From the Guidelines
Management of elevated sex hormone-binding globulin (SHBG) levels should focus on addressing the underlying cause, with lifestyle modifications being the primary approach, as there is no direct treatment for elevated SHBG levels. The most recent and highest quality study, 1, published in 2025, highlights the importance of understanding the underlying causes of elevated SHBG levels, which can include hyperthyroidism, oral contraceptives, or hormone replacement therapy.
Key Considerations
- Maintaining a healthy weight is crucial, as obesity is associated with lower SHBG levels 1.
- Regular exercise, particularly resistance training, can help normalize SHBG levels.
- Dietary changes, such as reducing sugar intake and increasing fiber consumption, may be beneficial.
- For those with elevated SHBG due to hyperthyroidism, treating the thyroid condition with medications like methimazole or propylthiouracil is essential.
- If oral contraceptives or hormone replacement therapy are causing high SHBG, adjusting or changing these medications may be necessary.
Monitoring and Treatment
- Regular monitoring of hormone levels, including free testosterone and estradiol, is important as elevated SHBG can reduce bioavailable sex hormones, potentially causing symptoms like decreased libido, fatigue, or menstrual irregularities.
- Certain medications like danazol (200-400 mg daily) can lower SHBG levels but are rarely used specifically for this purpose due to side effects.
- Supplementation with vitamin D (1000-2000 IU daily) may help if deficiency is present.
- The study 1 from 2021 also emphasizes the importance of understanding the relationship between SHBG levels and liver disease, highlighting that SHBG levels can be affected by liver function.
Conclusion Not Applicable
Instead, the focus should be on applying the above considerations to manage elevated SHBG levels effectively, prioritizing lifestyle modifications and addressing underlying causes.
From the Research
Elevated Sex Hormone-Binding Globulin (SHBG) Levels
Elevated SHBG levels can be associated with various conditions, including hyperthyroidism, liver disorders, and certain types of cancer. The management of elevated SHBG levels depends on the underlying cause of the elevation.
Causes of Elevated SHBG Levels
- Hyperthyroidism: Elevated SHBG levels have been observed in patients with hyperthyroidism 2, 3.
- Liver disorders: SHBG levels can be elevated in patients with liver disease, such as non-alcoholic fatty liver disease (NAFLD) 4.
- Certain types of cancer: Elevated SHBG levels have been observed in patients with breast and prostate cancer 5.
Management of Elevated SHBG Levels
- Treatment of underlying conditions: Management of elevated SHBG levels involves treating the underlying condition causing the elevation. For example, treatment of hyperthyroidism with antithyroid medications or radioiodine can help normalize SHBG levels 2, 3.
- Hormone replacement therapy: In some cases, hormone replacement therapy may be necessary to manage elevated SHBG levels. For example, androgen replacement therapy has been shown to decrease SHBG levels in patients with hypogonadism 6.
- Monitoring and follow-up: Regular monitoring and follow-up are essential to ensure that SHBG levels return to normal after treatment of the underlying condition.
Potential Therapeutic Applications
- SHBG as a potential drug candidate: Recent studies have suggested that SHBG may have potential therapeutic applications in the management of metabolic disorders, such as NAFLD, obesity, and insulin resistance 4.