Sex Hormone-binding Globulin Values Research Articles

Testosterone levels and risk of newly diagnosed type 2 diabetes mellitus in adult men: systematic review and meta-analysis.

Testosterone is a metabolically active hormone in males for metabolic homeostasis. Although the coexistence of low testosterone levels and type 2 diabetes mellitus (T2DM) have been associated, there are no reports that evaluate alterations in total testosterone (TT) levels and the risk of newly diagnosed T2DM. This review evaluates this question in adult men with high or low levels of total testosterone (TT), as well as the role played by other hormones such as free testosterone (FT), sex hormone binding globulin (SHBG), dihydrotestosterone (DHT), estrogens and testosterone bioavailable (bT). We searched for studies published up to July 30, 2023, in five databases, following a PECO strategy. We found twenty-two studies for quantitative analysis and meta-analyzed the same quantity of studies. This first meta-analysis incorporates the assessment of the risk of low TT and T2DM in longitudinal studies. 43,038 adult men are included. Our meta-analysis shows that there is an association between low TT levels and the risk of newly diagnosed T2DM (OR 1.52; 95% CI 1.10-2.10; p < 0.05; I²: 79%). It is also evident that SHBG in low TT studies behaves as a risk factor for T2DM in the same way as FT, although without statistical significance. bT behaves as a protective factor. There is no association between estrogen, DHT and T2DM. In adult men with low TT values, there is a greater risk of developing a newly diagnosed of T2DM. SHBG values in low TT patients also present a higher risk of T2DM as the same FT but without statistical significance. bT behaves as a protective factor We have not found an association between risk of T2DM and the levels of estrogen, DHT although there are very few studies that report these hormones.

The influence of anthropometric parameters on the concentration of globulin that binds sex hormones during the menopausal transition.

To determine the effect of body mass index (BMI) and waist-hip ratio (WHR) on the concentration of circulating sex hormone-binding globulin (SHBG) throughout the menopausal transition. This cross-sectional study included 150 women divided into three groups: premenopausal (n=50), perimenopausal (n=50), and postmenopausal (n=50). The processing of the test women consisted of three phases: interview, blood sampling and determination of BMI and WHR. The SHBG concentration was determined from the blood, and BMI and WHR were measured. The BMI and WHR of the postmenopausal women were significantly higher comparing to the other two groups, while the postmenopausal SHBG was significantly lower compared to the premenopausal concentration. In all three groups, a significant negative correlation was found between SHBG and BMI (Rho= -0.385; p<0.05), and between SHBG and WHR (Rho= -0.411; p<0.05). By the univariate regression analysis model, it was determined that BMI (β= -0.594; p<0.001) and WHR (β= -0.407; p=0.003) were independently negative predictors of SHBG in postmenopausal women, while in the multivariate regression analysis model only BMI as an independently negative predictor of SHBG in postmenopausal women was found (β= -0.263; p=0.024). The value of SHBG during the menopausal transition decreases and women with higher BMI and WHR have lower values of SHBG regardless of the duration of menopause. Considering the connection between SHBG and anthropometric parameters, and the drop in its values upon entering and passing through the menopausal transition as such it can be used as a predictor for an increased risk of cardiovascular diseases and metabolic syndrome in a selected group of women.

The value of luteinizing hormone basal values and sex hormone-binding globulin for early diagnosis of rapidly progressive central precocious puberty.

This study aimed to investigate the diagnostic value of luteinizing hormone (LH) basal values and sex hormone-binding globulin (SHBG) for rapidly progressive central precocious puberty (RP-CPP). A total of 121 girls presenting with secondary sexual characteristics were selected from the Department of Pediatric Endocrinology, Lianyungang Clinical Medical College of Nanjing Medical University, from May 2021 to June 2023. The children were followed up for 6 months and were divided into three groups: RP-CPP group (n=40), slowly progressive central precocious puberty (SP-CPP) group (n=40), and premature thelarche (PT) group (n=41). The differences in LH basal values and SHBG among girls in the three groups were compared. ROC curves were drawn to analyze the value of LH basal values and SHBG in identifying RP-CPP. Significant differences were observed in age, height, predicted adult height (PAH), weight, body mass index (BMI), bone age (BA), BA-chronological age (CA), LH basal, LH peak, FSH basal, LH peak/FSH peak, estradiol (E2), testosterone, and SHBG levels between the RP-CPP group and the SP-CPP and PT groups (P < 0.05). The LH basal value in the RP-CPP group was higher than that in the SP-CPP group and the PT group, while SHBG levels were lower than in the latter two groups, and these differences were statistically significant (P < 0.05). When the LH basal value was ≥0.58 IU/L and SHBG was ≤58.79 nmol/L, the sensitivity for diagnosing RP-CPP was 77.5% and 67.5%, and the specificity was 66.7% and 74.1%. Detection of basal LH and SHBG levels allows for early diagnosis of the progression of central precocious puberty.

Is testosterone deficiency a predictive factor for recurrence of urethral stricture?

Testosterone plays a vital role in maintaining tissue homeostasis, and testosterone deficiency may potentially influence the likelihood of urethral stricture recurrence. To evaluate the prognostic value of testosterone levels in the recurrence after direct visual internal urethrotomy in primary short segment bulbar urethral strictures and its clinical reflections. A total of 723 patients who underwent direct vision internal urethrotomy between January 2000 and October 2022 were retrospectively analyzed. After implying exclusion criteria, 116 patients with available data were enrolled. Patients were divided into two groups as recurrence and no recurrence. Age, stricture length, etiology, time of recurrence, diagnosis of previous diabetes mellitus, hypertension, smoking, body mass index, and total testosterone levels were recorded. Free testosterone and bioavailable testosterone values were calculated using total testosterone, albumin, and sex hormone binding globulin values. Hypogonadism was considered as a total testosterone level less than 300ng/dL. Demographic characteristics and total testosterone, free testosterone, and bioavailable testosterone levels were compared between the two groups for statistical significance. The recurrence rates of patients with and without hypogonadism were compared. Recurrence was observed in 41.4% of the cases (n=48). There was no statistically significant difference between the groups in terms of age, body mass index values, diabetes mellitus, hypertension, smoking status, presence of hypogonadism, and etiology (p=0.745, 0.863, 0.621, 0.622, 0.168, 0.051, and 0.232). In terms of total testosterone levels and bioavailable testosterone levels, the recurrence group had significantly lower values (p=0.018 and 0.04). There was no significant difference between the two groups in terms of stricture length (p=0.071). Sixteen of 28 patients with hypogonadism had recurrence, whereas 32 of 88 patients without hypogonadism had recurrence (p=0.051). Testosterone levels have potential to predict recurrence in primary short-segment bulbar urethral strictures. This study represents the inaugural analysis of the impact of testosterone deficiency on recurrence within the cohort of patients with primary short-segment bulbar urethral strictures. Testosterone levels and ratios may serve as predictive factors for identifying recurrent cases in primary short-segment bulbar strictures. For patients at a higher risk of recurrence, urethroplasty may be considered as an initial treatment option, even in cases of primary and short-segment strictures.

Sex Hormone Binding Globulin is an Independent Predictor for Insulin Resistance in Male Patients with Newly Diagnosed Type2 Diabetes Mellitus.

This study explored the correlation between sex hormones, sex hormone binding globulin (SHBG), and insulin resistance in male patients with newly diagnosed type2 diabetes mellitus (T2DM). A total of 48 male patients with newly diagnosed T2DM were enrolled in this study between March 2022 and December 2022. Clinical characteristics, sex hormones, and SHBG levels were collected. All enrolled subjects received intensive hypoglycemic treatment with insulin pump for 1week to achieve glycemic control, then the steady-state glucose infusion rate (GIR), an indicator of insulin sensitivity, was determined by the hyperinsulinemic-euglycemic clamp. Correlation analysis and multivariate logistic regression analysis were performed to explore the association of clinical characteristics, sex hormones, and SHBG with insulin sensitivity. The optimal cutoff value to predict insulin resistance was calculated using receiver operating characteristic (ROC) curve. According to the GIR cut-point value of 5.700mg/(kgmin), there were 40 patients with insulin resistance (IR group) and 8 patients without (non-IR group). The IR group exhibited lower testosterone and SHBG levels than the non-IR group (all p < 0.050). Correlation analysis showed that insulin sensitivity was positively associated with testosterone and SHBG, while negatively associated with body mass index, fasting blood glucose, alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglyceride, and apolipoproteinB (all p < 0.050). Multivariate logistic regression analysis demonstrated that SHBG is an independent predictor for insulin resistance (p = 0.029). Further ROC curve analysis revealed that the optimal cutoff value of SHBG to predict insulin resistance is 17.200nmol/L, with the corresponding area under the curve (AUC) and its 95% confidence interval (CI) being 0.813 and 0.691-0.934. SHBG is an independent predictor for insulin resistance in male patients with newly diagnosed T2DM. KY20220314-01.

Erectile Dysfunction in Relation to Metabolic Disorders and the Concentration of Sex Hormones in Aging Men.

Background: The aim of this study was to analyze the relationship between the prevalence of erectile dysfunction in men as diagnosed by the International Index of Erectile Function (IIEF) questionnaire and the respective levels of sex hormones and biochemical parameters, as well as indices of visceral fat accumulation and activity. Material and Methods: The study comprised 148 male (60–75 years) patients from primary care outpatient clinics in the city of Szczecin (Poland). The men were asked to complete a shortened survey questionnaire with sociodemographic data, as well as a shortened version of the IIEF (five items). Venous blood samples were collected. Total testosterone (TT), estradiol (E2), sex hormone-binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), total cholesterol (ChT), low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides (TG), fasting plasma glucose (FPG) and albumin were determined. Lipid accumulation product (LAP) and visceral adiposity index (VAI) were calculated. Results: A correlation was found in the analysis of LAP index values (OR = 1.017; p = 0.050). The analysis of hormone concentrations showed a correlation between the diagnosed trait and the value of TT (OR = 1.216; p = 0.046) and SHBG (OR = 1.020; p = 0.007). Conclusions: VAI and LAP have been shown to be good indicators for assessing erectile dysfunction in men over 60 years of age.

An Examination of sex hormone levels in epilepsy patients taking antiepileptic treatment

Aim Reproductive adverse events may be observed in patients with epilepsy associated with antiepileptic drugs. This study aimed to evaluate changes in sex hormone levels in patients receiving antiepileptic treatment as monotherapy and polytherapy. Method In this case-control study, the sex hormone levels and free androgen indexes were evaluated in 83 patients and 40 controls. In the hormone evaluations, measurements were performed for dehydroepiandrosterone sulfate, sex hormone-binding globulin, follicle-stimulating hormone, luteinizing hormone, total and free testosterone, prolactin and estradiol levels. Results A total of 83 patients (42 males, 41 females) with a mean age of 28±7.2 years and a control group of 40 healthy subjects (14 males, 26 females) with a mean age of 33±8.7 years were included. In the patient group, 45 were receiving monotherapy and 38 polytherapy, 13 (15.7%) patients had focal onset seizures, 68 (81.9%) had generalized onset seizure and 2 (2.4%) had seizure type of unknown origin. In the males of the study group, no difference was determined in the hormone levels. In the females of the study group, the free androgen index was determined to be significantly low in the carbamazepine group compared to the control group (p=0.04) and the sex hormone-binding globulin values were significantly high (p=0.01). In males, a significant positive correlation was determined between serum carbamazepine and follicle-stimulating hormone (p=0.046) and prolactin (p=0.035) and a significant negative correlation was determined with the free androgen index (p=0.032). In females, a statistically significant positive correlation was determined between carbamazepine and prolactin (p=0.036). Conclusion The use of antiepileptic drugs creates changes in the sex hormone levels in males, and associated reproductive side-effects may be seen. In the management of patients with epilepsy, an awareness of these side-effects and individual evaluation could have a positive effect on treatment compliance and patient satisfaction.

Low sex hormone binding globulin: a potential predictor of future glucose dysregulation in women.

Learning Points • Sex hormone binding globulin (SHBG) concentration associates with insulin-resistance. • We looked at the relation between baseline SHBG concentration and future glycaemic status over an up to 10-year period, for women who were normoglycaemic at baseline. • In multiple linear regression analysis, a lower SHBG was associated with a higher fasting glucose independent of age and index of multiple deprivation. • These findings suggest that a low SHBG level, at a relatively young age is a risk marker for future impaired glucose handling in women. Precis: In a laboratory study, we found that low sex hormone-binding globulin level is a risk marker for future relative dysglycaemia in women, with index of multiple deprivation also an independent predictor of future prediabetes/type 2 diabetes mellitus.Editor, Previous work has suggested that a low sex hormone-binding globulin (SHBG) concentration associates with insulin resistance [1]. We previously showed that a low circulating SHBG level (<30 nmol/L) is associated with the presence of the metabolic syndrome in a multiethnic population [2] with lower levels found in both men and women of Pakistan ethnic origin compared with Caucasian and African-Caribbean origin people. In that study SHBG correlated positively with insulin sensitivity as estimated by HOMA-S [3] and negatively with waist-hip ratio, BMI and DBP across all ethnic groups, whereas in multivariate logistic regression analysis a low SHBG increased the likelihood of the metabolic syndrome being present. Furthermore, SHBG levels are often lower in women with polycystic ovarian syndrome (PCOS) [4–6]. There is therefore the potential for SHBG, given its relative ease of measurement (commonly by automated immunoassay), not requiring fasting status or special processing to have utility in identifying people at increased risk or developing impaired glucose handling in the future. In the light of this, we looked at the predictive value of SHBG in relation to the future development of impaired glucose handling in women in a preliminary study in 115 women, over an up to 10-year period. The women were normoglycaemic at baseline. Outcome was either fasting glucose or glycosylated haemoglobin (HbA1c) [7], as measures of glycaemia. ‘As anonymised data were used for the analysis from a laboratory database and no patient was contacted in this study, approval was sought and obtained from the Research and Innovation team’. The mean age of the women at the start of follow-up was 26.8 years (SD, 9.0; range, 16–65). Over the up to 10-year follow-up period, 6% developed non-diabetic hyperglycaemia (defined as HbA1c 42–47 mmol/mol) to and 1% type 2 diabetes (T2DM, defined as HbA1c ≥48 mmol/mol). In multiple linear regression analysis, a lower SHBG was associated with higher fasting glucose [normalised beta (β) −0.22; P = 0.02] independent of age (β 0.28; P = 0.01) and index of multiple deprivation (IMD) (β −0.11; P = 0.06) and South Asian ethnicity (β −0.13; P = 0.04). In logistic regression, we found that age was predictive of subsequent development of prediabetes/T2DM [odds ratio 1.08 (95% CI, 1.02–1.15); P = 0.01] independent of IMD/SHBG/ethnicity. In the light of these results, we suggest that a low SHBG level may have value as a risk marker for the development of future glucose dysregulation in women, with age also an independent predictor of nondiabetic hyperglycaemia/T2DM. Where someone has been found to have a low SHBG, there is the potential for targeted lifestyle measures to be implemented to prevent or delay the onset of glucose dysregulation. In our study, a younger age profile of the group likely influenced the low cumulative incidence of T2DM over the 10-year follow-up period. Nevertheless, SHBG may prove to be a useful future marker for the impact of lifestyle change programmes to reduce metabolic risk those people found to have a low SHBG, including women with PCOS. We plan further work to improve our understanding of this and to continue to follow-up this cohort of women in the coming years. Acknowledgements Conflicts of interest There are no conflicts of interest.

Association of Serum Sex-Hormone-Binding Globulin in Pregnant Women with Gestational Diabetes Mellitus

Background &amp; objective: Gestational diabetes mellitus (GDM) is a common pregnancy complication and is associated with increase maternal and neonatal morbidity. Circulating Sex hormone-binding globulin (SHBG) levels are inversely associated with insulin resistance, and insulin resistance is the hallmark of GDM. This study was carried out to investigate SHBG level in pregnancy and to analyze the association of SHBG with GDM.&#x0D; Materials &amp; Methods: This case-control study was carried out in the antenatal clinic of the department of obstetrics &amp; gynecology, BSMMU, Shahbag, Dhaka, over a period of 12 months between August 2017 to July 2018. Participants were 80 in number, aged between 18 to 35 years, having singleton pregnancy with 24 to 28 weeks of gestation. 40 GDM cases were enrolled as the case, and 40 non-GDM cases were enrolled as the control. Pregnant women with overt diabetes/diabetes in pregnancy, previous history of GDM, pre-eclampsia, gestational/chronic hypertension, known case of liver disease, thyroid disorder, acute or chronic renal disease, congenital fetal anomaly, multiple pregnancies, smoking, H/O polycystic ovary syndrome (PCOS) was excluded from the study. Comparison of means made by using Student t-test and categorical data were analyzed by Chi-square Test, and Pearson's correlation was utilized between serum sex-hormone binding globulin level nmol/L with fasting plasma glucose (mmol/L) and 2-hour after 75g glucose (mmol/L). Statistical significance was set at p &lt; 0.05.&#x0D; Results: The median value of serum SHBG was 245.0nmol/L (195.8-278.1) in the case group and 390.1nmol/L (310.2-465.3) in the control group. Women with GDM were found to have significantly lower levels of SHBG compared to the controls (p&lt;0.05). There was a moderate negative significant correlation (r=-0.621; p=0.001) between fasting plasma glucose (mmol) with serum SHBG (nmol/l) in GDM patients. On the other hand, there was a weak negative but not significant correlation (r=-0.229; p=0.155) was found between 2 hours after plasma glucose with serum SHBG in the GDM group.&#x0D; Conclusion: A significantly lower SHBG level is associated with GDM.&#x0D; TAJ 2021; 34: No-1: 80-85

The Cutoff Value of Low Sex Hormone-Binding Globulin and Its Predictive Role in Impaired Glucose Metabolism Among Chinese Women with Polycystic Ovarian Syndrome.

Background: Low levels of sex hormone-binding globulin (SHBG) is a potential predictor of type 2 diabetes mellitus (T2DM), and when combined with insulin resistance (IR), lead to impaired glucose metabolism. Few studies involve women with polycystic ovarian syndrome (PCOS). Studies on cutoff values of SHBG among Asian women were scanty. Methods: The cutoff level of SHBG was computed using the 25th percentile method. Parameters were compared between the lower and higher SHBG subgroup. Area under the curve (AUC) for sensitivity and specificity of SHBG in predicting IR and impaired glucose metabolism was calculated. Results: This study included 733 patients with PCOS 20-45 years of age and 469 age-matched controls. The 25th percentile of SHBG in the control group was 51.90 nM. There were negative correlations between SHBG and age (r = -0.085, P < 0.05), body mass index (BMI) (r = -0.461, P < 0.01), waist-to-hip ratio (WHR) (r = -0.349, P < 0.01), fasting plasma glucose (r = -0.242, P < 0.01), Glucose-1h (r = -0.303, P < 0.01), Glucose-2h (r = -0.336, P < 0.01), fasting insulin (r = -0.324, P < 0.01), Insulin-1h (r = -0.238, P < 0.01), Insulin-2h (r = -0.307, P < 0.01), and homeostasis model 2 assessment of insulin resistance (HOMA2-IR) (r = -0.329, P < 0.01). Age, BMI, WHR, glucose and insulin levels (both pre- and postload), HOMA2-IR, free testosterone, and dehydroepiandrosterone sulfate were all higher in the lower than the higher SHBG subgroup. The AUC of SHBG for predicting IR was 0.706 [95% confidence interval (CI) 0.665-0.745, P < 0.001], impaired fasting glucose was 0.674 (95% CI 0.513-0.838, P < 0.001), impaired glucose tolerance was 0.637 (95% CI 0.586-0.690, P < 0.001), and T2DM was 0.674 (95% CI 0.556-0.780, P < 0.001). Conclusions: A 51.90 nM should be identified as the cutoff value of SHBG. Women with PCOS with lower SHBG values have a higher risk of developing impaired glucose metabolism. Low SHBG should be a predictive biomarker of impaired glucose metabolism in women with PCOS in southern China.

The importance of SHBG and calculated free testosterone for the diagnosis of symptomatic hypogonadism in HIV-infected men: a single-centre real-life experience

PurposeThe prevalence of low testosterone and symptoms of hypogonadism in HIV-infected men is still debated. We aimed to estimate the prevalence and type of hypogonadism in HIV-infected males complaining about sexual symptoms, and to evaluate the role of calculated free testosterone (cFT) vs total testosterone (TT) for diagnosis. Furthermore, we evaluated relationship between sex hormone-binding globulin (SHBG), gonadal status and clinical and virologic parameters.MethodsWe retrospectively evaluated 169 HIV-infected men with sexual symptoms, with TT available. Among them, we selected 94 patients with TT, SHBG, cFT, and luteinizing hormone (LH) available, and classified hypogonadism into overt (low TT and/or low cFT) and compensated (high LH, normal TT and cFT). Comparison was performed by non-parametric Kruskal–Wallis test and Spearman’s correlation was calculated to verify the possible associations.ResultsOvert and compensated hypogonadism were found in 20.2% and 13.8% of patients, respectively. With reliance on TT alone, only 10.6% of patients would have met diagnosis. SHBG values were elevated in one third of patients, and higher in men with compensated hypogonadism. Significant positive correlation was found between SHBG and HIV infection duration, TT and LH.ConclusionOnly a complete hormonal profile can properly diagnose and classify hypogonadism in HIV-infected men complaining about sexual symptoms. TT alone reliance may lead to half of diagnoses missing, while lack of gonadotropin prevents the identification of compensated hypogonadism. This largely comes from high SHBG, which seems to play a central role in the pathogenesis of hypogonadism in this population.

Efficacy of sex hormone-binding globulin on predicting metabolic syndrome in newly diagnosed and untreated patients with polycystic ovary syndrome.

The aims of this study were to investigate the correlation of sex hormone-binding globulin (SHBG) and the components of metabolic syndrome (MetS) and explore the ability of SHBG to predict MetS in newly diagnosed and untreated patients with polycystic ovary syndrome (PCOS). Ninety-eight newly diagnosed and untreated patients with PCOS and 37 healthy volunteers were recruited. A receiver operating characteristic (ROC) curve was used to explore the best cutoff values of SHBG for predicting that the patients with PCOS would fulfill at least one abnormal index of MetS components, at least two abnormal indexes of MetS components, or MetS. The numbers of patients with PCOS who fulfilled none, one, or two of the MetS criteria items and MetS were 33, 31, 19, and 15, respectively. SHBG was negatively correlated with BMI (r = - 0.615, P < 0.001), systolic blood pressure (SBP) (r = - 0371, P < 0.001), diastolic blood pressure (DBP) (r = - 0.285, P = 0.004), triglycerides (TG) (r = - 0.431, P < 0.001), fasting serum insulin (I0) (r = - 0.549, P < 0.001), HOMA-IR (r = - 0.557, P < 0.001), and plasma glucose 2h after glucose load (G120) (r = - 0.337, P < 0.001) and positively correlated with high-density lipoprotein cholesterol (HDL-C) (r = 0.629, P < 0.001) in patients with PCOS. The optimal cutoff value of SHBG for predicting MetS in patients with PCOS was 21.3nmol/L, with a sensitivity of 100.0% (95% CI 78.0-100.0%) and specificity of 85.12% (95% CI 77.5-90.9%). Sixty-five patients had varying degrees of metabolic abnormalities, accounting for 66.3% of the patients with PCOS. SHBG was associated with metabolic indexes, including BMI, SBP, DBP, TG, I0, HOMA-IR, G120, and HDL-C, and can therefore be employed as a useful index for MetS prediction.

SAT-LB134 Aging Related Changes in Sex Hormone-Binding Globulin in Men With HIV

Background: Sex hormone-binding globulin (SHBG) is a glycoprotein that regulates the bioavailability of sex hormones, may directly affect glucose metabolism, and increases with age in the general population. SHBG concentrations are higher in people with HIV, a population in whom accelerated aging has been hypothesized. It is unclear whether age-related trajectories of SHBG differ by HIV serostatus. Methods: SHBG was measured in 182 men with HIV (MWH) and 267 men without HIV (MW/oH) from the Multicenter AIDS Cohort Study (MACS) in four U.S. cities, who had ≥2 samples over a 10 year period. Outcome measure: SHBG, log2SHBG. Multivariable linear mixed-effects regression models were used to evaluate whether SHBG (log2-transformed) and its rate of change differed by HIV serostatus after adjustment for covariates: age, race, BMI, smoking, education, hepatitis C virus infection, total testosterone concentrations, time of day of blood drawn and comorbidities (history of diabetes, kidney disease, liver disease, cancer, depression, hypertension) Results: At baseline, mean age among MWH was similar to MW/oH (51±5 vs 49±6 years). However, SHBG values were higher in MWH compared to MWo/H (65.6±48.8 nmol/L vs. 45.4±22 nmol/L, p<0.001). The rate of SHBG change with age was (1.021 (95% CI:1.010-1.028) or 2.1% per year in MWH and (1.014 nmol/L/year (95% CI:1.010-1.019) or 1.4% per year in MW/oH, p=0.05 for difference in slopes. Among MWH, higher SHBG levels were significantly associated with lower CD4+ T cell count (0.99 (5%CI:0.98-1.00), p<0.05), fewer cumulative years on zidovudine (0.98 nmol/L (95%CI:0.96,1.00), p<0.001) and greater cumulative years on non-nucleoside reverse transcriptase inhibitors drugs (1.02 (95%CI:1.00,1.04), p<0.05). Conclusion: Aging-related increases in SHBG were greater in magnitude among men with HIV and were related to poorer immunologic status and antiretroviral factors. The mechanisms and consequences of these findings require further investigation.

Physical Activity and Sex Hormone–Binding Globulin in Older Adults

Besides its known function as a transport protein for testosterone and other steroid hormones, sex hormone-binding globulin (SHBG) is a biomarker associated with many adverse health effects. The aim of this study was to investigate the association of physical activity with SHBG serum levels in older adults. The physical activity and SHBG values for 1,259 older adults (43.4% female; 56.6% male) with a mean age of 75.6 ± 6.5 years were included in the analysis. The average daily walking duration was 104.2 ± 40.4 (mean ± SD) min. A positive dose-response relationship of daily walking duration with quartiles of SHBG was seen after adjustment for age, sex, history of cardiovascular diseases, diabetes, smoking, γ-glutamyl transferase, and C-reactive protein (p for trend = .010). However, this relationship disappeared after adjustment for body mass index (p for trend = .977). Body mass index seems to be an important determinant of SHBG and a possible confounding factor in the relationship of physical activity and SHBG.

Do 5α-Reductase Inhibitors Raise Circulating Serum Testosterone Levels? A Comprehensive Review and Meta-Analysis to Explaining Paradoxical Results.

Many studies have reported that 5α-reductase inhibitors (finasteride and dutasteride) raise serum testosterone (T) levels, yet there is lack of consistency among studies on this point. To review and meta-analyze available studies reporting changes in serum T concentrations in men treated with 5α-reductase inhibitors (5α-RIs). A Medline search using PubMed and EMBASE was performed including the following key words: "finasteride," "dutasteride," "testosterone and 5α-reductases." Relevant studies were extracted, evaluated, and analyzed. Of these, 40 studies were analyzed qualitatively and 11 were included in the meta-analysis. A random effects model was used to conduct the meta-analysis. In 11 studies comprising 1,784 patients with age ranging between 18 and 83 years and average treatment follow-up of 17 months, meta-analytic estimate of the mean baseline change was 27 (95% confidence interval 1-54). The meta-analysis did not demonstrate unequivocal significant increase in serum T levels. The increase was not uniform among all studies reported. Sensitivity analysis showed that no single study contributed decisively to the outcome or could be attributed to drug action. The reported increases in T levels with finasteride or dutasteride in men with low baseline serum T may be attributed, in part, to increased trapping of T by unsaturated sex hormone binding globulin (SHBG) due to dissociation of 5α-dihydrotestosterone. In men with high baseline T levels, there appears to be no change in serum T levels. 10 studies reported luteinizing hormone, follicle-stimulating hormone, SHBG, and estradiol values and none reported significant changes in their levels, suggesting that observed changes in serum T levels are unlikely mediated by gonadotropins levels or peripheral conversion of T to estradiol. 5α-RI therapy is not associated with consistent and significant increases in serum T levels. Traish AM, Krakowsky Y, Doros G, etal. Do 5α-reductase inhibitors raise circulating serum testosterone levels?A comprehensive review and meta-analysis to explaining paradoxical results. Sex Med Rev 2019;7:95-114.

Serum Concentrations of Sex Hormone–binding Globulin Vary Widely in Younger and Older Men: Clinical Data from a Men’s Health Practice

BackgroundThe testosterone (T) status of a man is influenced by serum concentrations of sex hormone–binding globulin (SHBG). Specifically, tight binding of T to SHBG is believed to render the SHBG-bound T fraction biologically unavailable, meaning that interpretation of T levels in the clinical setting depends in part on knowledge of SHBG concentrations. Although SHBG levels have been reported in population studies, there is scant information for men presenting with clinical symptoms. ObjectiveTo report SHBG values for a large cohort of men presenting to a men’s health center. Design, setting, and participantsMedical records were reviewed for 1000 consecutive patients seen at our center with a reported SHBG value. SHBG concentrations were measured by a national clinical laboratory using an immunoassay run on a Beckman Coulter DXi system. Outcome measurements and statistical analysisPatients were age-stratified and data were plotted in the form of comparative histograms. Results and limitationsThe mean age (±standard deviation) of the total cohort was 53.5±13.5 yr (range 17–91). The mean SHBG was 31.8±15.2nmol/l (range 6-109), with a nearly 20-fold difference from the lowest to the highest values. SHBG was >60nmol/l in 5.6% of the men. Patients were stratified according to age. A total of 535 patients were ≤54 yr old. In this younger cohort, the mean age was 40.52±7.9 yr (range 17–54) and mean SHBG was 27.7±13.3nmol/l (range 6–88), and 2.2% of patients had SHBG >60nmol/l. A total of 465 patients were ≥55 yr old. In this older cohort, the mean age was 64.8±7.23 yr (range 55–91) and mean SHBG was 36.6±15.8 nmol/l (range 11–109), and 9% of patients had SHBG >60 nmol/l. Mean SHBG was significantly higher in the older group (p<0.001). ConclusionsA remarkably wide distribution of SHBG concentrations was observed in a clinical population of men presenting to a men’s health center, among both younger and older men. Since SHBG concentrations greatly influence test results for hormones that bind to SHBG, recognition of this large interindividual variability should be considered in the clinical interpretation of these hormone results, particularly for T. Routine SHBG testing should be considered for men suspected of T deficiency. Patient summarySex hormone–binding globulin (SHBG) levels vary widely among both older and younger men. This may impact the interpretation of test results for hormones that bind to SHBG, such as testosterone, since the portion that binds to SHBG is believed to not be biologically available.

Risk factors for preeclampsia in infertile Chinese women with polycystic ovary syndrome: A prospective cohort study.

To explore preconception risk factors for preeclampsia (PE) in women with polycystic ovary syndrome (PCOS), a prospective cohort study was conducted in 92 infertile Chinese women with PCOS who had a singleton pregnancy by ovulation induction and were followed up for 6 weeks after delivery. The patients underwent assessment of physical, endocrine, and metabolic features before ovulation induction. Fifteen (16.3%) patients were diagnosed with PE. Logistic regression analysis showed that preconception sex hormone–binding globulin (SHBG), insulin level at 120 minutes, and body mass index were three independent risk factors for PE (odds ratio [OR], 0.981; 95% confidence interval [CI], 0.964–0.998 [P=.027]; OR, 1.011; 95% CI, 1.000–1.021 [P=.048]; and OR, 1.249; 95% CI, 0.992–1.572 [P=.059], respectively). Receiver operator characteristic analysis indicated the risk value of prepregnancy SHBG, insulin level at 120 minutes, and body mass index (area under the curve=.788, .686, and .697, respectively). Preconception low SHBG levels, overweight/obesity, and hyperinsulinism might be correlated with the subsequent development of PE in patients with PCOS.

Distinction of hypertriglyceridemic waist phenotype from simple abdominal obesity: interaction with sex hormone-binding globulin levels to confer high coronary risk

ABSTRACTObjective: The associations of total testosterone (TT) and sex hormone-binding globulin (SHBG) with the hypertriglyceridemic waist (HtgW) phenotype and coronary heart disease (CHD) risk have scarcely been examined. We explored such cardiometabolic risk mediations in middle-aged adults.Methods: Participants (n = 1924) in a population-based study were studied by forming categories consisting of abdominal obesity, hypertriglyceridemia, both (HtgW), or none (‘healthy’). Cardiometabolic risk was prospectively analyzed (mean follow-up 5.7 years).Results: With reference to the healthy group, SHBG values in HtgW were significantly lower, alike serum HDL-cholesterol. ApolipoproteinB-containing lipoproteins, fasting glucose and complement C3 levels, inverse to lipoprotein[Lp](a) especially in female participants with HtgW phenotype compared with those in the ‘healthy’ category, suggested the operation of aggregation to Lp(a). Multivariable Cox regression analysis in a model comprising age, waist circumference and systolic blood pressure showed significant protection by SHBG against incident diabetes which tended to be so with TT in men. Sex hormones were not associated with risk of incident CHD or MetS. In another multivariable model, compared to the ‘healthy’ and the hypertriglyceridemia categories, dichotomized high and, in females, low SHBG values within the HtgW category, positively predicted CHD at significant over 2–fold relative risks.Conclusion: HtgW phenotype distinguishes itself from the (virtually neutral) simple abdominal obesity in independently conferring high CHD risk when elevated or reduced SHBG levels interact. Underlying operation of Lp(a) aggregation is suggested.

Correlation of serum sex hormone levels with metabolic syndrome in elderly men

To investigate the relationship between sex hormones and metabolic syndrome (MS), as well as its components in elderly men. 1 505 elderly men (≥60 years old, mean age 75.4±9.7 years old) who participated in a routine health screening examination in PLA general hospital from May to June in 2012 were enrolled in this cross-sectional study. Serum lipids, glucose and sex hormones were measured along with body height, weight and blood pressure. Free testosterone (FT) and bioavailable testosterone (BT) were calculated. The correlation of serum sex hormones with the presence of MS and its components were analyzed. The prevalence of MS was 21.7% (326/1 505) in this study. Elderly men with MS had lower levels of sex hormone-binding globulin (SHBG), total testosterone (TT), FT and BT than those without MS. The levels of SHBG, TT, FT and BT were significantly lower in the overweight/obesity group, hyperglycemia group and dyslipidemia group than those in the respective control groups (P<0.05). Logistic regression analysis showed that the SHBG level was an independent risk factor for MS in elderly men(OR=0.977, 95%CI: 0.964-0.989, P<0.001), while the levels of TT, FT and BT were not associated with MS. The prevalence of MS gradually increased with decreasing of SHBG values (P<0.001). When comparing subjects in the lowest and highest quartile of SHBG, the former group demonstrated a 2.13-fold increase in the odds ratio for MS after adjusting for age, smoking, drinking and other sex hormone indices. In elderly men, lower SHBG level, not TT, FT or BT may be an independent predictor for the prevalence of MS, in which the mechanism requires further studies.

Essay of sex hormone binding protein in internal medicine:a brief review

The sex hormone binding globulin(SHBG) is a protein produced mainly in the liver that binds sex steroid hormones and thereby regulates their bioavailability. Many studies do correlate low levels in many diseases including diabetes mellitus and the metabolic syndrome with associated risks to the development of cardiovascular diseases. According to some jobs low SHBG can predict the onset of diabetes mellitus; based on other study that a healthy lifestyle can increase SHBG values.