The Surprising Connection Between PCOS, Low SHBG, and High Testosterone
By Amy Medling, founder of PCOS Diva
There are many symptoms associated with PCOS, with most of them revolving around too much-circulating testosterone. What causes testosterone to rise uncontrollably in women with PCOS varies. New research shows one factor stands out regarding circulating testosterone levels in PCOS women, and it’s called sex hormone-binding globulin or simply SHBG.
What is SHBG?
SHBG is a protein made by your liver that connects itself to sex hormones, especially testosterone. In women, SHBG is also produced in small quantities by the uterus.
What does SHBG do?
SHBG works to regulate the amount of testosterone your body can use, specifically to prevent having too much testosterone.
Although SHBG mainly binds to testosterone, it also binds to dihydrotestosterone or DHT, androstenediol, estradiol, and estrone. However, SHBG is more likely to bind with testosterone than any other hormone.
Since SHBG regulates testosterone levels, diseases and conditions that can cause hormonal imbalances significantly affect it, and PCOS is a good example.
PCOS disrupts the body’s normal hormonal functions and regulatory processes, suggesting that SHBG is lower in women with PCOS. This results in higher circulating testosterone levels and explains some of the symptoms women with PCOS experience.
What happens when SHBG is low?
If your SHBG levels are low, you can expect to see symptoms of excessive male hormones, especially testosterone.
Symptoms of high testosterone include:
- Hirsutism or unusual hair growth/male pattern hair growth
- Male pattern hair loss
- Deeper voice
- Irregular or absent periods
- Unexplained weight gain
- Mood disturbances or depression
What causes low SHBG levels?
Women with PCOS deal with various hormonal changes and imbalances, negatively affecting their natural body processes and overall quality of life. Unfortunately, some of the more prominent symptoms of PCOS can also cause lower SHBG levels, exacerbating their hormonal issues further.
Below are the top 2 common causes of low SHBG levels:
Elevated insulin levels
The one symptom strongly associated with low SHBG levels is having too much insulin circulating in your system. Remember, PCOS messes with our hormones and contributes to an increased risk for insulin resistance, where the body secretes too much insulin.
If low SHBG levels are also a factor in high insulin levels, this would explain why PCOS and type 2 diabetes are often connected. In the same light, it would also explain why obese women have lower SHBG levels.
This article explores PCOS and insulin connection.
Studies have shown that a pro-inflammatory state (where inflammatory markers are higher than average) is strongly linked to lower SHBG levels in women.
Women with PCOS are constantly in a state of inflammation with high insulin levels, so it’s wise to be mindful of managing systemic inflammation in your body.
Learn more about PCOS and inflammation here.
Are you ready to take the next step toward taking control of your PCOS? This free 32-page guide outlines the most basic issues and solutions for women with PCOS.
How do I know if I have low SHBG?
Blood work can detect SHBG levels and should be performed with tests that simultaneously analyze total and free testosterone in women with PCOS.
The most common is the SHBG blood test and is sometimes referred to as the testosterone-estrogen binding globulin test or TeBG test.
How do I naturally increase SHBG levels?
The following are ways to increase your SHBG levels without resorting to medications.
A sedentary lifestyle is linked to many disorders, imbalances, and chemical changes, including low SHBG levels. Researchers recommend moderate to intense exercise to increase SHBG.
It doesn’t matter how you exercise, so long as you do. Whether you’re going hard on barbells or simply doing stretching or walking, make it a part of your daily routine.
We are what we eat, so it’s only reasonable to avoid foods that lower SHBG levels.
Focus on a diet that consists of healthy fat sources such as olive oil, almonds, and walnuts and fiber sources like cabbages, broccoli, and cauliflower.
If you’re a coffee-lover, rejoice! Studies have found caffeine helps increase SHBG levels. If you’re not a coffee fan, caffeine from tea also counts.
Caffeine also has positive effects on insulin resistance and long-term health benefits on cardiovascular health.
Similar to exercise, research has shown that a high body mass index (overweight to obese) is linked with lower SHBG levels. Notably, obese women who find a way to manage their weight display a rise in SHBG levels.
Most SHBG is made in the liver, so it makes sense to consider taking supplements that support your liver.
A few options:
#1 Silymarin: The most common is silymarin, the active compound found in milk thistle.
#2 Glutathione: Studies had reported improvements in liver health when those with fatty liver disease took it as a supplement. It functions as a detoxification aid.
#3 Castor oil packs: Some alternative health practitioners advocate for castor oil heat packs. It is said to work by helping the liver function more efficiently by helping it move particles better.
#4 The Sparkle Cleanse kit: Our PCOS Diva cleanse kit contains a meal replacement shake specifically formulated for liver support.
It can be challenging to assess whether low SHBG levels started the symptom or if the symptom came first. Still, one thing is for sure: having low SHBG levels adds a layer of symptom management, especially for women with PCOS.
Fortunately, we live in a time where we know more about PCOS, allowing us to treat each of its symptoms individually and as a whole. Exercise, weight loss, dietary changes, and supplementation are excellent holistic approaches to low SHBG levels.
Amy Medling, the best-selling author of Healing PCOS and certified health coach, specializes in working with women with Polycystic Ovary Syndrome (PCOS), who are frustrated and have lost all hope when the only solution their doctors offer is to lose weight, take a pill, and live with their symptoms. In response, Amy founded PCOS Diva and developed a proven protocol of supplements, diet, and lifestyle programs that offer women tools to help them gain control of their PCOS and regain their fertility, femininity, health, and happiness.
Zhu JL, Chen Z, Feng WJ, Long SL, Mo ZC. Sex hormone-binding globulin and polycystic ovary syndrome. Clin Chim Acta. 2019 Dec;499:142-148. doi: 10.1016/j.cca.2019.09.010. Epub 2019 Sep 13. PMID: 31525346.
Wallace IR, McKinley MC, Bell PM, Hunter SJ. Sex hormone binding globulin and insulin resistance. Clin Endocrinol (Oxf). 2013 Mar;78(3):321-9. doi: 10.1111/cen.12086. PMID: 23121642.
Oscarsson J, Lindstedt G, Lundberg PA, Edén S. Continuous subcutaneous infusion of low dose growth hormone decreases serum sex-hormone binding globulin and testosterone concentrations in moderately obese middle-aged men. Clin Endocrinol (Oxf). 1996 Jan;44(1):23-9. doi: 10.1046/j.1365-2265.1996.635457.x. PMID: 8706289.
Maggio M, Ceda GP, Lauretani F, Bandinelli S, Corsi AM, Giallauria F, Guralnik JM, Zuliani G, Cattabiani C, Parrino S, Ablondi F, Dall’aglio E, Ceresini G, Basaria S, Ferrucci L. SHBG, sex hormones, and inflammatory markers in older women. J Clin Endocrinol Metab. 2011 Apr;96(4):1053-9. doi: 10.1210/jc.2010-1902. Epub 2011 Jan 14. PMID: 21239514; PMCID: PMC3070258.
Goto A, Song Y, Chen BH, Manson JE, Buring JE, Liu S. Coffee and caffeine consumption in relation to sex hormone-binding globulin and risk of type 2 diabetes in postmenopausal women. Diabetes. 2011;60(1):269-275. doi:10.2337/db10-1193
Zmuda JM, Thompson PD, Winters SJ. Exercise increases serum testosterone and sex hormone-binding globulin levels in older men. Metabolism. 1996 Aug;45(8):935-9. doi: 10.1016/s0026-0495(96)90258-9. PMID: 8769347.