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SHBG (Sex Hormone Binding Globulin)

SHBG in women: testosterone, the cycle and excessive hair growth

SHBG is a protein from the liver that according to the NVKC binds testosterone and oestradiol strongly and takes them along through the blood in an inactive state. According to the NVKC, women make mainly oestradiol in the ovaries and a little testosterone in the ovaries and the adrenal gland, and according to the NVKC oestradiol stimulates the production of SHBG.

According to the NVKC, in women about 75% of testosterone is normally attached to SHBG; if SHBG is raised, according to the NVKC probably less testosterone is freely available than the total test suggests, and with a lowered SHBG probably more. Only a blood test shows the SHBG.

Certe uses 32 to 128 nmol/L for women aged 19 to 49 and 27 to 128 nmol/L for women older than 49.

Doctor's Assessment Included

SHBG is a protein from the liver that binds testosterone and oestradiol and carries them in an inactive form through the blood. According to the NVKC, with a raised SHBG less testosterone is probably freely available than the total testosterone level suggests.

For SHBG, Star-SHL uses 18.3 to 54.1 nmol/l for men aged 20 to 49 and 32.4 to 128 nmol/l for women aged 20 to 49; Certe and Diagnostiek voor U give, for ages 19 to 49, 18 to 54 nmol/L for men and 32 to 128 nmol/L for women.
According to the NVKC, SHBG reference values depend on the test method, and a result should be compared with the reference values of the laboratory that performed the test.
According to MedlinePlus, a low SHBG may be related to an underactive thyroid, type 2 diabetes or insulin resistance and obesity, among others, and a high SHBG to liver disease and an overactive thyroid, among others.

Reference Ranges

See the value that applies to you:

Age years

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This range also depends on context such as cycle phase or sample material; the highlighted rows apply to your group.

Your reference range

nmol/l

27,1 128 nmol/l

Reference ranges by group, in nmol/l
Sex	Age	Reference range (nmol/l)	Relative scale
Female	· 20–49 years	32,4–128 nmol/l	32,4 128
Female	· 50 years and older	27,1–128 nmol/l	27,1 128

27,1 128 nmol/l

Package-insert value: 5th-95th percentile per subgroup (n = 241 men 20-49 years; 174 men 50 years and older; 166 women 20-49 years; 177 women 50 years and older), with fasting blood drawn between 06:30 and 14:00. The reference cohort consisted of non-pregnant adults with a BMI of 30 or lower who used no contraception or relevant medication. A hormone reference value is assay-specific; these values apply to the Roche Elecsys method (CE package insert). Important for interpretation: SHBG is linked to body composition. Weight, BMI and waist-to-hip ratio are inversely related to SHBG, and a lowered SHBG is seen with overweight, insulin resistance and hypothyroidism. The pill, pregnancy and hyperthyroidism raise SHBG instead, and hormone therapy after menopause changes SHBG depending on how it is given. If you use contraception or hormone therapy, or are pregnant, this reference value does not apply to you.

Source: Roche Diagnostics Reference population: Roche reference cohort (Elecsys SHBG package insert CE, study CIM 000669; fasting, BMI 30 or lower, not pregnant, no contraception)

Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.

Check your own value

SHBG (Sex Hormone Binding Globulin): what Dutch laboratories use

Reference ranges by group, in nmol/l
Laboratory	Group	Reference value (nmol/l)	Relative scale
Star-shl	· Female · 20–49 years	32.4–128.0 nmol/l	32.4 128
Star-shl	· Female · 50 years and older	27.1–128.0 nmol/l	27.1 128
Unilabs	· Female · 17 years and older	20–155 nmol/l	20 155
Certe	· Female · 19–49 years	32–128 nmol/L	32 128
Certe	· Female · 49 years and older	27–128 nmol/L	27 128
Diagnostiek voor U	· Female · 19–49 years	32–128 nmol/L	32 128
Diagnostiek voor U	· Female · 50 years and older	27–128 nmol/L	27 128

0 170.5 nmol/l

Source: Star-shl

Source: Unilabs

Source: Certe

Source: Diagnostiek voor U

Each value as the laboratory itself publishes it, retrieved in 2026.

SHBG (Sex Hormone Binding Globulin): what this test measures

Laboratories report the concentration of the liver protein SHBG in the blood in nmol/L. Unilabs uses 20 to 155 nmol/l for women older than 17, and Diagnostiek voor U gives 27 to 128 nmol/L for women aged 50 and over.

SHBG (Sex Hormone Binding Globulin): why this value matters

According to the NVKC, SHBG is used in particular to show excessive activity of male sex hormone in women with cycle disorders or excessive hair growth, because in them the total testosterone level does not always reflect the free testosterone. According to the NVKC, the combination of SHBG and testosterone matters especially in women, because women, compared with men, have a low testosterone and a high SHBG.

SHBG (Sex Hormone Binding Globulin): how the blood test works

Referral: No GP referral needed. After the order we arrange the referral through ZorgDomein, within one business day; orders after 17:00 or at the weekend start on the next business day. ZorgDomein emails a barcode, and that barcode is what the draw site needs.
The draw: A blood draw from a vein in the arm, at a partner laboratory's draw site. No home kit, no finger prick.
Where: 650+ draw sites run by independent laboratories across the Netherlands. Draw sites

SHBG (Sex Hormone Binding Globulin): how to prepare

Preferably in the morning
Recommended

A morning draw makes this value easiest to compare with its reference range. Plan the draw before 10:00 if you can.

Water is always fine. Drink as usual beforehand, it makes the draw easier.
Take your usual medication, unless your own doctor told you otherwise.

SHBG (Sex Hormone Binding Globulin): when is testing worthwhile?

According to MedlinePlus, an SHBG test may be needed in women with symptoms that may fit too much testosterone, such as too much hair growth on the face and body, a deeper voice, irregular or absent periods, acne, weight gain or fertility problems. According to MedlinePlus, an SHBG test alone cannot diagnose polycystic ovary syndrome (PCOS), a condition of the female reproductive system, but it can help with the diagnosis together with other results.

SHBG (Sex Hormone Binding Globulin): symptoms of a high or low value

Low Levels

According to MedlinePlus, a low SHBG may be related to PCOS, polycystic ovary syndrome, in women, and besides that to an underactive thyroid, type 2 diabetes or insulin resistance and obesity, among others. According to the NVKC, with a lowered SHBG more testosterone is probably freely available than the total testosterone level suggests.

High Levels

According to MedlinePlus, a high SHBG may be related to oestrogen-containing medicines in women, such as the contraceptive pill or menopausal hormone therapy. Other possible links MedlinePlus names are liver disease, an overactive thyroid and certain eating disorders.

SHBG (Sex Hormone Binding Globulin): causes of a low or high value

What lowers the value

Underactive thyroid

An underactive thyroid may be related to a low SHBG.
Type 2 diabetes or insulin resistance

Type 2 diabetes or insulin resistance may be related to a low SHBG.
Obesity

Obesity or being very overweight may be related to a low SHBG.
Overuse of steroid medicines or anabolic steroids

Overuse of steroid medicines and/or anabolic steroids may be related to a low SHBG.
PCOS in women

In women, polycystic ovary syndrome (PCOS) may be related to a low SHBG.

What raises the value

Liver disease

Liver disease may be related to a high SHBG.
Overactive thyroid

An overactive thyroid may be related to a high SHBG.
Certain eating disorders

Certain eating disorders may be related to a high SHBG.
Oestrogen-containing medicines in women

In women, oestrogen-containing medicines such as the contraceptive pill or menopausal hormone therapy may be related to a high SHBG.
Reduced sex-hormone production in men

In men, reduced production of sex hormones may be related to a high SHBG.

SHBG (Sex Hormone Binding Globulin): lifestyle and this value

Discuss an abnormal SHBG with your GP. MedlinePlus advises not to stop hormone-containing medicines such as the pill unless the doctor says so, even though such medicines can affect SHBG.

SHBG (Sex Hormone Binding Globulin): frequently asked questions

Which SHBG reference value applies after the menopause?

For the SHBG result of women older than 40, Unilabs adds a post-menopausal reference value of 26 to 120 nmol/l.

SHBG (Sex Hormone Binding Globulin): sources

Roche Diagnostics. Elecsys SHBG, Method Sheet 03052001500 V 15.0, 2024-11 (CE). Material 03052001190 (cobas e 411 / e 601 / e 602). Verwachte waarden: 5e-95e percentiel, studie CIM 000669 (415 mannen, 343 vrouwen; nuchter, BMI <= 30, niet zwanger, geen anticonceptie). (retrieved 2026) elabdoc-prod.roche.com
Unilabs, Bepalingenklapper (referentiewaarden per bepaling), bepalingenklapper.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenklapper.nl
Certe, Bepalingenwijzer (referentiewaarden per bepaling), bepalingenwijzer.certe.nl, geraadpleegd 2026-10-01 (retrieved 2026) bepalingenwijzer.certe.nl
Diagnostiek voor U, eLabgids (Referentiewaarden DvU), diagnostiek.getincontrol.eu, geraadpleegd 2026-10-01 (retrieved 2026) diagnostiek.getincontrol.eu
Star-shl, Labbepalingen (referentiewaarden per bepaling), star-shl.nl, geraadpleegd 2026-10-01 (retrieved 2026) star-shl.nl
MedlinePlus, SHBG Blood Test, U.S. National Library of Medicine, last updated 2026-01-12, geraadpleegd 2026-10-15 (retrieved 2026) medlineplus.gov

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