Evidence check: SHBG in the context of menopause

SHBG (sex hormone-binding globulin) is a protein that binds sex hormones like testosterone and estradiol, regulating their bioavailability. During menopause, declining estradiol levels often lead to lower SHBG. Low SHBG can increase free (active) testosterone and is associated with metabolic changes such as insulin resistance, weight gain, and higher cardiovascular risk. However, the evidence is moderate: most data come from observational studies, not randomized controlled trials. SHBG alone is not a diagnostic marker for menopause or its consequences; it should be interpreted alongside a full hormone panel (estradiol, testosterone, LH, FSH) and clinical symptoms. Decisions about hormone therapy or lifestyle interventions should not be based solely on SHBG values. Caveat: SHBG is also influenced by thyroid function, liver disease, insulin levels, and medications. A home test for SHBG is less precise than clinical lab measurement. Evidence: human-moderate.