Also Known As
Testosterone-estrogen Binding Globulin
TeBG
Formal Name
Sex Hormone Binding Globulin
This article was last reviewed on
This article waslast modified on
May 28, 2018.
At a Glance
Why Get Tested?

Most commonly measured in the evaluation of low testosterone (androgen deficiency) in men; also commonly used in the evaluation of women with signs and symptoms of excess male hormones (androgens)

When To Get Tested?

When you have signs and symptoms of increased or decreased testosterone and a total testosterone measurement is inconsistent with your symptoms

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab's website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

What is being tested?

Sex hormone binding globulin (SHBG) is a protein that is produced by the liver and binds tightly to the hormones testosterone, dihydrotestosterone (DHT), and estradiol (an estrogen). In this bound state, SHBG transports these hormones in the blood as biologically inactive forms. This test measures the level of SHBG in the blood and is most often used to help evaluate for testosterone deficiency or excess.

In men, about 45% to 65% of testosterone in blood is normally bound to SHBG, with the remainder weakly and reversibly bound to albumin (the main protein in the blood). Only about 2% to 3% of testosterone is immediately available to the tissues as free testosterone, but testosterone that is weakly bound to albumin is also bioavailable and can be readily taken up by the body's tissues.

A slightly increased amount of testosterone (66% to 78%) is bound to SHBG in the blood in women, compared to men. In women, SHBG plays an integral role in regulating the levels of bioavailable male sex hormones (androgens) and estrogens circulating throughout the body. SHBG has a higher affinity for the androgens testosterone and DHT and so, in the setting of low SHBG, women may have signs and symptoms related to androgen excess.

A total testosterone test does not distinguish between bound and unbound testosterone but determines the overall quantity of testosterone. In many cases, this is sufficient to evaluate excess or deficient testosterone production. However, if a person's SHBG level is not normal, then the total testosterone may not be an accurate representation of the amount of testosterone that is available to the person's tissues. An SHBG test may be performed when a person's signs and symptoms do not correlate with the results of a total testosterone test.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

Accordion Title
Common Questions
  • How is it used?

    The sex hormone binding globulin (SHBG) test may be used to help evaluate men for low testosterone and women for excess testosterone production. It may be ordered in conjunction with other tests to evaluate the status of a person's sex hormones.

    SHBG is a protein that binds tightly to the hormones testosterone, dihydrotestosterone (DHT), and estradiol (an estrogen). In this bound state, SHBG transports these hormones in the blood as biologically inactive forms. Changes in SHBG levels can affect the amount of hormone that is available to be used by the body's tissues.

    Testing for albumin level and one or more other sex hormones, such as prolactin, estradiol, and LH (luteinizing hormone), may also be performed to evaluate a person's existing balance of hormones.

    SHBG in men
    SHBG and total testosterone levels may be ordered for an adult male to help determine the cause of infertility, a decreased sex drive, or erectile dysfunction. Measurement of SHBG in addition to testosterone is especially helpful when total testosterone results are inconsistent with clinical signs.

    Measurement of total testosterone in the blood does not distinguish between bound and unbound (bioavailable) testosterone but, as the name implies, determines the overall quantity of testosterone in the blood. In many cases, this is sufficient to evaluate excessive or deficient testosterone production. However, if a person's SHBG level is not normal, then the total testosterone may not be an accurate representation of the amount of testosterone that is available to the body's tissues.

    Measurement of SHBG helps health practitioners assess bioavailable testosterone with a simple total testosterone measurement. Increased SHBG in men may be associated with symptoms of low testosterone levels (hypogonadism) because less testosterone is available to the body's tissues.

    The Endocrine Society professional guidelines recommend measuring total testosterone in the initial screen for testosterone deficiency. If abnormal, the test is repeated on another day. If repeat results are low-normal and/or if SHBG is abnormal, they recommend one of the following:

    • Measure bioavailable testosterone (using ammonium sulfate precipitation or SHBG)
    • Calculate free testosterone from total testosterone and SHBG
    • Measure free testosterone (using a method called equilibrium dialysis)

    SHBG in women
    In women, small amounts of testosterone are produced by the ovaries and adrenal glands. Even slight increases in testosterone production can disrupt the balance of hormones and cause symptoms such as irregular or missed menstrual periods, infertility, acne, and excess facial and body hair (hirsutism). These signs and symptoms and others are often seen with polycystic ovary syndrome (PCOS), a condition characterized by an excess production of male sex hormones (androgens). SHBG and testosterone testing may be useful in helping to detect and evaluate excess testosterone production and/or decreased SHBG concentrations and in evaluating women suspected of having PCOS.

  • When is it ordered?

    Currently, the SHBG test is not performed frequently or routinely. In many cases, health practitioners feel that the total testosterone, and perhaps free testosterone (as measured by a method called equilibrium dialysis), provides sufficient information. SHBG is ordered primarily when the total testosterone results do not seem to be consistent with clinical signs and symptoms, such as infertility, decreased sex drive, and erectile dysfunction in men or infertility, irregular menstrual periods, and excess facial and body hair in women.

  • What does the test result mean?

    A high SHBG level means that it is likely that less free testosterone is available to the tissues than is indicated by the total testosterone test. A low SHBG level means that more of the total testosterone is bioavailable and not bound to SHBG. This information may be important in the overall evaluation of an individual with signs and symptoms of a condition related to excess or deficient sex hormone production.

    Increased SHBG levels may be seen in:

    Decreases in SHBG are seen with:

  • Is there anything else I should know?

    SHBG concentrations are normally high in children of both sexes. After puberty, SHBG levels decrease more rapidly in males than in females. Levels are normally stable in adults and then begin to increase in the elderly male at the same time that total testosterone levels begin to decrease. In postmenopausal women, SHBG, testosterone, and estrogen concentrations decrease as hormone production by the ovaries tapers off.

  • Are there other uses for the SHBG test?

    Not yet, but researchers are evaluating conditions in which there are changes in SHBG levels to see if there may be additional clinical uses for the test. Recent studies have identified that there may be a link between SHBG levels and insulin resistance in type 2 diabetes.

  • What is a Free Androgen Index?

    The Free Androgen Index (FAI) is a calculation that provides information on the amount of testosterone that is not bound to SHBG and is available for the body to use (bioavailable). The results of a total testosterone test and the SHBG are used for the calculation: FAI = Total Testosterone / SHBG. The FAI may be useful in cases where tests for free testosterone or bioavailable testosterone are not available. It offers a reasonable substitute for estimating the concentration of bioavailable testosterone, when SHBG is normal.

View Sources

Sources Used for Current Review

Reviewer May 2015: Nicole V. Tolan, PhD, DABCC, Associate Director of Chemistry and POCT, BIDMC and Harvard Medical School.

Isbell TS, Jungheim E, Gronowski AM. Reproductive endocrinology and related disorders. In: Burtis CA, Ashwood ER, Burns DE, eds. Tietz textbook of clinical chemistry and molecular diagnostics, Vol. 5th ed: Elsevier, 2012.

Pugeat M, Crave JC, Tourniaire J, Forest MG. Clinical utility of sex hormone-binding globulin measurement. Horm Res 1996;45:148-55.

Wheeler MJ. The determination of bio-available testosterone. Ann Clin Biochem 1995;32:345-57.

Ly LP, Sartorius G, Hull L, Leung A, Swerdloff RS, Wang C, Handelsman DJ. Original article: Accuracy of calculated free testosterone formulae in men. Clinical Endocrinology 2010;73:382-

Sources Used for Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

(© 2004). Sex Hormone Binding Globulin. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_193b.jsp#1147406 through http://www.arup-lab.com.

(© 2004). Testosterone, Bioavailable and Sex Hormone Binding Globulin. ARUP's Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_225b.jsp#1148913 through http://www.arup-lab.com.

Camillo, P. (2004 January 27). How Should I Handle Complaints of Decreased Libido in Female Patients? Medscape, Ask the Experts about Women's Health for Advanced Practice Nurses [On-line information]. Available online at http://www.medscape.com/viewarticle/466490?src=search through http://www.medscape.com.

Dennerstein, L. (2003 February 12). Depressed Libido in the Postmenopausal Woman. Medscape, Ask the Experts about Menopause [On-line information]. Available online at http://www.medscape.com/viewarticle/448554 through http://www.medscape.com.

Reuters Health (2004 February 4). Postmenopausal Endogenous Hormones Influence Endometrial Cancer Risk. National Cancer Institute [On-line News]. Available online at http://ctep.info.nih.gov/resources/gcig/news020404.html through http://ctep.info.nih.gov.

Tenover, J. (2001). Male Hormone Replacement Therapy Including "Andropause."  WellMax.org [On-line News, Essays & Articles]. Available online at http://www.wellmax.org/NewsPub/Stories/2001/05/07/9892607709.html through http://www.wellmax.org.

Patient's Guide to Low Testosterone, 2003 Edition. Medem Medical Library [On-line information by The Hormone Foundation and Endocrine Society]. Available online at http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZO7PDVDLC&sub_cat=57 through http://www.medem.com.

Snyder, P. (2003 September 9). Testes and Testicular Disorders. Medscape, from WebMD Scientific American® Medicine 2003, What's New in Medicine [On-line information]. Available online at http://www.medscape.com/viewarticle/461007 through http://www.medscape.com.

Allan, C. and McLachlan, R. (2004 June 3). Age-Related Changes in Testosterone and the Role of Replacement Therapy in Older Men. Medscape, from Clin Endocrinol 60(6): 653-670, 2004 [On-line journal article]. Available online at http://www.medscape.com/viewarticle/479523?src=search through http://www.medscape.com.

Matsumoto, A. (2008 June 27). Diagnosis and Evaluation of Male Hypogonadism CME. Medscape Today, Selection from: Men's Sexual Health Consult Collection: Testosterone Replacement Therapy in the VA Setting [On-line information]. Available online at http://www.medscape.com/viewarticle/575491 through http://www.medscape.com. Accessed on 7-30-08.

Chang, R. (2007 September 14). The Reproductive Phenotype in Polycystic Ovary Syndrome CME. Medscape From Nature Clinical Practice Endocrinology & Metabolism [On-line information]. Available online at http://www.medscape.com/viewarticle/562712 through http://www.medscape.com. Accessed on 7-30-08.

Sabatini, L. (2007 May 29, Updated). Androgen Excess. emedicine [On-line information]. Available online at http://www.emedicine.com/med/TOPIC3489.HTM through http://www.emedicine.com. Accessed on 7-30-08.

Anawalt, B. (2007 June Reviewed). Male Reproductive Endocrinology, Introduction. Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec17/ch227/ch227a.html?qt=SHBG&alt=sh through http://www.merck.com. Accessed on 7-30-08.

Anawalt, B. (Revised 2010 January). Male Reproductive Endocrinology. The Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed January 2012.

Dandona, P and Rosenberg, M. (2010 May 10). A Practical Guide to Male Hypogonadism in The Primary Care Setting: Clinical Presentation and Diagnosis. Medscape Today News from Int J Clin Pract. 2010;64(6):682-696 [On-line information]. Available online at http://www.medscape.com/viewarticle/721069_4 through http://www.medscape.com. Accessed January 2012.

Peter, A. et. al. (2010 December 16). Relationships of Circulating Sex Hormone–Binding Globulin with Metabolic Traits in Humans. Medscape Today News from Diabetes. 2010;59 (12) [On-line information]. Available online at http://www.medscape.com/viewarticle/733605 through http://www.medscape.com. Accessed January 2012.

(Updated © 1995-2012). Test ID: SHBG9285 Sex Hormone-Binding Globulin (SHBG), Serum Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/9285 through http://www.mayomedicallaboratories.com. Accessed January 2012.

(Updated 2011 July). Hypogonadism, Male. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/HypogonadismMale.html?client_ID=LTD#tabs=0 through http://www.arupconsult.com. Accessed January 2012.

Lucidi, R. et. al. (Updated 2011 October 25). Polycystic Ovarian Syndrome. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/256806-overview through http://emedicine.medscape.com. Accessed January 2012.

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby’s Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 928-930.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. St. Louis: Elsevier Saunders; 2006, 2011-2012.

Maggio M, et al. Sex hormone binding globulin levels across the adult lifespan in women - The role of body mass index and fasting insulin. J Endocrinol Invest. 2008 July; 31(7): 597–601. Available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2648802/ through http://www.ncbi.nlm.nih.gov. Accessed February 2012.

Kelly JA, Vankrieeken L. Sex hormone binding globulin and the assessment of androgen status. Available online through http://www.medical.siemens.com. Accessed February 2012.

Ask a Laboratory Scientist

 

Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, the American Society for Clinical Laboratory Science (ASCLS). Click on the Contact a Scientist button below to be re-directed to the ASCLS site to complete a request form. If your question relates to this web site and not to a specific lab test, please submit it via our Contact Us page instead. Thank you.

Contact a Scientist