Do You Know Your Sex Hormone Status?

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Boston Testosterone Partners

Do You Know Your Sex Hormone Status?

Originally Published by Life Extension Magazine

Zach White reports on why SHBG level testing could be the most important test your doctor isn’t giving you. 

Experts have long emphasized the importance of maintaining a balanced and robust sex hormone profile as a core anti–aging strategy.

Hundreds of published studies link improper testosterone and estrogen balance (in men and women) with the onset of age–related pathologies such as coronary artery disease, stroke, osteoporosis, and bone fracture.

But in order for you to optimize your sex hormone status, precise and accurate measurement is of paramount importance.

In this article you will learn of a critical blood marker of hormonal balance called sex hormone–binding globulin or SHBG. Newly published studies reveal that the interaction of SHBG with testosterone and estrogen affects overall hormonal balance—yet very few doctors test for it.

As you will read, sex hormone imbalances precipitated by SHBG abnormalities are associated with multiple diseases of aging in both sexes. These include cardiovascular disease (especially in women), cancer, type 2 diabetes, metabolic syndrome, and sleep apnea.

SHBG: The Master Regulator for Testosterone and Estrogen 

SHBG is a protein produced primarily in the liver, although the testes, uterus, brain, and placenta also synthesize it. It serves as a transport carrier, shuttling estrogen and testosterone to sex hormone receptors throughout your body.SHBG also safeguards these vital hormones from degrading too rapidly and prevents their clearance from the body.

It thus acts as the master regulator of your sex hormone levels, maintaining the delicate balance between estrogen and testosterone critical to overall health in aging humans. 

New evidence further indicates that the SHBG molecule itself plays another key role in the body: conveying essential signals to the heart, the brain, and adipose (fat) tissue that ensure their optimal function. There’s even a special SHBG receptor molecule on cell surfaces that functions much like the ubiquitous vitamin D receptor protein, helping cells communicate with one another. In other words, SHBG itself functions much like a hormone.

Knowing your SHBG levels, along with testoste–rone and estrogen, thus gives you and your doctor a more precise picture of your overall health—and enables you to take preventive measures against life–threatening conditions for which you may be at greater risk.

Aging Humans and Increasing SHBG: An Overlooked Threat 

As you age, SHBG levels may steadily rise, even though your production of sex hormones continues to decline. The result? SHGB binds to what few sex hormones you have remaining and reduces their bioavailability to cells in your body.

With elevated SHBG in the blood, too much testosterone may be sequestered and thus functionally unavailable to healthy tissues.Because testing for SHBG is largely overlooked, many older men (and their doctors) may be led to believe through standard testing that they have “normal” total testosterone levels–but since most of it may be bound to elevated levels of SHBG, in actuality they may be testosterone deficient.

Why? Testosterone, like all steroid hormones, is derived from cholesterol, a fat molecule. Fats don’t dissolve in water, so the amount of testosterone floating freely in your bloodstream is small (about 0.5–2% of the total amount). Most of the circulating testosterone in your blood is either bound to the protein albumin or to SHBG.

It is the combination of free and albumin–bound testosterone that ultimately determines your bio–available testosterone status

As a result of imprecise testosterone measurement, aging men may experience signs of feminization as their increased SHBG binds testosterone, preventing testosterone from exerting its effects and leaving estrogen’s physiological impact on the male physiology unchecked. These may include gynecomastia (the development of fatty breast tissue in men), diminished libido and poor sexual performance, cognitive decline, and chronic fatigue.

Combating Metabolic Syndrome 

While excess SHBG creates problems with sex hormone balance, having SHBG levels that are too low is associated with other disorders. Nowhere is the impact of low SHBG so profound as in the cluster of conditions known as the metabolic syndrome, which encompasses obesity, insulin resistance, lipid abnormalities, and chronic high blood pressure.

In men, low total testosterone and low SHBG are predictors for a higher incidence of metabolic syndrome and many of its components. 

In late postmenopausal women, low SHBG and high estrogen levels correlate with the inflammatory state associated with metabolic syndrome. SHBG abnormalities have also been linked to an increased risk of acne, infertility, polycystic ovary syndrome, and uterine cancer in overweight women

The high insulin levels found in people stricken with metabolic syndrome have also been shown to suppress SHBG, creating a vicious cycle of abnormal SHBG activity.

The good news is that testosterone supplementation for men, and bioidentical hormone replacement for women, may safely and effectively reverse many of these adverse, age–related metabolic changes. Obtaining accurate measurement of sex hormone levels through SHBG blood testing thus enables you and your doctor to prevent or combat common medical disorders. 

Low SHBG Is a Key Marker of Cardiovascular Disease 

SHBG levels have an important relationship with nearly every biomarker of cardiovascular disease, from C–reactive protein (CRP) to arterial calcification. Low SHBG is also associated with elevated triglycerides and low–density lipoprotein (LDL). 

Calcification of blood vessels, an early finding in cardiovascular disease, is also associated with lower SHBG levels, especially in women. Low SHBG in women is associated with higher levels of C–reactive protein (CRP), an important marker of inflammation and cardiovascular risk. In men, low SHBG indicated an increased risk of death from cardiovascular disease. In both men and women, low SHBG levels are strongly correlated with obesity.

SHBG, alone and in the context of specific sex hormone levels, thus constitutes an integral predictor of a major chronic age–related condition. Some experts are now recommending SHBG measurements as another means of evaluating cardiovascular and metabolic risk. 

• Optimal sex hormone status, including a healthy balance of testosterone and estrogen, is a core component of any anti-aging strategy. 

• New scientific evidence has revealed the crucial importance to hormone balance of a widely overlooked active protein called sex hormone-binding globulin or SHBG.

• SHBG is an important regulator of your testosterone and estrogen levels, responsible for distributing sex hormones throughout your body—yet few doctors test for it.

• SHBG abnormalities are associated with multiple killer diseases of aging in both sexes, including cardiovascular disease (especially in women), cancer, type 2 diabetes, metabolic syndrome, sleep apnea, and osteoporosis.

Protection from Cancer 

Many kinds of cancers of the breast and prostate are stimulated by the sex hormones estrogen and testosterone. However, SHBG interpretations differ for men and women, which is why the SHBG test requires professional interpretation for accurate application. 

For example, in human breast cancer cells, higher levels of SHBG inhibit cell proliferation and promote programmed cancer cell death (apoptosis), by blocking the estrogen–related survival mechanisms that most breast cancer cells exploit.

For men, it is the opposite. Higher SHBG levels predict more severe and invasive tumor growth in men with prostate cancer. The association is so strong that some urologists have suggested using SHBG levels as a standard pre–operative measurement to identify patients at high risk of invasive cancers who should undergo a more aggressive surgical procedure.

Optimizing Bone Health 

It has long been known that declining estrogen levels in both sexes are significant contributors to bone mineral loss with aging. Experts now recognize that the steady rise in SHBG with aging is directly correlated with bone loss and osteoporosis in both men and women. As a general rule the higher the SHBG level, the less estrogen is available to contribute favorably to bone health.

New studies, however, are finding a direct role for SHBG and its cell surface receptor in bone loss. That suggests an effect that may be independent of estrogen levels. The association is so strong that some experts are now suggesting routine measurement of SHBG as a useful new marker for predicting severity of osteoporosis. 

The terminology for the different measurements of sex hormones in your blood can be confusing, but it needn’t be. Here’s a simple way to think about the levels, using testosterone as an example: 

Total Testosterone (T) is just that—a measurement of all of the testosterone in a given blood sample. It includes free T, T bound to SHBG, and T bound to albumin.

Free Testosterone is equally simple in concept, though harder to measure. Free T is that small proportion (0.5-3%) of testosterone not bound to SHBG or to albumin.

Bioavailable Testosterone (bioT) is simply the combination of the small amount of free T, plus the much larger amount of T that is loosely bound to albumin. You can also think about bioT as the amount of T that is not bound to SHBG, and some scientists refer to it that way. In general, higher SHBG will mean there’s less T that is bioavailable, while lower SHBG means there’s more bioavailable T, though that is a bit of an oversimplification.

The test for SHBG is useful for understanding and optimizing your sex hormone levels in combination with your other test results. 

Detecting Obstructive Sleep Apnea 

Sex hormone–binding globulin may provide an important clue that an individual is affected by obstructive sleep apnea, a relatively common condition that increases the risk of heart disease and stroke. 

Obstructive sleep apnea occurs when breathing repeatedly stops and starts during sleep due to blockage of the upper air passages. Frighteningly, many people are unaware that they suffer from this disorder. Sleep apnea often manifests with loud snoring, waking up feeling unrested, morning headaches, daytime sleepiness, fatigue, and unexplained high blood pressure. An overnight sleep study (polysomnography) is essential in order to definitively diagnose the condition.

Scientists have found that obstructive sleep apnea is associated with disruptions in the endocrine system in men, including decreased levels of SHBG as well as free and total testosterone. Lower levels of SHBG, free testosterone, and total testosterone correlate with more severe sleep apnea. In one study, men’s SHBG and total testosterone rose significantly following 3 months of sleep apnea treatment with continuous positive airway pressure (CPAP). 

Low SHBG combined with low testosterone may represent a novel marker for sleep apnea in men and may provide helpful information regarding which individuals should consider having a sleep study to diagnose the condition. 


Maintaining optimal sex hormone status, including a healthy balance of testosterone and estrogen, is a core component of any anti–aging strategy. New scientific evidence has revealed the crucial importance to hormone balance of a widely overlooked active protein called sex hormone–binding globulin or SHBG. It is an important regulator of your testosterone and estrogen levels, responsible for distributing sex hormones throughout your body—yet few doctors test for it. 

SHBG abnormalities are associated with multiple killer diseases of aging in both sexes, including cardiovascular disease (especially in women), cancer, type 2 diabetes, metabolic syndrome, sleep apnea, and osteoporosis. 


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Sermorelin Therapy for Weight Loss and Lean Muscle Mass




What is Sermorelin?

Sermorelin is an analog of Growth Hormone Releasing Hormone (GHRH) that is produced within the human brain and which stimulates the natural production and release of Human Growth Hormone (HGH) by the pituitary gland.

In our younger years, ample amounts of GHRH are produced so that the pituitary is able to provide the body with sufficient growth hormone to sustain health, vitality and vigor.

GHRH declines with age causing reduced production and secretion of pituitary HGH and thereby increasing the probability of growth hormone insufficiency.

Sermorelin a natural product designed replicate the effects of GHRH and act as a trigger to stimulate the body to produce it’s own HGH.

Simply, Sermorelin therapy jump-starts your body’s own production of HGH!


What are the benefits and advantages of Sermorelin?

 Human Growth Hormone (HGH) therapy has been used extensively and successfully for many years, and has proven effective for countless patients, worldwide.

Although usually effective and safe, direct injection with HGH is not universally the best approach to treating declining levels of growth hormone in every patient.

Unlike HGH therapy — which directly replaces declining levels of HGH from the outside — Sermorelin attempts to address the primary cause of declining HGH from the inside by naturally stimulating the pituitary gland to produce more HGH.

This natural stimulation of the pituitary is designed to preserve the operation of growth hormone production mechanisms that are declining as we age.


Sermorelin benefits include

 • Increases natural production of Human Growth Hormone

 • Improves Physical Performance

 • Improves Immune Function

 • Increases IGF-1

 • Improves sleep quality

 • Decreases body fat

 • Increases lean muscle mass

While Sermorelin produces largely the same effects on body composition, mood and the other benefits of HGH, it also has some additional and important benefits for many patients.


Additional benefits of Sermorelin HGH treatment 

 • The effects of Sermorelin are naturally regulated at the level of the pituitary gland by negative feedback and by release of somatostatin, so that medical concerns associated with the possibility of HGH overdosing are minimized.

 •  Tissue exposure to HGH released by the pituitary under the influence of Sermorelin is episodic — not square wave — therefore avoiding the possibility of tachphylaxis by mimicking normal physiology.

 •  For some patients, Sermorelin has a better overall safety profile, and its use for adult hormone deficiency is not restricted.

 •  Sermorelin-based HGH treatments are also far less expensive than direct injection of HGH.


Call or email Boston Testosterone Partners for more information on products and pricing.

855-617-MEDS (6337)

The Simple Diet

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Boston Testosterone Partners


Confused about what to eat?  Here is a great Simple Diet from T Nation.



The Simple Diet

by Tim Henriques – 3/28/2012 – T-Nation


Science can make nutrition complicated. Measure the glycemic index of this, the glycemic load of that. How much omega-6’s in this? What about omega-3’s?


While a deeper level of nutrition knowledge can certainly be useful, what we often get through the media are little bits of information that’s never paired with an overall philosophy.


It becomes especially hard when faced with nutritional science that seems to contradict itself. Eggs are a great source of protein and healthy fats. No, eggs have too much cholesterol and “bad” saturated fat. What do we do?

Enough. Here’s my philosophy: I call it the Simple Diet, because it’s simple to understand and the foods you’re eating will be in their simple, or basic, form.


This diet is particularly useful when you want to lean up a bit but still live a relatively normal lifestyle. If you hope to get unbelievably cut or prep for a bodybuilding show, this likely isn’t for you, but if you found that your holiday bingeing has extended into spring training, then this might be your answer.


This diet assumes you’re working out reasonably hard at least several days a week. If you’re not doing that, start. If you don’t plan on doing that, you’re on the wrong website.


Builders & Energy Providers


I think of food in terms of two categories: builders and energy providers. That’s how I teach the nutrition basics to my kids, who are all five and under. It’s simple, and it works. You can also add a third category: stuff that keeps you healthy.


This paradigm matches nicely with the primary functions of nutrients, which are to provide energy, build and repair tissue, and regulate metabolism.


Builders. The meathead’s favorite food group. The stuff that does this job is protein and fat. On this diet, you can eat as much natural, unprocessed protein and fat as you want.


Here are some examples:

  • Red meat
  • Eggs (whites or whole)
  • Chicken (with/without the skin)
  • Turkey (with/without the skin)
  • Fish (with/without the skin)
  • Butter
  • Coconut oil
  • Olive oil

You’ll notice that I’m pushing unprocessed foods. Slicing turkey meat from an actual turkey breast is better than opening a package of pressed mechanically separated turkey parts. You already know this, because that turkey sandwich the day after Thanksgiving tastes a hell of a lot better than that five-dollar foot long from Subway, it’s just less convenient. Get over it.


I’m a big fish fan. One of the rules of this diet is that you have to eat fish at least twice a week, and the more the merrier. However, fish from a can doesn’t count – it’s not off-limits, but it doesn’t count toward your twice-a-week total. Non-farmed fish is ideal, but work with what you have access to.


I’m not as excited about pork. Fish and lean red meat (and wild game if you have access to it) is number one. Pigs aren’t as good, in my opinion. Sneaking in some lean pork tenderloin is permitted, but no bacon or hot dogs. They’re processed junk.


Avoid things like mayonnaise, peanut butter, and sour cream. Mayo is too processed and peanut butter and sour cream, while natural, are better for weight gain, and this is a weight loss program. If you find yourself losing weight too fast and aren’t trying to get ultra lean, you can add those foods back in.


Energy providers. This is where carbs fall. This is not a low-carb diet – those diets can work but can be a pain to follow, not to mention they cause intense workouts to suck. This diet will have carbs, but they’ll be of the healthy sort.


Here’s what you can eat:

  • Potatoes (any version in its natural state)
  • Sweet potatoes (ideal)
  • Rice (any version)
  • Oatmeal (any version but steel cut preferred)
  • Any fruit
  • Any veggie

Note: Wraps and the like may be used sparingly (once or twice a week)

You may have unlimited amounts of any of the foods from either of the above categories. Yes, unlimited. Most people don’t crave natural foods, and there are far fewer reports of binging on chicken and rice than beer and wings. Natural foods are also enormously satisfying and contain more fiber, so they fill you up quicker.


Natural foods are also much harder to come by. You can get junk food at 2 AM just by hitting up the drive thru or vending machine. You’re much less likely to have a post-bar binge-fest if it requires grilling up chicken and digging out the rice cooker.


Finally, natural foods tend to spoil, so you usually don’t have unlimited quantities lying around, and they’re expensive – so even if your head or stomach doesn’t tell you to stop eating, your wallet will.

You still might find yourself a bit hungry or experiencing cravings while on this diet. That’s expected, but it won’t be cravings for these foods.



You will have veggies at every meal. Yes, every meal, including breakfast. You can have whatever veggies you want, but fresh or frozen is preferred over canned. Your veggies should be bright and colorful and actually have taste.

Peas, broccoli, shredded peppers, and mixed veggies are my personal favorites, but have whatever you want. This will help you feel full, give you some energy, and along with the good fats, help take care of the third category, keeping you healthy.


Avoid any processed carbs, junk food, desserts, sugar, soda, and fruit juice – all off limits. Pasta and bread are also on the avoid list.


Of course, you can eat that stuff if you must, just be aware that you’re cheating if you do. There are also no diet drinks allowed – no Diet Snapple, Pepsi One, Coke Zero, etc. They’re not natural things so they don’t qualify (hey, it’s my diet!).


Basic rule, if the food doesn’t look pretty close to what came out of the ground, you can’t have it.



Nuts. While healthy, nuts tend to slow down the weight loss process. If you’re losing weight too fast, or trying to gain a bit of muscle, then by all means include them. But for straight fat loss, go nut-free for a month and see what happens. You can then make a decision based on the results.


Coffee. I’m not a coffee drinker, but if you’re going to drink it in its relatively natural state (meaning your cup of joe doesn’t resemble a 30-ounce milkshake with caramel drizzle), then it’s likely okay. I also don’t think a person should be addicted to anything, so if you go into caffeine withdrawal without coffee, it’s time to get that under control.


Milk. I like milk and tend to include it in my diets. Start off with 16 ounces or less of whole milk (preferably organic) per day and see how you respond. If you’re losing weight too fast, start to add it back in, if not keep it out. The same holds true for most dairy products like yogurt and cottage cheese.


Alcohol. From a health and fitness point of view, wine is the best (although I don’t drink it, much to my wife’s chagrin). Try limiting wine to one or two times a week and see how you respond. I’d avoid beer or hard alcohol, although you can have them with your weekly cheat meal.


My rule of addiction holds true here, too, so if it’d be hard for you to go a month without booze, then now’s the time to stop and get it under control. One of my favorite quotes (from Epictetus) is, “No man is free who is not a master of himself.”


Supplements. While no diet “needs” supplements, a good peri-workout protocol would be one of the first things I’d put back into a diet, especially if you’re going for that “pretty lean but still big and powerful” look. Check out the Anaconda™ Protocol – the feedback is astounding.



What I like about this diet is that you can follow it long term. I should point out that to me, a diet doesn’t mean a plan you follow for a set time to accomplish a goal; it’s simply a word to describe one’s eating.


But denying yourself sucks, and we only have so much will power, so I want you to cheat on this plan. For one meal, once a week, every week, you can eat whatever you want, as much as you want. No limits.


Ideally, eat reasonably healthy for that meal; go out to a restaurant and order the fish and rice, but add that appetizer or dessert that you’ve been craving. In other words, it’s better to do “little cheats” instead of a big cheat.


So if you’re craving food not on the plan, eat a healthier choice like spaghetti with meat sauce instead of three Big Macs. Think of food as a continuum; just because you’re cheating doesn’t mean you have to go completely to the other side.

The leaner you are, the closer to where you want to be physique-wise, the more you can cheat. The heavier you are, the further away from your goals, the less you can cheat. You can rationalize this by saying heavier folks have already been cheating so now it’s time to pay up and be strict, while leaner people have earned a bit of freedom with their diet and can enjoy themselves accordingly.


Simple Summary


What to eat


  • Unlimited natural, unprocessed meat (chicken, turkey, red meat, wild game)
  • Unlimited animal skin
  • Unlimited natural fat
  • Fish (not from a can) twice per week minimum
  • Veggies with every meal, no exceptions
  • Unlimited fruit
  • Unlimited potatoes, sweet potatoes, rice, and oatmeal
  • If you follow the above rules, one meal per week eat whatever you want, as much as you want.

Note: Choose organic and/or high quality versions of the above foods whenever possible or as budgetary restrictions allow.



A typical 200-pound male following this plan should lose 1-2 pounds a week of mainly fat. Use the stomach/waistline as a progress guide – over time it should get smaller and noticeably leaner.


Once you’ve reached your goal you may modify the program a bit. You might include another cheat meal, or simply try to eat another meal on top of what you’re normally consuming to prevent further weight loss. Adding in additional pre or post workout nutrients would be the best place to start. By this point you should have learned how your body responds to different foods and can make changes appropriately.


Get Simplified

What’s great about this diet – apart from its efficacy – is that you can follow it for a long time, it works pretty well with “real life,” and it still supplies enough energy to get through your T Nation approved workouts.


But it isn’t complicated – when it comes to nutrition, simpler is often better.