Can a male with a Sex Hormone-Binding Globulin (SHBG) level of 90 reduce it to 60, and if so, how?

Can You Lower SHBG from 90 to 60?

Yes, you can likely reduce SHBG from 90 to 60 through targeted interventions addressing underlying causes, with weight loss and insulin optimization being the most effective strategies in males. 1, 2

Understanding Your Elevated SHBG

SHBG of 90 is elevated but typically reflects acquired conditions rather than primary genetic disorders. 1 While genetic polymorphisms exist (Asp327Asn and TAAAA repeat variants), they account for minimal variation compared to modifiable factors. 2

Key point: The European Urology guidelines emphasize that very high SHBG is usually caused by treatable conditions, not genetics. 1

Primary Causes to Investigate

Before attempting to lower SHBG, identify the underlying driver:

Medical Conditions That Raise SHBG:

• Hyperthyroidism - Check TSH and free T4 1, 3
• Hepatic disease - Obtain liver function tests 1, 3
• HIV/AIDS - Consider testing in appropriate contexts 1
• Aging - Natural age-related increase 1, 4

Medications That Raise SHBG:

• Anticonvulsants 1, 3
• Thyroid hormone replacement (if excessive) 1, 3
• Estrogens 1, 3

Lifestyle Factors:

• Smoking - Increases SHBG 1

Evidence-Based Strategies to Lower SHBG

1. Weight Optimization (Most Effective)

Fat mass is the strongest negative determinant of SHBG levels in men. 2

• Whole body fat mass and truncal fat mass show strong inverse correlations with SHBG 2
• Weight, BMI, and body fat percentage all negatively associate with SHBG levels 2
• This relationship is mediated by adipokines: leptin (inversely correlated) and adiponectin (positively correlated) with SHBG 2

Clinical application: Even modest weight gain in lean individuals or preventing further weight loss can lower SHBG. 2

2. Insulin and Glucose Optimization

• Insulin and glucose levels are negative determinants of SHBG 2, 5
• Insulin directly inhibits SHBG secretion by hepatocytes 5
• Low SHBG serves as a marker of insulin resistance, but the reverse is also true - improving insulin sensitivity raises SHBG 5

Strategy: If you're lean with high SHBG, increasing caloric intake (particularly carbohydrates) to optimize insulin levels may help lower SHBG. 2

3. IGF-1 Axis Modulation

• IGF-1 and IGF-BP3 are negatively associated with SHBG levels 2
• Resistance training and adequate protein intake increase IGF-1, which may help lower SHBG 2

4. Treat Underlying Medical Conditions

The European Urology guidelines state that treating the underlying condition is the most effective approach. 1

• If hyperthyroid: Treat to normalize thyroid function 1, 3
• If hepatic disease: Address liver pathology 1
• Review and discontinue medications that raise SHBG if medically appropriate 1

Pharmacological Considerations

Medications that decrease SHBG include: 1

• Growth hormone
• Glucocorticoids
• Testosterone or anabolic steroids

Critical caveat: The European Urology guidelines explicitly state these should only be used when clinically indicated for other conditions, not solely to lower SHBG. 1 Using testosterone to lower SHBG creates a feedback loop that may worsen your hormonal profile.

Clinical Monitoring

Assess Your Free Testosterone Status

With SHBG of 90, you must measure free testosterone, not just total testosterone. 6, 1

• High SHBG binds more testosterone, reducing free testosterone despite normal total levels 1
• The pituitary senses free testosterone, not total testosterone 1
• Free testosterone index (total testosterone/SHBG ratio) <0.3 indicates functional hypogonadism 1

Important finding: Research shows that in healthy men with intact pituitary function, higher SHBG is associated with higher total testosterone but NOT with lower free testosterone. 4 This suggests the body compensates by producing more testosterone when SHBG rises. 4

What to Monitor:

• Morning total testosterone (8-10 AM) 6
• Free testosterone by equilibrium dialysis 6
• SHBG levels 6
• LH and FSH if testosterone is low 6

Realistic Expectations

A reduction from 90 to 60 (33% decrease) is achievable through lifestyle modification in most cases. 2 The magnitude of SHBG reduction correlates with:

• Degree of weight/fat mass change 2
• Improvement in insulin sensitivity 2, 5
• Resolution of underlying medical conditions 1

Common Pitfalls to Avoid

• Don't use testosterone therapy solely to lower SHBG - This is not indicated and may worsen your hormonal balance 1
• Don't ignore thyroid function - Hyperthyroidism is a common reversible cause 1, 3
• Don't rely on total testosterone alone - Always measure free testosterone when SHBG is elevated 6, 1
• Don't assume it's genetic - Acquired causes are far more common and treatable 1

Practical Algorithm

1. Screen for underlying causes: TSH, liver function tests, medication review 1
2. Assess body composition: If lean, consider controlled weight gain; if overweight, this is less applicable 2
3. Optimize metabolic health: Resistance training, adequate caloric intake, optimize insulin sensitivity 2
4. Treat identified conditions: Normalize thyroid function, address liver disease, discontinue offending medications 1
5. Monitor response: Recheck SHBG, total and free testosterone in 3-6 months 6