SHBG and hormone testing: what the labs actually tell you

What's this video probably claiming?

Based on the caption, this creator, an NMD (naturopathic medical doctor), is making the case that standard hormone panels miss the point if SHBG isn't included. The core argument seems to be that total testosterone and estrogen numbers mean very little in isolation, because SHBG binds those hormones and makes them biologically unavailable. Two women with identical total hormone levels could feel completely different if one has high SHBG sequestering most of it. The implicit pitch is almost certainly that patients should request more comprehensive testing, possibly through a platform like the one this creator uses or promotes. This is a common framing in the functional and integrative medicine space, and it's not wrong on its face, but how far the creator takes it, and whether they suggest free hormone testing is a reliable fix, matters enormously.

What does the science actually show?

SHBG is real, its effects are measurable, and the critique of basic labs has legitimate grounding. A 2013 paper by Jasuja et al. in the Journal of Clinical Endocrinology and Metabolism confirmed that free testosterone calculated from SHBG correlates better with clinical symptoms of androgen deficiency than total testosterone alone in certain populations. SHBG is influenced by thyroid status, insulin resistance, liver function, obesity, and exogenous hormone use, meaning two people with the same total testosterone can have wildly different free fractions. A 2019 study by Handelsman in Endocrine Reviews noted that SHBG levels in women vary by roughly threefold across the population. However, the same literature is blunt that free testosterone assays, especially direct immunoassay methods used in most commercial labs, are notoriously unreliable. Calculated free testosterone using the Vermeulen equation is considered more accurate, but still imperfect. SHBG testing adds context. It does not resolve ambiguity entirely.

Where does the social media noise diverge from clinical reality?

The wellness content space has turned SHBG into a villain hormone, blamed for fatigue, low libido, brain fog, and weight gain in women. That framing outpaces the evidence. Elevated SHBG in premenopausal women is not automatically pathological. A 2021 prospective cohort study by Ding et al. in JAMA Network Open found that higher SHBG was independently associated with lower type 2 diabetes risk in women, suggesting it is not simply a problem to be suppressed. The social media version of this conversation frequently implies that if your SHBG is high, you need to take steps to lower it, sometimes through supplements like boron or through hormone therapy adjustments. Neither intervention has strong clinical trial support for symptom improvement in otherwise healthy women. There is also a commercial incentive at play here: more comprehensive lab panels cost more, and creators in the telehealth space have a financial interest in patients believing their current doctor is missing something.

What should you actually know?

SHBG testing is clinically appropriate in specific contexts: evaluating androgen deficiency, monitoring women on hormonal contraceptives or hormone therapy, assessing insulin resistance, or investigating unexplained symptoms in patients whose total hormone levels appear normal. The Endocrine Society does include SHBG in recommended workups for hyperandrogenism and certain hypogonadism evaluations. What it is not is a universal missing piece that explains every case of fatigue or low libido. If a provider tells you your labs are incomplete without SHBG and then sells you a panel, ask what clinical decision would change based on that result. That is the right question. Symptoms drive treatment decisions. A number on a lab report, including SHBG, is one data point in a broader picture. Regulated telehealth platforms should be ordering SHBG when it changes management, not as a marketing hook.