Why SHBG Matters More Than You Realize in Your Testosterone Journey
Most men walk into my clinic saying the same thing:
"My total testosterone looks fine, but I still feel tired and unmotivated."
Or: "My doctor told me the numbers look normal, so why do I feel this way?"
One reason often gets overlooked—and it might be the key to how you actually feel.
SHBG. Sex Hormone Binding Globulin.
It's one of the quietest, most misunderstood pieces of hormone health, yet it can completely shape your energy, mood, and vitality. SHBG determines how much testosterone is actually free to reach your muscles, brain, and tissues. This means your symptoms often tell a more accurate story than your lab sheet.
You don't treat a number. You treat a man. And SHBG helps us understand that man much better.
What SHBG Really Does
Think of SHBG as your testosterone's chaperone.
It binds to testosterone and keeps it locked up. Only a small portion remains free to move into tissues and do the work that matters.
Free testosterone is where the magic happens. It supports:
Energy and endurance
Mood stability and emotional resilience
Strength and muscle development
Cognitive sharpness and mental clarity
Libido and sexual performance
Recovery after workouts
Motivation and drive
If SHBG is too high, your free testosterone drops—even if your total testosterone looks "normal" on paper. This is the man who feels like he's running uphill all day, despite numbers that don't seem to justify it.
What It Means When SHBG Is High
High SHBG acts like a sponge. It soaks up testosterone and leaves far less available for your body to use.
Men with high SHBG often experience:
Low or flat mood
Slower recovery from workouts
Difficulty building or maintaining muscle
Lower libido and sexual function
Irritability and emotional distance
Brain fog and poor concentration
Fatigue that doesn't respond to more sleep
Loss of motivation or purpose
Here's the frustrating part: they're often the most misunderstood patients because their total testosterone can look okay on paper. That leads to dismissal, frustration, and men silently wondering if something is fundamentally wrong with them.
Nothing is wrong with you. Your SHBG is simply changing the rules of how your hormones work.
Why SHBG Can Rise
Several factors influence SHBG levels, including:
Age (tends to rise as men get older)
Genetics (some men are naturally predisposed to higher SHBG)
Thyroid function (hypothyroidism often increases SHBG)
Liver health (the liver produces SHBG)
Significant weight loss or caloric restriction
Elevated estrogen levels
Certain medications
Chronic stress and poor recovery
SHBG tends to rise as men age and as testosterone naturally declines. It's one of the reasons midlife men feel so different than they did in their twenties and thirties, it's not just about the testosterone number itself.
How TRT Works Differently When SHBG Is High
This part matters for dosing and expectations.
If SHBG is high, you often need a different strategy than a man with average or low SHBG. You can't simply chase total testosterone numbers. Instead, you focus on symptom improvement and free testosterone response.
Men with high SHBG may require:
Slightly higher dosing
More frequent administration to keep free testosterone stable
A different delivery method (sometimes a change from weekly to twice-weekly dosing works better)
Supportive treatment for thyroid function if it's a contributing factor
Emphasis on protein intake, resistance training, and metabolic health
Monitoring of estradiol levels to ensure proper hormonal balance
The goal is always the same: get free testosterone into the tissues where it matters.
Can You Lower SHBG?
SHBG is partly genetic, but there are evidence-based ways to influence it.
Factors that help optimize SHBG include:
Increasing protein intake (supports metabolic health)
Improving resistance training habits (muscle influences SHBG)
Optimizing thyroid levels (if there's a thyroid issue)
Stabilizing metabolic health and body composition
Adjusting TRT frequency if needed
Maintaining adequate caloric intake during muscle-building phases
Reducing excessive alcohol consumption
Building and maintaining lean muscle mass
Here's an important distinction: lowering SHBG too far isn't the goal. SHBG serves important biological functions. Finding the healthy range that allows you to function at your best in real life, that's the actual goal.
Why I Treat Men Based on Symptoms, Not Just Numbers
Too many men have been told their levels are "normal" even though they feel exhausted, disconnected, or stuck. Lab numbers never tell the full story. How you function in the gym, at work, and in your relationships matters far more than what's written on a lab report.
TRT isn't about chasing a perfect lab value. It's about restoring:
Purpose and direction
Focus and mental clarity
Emotional stability
Energy and vitality
Confidence in your abilities
Physical strength and resilience
Desire and engagement with life again
As both a Family Nurse Practitioner and a Psychiatric Mental Health Nurse Practitioner, I look at the complete picture: your mood, your stress load, your daily habits, your physiology, and—most importantly—how you actually feel. That integrated approach is how we find real answers.
Your Next Step
If you've been told your testosterone is "fine," but you know something is off, there's a reason for that disconnect. SHBG gives us information that many providers miss. And when we treat the whole picture, not just the numbers, most men feel better faster.
Schedule a men's hormone evaluation with The Listening NP. We'll look deeper into what's really driving how you feel.
You deserve clarity, answers, and a plan that matches how you want to feel.
The Listening NP specializes in comprehensive hormone evaluation and treatment for men and women seeking to optimize their health and vitality.
Key Points About SHBG and Men's Hormone Health
• SHBG determines how much testosterone is actually free and usable in your brain, muscles, and tissues.
• Men with high SHBG often feel tired, unmotivated, foggy, irritable, and weak even when their total testosterone looks normal.
• TRT must be individualized for men with elevated SHBG, since dose and frequency often need adjustment.
• You cannot treat a number. You treat the man sitting in front of you, and symptoms always tell the real story.
Schedule a Men's Hormone Evaluation