From the Guidelines
Elevated sex hormone binding globulin (SHBG) levels should be a cause for concern as they can indicate underlying liver disease, particularly in the context of chronic liver disease, where SHBG levels can rise due to increased estrogen stimulation, potentially leading to hormonal imbalances and symptoms such as erectile dysfunction, oligospermia, and feminization in men, and menstrual irregularities and infertility in women. SHBG is a protein produced in the liver that binds to sex hormones like testosterone and estrogen, regulating their bioavailability in the bloodstream 1. High SHBG levels may be associated with hypogonadotropic hypogonadism in men with advanced liver disease, leading to low testosterone levels and increased peripheral conversion of androgens to estrogen 1. In women with advanced liver disease, altered estrogen metabolism and disruption of the hypothalamic-pituitary axis can lead to anovulation, amenorrhea, and infertility 1.
Some key points to consider when evaluating elevated SHBG levels include:
- The underlying cause of elevated SHBG, such as liver disease, hyperthyroidism, or estrogen excess
- The potential impact on hormone balance and symptoms, such as decreased libido, erectile dysfunction, or menstrual irregularities
- The importance of evaluating thyroid function, liver function, nutritional status, and hormone balance in individuals with elevated SHBG
- The role of lifestyle modifications, such as maintaining a healthy weight, balanced nutrition, and appropriate exercise, in normalizing SHBG levels
- The need for regular monitoring of both SHBG and free hormone levels to provide better insight into the actual hormonal status 1.
In the context of chronic liver disease, it is essential to consider the potential effects of elevated SHBG on hormonal balance and overall health, and to address the underlying cause of elevated SHBG levels to mitigate these effects 1.
From the Research
Elevated Sex Hormone Binding Globulin (SHBG) Levels
Elevated SHBG levels can be associated with various clinical disorders, including:
- Obesity
- Metabolic syndrome
- Polycystic ovary syndrome (PCOS)
- Osteoporosis
- Breast and prostate cancer 2 SHBG levels can also be affected by certain endocrine disorders that impact tissues involved in sex hormone regulation.
Association with Specific Conditions
- In men with heart failure and type 2 diabetes, elevated SHBG levels may have an independent adverse impact on left ventricular ejection fraction (LVEF) 3
- In elderly women with Alzheimer's disease, SHBG levels were found to be 20% higher compared to controls 4
- Low SHBG levels have been linked to PCOS, and serum SHBG levels may be useful as a diagnostic biomarker and therapeutic target for managing women with PCOS 5, 6
Clinical Significance
- SHBG can serve as a marker of certain pathological states, and its value expands to the area of clinical medicine 2
- Therapeutic interventions that improve SHBG levels in PCOS women may reduce PCOS-associated complications 5
- Further research is needed to clarify the cause and consequences of elevated SHBG levels in various clinical contexts 4