SHBG (sex hormone-binding globulin) is a liver-made protein that binds testosterone and oestradiol, measured directly in blood in nmol/L. Practitioners use it to interpret total testosterone, to calculate free testosterone and FAI, and as an early metabolic signal, since low SHBG often travels with insulin resistance. The pill, oral oestrogen, pregnancy, thyroid status and steroids all shift it, so read it beside other hormones.
| Test type | Measured in a blood sample |
|---|---|
| Measurements required | SHBG only |
| Sample and collection | Blood draw at a collection centre |
| Preparation | This test doesn't need fasting on its own. |
| Turnaround | About 3 to 5 business days |
| Available through | Hormone Studies. Available in: Full Body Health Check, Weight Management Test, Male Hormone Health Test, Testosterone Panel, Female Hormone Health Test, Perimenopause Test, Menopause Test. |
| Pricing | Price on sign-up |
| Results | Returned in the Vively practitioner platform, beside your client's other markers |
What are the SHBG reference and optimal ranges?
| Typical lab reference | Vively optimal | |
|---|---|---|
| Men | 11 to 71 nmol/L | No separate optimal range. We read it against testosterone, fasting insulin and the trend. |
| Women | 20 to 110 nmol/L | No separate optimal range. We read it against testosterone, FAI, fasting insulin and the trend. |
Labs differ, so read the result against the range printed on the client's report (RCPA guidance). SHBG has no Vively optimal range; its meaning depends on the hormones and metabolic markers beside it.
Check a client's SHBG result
Enter the value from your client's lab report to see where it sits against the typical lab range and the Vively optimal range.
A guide only, not a diagnosis. One result is a starting point: read it with symptoms, history and a repeat test. Labs differ, so check the result against the range on your client's report. Nothing you enter is stored or sent.
How do you arrange SHBG testing through Vively?
- Get verified. Practitioners with a recognised qualification or membership (ATMS, NHAA, ANTA, Dietitians Australia, NSA, CMA or Ahpra registration) can request free practitioner access.
- Choose a panel. Log in to the practitioner platform and pick a panel that includes SHBG, or build your own. Add-on pricing shows when you sign up.
- Client collects. Your client collects at a partner collection centre, with their request on their phone or printed.
- Review results. Results come back to you in the practitioner platform, beside your client's other markers, ready for the follow-up consult.
Which Vively panels include SHBG?
Log in to the practitioner platform to view a panel in full, or build and save your own from 100+ tests and panels.
- Log in to view this panelTestosterone Panel5 markers · HormonesPrice on sign-up
- Log in to view this panelMale Hormone Health Test6 markers · HormonesPrice on sign-up
- Female Hormone Health Test17 markers · HormonesPrice on sign-up
Two blood tests timed to the cycle, to show how hormones shift across it.
Log in to view this panel
How do you read SHBG without an optimal range?
SHBG has no optimal band: the same number means different things in different clients, so read it with insulin, androgen, thyroid and liver markers.
Insulin suppresses hepatic SHBG production. In prospective data from women and men (Ding et al., 2009), lower SHBG predicted type 2 diabetes.
High SHBG can be benign with age or the combined pill. It also rises with hyperthyroidism, liver disease and low energy intake, and it reduces free testosterone.
Use fasting insulin or HOMA-IR, total and free testosterone, TSH and liver enzymes, and watch the trend after weight or diet change.
What should SHBG be read with?
- LowLow SHBG, high fasting insulin or HOMA-IR
Often seen with insulin resistance and fatty liver.
- LowLow SHBG, high free testosterone, irregular cycles
Pattern often seen in PCOS.
- HighHigh SHBG, normal total and low free testosterone (men)
Possible ageing, hyperthyroidism, liver disease or low energy intake.
- HighHigh SHBG in a woman on the combined pill
Expected; free testosterone and FAI will read low while she stays on the pill.
What can affect a SHBG result?
- Combined oral contraceptive pill, oral oestrogen HRT and pregnancy (raise SHBG)
- Thyroid status: hyperthyroidism and excess thyroxine raise SHBG, hypothyroidism lowers it
- Anabolic steroids, testosterone therapy and glucocorticoids (lower it)
- Recent weight loss or very low energy intake (raise it); weight gain (lowers it)
- Liver disease and anticonvulsants such as phenytoin and carbamazepine (often raise it)
When should you refer the client to their GP?
- Low SHBG with acne, hirsutism or irregular periods in a woman
- High SHBG with weight loss, palpitations or tremor (possible hyperthyroidism)
- High SHBG with jaundice, abnormal liver enzymes or heavy alcohol use
- Men: high SHBG with low free testosterone and symptoms on repeat testing
How should a client prepare for a SHBG test?
Copy or print this to send to your client.
Preparing for your SHBG test
- This test doesn't need fasting on its own.
- Women: if you have periods, book for day 2 to 5 of your cycle. Day 1 is the first day of full bleeding.
- Men: have this taken with your early morning testosterone sample, before 10am.
- Tell your practitioner if you take the combined oral contraceptive pill, as it raises SHBG.
- Take your pathology request to any of 4,000+ collection centres. Bring it printed or on your phone.
- Keep taking prescribed medicines as usual unless your doctor tells you otherwise.
- Results usually take about 3 to 5 business days and come to your practitioner. Book your results appointment for after that.
How do practitioners use SHBG with clients?
SHBG responds well to metabolic change: as insulin resistance improves with weight loss, less refined carbohydrate and more activity, SHBG tends to rise. Retest it with fasting insulin after 3 to 6 months to show the client progress.
SHBG FAQs
Can a naturopath, nutritionist or dietitian order SHBG through Vively?
Yes. Add it to any client panel on the Vively practitioner platform. It sits in Hormone Studies and is also in Full Body Health Check, Weight Management Test and Male Hormone Health Test. Add-on pricing shows when you sign up. No account yet? Request free access.
Why test SHBG if a client already has a testosterone result?
Because total testosterone cannot be read cleanly without it. SHBG binds most circulating testosterone, so it sets how much is free. With SHBG, the lab can calculate free testosterone and FAI, and you gain a separate pointer to insulin resistance or thyroid excess that total testosterone alone hides.
How much can SHBG change with lifestyle?
Enough to matter, within months. In clients with insulin resistance, weight loss and better glycaemic control usually lift SHBG, while weight gain and high refined carbohydrate intake lower it. Expect smaller changes in lean, insulin-sensitive clients. Retest after 3 to 6 months, at the same cycle timing and with no change in contraception.
What does a low SHBG suggest in a client with normal testosterone?
A low SHBG often points to hyperinsulinaemia, since insulin suppresses hepatic SHBG production. Read it with fasting insulin or HOMA-IR, liver enzymes and weight trend. In prospective data, lower SHBG predicted type 2 diabetes (Ding et al., 2009). In women, low SHBG with acne, hirsutism or irregular periods needs GP review.
What raises SHBG apart from the combined pill?
Hyperthyroidism or excess thyroxine, liver disease, anticonvulsants such as phenytoin and carbamazepine, pregnancy, oral oestrogen HRT, and recent weight loss or very low energy intake. A high SHBG lowers free testosterone, so check TSH, liver enzymes and intake before reading it as an isolated hormone finding.
References
- Ding EL, et al. Sex hormone-binding globulin and risk of type 2 diabetes in women and men. New England Journal of Medicine. 2009.
- Pathology Tests Explained. Sex hormone binding globulin (SHBG).
- Royal College of Pathologists of Australasia. RCPA Manual: Sex hormone binding globulin. Source
- Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. Journal of Clinical Endocrinology and Metabolism. 1999. Source
- Ding EL, Song Y, Manson JE, et al. Sex hormone-binding globulin and risk of type 2 diabetes in women and men. New England Journal of Medicine. 2009.