What to watch with SHBG and menopause?

SHBG (sex hormone-binding globulin) binds testosterone and estradiol, controlling their free, bioactive fractions. During menopause, estradiol declines while SHBG often decreases as well – but not consistently. Low SHBG can increase free testosterone, potentially contributing to hirsutism or metabolic issues. Importantly, SHBG is a sensitive marker of insulin levels: high insulin suppresses SHBG, flagging increased risk for metabolic syndrome and type 2 diabetes. Liver function and thyroid hormones also modulate SHBG. Therefore, when monitoring SHBG in menopause, one should assess it alongside estradiol, free testosterone, fasting insulin, liver enzymes, and TSH. An isolated low SHBG without other abnormalities is usually not concerning. Evidence is moderate: SHBG measurement is clinically established, but interpretation requires context. Caveat: Consumer DNA or blood tests often report a single number without guidance – always discuss with a healthcare provider.