Lowering Sex Hormone Binding Globulin (SHBG) Levels

Primary Strategy: Address Underlying Causes

The American College of Physicians recommends treating the root cause of elevated SHBG, such as hyperthyroidism, hepatic disease, and certain medications, to normalize SHBG levels 1
Managing liver disease and discontinuing medications that increase SHBG, such as anticonvulsants, estrogens, and thyroid hormone, can help lower SHBG levels 1
The Endocrine Society suggests considering HIV testing in appropriate clinical contexts to address elevated SHBG 1

The European Association for the Study of Obesity recommends that obesity and insulin resistance be addressed to decrease SHBG levels, as increased body mass index (BMI) inversely correlates with SHBG 2
Insulin directly inhibits hepatic SHBG synthesis, making insulin resistance a powerful SHBG-lowering mechanism 2
The American Diabetes Association notes that low SHBG levels are found in obese patients regardless of androgen status, and that SHBG levels progressively decline as metabolic syndrome components accumulate in type 2 diabetes patients 2

The American College of Clinical Endocrinologists recommends that medications that decrease SHBG, such as glucocorticoids, testosterone or anabolic androgenic steroids, and growth hormone, should only be used when clinically indicated for other conditions, not solely to lower SHBG 1
Glucocorticoids, testosterone or anabolic androgenic steroids, and growth hormone can decrease SHBG levels, but should be used with caution and only under medical supervision 1

The American Society for Reproductive Medicine notes that low SHBG is characteristic of Polycystic Ovary Syndrome (PCOS) and contributes to increased free testosterone, and that insulin resistance is the primary driver of low SHBG in PCOS patients 1, 2
The European Society of Human Reproduction and Embryology recommends that insulin resistance be addressed in PCOS patients to improve SHBG levels and overall metabolic health 2