University of Lynchburg DMSc Doctoral Project Assignment Repository
Specialty
Endocrinology
Advisor
Dr. Debra Munsell DHSc, PA-C, DFAAPA
Abstract
ABSTRACT
The purpose of this review is to highlight the clinical importance of sex hormone–binding globulin (SHBG) in evaluating candidates for testosterone therapy (TTh). A targeted literature search of PubMed and relevant professional society guidelines was conducted to identify key evidence regarding testosterone deficiency (TD), historical and current challenges in TTh, and the long-term sequelae of untreated TD. While many guidelines do recommend a comprehensive approach, many current clinical approaches rely solely on various lab ranges of total testosterone (TT), overlooking the influence of SHBG, which strongly binds circulating testosterone and reduces bioavailable testosterone values, leading to misclassification and undertreatment. This review underscores the need for an evidence-based, comprehensive approach to TTh that incorporates SHBG and other key biomarkers, and recognizes TD’s direct and bidirectional associations with common metabolic and cardiometabolic comorbidities.
Recommended Citation
Ramos E. Sex Hormone Binding Globulin: Impact on Testosterone Therapy Treatment Paradigms. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).
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