Low SHBG Associated with Male and Female Pattern Baldness. As featured in a prior update, low levels of SHBG in young men are strongly associated with both MPB and insulin resistance.

      SHBG is a hormone that “binds” to testosterone, regulating its ability to do its metabolic job. Insulin resistance correlates with lower SHBG resulting in higher amounts of unbound free testosterone in the blood. From there the the testosterone can be converted into excessive amounts of DHT through 5-alpha reductase. 

      SHBG is also linked to high cortisol, low thyroid, which are both implicated in the onset of MPB. 

J Am Acad Dermatol. 2011 Apr 19.

Sex hormone-binding globulin and risk of hyperglycemia in patients with androgenetic alopecia.

Arias-Santiago S, Gutiérrez-Salmerón MT, Buendía-Eisman A, Girón-Prieto MS, Naranjo-Sintes R.


Dermatology Unit, San Cecilio University Hospital, Granada, Spain.


Low circulating levels of sex hormone-binding globulin (SHBG) are a strong predictor of the risk of type 2 diabetes. Androgenetic alopecia (AGA) has been related to an increase in cardiovascular risk, but the mechanism of this association has not been elucidated. AGA can be associated with low levels of SHBG and insulin resistance, which could be related to hyperglycemia and type 2 diabetes.

The objective of this study was to evaluate SHBG and blood glucose levels in men and women with early-onset AGA and control subjects to determine whether low levels of SHBG are associated with hyperglycemia.

This case-control study included 240 patients consecutively admitted to the outpatient clinic (Dermatology Department of San Cecilio University Hospital, Granada, Spain), 120 with early-onset AGA (60 men and 60 women) and 120 control subjects (60 men and 60 women) with skin diseases other than alopecia.

Of patients with AGA, 39.1% presented with hyperglycemia (>110 mg/dL) versus 12.5% of controls (P < 0.0001). AGA patients with hyperglycemia or diabetes presented lower significant levels of SHBG than alopecic patients without hyperglycemia or type 2 diabetes, respectively. Patients with AGA and hyperglycemia presented significantly lower levels of SHBG than controls with hyperglycemia (22.3 vs 39.4 nmol/L for AGA patients and controls, respectively, P = .004). No significant differences in SHBG levels were noticed between patients and controls without hyperglycemia. Binary logistic regression showed a strong association between lower SHBG levels and glucose levels greater than 110 mg/dL in patients with AGA even after additional adjustment for sex, abdominal obesity, and free testosterone (odds ratio = 3.35; 95% confidence interval = 1.9-5.7; P < .001).

The study of a wider sample of AGA patients would confirm these findings and would permit analysis of the pathogenic mechanisms underlying the increase in cardiovascular risk in patients with AGA.

An association between early-onset AGA, hyperglycemia/diabetes, and low levels of SHBG was observed in the current study. Low levels of SHBG could be a marker of insulin resistance and hyperglycemia/diabetes in patients with AGA.

Hormonal Profile in men with premature androgenic alopecia [Article in Czech]

Starka L, Hill M, Polacek V.

Endokrinologicky ustav a IPVZ, Praha, Czech Republic.

Androgenetic alopecia especially that with premature onset can be a cause of serious psychic trauma. As far as the treatment with antiandrogens, inhibitors of 5 alpha-reductase or hair transplantation represents a heavy economic burden for the patient, we tried to exclude other hormonal causes or to find a criterion for the apt candidates for the treatment in 15 young men with premature androgenetic alopecia.Hormonal analysis discovered a significantly lower plasma level of sexual binding globulin (SHBG) and FSH and nearly significantly higher concentration of 17 alpha-hydroxyprogesterone. These data resemble those in the hormonal pattern of women suffering from the syndrome of polycystic ovaries (PCOS). The finding of premature balding as the possible male phenotype hormonal equivalent of polycystic ovaries is in concordance with several pedigree studies in kindreds with PCOS, which have suggested a genetic basis of this syndrome in some families in which balding and pilosity was frequent in male members.

Sex hormone-binding globulin and saliva testosterone levels in men with androgenetic alopecia.

Cipriani R, Ruzza G, Foresta C, Veller Fornasa C, Peserico A. 

Sex hormone binding globulin (SHBG), plasma testosterone and saliva testosterone were measured in sixty-four men with androgenetic alopecia and in forty males within the same age range without alopecia. There was a significant reduction in SHBG levels in bald men, compared with controls. Plasma testosterone levels were not raised in bald men, but their salivary testosterone levels were significantly higher than in controls.

      Normalizing SHBG is impossible without blood sugar stabilization. 

      Avoidance of refined grains and sugars, Soy Isoflavones and Green Tea Polyphenols will normalize SHBG, and as a result, decrease serum DHT. The combination of Soy Isoflavones and Green Tea Extract is especially effective at accomplishing this. Beta Sitosterol and Flax Lignans also raise SHBG, inhibit DHT binding, and have reported benefits for hair loss as well.

      Finasteride, Durasteride, and Spironolactone, pharmaceutical anti-androgens, all have documented benefits for hair loss and all raise SHBG as well. Unfortunately, their side effects preclude their sustained usage in most.

      Mega Green Tea Extract, Ultra Natural Prostate Formula, and Super Absorbable Soy Isoflavones, are all mainstays in our Best Current Practice, and all have in common documented elevating effects on SHBG, at least partially accounting for their benefits for those with MPB.