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SHBG The protein that carries your sex hormones

Also called Sex hormone-binding globulin and Sex hormone binding globulin Not on a standard checkup No fasting needed

The short answer

SHBG is the protein that holds much of the testosterone in your blood. In men, only about 2% to 4% of testosterone is left free, so when SHBG runs high or low, a total testosterone result can mislead.1

A normal result
At Labcorp, 16.5 to 55.9 nmol/L for men under 50 and 24.6 to 122.0 for women under 50. It runs higher in older men.3
If yours is low
It often goes with extra weight, insulin resistance or type 2 diabetes, and it can make total testosterone read low.1,2
Should you test?
If your total testosterone is borderline, or you’re being checked for PCOS. It’s a guide to reading testosterone, not a diagnosis on its own.1,2,8

Check your result

Type the number from your report. It stays on this page.

Which fits you?

Labcorp’s ranges start at age 20. Stop biotin supplements at least 72 hours before the test, because high doses can throw off the result.3

16.5 56
  • Low Under 16.5
  • Normal 16.5 to 55.9
  • High 56.0 or more

Enter your result to see what it means and what to do next.

Got a result from another lab? Ask Picardo about it. The app explains your results, and a physician can follow up.

Ranges are Labcorp’s, by sex and age.3 SHBG has no guideline cutoffs. It matters mainly for reading your testosterone.1,2 The bar isn’t to scale.

What is a normal SHBG level?

SHBG has no guideline cutoffs.1,2 Labs use ranges that differ by sex and age. These are Labcorp’s:3

Low Under 16.5 nmol/L (men under 50), 19.3 (men 50 or older), 24.6 (women under 50) or 17.3 (women 50 or older)

Low: often a sign of extra weight or insulin resistance

Low SHBG often goes with extra weight, insulin resistance, type 2 diabetes and fatty liver. An underactive thyroid and steroid medicines lower it too, as do testosterone and anabolic steroids.1,2 It can make total testosterone read low even when free testosterone is normal.1 In women, it often goes with excess hair growth.3

How worried to be

Not urgent, but worth a look at your blood sugar.

What to do next
  1. 1 Check HbA1c. People with low SHBG are more likely to develop type 2 diabetes.4,6
  2. 2 If your total testosterone is low, check free testosterone before reading anything into it.1,2
  3. 3 If you’re a woman with excess hair, acne or irregular periods, ask about PCOS and a testosterone test.8
Normal 16.5 to 55.9 nmol/L (men under 50); 19.3 to 76.4 (men 50 or older); 24.6 to 122.0 (women under 50); 17.3 to 125.0 (women 50 or older)

Normal

Your SHBG is in Labcorp’s range for your sex and age,3 so it isn’t a reason to doubt your total testosterone result.1

How worried to be

Nothing to worry about.

What to do next
  1. 1 If your total testosterone is borderline, a free testosterone test can still help.1
High Over 55.9 nmol/L (men under 50), 76.4 (men 50 or older), 122.0 (women under 50) or 125.0 (women 50 or older)

High: your total testosterone may overstate what’s free

SHBG rises with age, and with estrogen taken by mouth, including the combined pill. Thyroid hormone, an overactive thyroid, liver disease, HIV, some seizure medicines, smoking and pregnancy raise it too.1,2,3,7 A high SHBG can make total testosterone look normal or even high while free testosterone is low.1 In women, it makes testosterone treatment for low desire less likely to help.7

How worried to be

Not a worry on its own.

What to do next
  1. 1 If you have symptoms of low testosterone and a normal total, check free testosterone.1
  2. 2 Check your thyroid if it hasn’t been tested lately.1,2
  3. 3 If you have low desire and take estrogen tablets for menopause, ask whether a patch or gel would suit you.7
SHBG test, $11.00
Results in 2 to 3 days, explained in the app
Order

What is SHBG?

Think of SHBG as a sponge for sex hormones. It soaks up testosterone and estrogen and holds them in your blood. More sponge leaves less hormone free; less sponge leaves more.

SHBG, short for sex hormone-binding globulin, is made in the liver. Estrogen and thyroid hormone push it up, and androgens such as testosterone push it down.3

Most of the testosterone in your blood is bound to SHBG or albumin, and in men only about 2% to 4% is free.1 So your SHBG changes what a total testosterone result means.

Why SHBG changes your testosterone result

When SHBG is off, total and free testosterone can point in different directions:

Your SHBG Total testosterone Free testosterone
LowCan read low, even below the rangeCan stay normal
HighCan read normal, or even highCan be low

From the Endocrine Society guideline.1

That’s why guidelines check free testosterone when SHBG is likely to be off. European guidelines strongly recommend measuring SHBG and using it to calculate free testosterone.1,2

What raises and lowers SHBG?

These raise it:1,2,3,7,8

  • Getting older
  • Estrogen, including the combined pill and estrogen taken by mouth
  • Thyroid hormone, and an overactive thyroid
  • Liver disease, such as cirrhosis or hepatitis
  • HIV
  • Some seizure medicines
  • Smoking
  • Pregnancy

These lower it:1,2

  • Extra weight
  • Insulin resistance and type 2 diabetes
  • Fatty liver
  • An underactive thyroid
  • Steroid medicines, some progestins, testosterone and anabolic steroids
  • Nephrotic syndrome, a kidney condition that leaks protein
  • Acromegaly and Cushing’s disease, two hormone disorders
  • Growth hormone treatment

Common variants in the SHBG gene shift it up or down too.1

Is low SHBG a sign of diabetes risk?

Yes, as a marker. In two US studies, one of women after menopause and one of men, those in the top quarter for SHBG had about a tenth the odds of developing type 2 diabetes of those in the bottom quarter.4

Genetic studies suggest SHBG may play a part itself. In over 85,000 people, a gene variant that raises SHBG went with a slightly lower risk of diabetes, about as much as its effect on SHBG predicted.5

But much of the link runs through fat in the liver and around the organs. In a Dutch study of middle-aged adults with overweight, that fat explained 43% of the link in women and 60% in men.6 So a low SHBG is a reason to check your blood sugar, not a diagnosis.

How to change SHBG

SHBG follows its causes, so the way to change it is to treat the cause.1,2

  • Switching oral estrogen to a patch or gel

    Estrogen taken by mouth, including the combined pill, raises SHBG.7,8 For menopause treatment, estradiol through the skin has little effect on SHBG or free testosterone.7

    How much it helps
    Some
    How sure we are
    Fairly sure
  • Treating a thyroid problem

    Thyroid hormone pushes SHBG up, so an overactive thyroid raises it and an underactive one lowers it.1,3

    How much it helps
    Some
    How sure we are
    Fairly sure

If yours is low, the usual companions are extra weight, insulin resistance and fatty liver.2,6

Who should get an SHBG test?

It’s worth checking if any of these apply to you:

  • You’re a man with a borderline total testosterone, or symptoms of low testosterone with a normal one.1,2
  • You’re a man with extra weight, diabetes, HIV, liver disease or a thyroid problem.1
  • You’re a woman being checked for PCOS. SHBG is needed to estimate free testosterone.8
  • You’re a woman about to start testosterone for low desire.7

How to get an SHBG test, and what it costs

An SHBG test costs $11.00 through Picardo.

Order the test

SHBG test

$11.00
Labcorp 082016 · no fasting needed
Order SHBG
  • Results in 2 to 3 days, in the app
  • Physician follow-up if you want one
  • Free Labcorp draw, or $75 at home
  • No other fees. HSA and FSA eligible.

It’s also part of the Base Core Annual – Men, Base Core Annual – Women and Fertility panels, if you’d rather test more at once.

Already have a result? Ask Picardo about it

Questions people ask

Can biotin affect an SHBG test?

Yes, at high doses. Labcorp asks you to stop biotin supplements at least 72 hours before the blood draw.3

Does the pill raise SHBG?

Yes. The combined pill raises SHBG, which makes androgen tests hard to read. If testing for PCOS is essential, guidelines suggest stopping the pill for at least 3 months first and using other contraception.8

What’s the free androgen index?

A ratio of total testosterone to SHBG, used as a quick estimate of free testosterone. The PCOS guideline accepts it.8 It assumes testosterone binds to SHBG the same way at every level, which isn’t quite true.7

Does it matter which lab measures SHBG?

It can. The main SHBG tests agree within about 7%. But in a simulation, differences between labs and the choice of formula shifted calculated free testosterone enough to change some diagnoses.9 If you’re tracking it, use the same lab.

Often checked alongside

Total testosterone
All the testosterone in your blood
Free testosterone
The testosterone your body can use
HbA1c
Average blood sugar over three months
Estradiol
The main estrogen

Test details

Labcorp test
Sex Hormone-binding Globulin, 082016
LOINC
13967-5
Sample
Blood
Fasting
Not needed for SHBG. If it’s tested with testosterone, go before 10 a.m., fasting.1,2
Typical lab range
16.5 to 55.9 nmol/L (men 20 to 49); 19.3 to 76.4 nmol/L (men 50 and older); 24.6 to 122.0 nmol/L (women 20 to 49); 17.3 to 125.0 nmol/L (women 50 and older)3
Units
nmol/L
Biotin
Stop high-dose biotin at least 72 hours before3

Sources

  1. 1 Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. doi.org/10.1210/jc.2018-00229
  2. 2 Salonia A, Boeri L, Capogrosso P, et al. EAU guidelines on sexual and reproductive health: male hypogonadism. Edn. presented at the EAU Annual Congress, London 2026. Arnhem: EAU Guidelines Office; 2026. uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-hypogonadism
  3. 3 Labcorp. Sex Hormone-binding Globulin, test 082016. Labcorp test menu. Accessed October 28, 2026. www.labcorp.com/tests/082016/sex-hormone-binding-globulin
  4. 4 Ding EL, Song Y, Manson JE, et al. Sex hormone-binding globulin and risk of type 2 diabetes in women and men. N Engl J Med. 2009;361(12):1152–1163. doi.org/10.1056/NEJMoa0804381
  5. 5 Perry JR, Weedon MN, Langenberg C, et al. Genetic evidence that raised sex hormone binding globulin (SHBG) levels reduce the risk of type 2 diabetes. Hum Mol Genet. 2010;19(3):535–544. doi.org/10.1093/hmg/ddp522
  6. 6 Stangl TA, Wiepjes CM, Smit RAJ, et al. Association between low sex hormone-binding globulin and increased risk of type 2 diabetes is mediated by increased visceral and liver fat: results from observational and Mendelian randomization analyses. Diabetes. 2024;73(11):1793–1804. doi.org/10.2337/db23-0982
  7. 7 Parish SJ, Simon JA, Davis SR, et al. International Society for the Study of Women’s Sexual Health clinical practice guideline for the use of systemic testosterone for hypoactive sexual desire disorder in women. J Womens Health (Larchmt). 2021;30(4):474–491. doi.org/10.1089/jwh.2021.29037
  8. 8 Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. J Clin Endocrinol Metab. 2023;108(10):2447–2469. doi.org/10.1210/clinem/dgad463
  9. 9 Walravens J, Adaway J, Reyns T, et al. Variability in SHBG assays and the effect thereof on calculated estimates of free testosterone. Ann Clin Biochem. 2025;62(6):493–500. doi.org/10.1177/00045632251350676

Updated 28 Oct 2026.

This is general health information, not medical advice: talk to your clinician about your results and before changing any treatment.