The test for sex hormone binding globulin (SHBG) is primarily ordered in conjunction with other tests to evaluate the status of a person’s androgen levels – the male hormones. With men, the issue of concern is testosterone deficiency, while with women the concern is excess testosterone production. A total testosterone may be ordered prior to or along with a SHBG test. The usual indications for the tests is a part of a workup of infertility and a decreased sex drive.

This patient had anemia, increased menstrual bleeding and lethargy. She did not have any diagnoses that would indicate testing for sex linked globulins. She did have a history of hypothyroidism but it is diffucul to see how this test would assist in management of that condition. It is certainly not a test for anemia, which was thep resenting complaint.

Sex linked globulins have been associated with an increased risk of diabetes.  The level of evidence supporting this conclusion does not rise to the level of clinical utility and remains in the realm of association. For example, a recent study (Hedderson et al) concludes that “Low prepregnancy SHBG concentrations were associated with increased risk of GDM and might be useful in identifying women at risk for GDM for early prevention strategies.” I was not able to find guidelines that recommend this test in any setting for screening or prognostication of diabetes.

REFERENCES:

1. Ding EL, Song Y, Manson JE, Hunter DJ, Lee CC, Rifai N, Buring JE, Gaziano JM, Liu S (2009). “Sex Hormone–Binding Globulin and Risk of Type 2 Diabetes in Women and Men”. New England Journal of Medicine 361 (12): 1152–1163.

2.Monique M. Hedderson et al, Prepregnancy SHBG Concentrations and Risk for Subsequently Developing Gestational Diabetes Mellitus. Published online before print, February 21, 2014, doi:10.2337/dc13-1965Diabetes Care February 21, 2014

3.Chaoyang Li, et al, Association of Testosterone and Sex Hormone–Binding Globulin With Metabolic Syndrome and Insulin Resistance in Men Diabetes Care July 2010 vol. 33no. 7 1618-1624