My SHBG is low — what should I do?
Low SHBG raises free testosterone relative to total and signals metabolic context — insulin resistance, hepatic steatosis, hypothyroidism, or androgen excess. Workup includes fasting insulin, HbA1c, LFTs, and TSH. Address the metabolic driver before adjusting hormone strategy.
Full answer
SHBG is produced by the liver and inversely tracks insulin and androgens. Low SHBG most commonly reflects insulin resistance, hepatic steatosis, or exogenous androgens; less commonly hypothyroidism. The workup includes fasting insulin, HOMA-IR, HbA1c, ALT/AST, GGT, TSH, and lipids. The clinical implication is that calculated free testosterone may overstate biologically available androgen action. Treatment targets the underlying metabolic driver. On TRT, low SHBG narrows the dosing window and is monitored at each recalibration.
Educational. Not a substitute for individualized provider review.
- Methodology — Primary source · oMeds
- Reviewed by Dr. Laura Purdy, MD, MBA · Clinical Director, oMeds · Last reviewed 2026-06-03