Control
SHBG levels appear to be controlled by a delicate balance of enhancing and inhibiting factors. Its level is decreased by high levels of insulin and insulin-like growth factor 1 (IGF-1). Also, high androgen levels decrease SHBG, while high estrogen and thyroxine levels increase it. However, recent evidence suggests that it is the livers production of fats that reduces SHBG levels, not any direct effect of insulin and specific genetic mechanisms have been found that do this.
Measurement of sex hormones
When determining levels of circulating estradiol or testosterone, either a total measurement could be done that includes the "free" and the bound fractions, or only the "free" hormone could be measured. A free androgen index expresses the ratio of testosterone to the sex hormone binding globulin and can be used to summarise the activity of free testosterone.
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