What does the research show about sex hormone binding globulin (shbg)?

Sex hormone binding globulin (SHBG)

SHBG binds testosterone and estradiol in blood and is used to calculate free testosterone. Published reference intervals differ by sex and rise with age in men, from 13.5 to 57.4 nmol/L at 30 to 27.8 to 101 at 70. Low levels go with more type 2 diabetes, and high levels with more fractures in older adults.

Checked 2026-11-13

Status: A blood test ordered by a clinician, often together with total testosterone, and also sold direct to consumers by some US laboratories.
Measures: The level of sex hormone binding globulin, a protein made mostly in the liver that binds testosterone and estrogen and helps control how much of them is active [1].
Also called: SHBG, sex hormone binding globulin, sex hormone-binding globulin, SHBG blood test, SHBG serum, testosterone-estrogen binding globulin, TeBG
Tested for: low testosterone workup, free testosterone calculation, excess hair growth in women, polycystic ovary syndrome, irregular periods, low sex drive, infertility, insulin resistance

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Linked in research5

ModerateShown in genetic and cohort studies to go with less type 2 diabetes at higher levels, in both women and men.
ModerateLinked to more fractures at higher levels in older adults, 18% more for each 1 µg/dL higher SHBG across 16 pooled studies.
ModerateLinked to fewer deaths in men at lower levels: 15% lower mortality in the bottom fifth of SHBG than the top fifth in pooled cohorts.
ModerateLinked in cohort and genetic studies to age, body weight and thyroid status: higher with age in men and with an overactive thyroid, lower at a higher body mass index.
ModerateLinked to lower SHBG in women with polycystic ovary syndrome than in women without it, in a meta-analysis of 62 studies and in a genetic study.

Reported risks0

No risks sourced yet.

Reference ranges

Each range is the one its source published, in nmol/L. Where sources differ, each is shown.

Nordic Reference Interval Project, Bjerner and colleagues, 2009, men at age 30

Men at 30 years of age · [2]

Range	What the source calls it
below 13.5 nmol/L	No name given
13.5 to 57.4 nmol/L	"reference interval"
above 57.4 nmol/L	No name given

Reference limits calculated for age 30 from 599 males in the Nordic Reference Interval Project. The limits rose with age, and the authors report that all age-related changes were statistically significant. The abstract names no assay and does not state which percentiles the limits are [2].

Nordic Reference Interval Project, Bjerner and colleagues, 2009, men at age 50

Men at 50 years of age · [2]

Range	What the source calls it
below 18.4 nmol/L	No name given
18.4 to 75.6 nmol/L	"reference interval"
above 75.6 nmol/L	No name given

Reference limits calculated for age 50 from the same 599 males. See the block for age 30 [2].

Nordic Reference Interval Project, Bjerner and colleagues, 2009, men at age 70

Men at 70 years of age · [2]

Range	What the source calls it
below 27.8 nmol/L	No name given
27.8 to 101 nmol/L	"reference interval"
above 101 nmol/L	No name given

Reference limits calculated for age 70 from the same 599 males. See the block for age 30 [2].

Braunstein and colleagues, 2011, premenopausal women

Premenopausal women with regular menstrual cycles, estimated for age 30 · [3]

Range	What the source calls it
below 18 nmol/L	No name given
18 to 86 nmol/L	"reference range"
above 86 nmol/L	No name given

The estimated 5th and 95th percentiles for a 30-year-old woman, so a tenth of the reference women fall outside them by construction. From 161 women aged 18 to 49 with normal menstrual cycles, sampled in the morning in the follicular, mid-cycle and luteal phases and measured by immunoassay. The authors report that SHBG remained relatively stable across the ages studied [3]. This page carries no range for women after menopause.

What has been shown to move it

Shown to lower it1

SARMsGrey marketModerateHow often is not known

Lower testosterone and HDL cholesterol

Shown to lower testosterone and HDL cholesterol in healthy men, more at higher doses. Levels returned to baseline after stopping.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: LGD-4033 lowered total testosterone, sex hormone-binding globulin, HDL cholesterol and triglycerides in a dose-dependent way. FSH and free testosterone fell at the highest dose. Levels returned to baseline after stopping [1]. The 2026 review reports suppression of testosterone, sex hormone-binding globulin and HDL cholesterol across randomized trials, with reversible rises in liver enzymes for some compounds [4].
Population: 76 healthy young men over 21 days and 5 weeks of follow-up [1]; trials summarized in a review [4].
Sources: [1], [4]
Caveats: Trial doses were lower and shorter than the stacked, unmonitored use the review describes [4].

Shown to raise it5

Hormonal birth controlModerateStudied in womenHow often is not known

Lower testosterone and higher SHBG

Shown to lower total testosterone and cut free testosterone by about 61% in healthy women on combined pills, while SHBG rose about 99 nmol/L.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: Total testosterone fell (MD -0.49 nmol/L, 95% CI -0.55 to -0.42), free testosterone fell 61% (relative level 0.39), and SHBG rose (MD 99.08 nmol/L, 95% CI 86.43 to 111.73). Ethinyl estradiol dose and progestin type did not change the testosterone fall, but pills with second-generation progestins or 20 to 25 µg ethinyl estradiol raised SHBG less [7].
Population: 1,495 healthy women aged 18 to 40 in 42 studies [7].
Sources: [7]
Caveats: Half the studies were non-comparative. The clinical effects of lower androgens remain unclear [7].

InositolModerateStudied in women

Hormones and blood sugar in PCOS

Shown to lower free and total testosterone and glucose and raise SHBG in women with PCOS. Metformin did better on hirsutism.

The numbers and sources

Effect: Against placebo, inositol lowered BMI (MD -0.45), free testosterone (MD -0.41), total testosterone (MD -20.4) and glucose (MD -3.14), and raised sex-hormone-binding globulin (MD 32.1) [1]. The guideline review found benefits for some metabolic measures and none for others. Metformin did better on waist-hip ratio and hirsutism [3].
Population: 1,691 women in 26 trials [1]; 2,230 women in 30 trials [3].
Sources: [1], [3]
Caveats: Units are as reported in the abstract. The guideline review rated BMI evidence very uncertain [3].

Keto dietModerateStudied in women

Reproductive hormones and cycles in PCOS

Shown in pooled studies, mostly before and after the diet, to lower LH and testosterone and raise SHBG in women with PCOS. Against other diets, androgen results were inconsistent.

Compared with before the diet, in the same women [25][23][21][22]; other diets [21]; low-calorie diets [22]

The numbers and sources

Effect: After 45 days or more on a ketogenic diet, the LH to FSH ratio fell (d -0.851, 95% CI -1.015 to -0.686), free testosterone fell (d -0.223, 95% CI -0.328 to -0.119) and SHBG rose (d 9.086, 95% CI 3.379 to 14.792) [25]. A second review found lower LH, LH to FSH ratio, free and total testosterone and higher SHBG and FSH after the diet [23]. Menstrual cycle length shortened and LH fell from before to after the diet, while androgen results against other diets were inconsistent [21]. In 2 RCTs, LH was lower than on low-calorie diets [22].
Population: Women with PCOS in single- or double-arm clinical trials [25]; 7 studies [23]; 15 studies, 10 pooled [21]; 10 studies including 3 RCTs [22].
Sources: [25], [23], [21], [22]
Caveats: Diets lasted weeks to months, and all reviews were limited by small, mostly uncontrolled studies. Pregnancy and live birth data were too scarce to pool [23].

Letrozole and clomipheneModerateStudied in men

Testosterone in men: clomiphene

Shown to raise total testosterone in men with low testosterone, by about 274 ng/dL against placebo, in pooled trials of clomiphene or enclomiphene.

Compared with placebo [13]; testosterone gel [13]; human chorionic gonadotropin [13]; the same men before treatment [14]

Across 17 studies pooled in a second review, total testosterone rose during treatment (pooled estimate 2.60, 95% CI 1.82 to 3.38, unit not given in the abstract), along with free testosterone, LH, FSH, SHBG and estradiol.

The numbers and sources

Effect: Against placebo, clomiphene or enclomiphene raised total testosterone by 273.76 ng/dL (95% CI 191.87 to 355.66, I² 89%), LH by 4.66 IU/L and FSH by 4.59 IU/L. Total testosterone did not differ from testosterone gel. Levels were higher than with hCG alone [13]. Across 17 studies pooled in a second review, total testosterone rose during treatment (pooled estimate 2.60, 95% CI 1.82 to 3.38, unit not given in the abstract), along with free testosterone, LH, FSH, SHBG and estradiol. Symptom scores on the Androgen Deficiency in Aging Males questionnaire improved. Side effects were reported by fewer than 10% of study populations and no serious adverse events were reported [14].
Population: Men with functional hypogonadism in randomized trials [13]. 1,642 men with hypogonadism in 19 studies, 4 randomized and 15 observational, treated for 1.5 to 52 months [14].
Sources: [13], [14]
Caveats: The first review pooled clomiphene with enclomiphene and heterogeneity was high [13]. The second rests mostly on before-and-after observational studies [14]. Use in men is off-label in the US [1]. Neither abstract reports fractures, heart events or fertility.

Low-carb dietModerateStudied in women

Testosterone and SHBG in PCOS

In one meta-analysis, testosterone fell and SHBG rose more than on a regular diet only in trials of women with PCOS lasting longer than 4 weeks.

Compared with a regular diet with about 45% of energy from carbohydrate [13]

The numbers and sources

Effect: In trials of low-carbohydrate diets lasting more than 4 weeks, testosterone fell (SMD -1.79, 95% CI -3.22 to -0.36), SHBG rose (MD 5.98, 95% CI 3.51 to 8.46) and FSH rose (MD 0.39) more than on a regular diet. Diets low in both fat and carbohydrate raised SHBG and FSH more than higher-fat versions [13].
Population: 327 women with PCOS in 8 RCTs [13].
Sources: [13]
Caveats: These are subgroup results by trial length, from small trials. The abstract does not report an overall pooled effect on testosterone or SHBG [13].

Tested, and not shown to change it5

Soy foodsStrongStudied in men

Testosterone and estrogen in men

Not shown to change total or free testosterone, estrogen or SHBG in men eating soy foods, soy protein or isoflavones, in two pooled analyses of clinical studies.

Compared with placebo groups [15]; values before intake in the same men, in simpler models [15]; control and baseline values the abstract does not detail [14]

The numbers and sources

Effect: Across 41 studies, soy protein or isoflavone intake had no significant effect on total testosterone, free testosterone, estradiol, estrone or SHBG, regardless of the statistical model, dose or study duration [14]. An earlier analysis of 15 placebo-controlled treatment groups, and 36 groups in simpler models, found no effect on testosterone, SHBG, free testosterone or free androgen index [15].
Population: Total testosterone measured in 1,753 men, free testosterone in 752 and estradiol in 1,000 [14]. Adult men in 32 reports [15].
Sources: [14], [15]
Caveats: Several authors of both analyses overlap. Studies included isoflavone extracts from soy or red clover as well as soy foods [14][15].

N-acetylcysteineModerateStudied in women

Polycystic ovary syndrome

Shown to raise progesterone and endometrial thickness in women with PCOS. These are hormone and ultrasound measures, not pregnancy rates.

Estradiol, SHBG and FSH did not differ.

The numbers and sources

Effect: Across 22 studies (2,515 women), NAC was associated with higher progesterone (SMD 0.95, 95% CI 0.13 to 1.77) and thicker endometrium (SMD 0.58, 95% CI 0.10 to 1.06) than placebo and other drugs. Estradiol, SHBG and FSH did not differ [7].
Population: Women with PCOS, compared with placebo, metformin or clomiphene [7].
Sources: [7]
Caveats: Hormone and ultrasound measures, not pregnancy or live birth rates. Comparators were mixed.

Vitamin DModerateStudied in men

Testosterone in men

Not shown to change testosterone in adult men.

The numbers and sources

Effect: Across 11 trial comparisons, vitamin D did not change total testosterone (MD 0.47 nmol/L, 95% CI -0.50 to 1.44, I² 24.1%), SHBG (MD 0.27 nmol/L, 95% CI -2.14 to 2.68) or free androgen index (MD -0.37, 95% CI -4.28 to 3.55) [32].
Population: Adult men in RCTs [32].
Sources: [32]
Caveats: GRADE certainty was low for total testosterone, SHBG and free androgen index, and very low for calculated free testosterone [32].

Vitamin DModerateStudied in women

Excess hair and androgens in PCOS

Not shown to change hair growth scores or SHBG in women with PCOS in one review. Total testosterone fell slightly against placebo.

Compared with placebo [73]; placebo, metformin, short-acting contraceptives, ovulation drugs or assisted reproduction without vitamin D [69]

The numbers and sources

Effect: Across 13 RCTs (840 women), modified Ferriman-Gallwey hair scores (MD 0.04, 95% CI -0.79 to 0.86) and SHBG (MD 1.33, 95% CI -2.70 to 5.36) did not differ from placebo. Total testosterone fell by 0.17 (95% CI 0.05 to 0.29) and serum vitamin D rose by 17.81 [73]. A review of add-on vitamin D in women seeking pregnancy also found lower androgen levels (MD -2.31, 95% CI -3.51 to -1.11) [69].
Population: 840 women with PCOS in 13 RCTs [73]; 1,961 women with PCOS in 20 RCTs [69].
Sources: [73], [69]
Caveats: The abstract of [73] does not give units for testosterone or vitamin D. The hair score result rests on one review.

D-aspartic acidLimitedStudied in menHow often is not known

Lower testosterone at 6 g a day

One small trial found 6 g a day for 14 days lowered total and free testosterone in 24 trained men. A 12-week trial found no change.

Estradiol, SHBG and albumin did not change.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: In trained men, 6 g a day for 14 days lowered total testosterone (p = 0.03), and free testosterone was lower than with the flour placebo (p = 0.005). Estradiol, SHBG and albumin did not change [3].
Population: 24 resistance-trained men [3].
Sources: [3]
Caveats: The 12-week trial at the same dose found no change in testosterone [4].

Type in your own result

How it compares with the reference method

Matched the reference method1

Limited

Agreement between immunoassays

One study found three SHBG immunoassays agreed within 7% of each other in samples from 219 adults.

The numbers and sources

Compared with: Each other, on the same serum samples
Effect: SHBG was measured with three immunoassays, from Roche, Abbott and Siemens. The largest difference was 7%, between the Abbott and Siemens assays, and free testosterone calculated from the results differed by at most 3%. When the authors shifted SHBG by 15% to imitate differences between laboratories, the share of people classed as having low or high androgen levels changed, by an amount that depended on the formula used [17].
Population: Serum samples from 113 men and 106 women [17].
Sources: [17]
Caveats: One study of three assays. The authors conclude that the choice of assay is not expected to greatly influence decisions, while variation between laboratories and the choice of formula might [17].

Mixed results1

Limited

Variation from one test to the next

Limited evidence: two hormone results from the same man differed by more than 18% to 28% about half the time, across eleven measures that included SHBG.

The numbers and sources

Compared with: The same person's earlier result
Effect: In men sampled up to six times over 6 months, the within-person variation of eleven hormone measures, SHBG among them, implied that two measurements would differ by more than 18% to 28% about half the time and by more than 27% to 54% about a quarter of the time, depending on the hormone [18]. In 11 controls without polycystic ovary syndrome sampled ten times at 4-day intervals, mean SHBG was 57.6 nmol/L and the mean variation within a person was 6.3 nmol/L [19].
Population: 132 men aged 30 to 79 in Boston [18]. 12 women with polycystic ovary syndrome and 11 controls matched for age and weight [19].
Sources: [18], [19]
Caveats: The percentage ranges cover all eleven hormone measures, and the abstract does not give the figure for SHBG alone [18]. The second study is small [19].

What studies tie it to

Linked in research5

Moderate

Type 2 diabetes

Shown in genetic and cohort studies to go with less type 2 diabetes at higher levels, in both women and men.

The numbers and sources

Effect: In a meta-analysis of prospective studies, women with SHBG above 60 nmol/L had an 80% lower risk of type 2 diabetes than women at or below it (relative risk 0.20, 95% CI 0.12 to 0.30), and men above 28.3 nmol/L had a 52% lower risk than men at or below it (0.48, 0.33 to 0.69) [4]. In a nested case-control study of postmenopausal women, the odds ratios for the second to fourth quarters of SHBG against the lowest were 0.16 (0.08 to 0.33), 0.04 (0.01 to 0.12) and 0.09 (0.03 to 0.21), and the finding was replicated in men (highest against lowest quarter 0.10, 0.03 to 0.36). In the same study's genetic analysis, each standard deviation of genetically higher SHBG had a predicted odds ratio of 0.28 (0.13 to 0.58) in women and 0.29 (0.15 to 0.58) in men [5]. A second genetic study found the SHBG-raising allele of one common variant associated with less type 2 diabetes (odds ratio 0.94, 0.91 to 0.97) [6].
Population: 43 prospective and cross-sectional studies with 6,974 women and 6,427 men [4]. 359 women with new type 2 diabetes and 359 controls, then 170 men with it and 170 controls [5]. 27,657 people with type 2 diabetes and 58,481 controls from 15 studies [6].
Sources: [4], [5], [6]
Caveats: The cohort findings are observational. Genetic estimates describe lifelong differences, not the effect of changing the level later in life.

Moderate

Fractures in older adults

Linked to more fractures at higher levels in older adults, 18% more for each 1 µg/dL higher SHBG across 16 pooled studies.

The numbers and sources

Effect: In a meta-analysis of 16 observational studies, each 1 µg/dL higher SHBG had a relative risk of fracture of 1.18 (95% CI 1.11 to 1.26), with 1.22 (1.12 to 1.33) in men and 1.15 (1.05 to 1.26) in women. By site it was 1.43 (1.23 to 1.65) for hip fracture and 1.31 (1.12 to 1.54) for vertebral fracture [7]. In women aged 65 or older, SHBG of 1.0 µg/dL (34.7 nmol/L) or higher had a relative risk of 2.0 for hip fracture (1.1 to 3.9) and 2.3 for vertebral fracture (1.2 to 4.4) [8]. In older Swedish men, each standard deviation higher SHBG had a hazard ratio for fracture of 1.41 (1.22 to 1.63) [9].
Population: 16 observational studies of older adults [7]. 133 women with later hip fracture and 138 with later vertebral fracture, compared with randomly selected women from the same cohort [8]. 2,639 men with a mean age of 75 [9].
Sources: [7], [8], [9]
Caveats: Observational. One source prints 1.0 µg/dL as 34.7 nmol/L [8]. SHBG rises with age in men [2], and the meta-analysis authors call for study of the mechanisms behind the link [7].

Moderate

Death from any cause in men

Linked to fewer deaths in men at lower levels: 15% lower mortality in the bottom fifth of SHBG than the top fifth in pooled cohorts.

The numbers and sources

Effect: In pooled individual data from cohorts of community-dwelling men, the bottom fifth of SHBG (median 20.6 nmol/L) had lower mortality from any cause than the top fifth (median 68.3 nmol/L), with an adjusted hazard ratio of 0.85 (95% CI 0.77 to 0.95). For cardiovascular death it was 0.81 (0.65 to 1.00) [10].
Population: 9 cohorts with individual data covering 255,830 participant-years, plus 11 studies with summary estimates [10].
Sources: [10]
Caveats: Observational, with differences between studies and imputed missing data. The direction runs opposite to the diabetes findings, where lower SHBG went with more disease [10][4].

Moderate

Age, body weight and thyroid status

Linked in cohort and genetic studies to age, body weight and thyroid status: higher with age in men and with an overactive thyroid, lower at a higher body mass index.

The numbers and sources

Effect: In pooled individual data from 21,074 men, SHBG was directly associated with age and inversely associated with body mass index [13]. In a population-based cohort, SHBG rose in a straight line with age in men and followed a U-shaped pattern with age in women, and people with more cardiovascular risk factors had lower levels. Total testosterone and triglycerides explained 46.2% of the variation in men. Total testosterone, triglycerides, body mass index and fasting insulin explained 31.8% in women [14]. Among women with thyroid disorders, mean SHBG differed between groups because of the group with an overactive thyroid, where thyroid hormone levels were the main correlates. In the other groups the main correlates were body mass index and age [15]. In a genetic analysis, each standard deviation of genetically higher thyroid stimulating hormone went with SHBG 1.332 nmol/L lower (95% CI 0.717 to 1.946). Genetic predisposition to an underactive thyroid went with lower SHBG and to an overactive thyroid with higher SHBG [16].
Population: 9 cohorts of community-dwelling men with individual data [13]. 3,264 men and women in a population-based cohort [14]. Women with overt or subclinical thyroid disorders [15]. Up to 194,174 women and 167,020 men in UK Biobank [16].
Sources: [13], [14], [15], [16]
Caveats: These are associations seen across people. The cohort analyses are cross-sectional and do not show that a change in weight alters a person's SHBG. The genetic analysis found no association between thyroid function and sexual function [16].

Moderate

Polycystic ovary syndrome

Linked to lower SHBG in women with polycystic ovary syndrome than in women without it, in a meta-analysis of 62 studies and in a genetic study.

The numbers and sources

Effect: In a meta-analysis, SHBG was lower in women with PCOS than in controls (standardized mean difference -0.83, 95% CI -1.01 to -0.64), with very high heterogeneity (I² 93.9%) [20]. In a Mendelian randomization study using 289 gene variants tied to SHBG, genetically higher SHBG went with lower odds of PCOS (odds ratio 0.56, 95% CI 0.39 to 0.78) [21]. In a meta-analysis of insulin clamp studies, lower SHBG went with lower insulin sensitivity in women with PCOS (-10%, 99% CI ±10%), an association not explained by body mass index [22].
Population: 62 studies [20]. Published genome-wide data on SHBG and on PCOS [21]. 28 clamp studies of premenopausal women with PCOS and controls [22].
Sources: [20], [21], [22]
Caveats: Observational, apart from the genetic study. The meta-analysis abstract does not say whether body mass index was matched or adjusted for [20], and SHBG is lower at a higher body mass index (see the block on age, body weight and thyroid status). Genetic estimates describe lifelong differences, not the effect of changing the level later in life [21].

Mixed results1

ModerateStudied in women

Breast cancer

Shown in a genetic study to go with 6% less breast cancer overall per 25 nmol/L higher SHBG, and with more estrogen receptor negative disease.

The numbers and sources

Effect: In a Mendelian randomization analysis, each 25 nmol/L of genetically higher SHBG had an odds ratio of 0.94 for breast cancer overall (95% CI 0.90 to 0.98), 0.92 for estrogen receptor positive disease (0.87 to 0.97) and 1.09 for estrogen receptor negative disease (1.00 to 1.18) [11]. In pooled prospective studies of postmenopausal women, higher SHBG was associated with a decrease in breast cancer risk (P for trend 0.041) [12].
Population: 122,977 breast cancer cases and 105,974 controls in genome-wide data [11]. 663 postmenopausal women who developed breast cancer and 1,765 who did not [12].
Sources: [11], [12]
Caveats: The genetic study's authors describe the finding for estrogen receptor negative disease as new and in need of further investigation [11]. Genetic estimates describe lifelong differences.

Sources

US National Library of Medicine. SHBG Blood Test. MedlinePlus Medical Tests. Last updated January 12, 2026. https://medlineplus.gov/lab-tests/shbg-blood-test/
Bjerner J, Biernat D, Fosså SD, Bjøro T. Reference intervals for serum testosterone, SHBG, LH and FSH in males from the NORIP project. Scandinavian Journal of Clinical and Laboratory Investigation. 2009. https://doi.org/10.3109/00365510903380886
Braunstein GD, Reitz RE, Buch A, et al. Testosterone Reference Ranges in Normally Cycling Healthy Premenopausal Women. The Journal of Sexual Medicine. 2011. https://doi.org/10.1111/j.1743-6109.2011.02380.x
Ding EL, Song Y, Malik VS, Liu S. Sex Differences of Endogenous Sex Hormones and Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA. 2006. https://doi.org/10.1001/jama.295.11.1288
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. https://doi.org/10.1056/nejmoa0804381
Perry JRB, Weedon MN, Langenberg C, et al. Genetic evidence that raised sex hormone binding globulin (SHBG) levels reduce the risk of type 2 diabetes. Human Molecular Genetics. 2010. https://doi.org/10.1093/hmg/ddp522
Hidayat K, Du X, Shi BM. Sex hormone-binding globulin and risk of fracture in older adults: systematic review and meta-analysis of observational studies. Osteoporosis International. 2018. https://doi.org/10.1007/s00198-018-4600-z
Cummings SR, Browner WS, Bauer D, et al. Endogenous Hormones and the Risk of Hip and Vertebral Fractures among Older Women. New England Journal of Medicine. 1998. https://doi.org/10.1056/nejm199809103391104
Mellström D, Vandenput L, Mallmin H, et al. Older Men With Low Serum Estradiol and High Serum SHBG Have an Increased Risk of Fractures. Journal of Bone and Mineral Research. 2008. https://doi.org/10.1359/jbmr.080518
Yeap BB, Marriott RJ, Dwivedi G, et al. Associations of Testosterone and Related Hormones With All-Cause and Cardiovascular Mortality and Incident Cardiovascular Disease in Men: Individual Participant Data Meta-analyses. Annals of Internal Medicine. 2024. https://doi.org/10.7326/m23-2781
Dimou NL, Papadimitriou N, Gill D, et al. Sex hormone binding globulin and risk of breast cancer: a Mendelian randomization study. International Journal of Epidemiology. 2019. https://doi.org/10.1093/ije/dyz107
Key T, Appleby P, Barnes I, Reeves G, Endogenous Hormones and Breast Cancer Collaborative Group. Endogenous Sex Hormones and Breast Cancer in Postmenopausal Women: Reanalysis of Nine Prospective Studies. Journal of the National Cancer Institute. 2002. https://doi.org/10.1093/jnci/94.8.606
Marriott RJ, Murray K, Adams RJ, et al. Factors Associated With Circulating Sex Hormones in Men: Individual Participant Data Meta-analyses. Annals of Internal Medicine. 2023. https://doi.org/10.7326/m23-0342
Aribas E, Kavousi M, Laven JSE, Ikram MA, Roeters van Lennep JE. Aging, Cardiovascular Risk, and SHBG Levels in Men and Women From the General Population. The Journal of Clinical Endocrinology and Metabolism. 2021. https://doi.org/10.1210/clinem/dgab470
Brenta G, Schnitman M, Gurfinkiel M, et al. Variations of Sex Hormone-Binding Globulin in Thyroid Dysfunction. Thyroid. 1999. https://doi.org/10.1089/thy.1999.9.273
Kjaergaard AD, Marouli E, Papadopoulou A, et al. Thyroid function, sex hormones and sexual function: a Mendelian randomization study. European Journal of Epidemiology. 2021. https://doi.org/10.1007/s10654-021-00721-z
Walravens J, Adaway J, Reyns T, et al. Variability in SHBG assays and the effect thereof on calculated estimates of free testosterone. Annals of Clinical Biochemistry. 2025. https://doi.org/10.1177/00045632251350676
Brambilla DJ, O'Donnell AB, Matsumoto AM, McKinlay JB. Intraindividual variation in levels of serum testosterone and other reproductive and adrenal hormones in men. Clinical Endocrinology. 2007. https://doi.org/10.1111/j.1365-2265.2007.02976.x
Jayagopal V, Kilpatrick ES, Jennings PE, Hepburn DA, Atkin SL. The Biological Variation of Testosterone and Sex Hormone-Binding Globulin (SHBG) in Polycystic Ovarian Syndrome: Implications for SHBG as a Surrogate Marker of Insulin Resistance. The Journal of Clinical Endocrinology and Metabolism. 2003. https://doi.org/10.1210/jc.2002-020557
Deswal R, Yadav A, Dang AS. Sex hormone binding globulin - an important biomarker for predicting PCOS risk: A systematic review and meta-analysis. Systems Biology in Reproductive Medicine. 2018. https://doi.org/10.1080/19396368.2017.1410591
Guo X, Chen L, He J, et al. Genetically predicted high sex hormone binding globulin was associated with decreased risk of polycystic ovary syndrome. BMC Women's Health. 2024. https://doi.org/10.1186/s12905-024-03144-6
Cassar S, Misso ML, Hopkins WG, et al. Insulin resistance in polycystic ovary syndrome: a systematic review and meta-analysis of euglycaemic-hyperinsulinaemic clamp studies. Human Reproduction. 2016. https://doi.org/10.1093/humrep/dew243

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