 

  • Weight gain
  • Fatigue or low energy
  • Menstrual irregularities
  • Facial hair growth
  • Hair loss
  • Acne
  • Depression/anxiety

Please note that the symptoms associated with low SHBG can vary widely from individual to individual. 

For this reason, it’s always best to assess SHBG in the context of other circulating hormones (testosterone, estrogen/progesterone, and thyroid hormone). 

Using SHBG for Assessing Thyroid Function During Thyroid Hormone Replacement Therapy

Another very important clinical utility of SHBG is its ability to assess thyroid function. 

With up to 20% of the population suffering from subclinical hypothyroidism or overt hypothyroidism, this hormone imbalance is incredibly common. 

Furthermore, SHBG is a tool that can help evaluate thyroid function at the cellular level. 

In states of low thyroid function, the SHBG tends to drop. 

When thyroid hormone is replaced, SHBG tends to rise. 

This allows for the SHBG to be used as a marker to assess thyroid hormone absorption and thyroid hormone cellular action. 

If you have low SHBG AND hypothyroidism then testing your SHBG at baseline is very important for assessing if you are taking the right type and dose of thyroid hormone. 

In some cases, taking T4-only thyroid medication such as Levothyroxine or Synthroid may not actually increase the SHBG (9).

This may be a sign that the body is having difficulty with the conversion of T4 to T3 in peripheral tissues. 


T3 tends to increase SHBG more so than T4 levels. 

SHBG can also be used to assess if your thyroid dosing is too high. 

If your SHBG is elevated AFTER you take thyroid hormone then this may indicate that your thyroid dosing is excessive and should be reduced. 

It’s very important to keep SHBG in the “Goldilocks” range of 60-80 nmol/L. 

How to Treat High SHBG (how to lower it when it’s high)

Treating high SHBG has more to do with finding out the CAUSE of high SHBG in your body, rather than treating the SHBG level itself. 

With that in mind if you have high SHBG you will want to take the following steps to find the root cause:

#1. Check serum estrogen levels

The first step is to assess both estrogen and progesterone levels. 

This means assessing estradiol (the most potent estrogen in your serum) as well as progesterone. 

Estradiol levels vary from woman to woman so the absolute value is not as important as the difference in the ratio between progesterone and estradiol. 

It’s best to assess the estradiol/progesterone ratio mid-luteal phase of the menstrual cycle (if menstruating). 

Look for a ratio that is 10:1 (estrogen:progesterone). 

How to treat endometriosis naturally without drugs

If you have high levels of estrogens in your body (or low progesterone) you can find more information about treating both here

#2. Check free thyroid hormones (consider altering your thyroid hormone dose)

If your estrogen:progesterone ratio is not an issue then your high levels may be related to thyroid function. 

At a minimum, make sure to assess both free T3 and free T4 levels (but really you should check a complete thyroid panel). 

Excessively high free T3 and/or free T4 may be the cause of high SHBG in individuals taking thyroid hormone replacement medication (especially if it contains T3). 

#3. Consider alternatives to OCP if you are taking birth control medication

One of the most common causes of high SHBG is the use of oral contraceptives or birth control medications. 

The only way to lower SHBG if it’s related to these medications is to discontinue their use. 

You should discuss this option with your physician and talk about other options (depending on why you are using them in the first place). 

If you are using OCP medications for birth control then you may find better results switching to a form of birth control that does not include hormones such as the copper IUD. 

How to Treat Low SHBG (how to increase it when it’s low)

Low SHBG tends to be more difficult to treat than high SHBG. 

If you know that you have “suboptimal” SHBG then you will need to look at the following areas: 

#1. Get a complete thyroid lab panel

If you are a menstruating woman with low SHBG then this is the most important first step to take. 

To get a full thyroid panel you will need the following tests: 

Once you get all of these tests you can compare your set of labs to optimal thyroid lab tests and determine if your thyroid is contributing to your SHBG level. 

If it is, then you will need to take steps to increase thyroid function in your body either by taking thyroid hormone replacement therapy or by increasing thyroid function naturally

#2. Assess your estrogen/progesterone ratio (especially if menopausal)

This is really only important if you are menopausal. 

After menopause estrogen levels fall which can cause SHBG to drop. 

Some menopausal women are sensitive to this small drop and therefore may benefit from bio-identical hormone replacement therapy. 

#3. Check free testosterone levels

Low SHBG may indirectly leave more testosterone in the free and active state. 

You can determine if this is happening in your body by assessing the free testosterone in the serum. 

The combination of low thyroid function and low SHBG causes many of the symptoms seen in PCOS. 

If you think this might be happening to you, then the best treatment is to get on the right thyroid hormone replacement medication which is often enough to normalize SHBG and help alleviate many of the symptoms of PCOS. 

There are many other causes of PCOS, however, so this may not work for everyone. 

Back to you

The bottom line?

This binding protein gives you important information about what is happening with various hormones in your body. 

High SHBG is often caused by excessive estrogen levels while low SHBG is often the result of hypothyroidism (or low thyroid function). 

The key to treating SHBG is to identify what is causing the abnormality and fix that problem. 

This will help normalize SHBG levels in your serum and should help to reduce your symptoms. 

Now I want to hear from you:

Do you have abnormalities in your SHBG level?

Have you been able to identify what is causing the problem?

Why or why not?

Leave your comment below! 










shbg lab test guide

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

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130 thoughts on “SHBG Lab Test Guide – What to do About High Levels, Low levels & More”

  1. Interesting…. is there a specific time to test shbg? I’ve tested before and it’s been low .. 25-50 I’ve had regular periods all my life but free t3 is 2.6 low end of range. I was on ndt before and a 7 month hair nightmare ensured so no way I want that again. I never had thyroid issues before I’m 48 just the pst 3 years I’ve had the hair loss issues Need to figure a way to help thyroid without meds if that is possible

      • So when is best to dose your hormones prior to testing? I currently do progesterone and estrogen cream 5 hours prior and testosterone the night before. Thyroid 5 hours prior

        • Hi Cheri,

          It depends on how you are taking the hormones (transdermal vs injection, etc.). For thyroid hormone, it’s usually best to check right before your next dose, or around 23-24 hours after your last dose.

        • What about when you are in peri-menapause and start HRT. Once I started HRT, including Testosterone, my Free Testosterone stayed almost exactly the same, but my total testosterone doubled. Is it better to take HRT cyclical when you are in Peri vs taking the hormones the same all month long? When I recently switched from Bi-Est to injectables, my nightsweats came back and I have not been happy about that. What hormone levels should I am for on HRT with Estradiol, progesterone, and Testosterone? Thanks,

    • Dr. Childs, you are the best in all that you have done and continue to do to help us better understand the valuable medical topics you cover.

  2. My SHBG levels are very high, around 196,sometimes as high as 300. I was trying to increase my estrogen levels and I have Hashimotos, so I take Naturethroid 65mg per day. I knew that too much thyroid could raise SHBG, but didn’t know about estrogen. I am in a detox stage right now because I developed fibroids, so I decided to stop estrogen and just take a little testosterone and then go back for a blood test before deciding what to do. Thanks so much for your article!

    • Hi Robin,

      The presence of fibroids is an indication that you have too much estrogen in your body and is definitely not something you want to have happen as it may be a precursor to endometrial hyperplasia.

  3. So low shbg could be part of the cause to hair loss? Esp receding and temples loss? How else can I increase shbg without thyroid meds?

    • Hi Tina,

      Low SHBG is generally caused by something else, so if your hair loss was caused by low thyroid it might also cause low SHBG. But it’s not the low SHBG that is causing the problem, it’s more of a side effect of the main problem.

  4. My SHBG seems high but I am not having any symptoms and when it was at 80 I was very hypothyroid. Now on treatment it is high. My question is how does it cause type II diabetes? My doctor doesn’t seem concerned. So I am confused.

    • Hi J,

      SHBG doesn’t cause type II diabetes, it’s just an association between the two – most likely that insulin resistance causes other hormonal issues or hepatic damage which results in changes to SHBG.

      • Very interesting article! What if your shbg is very high but your estrogen is low and so is your ft3 and ft4? Goes against all the scenarios. Symptoms of low T present but a serum test shows 4.2?? Taking 1 grain of armour and use topical bhrt e &p. What could this mean?

  5. Great article. I am 55 post menopausal & using a HRT patch 0.75 vivelle dot for estradiol and armour (60) for subclinical hypothyroid. Blood test in April showed free T3 was 3.4 (range 2.3-4.2 and free T4 was 1.0 (range 0.8-1.8).
    I have high SHBG of 116 (range 17-124).
    How do I get my SHBG down? Do I lower my thyroid meds or estradiol or both? I tick every box for your symptoms of high SHBG but I cannot get the balance right between estradiol and thyroid. Afraid to adjust because I had severe menopause symptoms & def need the estrogen. Do you have suggestions?

    • Hi JSwain,

      It’s probably best to find a competent physician to help guide you if possible. The idea would be to use a combination of estriol + estradiol (low dose) sufficient enough to eliminate estrogen deficiency symptoms and then address thyroid function from there.

      • Thanks for the suggestion. I am using a moderate dose at this time- armour 60 & estradiol patch 50 for menopause. Would lowering the dose even further help with my high shbg? – currently 140 & free testosterone high 47.
        My estradiol is not high – pretty low actually at 38 and free t4 0.9 free t3 3.1
        I feel dreadful.

  6. 37year old man. Have high estradiol, even higher SHBG, almost off the scale. Total testosterone is normal for my age(650-800). Free testosterone is down to almost nothing. Doc put me on low dose of anastrozole, took my estradiol to 0, experienced same symptoms(fatigue, irritability, 0 sex drive). Been to see 3 Endocrinologists and 3 naturopaths. O answers. Help!

    • Jim, I have an idea of why your symptoms are continuing. My SHBG is also extremely high. My doctor said there is nothing you can do about it. That is not true. A supplement called Tongkat Ali will bring it down, which I tried and it worked really well. Too well in fact. My doctor told me to stop taking it. SHBG binds to testosterone first, then if you don’t have enough, it binds to your estradiol. What happens is you could have high testosterone, but your free testosterone will be zero. So just because your estradiol is now zero, your free testosterone is still being bound by high SHBG. I would give Tongkat Ali a try for 30-60 days and get labs run to see if your free testosterone is better. I used Source Naturals. They say to take one tablet twice per day.

    • Hi Jim,

      You would want to start with a full evaluation including sex hormones, thyroid function, cortisol, basic nutrients and insulin/leptin – chances are high that you will find your issue in one of these areas.

  7. Thanks doc
    Awesome article. Informative and proactive thanks, shall work with my naturopath, and integrative doc on this now that I can come to the table with a solid understanding of what is going on with my SHBG.

  8. I am a 32 year old female .My SHBG is 54 nmol/L. I know this is a bit low. I have sub clinical hypothyroidism and hair loss is my main problem. I have some PCOS symptoms like hair loss at temples and irregular cycles. I am trying to rule out PCOS. Is it safe to say that I can? Where do I want my free testosterone to be? Mine is 0.7 pg/mL.

    • Hi. My shgb is high at 144 and the doctor dismissed it. I am post menopause and estrogens total at 67 and progesterone .73, with estradiol at <5. I have Hashimoto’s and was on a combo T3/T4 with low range free T3/T4 (40% range) and 2.7 tsh. I don’t know how to lower shbg.

      • My anti-tg <10
        Tpo an is 93.8
        SHBG 188
        T4 Free 1.16
        T3 Free 2.7
        B12 is 1891

        Had thyroid ultrasound normal.

        Estradiol 35.4
        Progesterone 1.31

        I am 48 yr, old woman.

  9. I am a 26yr old female, was diagnosed with PCOS at 22. Confirmed by ultrasound of my ovaries I had the ‘string of pearls’ in both, as well as weight gain, high testosterone levels, facial hair, irregular cycles, etc. They prescribed me desogestrel-ethinyl estradiol 0.15-30 MG-MCG to help control my menstrual cycles. I just had my labs done on Dec 23 and they show my SHBG is high at 181 nmol/L; my testosterone free is at 2.5 pg/mL and testosterone at 51 ng/dL. Should I stop with the birth control?

  10. I have low shbg – last test was 8! I am tired, have hirsutism and have gained a large amount of weight around my middle. I have been put on 100 mg of spironlactone to treat the hair growth which isnt working but doctor is reluctant to try to find out why my shbg is so low. I am factor v deficient and have a coil for contraception. Any advice as to what i should ask for at my next appointment

  11. Dr. Childs,

    I’m a male with low SHBG (< 13 nmol/L.) The side effects include lowered total testosterone (hypogonadism) via excessive free testosterone conversion and therefore increased aromatization to estradiol. This makes testosterone replacement therapy a nightmare, because exogenous testosterone further lowers SHBG and therefore creates obscene free estradiol/testosterone excesses. T3 administration lowered TSH < 2.0, but failed to increase SHBG. Is it possible that low SHBG can be entirely genetic? Many doctors say low SHBG is secondary to something, but for me the low SHBG seem to be the root cause and not the result of another issue.

    • Hi James,

      I think there is definitely a genetic component which may determine the sensitivity to how SHBG reacts to various stimuli, but I’m unsure if there is a polymorphism that results in chronically and irreversibly suppressed SHBG. I would consider looking into other factors such as insulin resistance which can alter SHBG levels as well (if you haven’t already).

  12. Thank you for this really interesting article! I’m 31 yo male 185cm/85kg. For some time I’ve been dealing with couple of issues, fatique, 0 sex drive and hair loss.
    Results of my morning blood test show elevated TST,progesteron and very high SHBG. I don’t work manualy and go to gym (on average) once per week, not taking any illegal supplements.
    Thyroid gland and liver values seem to be okay. Endocrinologist told me to wait, but don’t know what for and how long.
    It’s been going on for approx 2 yrs and values are slightly increasing little by little.

    Where should I start? I guess that high SHBG is just a result of high TST.
    I assume that SHBG binds up all my TST and that leads to very little free TST.

    S-TSH 4.3 mIU/l ref.range(0.55-4.78)
    S-fT3 5.5 pmol/l (3.5-6.5)
    S-Tg 3.7 ug/l (3.5-77)
    S-fT4 17.1 pmol/l (11.5-22.7)
    S-aTG <15 kIU/l (0-60)
    S-aTPO <28 kIU/l (0-60)
    S-Cortisol 495 nmol/l (145-619)
    S-DHEAS 7.3 umol/l (4.3-12.2)
    ***S-TST 40.2 nmol/l (9-29)
    S-freeTST 51 pmol/l (31-147)
    ***S-SHBG 129 nmol/l (16.5-56)
    ***FAI 31% (35-93)
    ***S-PROG 0.66 nmol/l (0.159-0.474)
    S-PRL 13.1 ug/l (2.1-17.7)
    S-FSH 7.6 IU/l (1.5-12.4)
    S-LH 6.4 IU/l (1.7-8.6)
    S-E2 (estradiol) 173 pmol/l (99-192)
    S-AST 0.3 ukat/l (0.2-0.7)
    S-ALT 0.6 ukat/l (0.15-1.05)
    S-GMT 0.3 ukat/l (0-1.13)
    S-B12 244 pmol/l (156-672)
    MCV 82
    S-Zinc 15.3 umol/l (9.1-16.4)
    S-Fe 19.3 umol/l(5.8-34.5)

  13. Male 34, hashimotos hypothyroidism.
    Currently on 125mcg levothyroxine and 25mcg cytomel

    Total T: 672 ng/dl
    Free T: 13.43 pg/ml
    Estradiol: 50.97 pg/ml
    SHBG: 52.13 nmol/L

    Free T3: 3.39 pg/ml
    Free T4: 1.35 ng/dl
    TSH: 5.19 uIU/ml

    Would you agree that a lot of my testosterone is aromatizing hence the high E2, thus causing low free T?

    • One thing about high estrogen levels in men. From what I have heard, if a man is overweight, the fat on a man’s body can cause his testosterone to aromatize more than usual, therefore greatly reducing free Testosterone. So if there is a weight problem, that should be the first thing you should look at.

  14. Hi Dr. Child’s,

    I am a 31 year old female with a SHBG of 154, it has been as high as 165. My testosterone levels are extremely low, ranging from <3 to 6, and my estradiol is normal. My thyroid hormones have been tested as well, and are in the normal range. I have taken OCP throughout my life my life, but have been off of them for almost 3 years. Though the OCP has been discontinued, the SHBG remains extremes high and isn’t normalizing. I have extremely low libido (as you could imagine) and challenged sexual function. I have been to multiple physicians including western medicine doctors, Integrative medicine doctors, and I have explored eastern medicine including acupuncture and supplements. No one seems to be able to figure out what’s wrong with me, and ultimately offers a band aid such as DHEA suppositories or testosterone cream. Any suggestions would be appreciated.

    • Have you had an MRI to check for potential pituitary tumor? Your case sounds similar to mine, I have a microadenoma that might be causing the high SHBG

  15. Male 34, hashimotos hypothyroidism.
    Currently on 125mcg levothyroxine and 25mcg cytomel

    Total T: 672 ng/dl
    Free T: 13.43 pg/ml
    Estradiol: 50.97 pg/ml
    SHBG: 52.13 nmol/L

    Free T3: 3.39 pg/ml
    Free T4: 1.35 ng/dl
    TSH: 5.19 uIU/ml

    Would you agree that a lot of my testosterone is aromatizing hence the high E2, thus causing low free T?

  16. I’am 45 years old my SHBG was 161.2 May of last year but nothing was ever discussed or done about it, I was told I have too much estrogen in right breast. I stopped taking birth control ten years ago and I’ve been in menopause for five years now and haven’t had a period in a year.

  17. Hi there. New to this all and trying to figure out the reason for my symptoms. Just had blood work done and SHBG was 144 – never had it tested before, so nothing to compare it against. I was on day 18 of my cycle (26-28 day regular) of that matters. Also my TSH was elevated, 4.38. It was like this 9 months ago. Can you give me any insight: I have symptoms of estrogen dominance AND hypo thyroid. I’m just trying to feel better so I can function and be a happy mum to my kids! I appreciate any insight and help!! Thank you!!

  18. I’m a 47yo female with hypothyroidism and perimenopausal. My thyroid hormone levels are in the top half of reference range which is where I feel best (finally). I take Yaz continuously without the break for PMDD and hot flashes (which gone away since doing this) I take testosterone injections to keep free levels in the reference range and help with fatigue. I also take Progesterone. My SHBG is through the roof (300s) and of course, my integrative dr wants me to stop Yaz but I tried to a year ago for 4 mos & I felt absolutely horrible, as well as had abnormal irregular bleeding, and basically felt like I had severe PMS that never stopped.
    I would rather take Yaz through menopause and take the testosterone injections (than go on the horrible roller coaster ride without. I actually feel better than I have in awhile. My only issue is my BMI 27 and simply can’t lose more than a couple lbs at a time no matter what. I’ve always been thin until the thyroid & now the perimenopause.
    So if I feel good and all my labs are in a good part of the reference range except SHBG why do I have to do anything about it? Especially when I feel worse off Yaz. It makes no sense to me.

  19. I got tested and got my results back just over a week ago and my thyroid showed fine but my Testosterone was marginally down and SHBG very high
    Testo 0.3
    fTesto.c 2
    SHBG 147

    I had unexplained rapid weight gain about 8 months ago and have not been able to get rid of it since!! the past 6 months I got back to my regular gym routine of minimum 4 days a week training weights and some cardio with a structured eating plan.. When that wasn’t working after 3 months my PT re assessed my eating plan and I increased my training with morning fasted cardio and added classes into my gym workouts.. still didn’t decrease in size (measured weekly for 2 months) nor did that scales go down.
    I’ve been regular at gym and training for about 5 years and know my body. my regular weight is about 72-73kg (I’m 180cm tall) When the weight gain hit I went up to 80kg and now float between 77-78kg regardless of what I do.
    I have another 3 weeks before my second round of testing and am off all supplements, protein powders etc..
    I’ve been on the same oral contraceptive for 14 years and have never had an issue.

  20. 51 year old woman – Hashimotos’s – Armour Thyroid – 225mg daily (split 120 in a.m, 105 in p.m.) – TSH 0.02 – Free T3 in upper end of lab range – Free T4 in lower end of range – Estradiol 34 (during menstruation) SHBG 86 – Low Iodine level for first time on recent test this week – experiencing Fluid Retention and Weight Gain for past year – Thyroid Anti-bodies non-existent or very low (4 and <1). Based on symptoms (weight gain, fluid retention, lethargy, low libido, etc.) I assume that my Armour dose is too high and should lower while checking sex hormones every 2 weeks until ranges are "balanced" per your ranges – should bring SHBG down to 65-70 while keeping Free T3 in upper 50% – would that make sense? (waiting on Reverse T3 and other Thyroid hormones to come in – Dr. office only had the partial of items listed above as of today)

  21. My 62 yr old girlfriend had blood work done recently. Her Sex Horm Binding Glob is 188.0. All other sex hormones are in the recommended ranges. Her TSH is 3.8. What could be causing this high SHBG? Thank you

  22. Hi,

    I’m 43 yr old female.. high SHBG… close to zero free testosterone … not even close to menopause… zero sex drive. Little low progesterone. I supplement with testosterone and am still low and honestly have not seen any changes at all. Maybe just some more water retention. No libido. I’m still tired. My relationship is suffering and I’m miserable. I’m also hypothyroid. I was taking 120 Armour… levels were little high, dose just got lowered to 90 and I feel even worse.

  23. My SHBG is 141. I don’t take estrogen and it’s in the normal range. My FT4 is low and my FT3 is in the low normal range. I take Armour Thyroid.

  24. Dr. Childs,

    This is such a fascinating article! I’ve searched high & low and found very little information regarding SBGH levels. I see a Natropath and at my last visit I was complaining that despite my increase in thyroid meds (NP Thyroid & levoxyl), my weight has been very stagnant and I cannot get it to budge! She mentioned that I had a High SHBG level & gave me stinging nettle root, which helps to “unbind” the proteins. So far it’s been working & my weight has dropped a bit. I’m also taking Prometrium and having me lab work redone this coming week (mid leutal) to check all my hormones. I just wanted to say thank you for the article!!

  25. Please help me! I’ve been to 5 doctors no one helps me!
    So my doctor called saying my results were all ok but I don’t trust them and asked for my lab results. Got them now and saw that my SHBG levels are way high (30-90 mine is +200). Oddly my estrogen is supposed to be high but it is low! (only 34 from a minimum of 100-1150)! And scarier is that my testosterone is borderline (1.5 out of 1.7).
    This does not make sense because most of my ‘google work’ suggests that high SHBG is high estrogen which I don’t have. And my testosterone is high as well. Any help??

    • Please let me know if you found answers. I guess I’m your twin because I am having very similar issues and Google is no help. My SSHG is HIGH as is my testosterone, while my estrogen is LOW, and my progesterone is LOW NORMAL. I’m a 36-year-old female.

  26. My shbg is 162. And my TSH level is Sky High 35. I take nature-throid 130 MGs. But my doctor increased it to the next level because of my high TSH. She didn’t know what to do with the SHBG test. I’m very confused.

    • Hi Mary,

      If you were taking birth control pills then that would explain the high SHBG, but it’s impossible to say for sure without a lot more information!

  27. Hello again Dr. Childs,

    I posted above regarding high SHBG levels. I am 45 yrs old with Hashimotos and Perimenopause. I had recent blood work and have the following results:

    SHBG: 136 (range: 20-130)
    TSH: 2.10 (range: .27-4.20)
    Free T3: 4.8 (range: 2.0-4.4)
    Free T4: 1.25 (range: .93-1.70)
    Estradiol: 148.8 (Luteal phase 22-341)
    Progesterone: 12.63 (Luteal phase 1.83-23.90)
    Testosterone: 17 (range: 12-82)
    Free Test: .11(range: .06-.92)

    I am currently on 82.5 mg of NP Thyroid & 25 mcg Levoxyl; also on 100 mg Prometrium (daily for about 6 wks now).

    I am very sensitive to T3 and feel that I’m running TOO Hyper right now (heart palps, insomnia). When I was on straight T4 I found that I felt best with a TSH of 1.0-1.5. I have still been struggling with my weight despite the high free T3. I have spoke with my Endo and decided I would drop the NP Thyroid to 60 mg & increase my Levoxyl to 50 mcg. I am hoping that lowering the NDT that I’m on will decrease the hyper feeling but I also feel I do better with my free T4 at the higher end.

    I’m guessing that too much thyroid hormone is causing the high SHBG and possibly the weight gain. I’m trying to stay on the NDT but afraid it may not be working well with me body ;-( Any suggestions?? Thank you!

  28. Thank you for such a timely and informative article! I recently found out (through some labs done by my naturopath to address low libido/low energy) that my shbg is 234. All my other hormone levels and nutrient panels are “perfect,” according to my doctor. I am a good weight and I do crossfit 3-4 times a week. I am 52 and perimenopausal. I have been taking pueraria mirifica (“Amata”) for about 6 months, in hopes of restoring my lost libido. It is a product heavily promoted by Dr. Christiane Northrup. My question is, do you think that this product could have elevated my shbg? My naturopath seems to think it’s not getting enough carbs that caused my shbg to spike. I would appreciate your thoughts.

  29. I’m confused. My shbg is low at 43nmol/L but so is my testosterone. Free t is .29ng/DL and total is 16ng/DL.
    I am 32, mostly regular menstrual cycle, follicle stimulating hormone 5.7 mIU/ML but luteinizing hormone 11.5 mIU/mL (ratio about 2:1)

    These results are from day 7 of a 25 day cycle. Hemoglobin a1c 4.9%

    I don’t know how to decipher any of this.

    • Hi Crystal,

      You should look at SHBG in conjunction with estrogen and thyroid hormone since these hormones influence SHBG.

  30. Thanks for the article. I am an 80 yr. old female and have been having a problem of my breasts feeling full. I had one hormone test and the only thing that showed was low testosterone. 6 months later I had a test and the testosterone was ok but the SHBG was 107. Can’t figure out what is causing the high SHBG. The T3 and T4 levels are within range. Any ideas?


    • Hi Patty,

      You will also want to check your estradiol level which can impact your SHBG and may cause the breast fullness you are experiencing.

  31. My SHBG is high – currently 101 but was even higher at 140 a few months ago. I have to take armour 90mg because I am hypothyroid. I use a low dose estradiol patch to control my unbearable menopause symptoms (50mcg patch).
    Am I in a catch 22 here? I need the medication but could it be this that makes my SHBG high? If high SHBG binds it up then the medication is not going to do anything for me. My T3 and T4 is still low even on 90mg. I never know whether to increase/decrease or stop. My Dr is not very useful. I get a lot more information from your articles – thank you for helping us.

    • Hi Jay,

      The problem with estradiol patches is that you can’t titrate them very well, the reality is that you may be fine taking 2/3 of your current estrogen dose and still remain asymptomatic.

      • Estrogen patches can be titrated by cutting them and measuring the pieces so you know exactly how much you are applying.

        So, for example, if you take the vivelle-dot 0.1 patch (this delivers 0.1mg/day) that measures 40 millimeters lengthwise. If you cut a small piece off of the end, so that the large piece measure 35mm and the removed piece is 5mm, and you plan to apply the large piece, then you divide 35 by 40 to determine the dose. So, 35/40 = 0.875, so you are getting 87.5% of the full 0.1 patch. Then multiply the 0.875 times 0.1 (full patch) and that =.0875 and that is the dose you will get if you apply that piece. Just adjust the numbers above for whatever size pieces you choose to cut.

        Vivelle patches are rectangular shaped, so that makes it easy to do this calculation. Of course, if you are using a different size/dose patch from Vivelle, you would need to adjust the calculation above to account for the different size/length of the patch AND for the different dose of E2.

        With other patches that are circular shaped the calculation is a little more complicated, but can be done, just look up how to calculate the area of a circle and go from there.

        Or, you can just wing it and try to consistently cut off the same size sliver that helps you to get a dose that works for you without the precise measuring. Personally, when it comes to the fairly large dose 0.1 patch, I prefer to measure it and be precise, because I find that very small changes can make a big difference in my body’s response in a dose of this size. Estradiol (E2) is a powerful hormone at extremely small concentrations.

        I prefer patches over pills for E2, because it gives a slow steady release, mimicking our bodies, and helps prevent migraines in those that are sensitive to rapidly fluctuating hormones levels. Plus, it bypasses the liver upon entry.

        • Hi Angela,

          Thanks for sharing and I’m glad you found something that works for you! It’s certainly possible to titrate them, I just think it’s easier to titrate other routes of administration.

  32. Hi, I’m confused. I do not think you covered my situation. I am a 36-year-old female. I am a mom to three children.

    I recently found out my SHBG and testosterone are high and my estrogen and progesterone are low. I don’t think you spoke on this matter.

    To paint a better picture of me, I have no abnormal thyroid tests. I have had 7 pregnancies and 3 living children with mostly early miscarriage. I used progesterone suppositories to carry 2/3 living children. My periods are normal though heavy and very painful. I was dx with PMDD. Other medical info: I have had 1+ and 1- ANA and elevated SSB. I have Alpha-1 Antitrypsin deficiency. My Alpha Phosphate liver test is a little high. I have severe Vit D deficiency it is 11. I suffer chronic pain and take opiate pain meds as prescribed.

    Please explain what can cause both “male” hormones to be high and both estrogen and progesterone to be low. I have no abnormal facial hair though my anger and moodiness has been extreme as has itching and bright redness of my face.

  33. Okay so I am the opposite of what you described here. I have very high SHBG (165nmol/L) but I am subclinical hypothyroid and also low testosterone and very low estrogen. I am actually in postmenopausal range (I am 28) in my luteal phase. This makes sense to me because wouldn’t he SHBG bind up my sex hormones? I am so confused. I got it tested about 6 months ago and it was 158, so it’s not getting any better. Have you ever seen this? Any clue how to lower it?

  34. Hi Dr. Childs,
    I’m a 55 year-old male with high SHBG. Thyroid tests all normal. In reading above on the same, the focus appears to be primarily towards causes in women. Are there any unique differentiators between male and female that you can call out – I’m not sure where to start in seeking a root cause. Thank you.

  35. Dr. Childs,

    Good afternoon. I’m a clinician and one of my specialties is BHRT. I’m fairly proficient in this, however, cannot find clear evidence based algorithm for elevated SHBG. I think I grasp the biochem of it, however, not sure if SHBG has transient spikes, and if so, is retesting to confirm an option? I have a 39 yo patient (BMI 24) who has total T 400’s but pretty symptomatic so tested his SHBG, which was 69, so free T low. E2 normal at 18, denies current meds, suppliments, paleo diets, significant med hx (DM, hempatic, etoh, etc) He does have hx of elevated SHBG and alchohol abuse, however, d/cd last year and nl liver function tests. He did have nl tsh 6 mo ago, not sure about t3, t4. Thoughts? Thank you so much for your reply.

    • Hi Josh,

      SHBG is felt to act as a “buffer” to help maintain normal sex hormones throughout the day and is thought to only respond to changes in the hormones themselves. So checking the SHBG in conjunction with free/total hormones should be sufficient to get a picture as to what is happening. There are some men who have, likely for genetic reasons, an abnormally high SHBG and these men can be difficult to treat with TRT and other hormones. It would be reasonable to re-check SHBG if you feel it appropriate, but you may need to play around with testosterone/estrogen/thyroid hormone and SHBG to try and find a “sweet spot” for this patient. Hope this helps!

  36. Why is an elevated SHBG a bad thing? My hormone levels are finally at a range that I feel well and my T3 is finally a decent range too on nature throid.

    • Hi Diane,

      If it’s related to taking thyroid medication then it’s a potential indication that your dose is too high.

  37. Hi Dr. Childs-

    I am a 32 year old female, NOT taking any form of oral contraceptives but am having issues with uterine polyps, low iron, hair loss, extreme fatigue and weight gain. I had my testosterone and sghb tested which came back high, 155. Free testosterone was 2.5pg/nl, bioavailable was 7.3ng/dl and total was 45. I am experiencing everything you listed under the section regarding high SGHB in addition to Rosacea, acne, angular chelitis, canker sores, bloating, swollen fingers and more. Could this be the result of a digestion or gut issue?


    • Hi JBlanch,

      Intestinal issues may be certainly contributing, but it’s hard to say without a lot more information.

  38. Hello Dr. Childs,
    My name is Karen. I have had a thyroid disease my entire adult life. First, diagnosed with Grave’s disease-had a partial thyroidectomy in 1989. I also have a Mirena IUD, which was done in 2015. My thyroid levels have been out of range for a long time. Meds have been changed repeatedly. I was on Tirosint 125mcg, Endo decreased it to 112mcg after the following tests results on 7-10-18:

    TSH (Thyroid Stimulating Hormone) – 0.01 uIU/mL – L (Why Low)
    FREE T3 – 3.73 pg/mL
    FREE T4 – 1.62 ng/dl – H (Why so high)
    REVERSE T3 – Endo would not test
    TPO ANTIBODIES – 159 IU/mL – H (Why so high)
    THYROGLOBULIN ANTIBODIES – 138 IU/mL – PH (Why so high)
    SEX HORMONE BINDING GLOBULIN (SHGB) – 153.5 nmol/L – H (Why is this so high – Would it be my thyroid or Mirena IUD)
    FERRITIN – 35.3 ng/mL
    SERUM IRON -Endo would not perform test
    TIBC – 320.5 ug/dl
    TRANSFERRIN – 256.4 mg/dL
    LH – 5.8 mIU/mL
    FSH – 13.4 mIU/mL
    ESTRADIOL – 126.8 pg/mL
    CHLORIDE – 95 mmol/L – L (why)
    C02 – 32.7 mmol/L – H (why)
    SED RATE – 49.0 – H (why)
    VITAMIN B12 – 1133.0 – H (Why is this so high)
    PROLACTIN – 11.3 ng/mL
    COPPER,SERUM/PLASMA – 206 – H (Why is this so high)
    Had a Thigh Biopsy – Diagnosed with Thrombus in Subcutaneous areas.
    Diagnosed by Rheumatologist with UCTD and Discoid Lupus

    I have chronic fatigue, numbness & tingling, severe swelling and edema-upper and lower, chronic joint paint and stiffness, purple blotches on legs and arms, muscle cramps and weakness, memory fog, severe hair loss, Severe Scalp burning pain, scalp, ear, nose and mouth ulcer sores, Chronic Migraines, Depression & Anxiety, hands and feet cold all the time, and severe weight gain.

    Please let me know why my levels are so off so that I can start to feeling better. My doctors make me feel like I am losing my mind.


  39. Hello, very interesting article. Thank you. Have read it 3 times now! Post menopausal on BHRT. My SHBG is always high: over 125. My estrogen level stays about 70-120 pg/ml on BiEst cream which my doctor says is good but now wondering if it’s too high? 100mg oral Progesterone gets me about 4-6 ng/ml. I also take testosterone cream but only about 1mg right now. If I raise it I have strong androgen symptoms even with levels on paper that are super low – <.3 ng/dl free. I'm also hypothyroid and on NDT. My doctor keeps telling me having a High SHBG is a good thing metabolically. I don't get it. I would absolutely LOVE to experience the benefits of testosterone without high androgen symptoms. I've been asking this for years to several doctors who just say they don't know and they don't believe in estrogen to progesterone ratios. Thoughts?

    • Hi Cheri,

      Generally, when I dose with estrogen it doesn’t dramatically increase serum estrogen levels. It’s usually not necessary to get the benefits of estrogen.

  40. I’m 28 trying to lose weight esp in thighs/lower half. Estradiol is 138 while progesterone is 8. Free test is 1.1 but SBHG Is high at 270. I’m also on compounded t4 and t 3 meds but all my thyroid numbers are finally perfect. What’s the reasoning here why I can’t gain muscle and lose fat?

      • Dr Child’s,

        I’m having a lot of problems losing weight and with cellulite, sagging skin, aging skin, collagen loss.

        I’m F age 28

        Free Testosterone= 1.0
        DHEA= 213.5
        GH= .6
        Cortisol (AM)=14.6
        Leptin = 7.5
        Progesterone = 22.4
        Estradiol = 320
        Insulin= 4.1
        SHBG = 169

        PS all thyroid hormones are now in range with compounded T4 and T3.

        What gives?

  41. I’ve had low SHBG my whole life (~ 13 nmol/L). My TSH is only mildly elevated (1.8) and my T3/T4, free and total, are towards the high ends of the range. RT3 has shown to be towards the high end of the range (22). However, T3 supplementation for two months at 10-20 mcg per day did NOT alter SHBG. It DID lower TSH to 0.8, but SHBG never recovered. What else could be going on here?

  42. Hi,
    I am a 32 year old female and just had a blood test because I have had hormonal cystic acne on my cheeks for 10 years. I had the blood test during my luteal phase and my SHBG was the only thing that showed as abnormally high at 156. I also get facial hair, have irregular periods and get really irritable and depressed before my period. I am a little confused why my symptoms are more in-line with low SHBG but I have high SHBG?

    • Hi Amy,

      You should also check your testosterone, estrogen and thyroid panel to get a better picture. It sounds like you may be suffering from high total/free testosterone and probably higher than normal estrogen.

  43. Hi there. Thank you for this article! I feel like I am in the dark here. My doctor tested me and my T3 was really low when tested and my Prolactin levels were 2.15. My SHBG is at 190. I’m 34 and have 2 young children- the youngest is 2. I haven’t had a period since before she was born. I had 1 period miscarried and then had 1 more and was pregnant with my second child. I struggled with breastfeeding both of my children yet after my first I also didn’t have a period for almost a year and a half after breastfeeding. Please help! Thank you!

  44. I am a 53-year-old woman who is experiencing dizziness, general not feeling well and numbing and tingling in both feet. (Started out of nowhere). Many blood tests and MRI and tests. My gynecologist tested my thyroid T3 uptake 32.7, TSH 1.67, FSH 38, Free T4 1.30, Testosterone 41, albumin 4.4, free testosterone 2.3. My sex hormone binding globulin is 159.2. What could be causing my dizziness and a general feeling of yuck? They are trying to figure out my feet. Possibly neuropathy of unknown causes. ( need to find out what it is). Any ideas?

  45. Hey Dr. Childs, I began working with a functional medical dr. who doesn’t know why my SHBG is consistently high at 170 now, up from 140 since March, while my Free Testosterone is 5.1. She insists it’s a lab error and this does not happen, yet I tested this way twice!

    I thought my SHBG was the reason my upper arms and upper thighs started sagging horribly, my muscles are squishy, skin lost all tone. I’m 54, in late perimenopause and estrogen dominant. Is she right that my free testosterone at 5.1 is UNBOUND by SHBG and available to my cells? She thinks we need to lower my estrogen through the B vitamins I was found deficient in and use liver detox supplements to flush the estrogen out.

    If I’ve got enough free available testosterone why am I getting the sagging arms that look like my skin is suddenly many sizes too big and wrinkly, and squishiness?

    I’ve also dealt with thinning and hair loss since turning 50, 3.9 years ago. Now I’m freshly on Armour Thyroid to treat a TSH that hovers around 4 -4.7. I reacted to synthetic levothyroxine and now that’s out. I need reassurance my new dr. is going the right way by dealing w/ nutritional issues, thyroid optimization and estrogen flushing and not doing anything in particular with SHBG besides testing it again in a couple months. THANK YOU!

    • Hi April,

      You’ll want to look at other markers including your estradiol and free thyroid hormone levels to see if they are inflating with your SHBG. If it’s been tested twice and it’s high then it’s unlikely to be spurious.

  46. Thanks!! Yes my estradiol is high and progesterone 0.2, so it is estrogen dominance. My estradiol was 170 in February and 143 in August, but my SHBG climbed from 147 in May to 170 in August even though estradiol dropped slightly. Free T3 and Free T4 remain low. RT3 increased from 17 to 18. I wonder how much hormone is really being used by my cells with my RT3 that high.

  47. I jsut got my numbers back and my numbers are high @166. I have hasimotos am menopausal and am on T3 only and have been for almost 2 years now. My FT3 is at top of range and for the first time in what seems like forever I feel good with no hypo symptoms. Do I need to have more labs done and if so what? I had cortisol saliva tests done in July and they were 5.5, 1.4, .4, and .2. When my last iron panel was done it showed inflammation and am working on getting that down. Suggestions?

  48. I have hashimoto my tpo is high 382 and my SHBG is high 194.8 how do I get it lowered. I have been thru menopause already. I 61. Also, have mthfr gene and a slow metabolizer. None of my doctors have addressed these high doses. Is there anything I can do. I have high anxiety and taking meds for that also. Taking levothyroxine. They tried me on cytomel, only been taking it 3 weeks but feel it is giving me headaches. Any advice appreciated thru email please. Thanks

  49. What a great article and so helpful! I have felt something was off for several years and my primary care physicians over the years have told me “you’re older. It’s to be expected. What makes you think you need to lose weight?” etc; basically suck it up, you’re old. lol But there were just several things that while minor or possibly difficult to identify I felt were off.
    Granted I only need/want to lose about 35 lbs but the fact that despite tremendous efforts in the gym and the kitchen I’ve been unable to make any progress (even working with personal trainers) and it has left me frustrated (as well as several other symptoms). I decided to go to an N.D and pay out of my own pocket. She requested a lot of blood work and determined I had high SHBG, low D25, low free testosterone, low free T3, low DHEA, low pregnenolone, low RT3, high homocysteine plasma, low MCV, low cortisol and my progesterone to estrogen ration was 4. She has me on a path to correct these and I’m excited to see how it goes. I was nervous because I’m used to the “regular” thought process to medicine but your article has made me feel better that the path she has me on may help. Thank you for this great information!

  50. Hi Dr. Childs, I have a pretty high SHBG level – 174. I am 61 and have been on BHRT for 14 years. My estradiol is 32, my progesterone is 12.4. I am also on thyroid NP thyroid and take 60mg. My free T3 is 2.2, which is low. My free Testosterone is 2.3. I think it’s probably high due to my estrogen:progesterone ratio, but I really need progesterone to sleep at night. Plus I feel like progesterone keeps the negative effects of estrogen in check.

  51. Hello! This article was just in time … I’m very concerned about my recent lab results (gaining weight like crazy, very tired) SOS!
    TSH .01
    Free T4 1.29
    Free T3 4
    Reverse T3 37.5
    SHBG 104.8
    Free Testosterone .21
    Progesterone .2
    Estradoil 193.2
    Testosterone 26

  52. Hi, Dr. Childs!

    I just got results back from an extremely complex blood panel and complete thyroid testing. The only things elevated were the SHBG (194) and the rT3 (24.5 I believe) literately EVERYTHING else was within normal range. Estrogen, estradiol, testosterone, free T3, free T4, DHEA, tbh, etc!

    I’m not on any medications except Adderall. I am 39, have three kids, still having regular periods, but was sterilized in 2005 (Essure coils in Fallopian tubes).

    Had weight loss surgery in 2015, lost 145lbs (from 330), holding steady weight for two years. No health issues at all. Didn’t have diabetes or high blood pressure or anything prior to surgery.

    Any idea why just those two are elevated? And what should I do about it?

    Thank you for your time!

  53. Hi Dr. Childs, I’ve got high SHBG, high free testosterone, practically no proesterone AND high estrogen with subclin (TSH 4.0) hypothyroidism. (Diagnosed with ED). I do not take hormone therapy or thyroid meds and am still going thru meno age 54. Would DIM be right for me if goal is to reduce/balance estrogen or might it just raise my free testosterone more? Symptoms include fat around middle I can’t lose, loss of muscle tone, hair thinning and loss. Blessyou.

  54. Hey Dr. Childs, I’ve tested high SHBG and high free testosterone three times and my FM is baffled. Finally got my thryoid under control from TSH around 4.0 to around 2.7 just by dealing with Vitamin B’s and other deficiencies. Estradiol dropped from 170 to 13 in eight mos. FM says my formerly high estrogen wasn’t a cause of high sHBG and high Free Testosterone. I am neither obese nor hyperthyroid so why are these numbers both so high as the said “it’s impossible”. I blame high SHBG for my flabby arm and leg muscles despite all my workouts. What is the deal here? Would appreciate your insight. Thanks I am 55 with sporadic periods still.

  55. When on natural desiccated thyroid hormone replacement, is the SHBG level a better indicator of how much T-3 is making it into the cells versus looking at a serum based free T3 test? Think of a situation where TSH is low, Free T3 and T4 are low (Also low reverse T3), and SHBG is high. Focusing on the low free T3 alone would suggest taking more NDT. However, the low TSH in combination with an elevated SHBG might suggest enough T3 hormone is getting to the cell.… Taking more NDT will just elevate the SHBG and decrease the TSH. Thanks for your insights. I really appreciated the article.

    • Hi Peter,

      The short answer is that you are certainly correct in that there are situations where the SHBG can be a better indicator of thyroid function depending on certain circumstances. The combination of SHBG, total T3, and reverse T3 become more important in the situations you are describing.

  56. Hi,

    I have hyperactive throid, antibodies are fine and high SHGB along with high free testosterone and estrogen, high fatty liver.
    Sexual performance has taken a dive and on medication for thyroid.

    Is there anything else I can do other than medication I am taking?
    Maybe Prozac for short term as thyroid balances?


  57. Hi Dr. Childs.
    I’ve recently tested high SHBG 126 and I’m not clear on the next steps. Blood tests were ordered via my new endo. due to weight gain and low libido. My testosterone and free are both normal as are progesterone and estradiol. During initial blood work, my thyroid levels all appeared to be normal.
    How do I lower my SHBG?
    thank you

  58. This article was unbelievably helpful! I am a 63-year-old female and have been struggling for over two years with sudden unexplained weight gain (30 lbs) and all the other signs of high SHBG that you listed (to extreme levels). I had a high SHBG level of 188.4, which my primary doctor said was not significant. The symptoms worsened over the next year to the point where they have aggravated my pain from Spinal Stenosis and DDD to a degree where my functioning and quality of life has tanked dramatically, making it impossible to walk at times. I reached a point of total desperation and found a Functional Medicine doctor, hoping he may be able to figure out what imbalance was causing this. He admitted he’s very new to it. I’ve got Hashimoto’s and take Nature Throid (68.75, the second increase in three months). I’m also on BHRT: Bi-Est and Progesterone. The labs show ratio is fine. Thyroid levels are also fine. Free Testosterone: 2.2, Total Testosterone:40. Since these are all normal, what can I do? Despite many therapies and low carb/IF nothing has helped at all. In fact, I gained 3 more pounds! Desperately need some guidance! Would Nettle Root be something that may help? Would so appreciate if you could help. Many thanks for your awesome website, FB and YouTube. You are helping so many! Bless you!

    • Hi May,

      All comments are moderated before being approved. Your comment didn’t go anywhere 🙂 If the comment contains poor grammar, poor punctuation, or has other issues then it won’t be approved. The approval process can take a few days depending on how busy we are.

  59. What units do you use to get your ratio of estrogen to progesterone? Does it matter post menopausal? At least several of the people that have posted here use units – why don’t you? My wife is 80 yrs old and hypothyroid. She has been on T4 (50 mcg/d) and T3 (20 mcg/d) and her levels are now at the low end of normal. Following the “ReCODE Protocol” she started using an estradiol patch (.025 mg/d) 12 weeks ago and had SHBG tested for the first time this week – high at 130 nmol/l with estradiol still low (all being bound??). Free testosterone was not tested. Is high SHBG problematic at this level for the elderly? If you reply can you copy to my email?

  60. Hi Doctor,is it possible Sir too much Antithyroid medication propthyuracil (PTU)cause high SHBG levels or hyperthyrodism disease self cause high SHBG? Thanks Doctor

  61. I am a 45 year old woman with a normal health history, regular monthly cycles, routine negative pap and pelvic exams. I have had one normal pregnancy 15 years ago. Only significant health issue is anemia and low Vitamin D and B-12. I have taken oral contraceptives in my 20s and a few times off and on in my 30s but I felt that they caused me to feel depressed so I stopped taking them.

    I recently went to the doctor and blubbered out how my periods are not regular anymore, they are heavy and my PMS symptoms are worse than they used to be and I wondered if I should try oral contraceptives to control the symptoms. I also feel tired and anxious all the time with a dead libido but chalked that up to a stressful, demanding career. My doctor ran some tests to measure my hormones. These are the results:
    SHBG- 133.0 high
    Progesterone 1.10
    Estradiol 281.0
    Testosterone FT .10 Low

    As I said before I am not currently (or have in the last 10 years or more) taking Oral Contraceptives. My thyroid is fine and I’ve never taken Thyroid medication. So what does this mean for me and what treatment can I expect?

  62. Hi Dr. Child,

    I had a question. I am dealing with high testosterone, free testosterone, DHEAS, and DHEA. I never struggled with high free testosterone until the past few months. Could over exercise have decreased my SHBG and therefore increased my free testosterone? I was running 4 miles 6x/week, but have since stopped since all my female hormones were also low! How long can it take to recover from a hormone imbalance caused by overexercising? Thank you!!

  63. Hi Dr. Childs,

    I have high SHBG, but normal estrogen and thyroid levels in a recent blood test. Is there some other cause for extremely high SHBG level of 129 in a women whos 28, other than the ones you listed in this article?

    • Hi Jessica,

      The most common would be the use of birth control pills but some people just have high SHBG presumably due to genetics.

  64. Hello, thank you for all that you do to try to educate us on our thyroids and hormones. I have learned a lot. I am Hypothyroid now and felt great, something is off because it is winter and I am freezing, the weight is coming back and I feel achy. I am not sure what my labs should be. My last results are
    FSH 3.0
    Estradiol 167
    Progesterone 9.4
    Testosterone 21
    AM Cortisol 6.8
    Vit D 22
    SHBG 89.2
    TSH 0.277
    T4 0.70
    FreeT3 2.45
    Do you have any suggestions? I plan on ordering Functional Fuel Complete – Thyroid Friendly Protein Powder for Hypothyroidism & Hashimoto’s – French Vanilla, Gut Bomb 350 Billion | Ultra Potency & Multi Strain Probiotic for Weight Loss & A.R.C II (Adrenal Reset Complex – Adaptogens) – Non GMO, Vegan, Adrenal Formula. Do you think these will help with weight-loss?
    Thank you!

    • Hi Millie,

      Those are a good start but I think you’ll probably do better on these:

      2 scoops of Functional Fuel ENERGIZE daily during weight loss period
      1-2 capsules of Leptin Resistance Rx daily during weight loss period (continue for 2 months once desired weight is achieved)
      1 packet of Gut Bomb 350 billion daily (1-2 rounds as necessary)
      1-2 soft gels of Omega Soothe SR daily (for duration of weight loss)

  65. Hey doc,

    My current TSH level is 3.9 with the previous check being 4.7( ref range
    .30 – 5mciu) My T4 has been right at 1.1 regardless of my TSH level. I do have a lot of the symtoms and family history in regards to thyroid.

    I do also have very low total testosterone (208) with a SHGB of 12nmol.

    I cont pinpoint why i suddently came down with anxiety and the depression so im thinking it maybe thyroid od testosterone related.

    Do these results seem peculiar?

  66. Dr. Childs,

    Thanks for your informative website. I began HRT a few months ago (Armour Thyroid up to 90Mg daily) to address hypothryoidism (TSH over 5) and absent libido. My Free T3 and T3 and bio-available testosterone have always been at the bottom or below the RR. T4 in the middle of the RR.

    Just had my first follow-up labs. My TSH is now below 0.5. My Free T3 and T3 did not move, my bio-available test. did not move. My SHBG went up from 94 to 119. T4 still dead center.

    My doctor and I are now adding liothyronine sodium, in slow but steady increases. I’m concerned that we’re just fueling a further rise in SHBG and a suffocation of the Free T3 I’d rather see getting to my tissues. Is it self-defeating to add T3? I’m also supplementing with boron and avena sativa, hoping that will help bring SHBG down.

    I’m worried my doctor and I are at cross-purposes and feeling like there’s no solution for me that doesn’t backdoor me into worsening my symptoms. Any advice or encouragement?

    Thanks, Jim

  67. i am a 58 year old post menopausal woman with very high SHBG levels for years. Most recent 186 nmol/L. My progesterone to estradiol ratio is good at 250. I take compounded SRT4/T3 combination and high doses. 57mcg total of each, taken in divided doses 12 hours apart. What’s interesting is that every 6 months for the past 2 years , my Free T3 and Free T4 go down , eventhough i have been increasing my dosage gradually over the same time period. My TSH is very suppressed at 0.01 for 2 years now.
    Can’t seem to optimized my Free T3 levels , even when adding 5mcg of cytomel. Main symptoms are cold hands and feet, very dry skin and itching. Any thoughts ? Thank you

  68. I have the opposite, low T3 (I am on 30mcg Liothyronine and still below the bottom of the range), and low estrogen, yet by SBG are high at 95. What could cause this?

    Also, Hoffman’s Syndrome – could you write about this, could you discuss how long it takes to reverse painful, tight muscles once thyroid levels are optimal? Is there any correlation between how long it takes to resolve and the duration of hypothyoridism/muscle issues. Thank you –

  69. You are very interesting. I’ve never heard of this before. I’ve had a complete hysterectomy and do HRT. For a recent refill of the script I had to get a blood test. Dr. Said all numbers were fantastic except my testosterone was 807. She immediately took that out of the formula. I have no symptoms other than hair loss. Any suggestions of why my body is not absorbing the minimal testosterone I had in my script and now just floating around in my blood.
    Desperate April

    • Hi April,

      If you received it via injections or cream then it was being absorbed, it may have just been that the dose was too high in the preparation.

  70. Hi Dr Childs–
    You are amazing! Really think you are one of the best resources I have seen–thank you!
    What do you think about this? I am 66, very fit, have CVID, high arsenic, many SNPS.

    Labs With No Meds: Drawn 4-20-21 (28 hr after last dose/non fasting)
    TSH 2.98
    Free T-3 1.2 (L)
    Free T-4 0.38 (L)
    R-T3 5.6 (L)
    Test F/tot 9
    DHEA 59.5
    Estradiol 183.0
    Progesterone 7.3
    SHBG 148.(H)

    I have been very hard to balance for years. 35 TSH tests show a wide range. Total T-3,RT3,T4 most often low.
    I work hard on my health! I am a saint!

  71. What about High SHBG and low Estrogen in male ?
    I’m 31 male with low estrogen (a lot lower than the minimum normal range) Having all the symptoms of low estrogen but my SHBG is high.

    Healthy diet and fairly active lifestyle.

    Everything else like T, Thyroid hormones, vitamin and minerals.. everything is spot on perfect. Cortisol is ok as well.

    Estradiol: 25.3pmol/L – Normal range for male is 41-159pmol/L
    SHBG: 71.48 nmol/l


  72. My SHBG is quite high. I was taking DIM to reduce it, but this isn’t enough. As a 69 yr old woman on Bi-Est with Testosterone, and also on synthetic T3 and T4, I understand either could be causing the SHBG to be high. But I’m unclear what my problem might be based on what you’ve covered in the article. In my circumstances, should I should question the Bi-Est ratio with the compounded oral progesterone I also take? And how to I calculate my own ratio? As for thyroid calculations, I’ve got mid-range T3 and T4 numbers, with a bad Free T3 to RT3 ratio.

    • Hi Patricia,

      It’s more common for women to be overdosed on estrogen than it is to be overdosed on thyroid medication, though both can occur. Given the probabilities, I would probably look at estrogen first, though.

      Calculating estrogen/progesterone ratios doesn’t quite work the same way it does for the thyroid, especially in menopausal women.

      • Thank you, you are very kind. Your staff let me know your hypo bundle will also help me (even though it is Central Hypothyroidism).

  73. I recently got blood work done and I have high TSH and high SHBG which seems the opposite of what should be happening also my free g is very low I’m a 40 year old male, any ideas on what’s going on?

    • Hi Matthew,

      Have you tested your estrogen level yet? Other factors can influence SHBG such as estrogen, medications, and genetics.

  74. Hi Dr. Childs,

    I have recently discovered your work and really appreciate the podcast and information. I have was diagnosed with PCOS when I was 20 as I had lost my menstrual cycle. I have recently gained my period back via following treatment plan for hypothalamic amenorrhea. Since this, my estrogen levels are in range and my androgen and free testosterone are no longer abnormally high. Within the 10 years following recommendations for PCOS, I progressively and excessively increased my exercise routines and unrefueled. I now believe this led to my suppressed hormone levels and hypothyroid. My thyroid levels are normalizing and now free t3 is high but free t4 is low (I am taking armour and listened to your podcast on free t4 levels dipping down while taking armour as opposed to levo or synthroid).

    Recent labs how SHBG is 30nmol/liter, last year 25nmol/liter. I appreciate you telling me if SHBG levels tend to increase with further hormone regulation (i.e. maintaining menstruations and healing thyroid)? Do you see decreased SHBG in low energy states / do you think this is solely linked to the hypothyroid in low energy states?

    Would you recommend adjusting thyroid medications to raise free t4 levels in order the potentially increase SHBG?

    Thank you. I really appreciate your time here.

  75. Dear Sir,

    I’m a 58 year old male from England, if that makes a difference, diagnosed with hypothyroidism 2 years ago, put on 50 of levo increased to 200 and found not to convert well so consequently started on Lio start dose 15 increased to 60 while reducing levo to 50, currently on 42.5 of Lio and 100 levo,
    Latest results show T4 below range and T3 about 30 percent through the range TSH suppressed. I have recently found out that my SHBG is extremely high and my androgen is very low, my question is this could my initial diagnosis be incorrect, the endo- is suggesting that I am over medicated although my results don’t back that up, also I have found out that I have osteoporosis, which again he suggests is a result of over medication, in 2years? I could really do with some sound advise and direction being as 2 years on and I’m still suffering.

  76. i have the same concern as these people…i could not find any replies though…perhaps you could offer some insight.
    March 1, 2021 at 7:54 pm
    Very interesting article! What if your shbg is very high but your estrogen is low and so is your ft3 and ft4? Goes against all the scenarios. Symptoms of low T present but a serum test shows 4.2?? Taking 1 grain of armour and use topical bhrt e &p. What could this mean?


    Reenie B
    January 20, 2022 at 10:14 am
    I’d also like to know this answer. My SHBG is over 1,000 and my hormones are all very low.


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