Most testosterone and estrogen circulate bound to SHBG, with only the small unbound fraction biologically active. SHBG levels are influenced by thyroid function, insulin resistance, liver disease, obesity, and various medications. Variations in SHBG can distort total hormone measurements without changing actual hormone activity.
This test is used alongside testosterone in evaluating men with possible hypogonadism and women with hyperandrogenism, to calculate bioavailable or free hormone levels, and to evaluate androgen excess in PCOS or other conditions. Sample type is serum.