Symptoms and Treatment for Women with Elevated SHBG and Low Free Testosterone
Women with elevated Sex Hormone-Binding Globulin (SHBG) and low free testosterone commonly experience decreased libido, persistent fatigue, diminished sense of well-being, and reduced quality of life, which should be addressed through targeted hormonal evaluation and appropriate treatment options. 1
Common Symptoms
Physical Symptoms
- Decreased sexual desire (libido) and reduced response to sexual stimulation 2, 3
- Persistent unexplained fatigue 1, 4
- Reduced muscle mass and strength 5
- Decreased bone mineral density 1
- Weight changes (particularly central adiposity) 6
Psychological Symptoms
- Diminished sense of personal well-being 2, 4
- Increased anxiety and depression 2
- Reduced cognitive function 5
- Mood disturbances 5
Reproductive Symptoms
Diagnostic Approach
Laboratory Testing
- Comprehensive hormone panel including:
- SHBG levels
- Total and free testosterone (morning samples preferred)
- Estradiol
- FSH and LH 1
- Additional testing based on clinical presentation:
- Thyroid function tests (TSH, free T4)
- Liver function tests
- Nutritional assessment 1
Clinical Evaluation
- Assessment of medication use that may affect SHBG levels:
- Oral contraceptives
- Hormone replacement therapy
- Anti-obesity medications 1
- Evaluation for underlying conditions:
Treatment Options
Medication Adjustments
- Consider discontinuation or switching from oral contraceptive pills to:
- Non-hormonal contraception
- Progestin-only options 1
- For women on HRT, consider:
- Adjusting the dose
- Switching from oral to transdermal administration (which has less impact on SHBG) 1
Lifestyle Modifications
- Weight management for overweight or obese women to help normalize SHBG levels 1, 6
- Regular physical activity to improve metabolic health 1
- Calorie restriction in obese women (shown to reduce serum insulin, increase SHBG, and decrease free testosterone) 6
Hormonal Treatments
- Testosterone replacement therapy may be considered for women with symptoms of androgen deficiency 1, 4
- Available options include:
- Testosterone implants
- Testosterone creams
- Transdermal patches and sprays (in development) 4
Monitoring and Follow-up
- SHBG levels should be monitored every 3-6 months until normalized 1
- Regular assessment of:
- Sexual function
- Energy levels
- Mood
- Menstrual regularity 1
- Treatment plan should be adjusted based on clinical response and laboratory values 1
Important Considerations and Cautions
- Testosterone replacement should be monitored to maintain physiological circulating testosterone concentrations 4
- Potential adverse effects of testosterone therapy should be discussed with patients
- Long-term safety data for testosterone therapy in women is limited 4
- Treatment should be targeted at the underlying cause of elevated SHBG when possible 1
Special Populations
- Surgically menopausal women are among those most likely to experience testosterone deficiency 2
- Women with premature ovarian failure may require special consideration 5
- Age-related androgen insufficiency may occur in women in their late 30s and 40s, as well as postmenopausally 4
Recognizing and addressing elevated SHBG and low free testosterone in women is essential for improving quality of life and preventing long-term health consequences related to hormonal imbalances.