Many of my readers are fully aware of why getting blood work 1-2 times a year is critical for fully optimized health, especially if you are using therapeutic testosterone.
On top of monitoring your symptoms, you have to ensure your critical biomarkers are within an optimal range and not escaping into extreme highs and lows.
Since the use of testosterone is a lifelong ordeal, you’ll have to get used to keeping a close eye on your blood labs.
But if there’s any particular biomarker that gets widely misunderstood and unreasonably targeted, it’s sex hormone binding globulin (SHBG).
Too many bodybuilding bros and non-evidenced based docs are eager to learn how to lower SHBG as much as possible and as fast as possible (you’ll see why very soon).
This is a critical mistake, and one I learned about years ago from the late and great Dr. John Crisler.
Dr. Crisler was eons ahead of his time in that he saw SHBG as the foundation of hormonal optimization.
It wasn’t just another number to track, but rather the centerpiece of every proper sex hormone evaluation”
This article will show you exactly how SHBG “hands out the cards” (in the words of Dr. Crisler), where your values should be, and how to tweak it so your body isn’t producing too much or too little of it.
What is SHBG (Sex Hormone Binding Globulin)?
Before we can talk about how to lower SHBG in men, we need to first revisit how the process of testosterone production works in our bodies:
“Your brain sends a chemical signal to the hypothalamus (the part of your brain that connects the endocrine system with the nervous system) and tells it to make some testosterone.
Thypothalamus releases a chemical messenger called gonadotropin (GnRH) that gets picked up by the pituitary gland (the part of your mind that controls other hormone glands in your body).
The pituitary gland releases luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which signal the Leydig cells in the testes to produce testosterone.
Testosterone is then released into the bloodstream where it will either be bound to sex hormone-binding globulin (SHBG) and albumin or remain in its free form.”
SHBG, a protein that’s primarily produced in the liver, is responsible for transferring testosterone through the bloodstream to the target tissues.
(NOTE: SHBG also binds to and transfers DHT (dihydrotestosterone) and estradiol (estrogen) in the same way, but we’re going to focus on testosterone in this article)
And while testosterone is bound to SHBG, it is biologically inactive.
This is important to remember because the SHBG-bound testosterone CANNOT be used by our bodies:
“The body can’t use hormones bound to SHBG, and therefore they lose their anabolic effect. As men age, SHBG levels rise and bind strongly to the testosterone molecule.
It lowers the body’s absorption of free testosterone. We want to have as much free (usable) testosterone available as possible to enjoy the benefits it provides.
…In aging men, the rise in SHBG and associated maintenance of total testosterone values may mask low levels of free testosterone“
(Remember this bolded sentence because we’re going to revisit it very soon!)
Roughly speaking, here is what you see in a healthy young male with respect to bound and unbound testosterone in the body:
- 2% of the body’s testosterone is completely free
- 60% of the body’s testosterone is bound to SHBG
- 38% of the body’s testosterone is bound to albumin
But as I discussed in The TOT Bible with Dr. Crisler, SHBG is much more than an inert carrier protein:
“SHBG has its own actions. There are receptors for it on the outside of the cell. Usually, these hormones have to enter the cell before they do anything.
But if SHBG is not already bound to a sex hormone, it can bind to these SHBG receptors [SHBG-R], and then a sex hormone (either androgen or estrogen – the opposite of androgen is estrogen, as estrogen is actually a group of about 40 hormones) binds to the anchored SHBG. This initiates a mechanism inside the cell.
So, obviously, if we have a higher SHBG level, more of this is going on. But, as I just said, both testosterone and estrogen also do this—and that is a can of worms to think about.”
You’ll see why this distinction is important in the next section, and why “how to lower SHBG” may be the wrong question to ask.
What Does It Mean if SHBG is High?
Remember when I said that SHBG levels go up with age?
Well, anybody who has followed me for more than one day is well-aware of how our natural production of testosterone goes DOWN with age.
In case you haven’t made the connection yet, let me spell it out for you…
As you get older, you will (1) have less total testosterone (i.e. bound AND unbound testosterone) in your body, and (2) have even more SHBG binding to testosterone.
The end result is you have LESS free testosterone available for your body to use.
To make matters worse… if your total testosterone values stay the same, the rise in SHBG can mask low levels of free testosterone when you look at your bloodwork.
This is where most Doctors (who are not specialists with endocrinology and hormonal optimization) mis-evaluate patient blood work.
And with SHBG levels steadily increasing, you’ll need MORE testosterone to get over top of it so you can have enough free and bioavailable testosterone left over.
This is why any physician who’s worth their salt will test both total testosterone AND free testosterone.
Here are the values to monitor for both biomarkers, taken directly from The TOT Bible:
- Total Testosterone > 600 ng/dL (Remember that symptoms are always more important than lab values)
- 2-3 times per year, depending on age and whether one is on TOT or not. Levels over 1500 ng/dL accompanied by high Hematocrit, low HDL and/or other side effects may require dosage reduction.
- Free Testosterone > 2% of Total Testosterone
- If low, test for SHBG. Higher TOT dose may increase free testosterone by decreasing SHBG. Low SHBG levels may be from diabetes.
I didn’t include specific lab values to look for in a blood test, but in my article on statins I mentioned the ideal range for men to be in for SHBG is anywhere between 10-57 nmol/L (and 18-144 nmol/L for non-pregnant females).
Why SHBG Blood Tests Are NOT Set in Stone
Dr. Crisler, in his prophet-like wisdom, was careful to warn people about the dangers involved with blindly seeking the lowest SHBG reading possible… not unlike people who are recklessly lowering their estrogen levels for no good reason.
All of this is directly taken from The TOT Bible, where he gave me an ENTIRE interview on the subject of SHBG alone.
First, the reading for SHBG encompasses multiple things:
“The results of the SHBG blood test are a combination of that which is freely floating around, plus that which is bound to hormones in the blood sample.
The SHBG bound to its own receptor on the outside of the cell is not measured routinely, yet… the SHBG blood test seems to be a rather tricky test to run properly, and results may vary.”
Second, there are tissues in our body that make their “own” SHBG, but this is nothing to be concerned about
“There is even a special kind made in the testicles. Maybe these SHBG molecules are produced by the cell to act on itself, or even on its neighbors.
But the majority of the SHBG in the body and what we test for on labs – is made in the liver, then released into the bloodstream. It’s basically a protein, as the liver makes many of our proteins.”
Third, high SHBG levels do not only affect testosterone availability in your body:
“…you do get some buffering action with respect to balanced estrogen levels, because some of the unnecessary estrogen is being eaten up too.
But this happens to a lesser degree, because the affinity for SHBG is less with estrogen than testosterone, and therefore SHBG will preferentially grab on to androgens (i.e. testosterone) over estrogens.
So as SHBG goes up, it grabs more and more of the testosterone, so your ratio between your testosterone and estrogen will go down and ultimately balance out.
Conversely, if testosterone levels are lower, you can get away with a lower SHBG level because more testosterone will be free and bioavailable for your body to be used.”
Fourth, SHBG can be used as a predictive biomarker for various diseases:
As I highlighted in the book, it is an essential marker of insulin resistance and an independent predictor of Type 2 Diabetes.
Fifth, blood work NEVER takes priority over clinical symptoms:
“I don’t think much of ratios [between total T and free (bioavailable) T]. Their use is to help describe clinical symptoms. They are not a treatment goal.
Without getting any more technical, it helps to remember that this is a bell-shaped world. Again, if a guy comes in at 415 ng/dL and he’s happy, he’s happy.
You also have to keep in mind the variability of hormone levels throughout the day, pre-TOT or after, and especially when clomiphene therapy is added into the mix, which oftentimes closely mimics natural testosterone production patterns.”
Sixth, the blood test for SHBG can be easily compromised by numerous lifestyle habits:
“The pre-lab instructions I email my patients always directs them to not work out the day before (and the morning before) getting their blood drawn.
Not only can a workout increase liver function test results (especially alanine transaminase), it also increases SHBG levels. This could completely change the regimen I put them on.”
I don’t yet have a list of all the other factors which can affect the reading on an SHBG test, but I know for sure you should avoid biotin supplementation the day before the test.
What Happens if SHBG is Too Low?
Our bodies more than anything else seek hormonal equilibrium, which means we cannot talk about how to lower SHBG without acknowledging the consequences of doing so.
Indeed, chronically low SHBG levels can be indicative of conditions such as obesity, hypothyroidism, Cushing disease, and nonalcoholic fatty liver disease.
The worst thing, however, is that men with very low levels of SHBG are literally “wasting” testosterone.
Dr. Crisler explains in further detail:
“The real problem with low SHBG is that sometimes the patient can tolerate low levels of estrogen because so much of it will be free. And also, the patient tends to be what we call a “hyper-excreter,” which means that he excretes a lot of testosterone into his urine.”
“For guys with lower levels of SHBG, when comparing their blood testosterone to their urine testosterone, the urine will be way higher (within their respective ranges). The kidneys can excrete extra testosterone in the urine… [but] they don’t excrete more estrogen in the same way.
“So guys with lower SHBG (and therefore a higher percentage of free testosterone, or after a concentrated dosage of testosterone) are basically leaving the testosterone in the urine.”
What’s the solution, then?
If you happen to be someone who’s SHBG readings are way too low, the fix is simply increasing the frequency of your therapeutic testosterone administration (ie more frequent injections or perhaps even better, daily scrotal application at once or twice per day).
Again, I’ll give the mic back to Dr. Crisler:
“This is EXACTLY why increasing the frequency of administration (NOT THE DOSAGE) of your weekly dose of testosterone will leave you feeling better: it’s still left in the body, but a lower amount is flushed down the toilet. I’ve seen this make as much as a 20% difference in well being!”
“The guys who have lower SHBG levels need multiple smaller doses of testosterone because they’re basically peeing it out as soon as it’s released from the cypionate ester from shots, or as it’s absorbed from a transdermal cream. Whereas guys with higher SHBG levels might be able to get away with once-per-week shots (i.e. a bigger single dose), then they’d be fine for the rest of the week.”
Given how many other bodybuilding bros eventually wised up to this revelation (as seen here and here), it seems Dr. Crisler was right on the money.
So far I hope you can start to appreciate just how brutally difficult it is to be a COMPETENT hormone optimization physician.
And how just one reading can completely change the type of protocol recommended to a patient, which is why everything has to be done correctly on the very first go.
How to Lower SHBG in Men
This section is going to be more about how to lower SHBG naturally as later on I’ll have a separate section about doing so while using testosterone at the same time.
For the most part, my lifestyle recommendations for reducing SHBG levels (ONLY if deemed necessary by a physician) can be summed up in two sentences:
Lose body fat, improve diet and exercise (via resistance and cardiovascular training) which will significantly reduce systemic inflammation. Fix everything naturally first via optimizing your lifestyle factors, and then medicate with TOT once all lifestyle factors are accounted for.
But given the massive endocrine disruption taking place in society, it’s inescapable that your average man will have naturally higher SHBG levels.
So if you’re going to take your SHBG levels down to a lower baseline without any pharmacological intervention and do things the hard way, you might what major factors will increase or decrease SHBG production.
Excess glucose/fructose consumption will lower SHBG production.
A low-carbohydrate diet such as the ketogenic diet will increase SHBG levels (but also increased total testosterone in the study referenced).
Conversely, extended caloric restriction (ex.) intermittent fasting) will increase SHBG levels.
Funny enough, higher protein intake will lead to a decrease in SHBG levels.
Caffeine consumption can raise SHBG production, and alcohol consumption has the same effect.
DHEA supplementation will lower SHBG levels, and so will Vitamin D and zinc. (But please never supplement with DHEA unless your blood work shows a clinical need to do so).
However, the one supplement I’ve seen consistently hawked on forums is boron.
While boron supplementation leads to a small increase in testosterone levels, we have direct evidence that a large part of this bump is due to the accompanying decrease in SHBG levels.
This tells us that somehow, there is more free testosterone available as a result.
Dosages commonly recommended are anywhere between 3-10 mg a day (going no higher than 20 mg in a single day), and some users suggest it’s best to take it for 1-2 weeks before taking an equivalent amount of time off to resume another cycle.
How to Lower SHBG on Therapeutic Testosterone (TRT/TOT)
This is the part of the article where I deliver maximum value, and you will realize why the discussion of “how to lower SHBG” is ultimately meaningless.
As Dr. Crisler correctly notes in The TOT Bible, there are HUNDREDS of biological factors simultaneously pushing SHBG levels up and down:
“We do know that SHBG levels decrease in the presence of androgens like testosterone, insulin (such as seen in Type II diabetics), growth hormone, IGF-1, and prolactin. Estrogen tends to increase SHBG levels, and so can ANY form of Thyroid Replacement Therapy.”
For this reason alone, it is completely pointless to prioritize a low-as-possible SHBG reading over fully optimized testosterone levels:
“You can drive SHBG down by taking 50 mg of Danazol per day. But why take – and pay for – an extra medication when we can simply adjust our TOT protocol to compensate? And I have never seen lowering SHBG levels lead to an increase in testosterone levels for any length of time. I’ve tried it numerous times with labs.
That’s because, with normal feedback mechanisms in place, the body just lowers Luteinizing Hormone (LH) to compensate and therefore testosterone production is also lowered. You end up right back where you started, except your wallet is lighter. This is known in medicine as “wallet diuresis.””
There are numerous SHBG-lowering medications that serve as a perfect example of the “wallet diuresis” phenomenon Dr. Crisler is talking about:
- Proviron, a derivative of dihydrotestosterone
- Anavar (Oxandrolone), an anabolic steroid
- Aromasin, an aromatase inhibitor
However, NONE of these medications are recommended by yours truly.
The real key to fixing your SHBG levels once and for all is to first and foremost fix your suboptimal testosterone levels.
Once testosterone is optimized, SHBG normalizes. There really is no need to even check it once a man is hormonally balanced.
When I asked Dr. Crisler many years ago how to evaluate SHBG levels for a patient, he had this to say:
“We must treat SHBG like a cork floating on the top of the water. Wherever it bobs, that’s where we play it. We just monitor it regularly. It can change drastically in a month or so, which is about how long it takes to reestablish its new baseline after a change.”
His statement is missing one crucial piece of information, which is provided by none other than Dr. Keith Nichols of Tier 1 Health and Wellness.
The best way to treat high SHBG (which is a good thing) is to increase the testosterone dose, which raises free testosterone (the ultimate determinant of how much unbound and biologically active testosterone is available for your body to use) and therefore overcomes the effects of high SHBG.
He expanded on this further in a recent email he sent to me:
“There are ultimately two goals with testosterone optimization.
The first goal is to raise testosterone levels enough to an optimal level and keep them there in order to resolve any negative symptoms (i.e. without any extreme peaks or troughs).
The second goal is to reach an even higher level that NOT ONLY resolves symptoms but maximizes all the health benefits of therapeutic testosterone.
This is in sharp contrast to the majority consensus on hormone optimization Internet forums, which is using a minimum effective dose (MED) to resolve symptoms.
It’s like asking a man if he wants just enough testosterone to make his bad problems away, or if he wants enough testosterone to resolve all his symptoms AND feel like a completely different man. Only a bonehead would pick the first option.
As for the naysayers who will complain about SHBG levels rising up, Dr. Nichols explains why this is not a concern at all:
“When an insulin-resistant man is put on testosterone, frequent exercise and proper nutrition, his SHBG will go up.
His testosterone measurements will show this in the form of him having a relatively decent total testosterone level, but a high free testosterone reading that declines as he gets healthier.
He’s not becoming “immune” to testosterone, nor is the testosterone no longer working. It’s just that we need to raise his free testosterone levels by increasing his dose of therapeutic testosterone”.
But don’t expect your SHBG levels to change overnight — you’ll need to give it a minimum of 6 weeks, and more likely the change will be seen when you come to a doctor’s clinic for your next round of blood work.
Clearly, the title “how to lower SHBG” now seems a little misleading when you reflect on everything you learned in this article.
But I did this for two reasons…
One, if people want to know how to reduce SHBG and have a CLINICAL NEED to do so, they might as well come to somebody who can show them how to do it properly and safely.
Two, SHBG is too critically important in the context of hormonal optimization to leave buried in my 600-page book The TOT Bible for the biochemistry nerds.
And speaking of the book, I want to close off with a quote from Dr. John Crisler that changed how myself and many other doctors perceived the importance of blood work:
“About 15 years ago, I decided to stop being surprised by anything I see in this field of medicine.
If a guy tells me he’s happy, he’s happy. That’s how we roll. It doesn’t matter what the numbers are on the laboratory printout. So there’s a quantum quality to Interventional Endocrinology in that the numbers on labs, and how the guy feels, often don’t match up at all. T
There is just too much going on here globally with a person’s hormonal milieu and its optimization. I like to say that I’m treating a living, breathing human being, not ink on a piece of paper.”
Don’t be, I can easily connect you with the best hormonal optimization clinics and Doctors.
Whether you are a man or a woman looking for optimization, send my team an email with subject line “The Best Hormonal Optimization”.
SHBG is just one of many biomarkers you’ll be responsible for tracking when you go on testosterone optimization therapy for the very first time.
You should ensure any doctor you work with is well-educated about how SHBG works and what needs to be done to optimize it.
That and 10 other MUST-HAVE criteria that I talk about in my eBook The Top 10 Questions to Ask Your Doctor About Therapeutic Testosterone:
Click the image below to download a FREE PDF copy of the book:
From there, you’ll get one email a day for several days that goes through the basics of testosterone therapy.
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