What role does sex hormone-binding globulin (SHBG) play in evaluating women with low libido? Is there any treatment for low levels of SHBG when all other hormone levels are within normal range?
—Dana Nicole Nadalo MHS, PA-C, Houston

Rising levels of SHBG lead to decreased bioavailability of circulating androgens, which can be associated with sexual dysfunction in some women. (For example, this might be seen with the administration of exogenous estrogens, such as oral contraceptives or HRT.) A cause-and-effect relationship is hard to establish, however, because sexual function depends on the interaction of both mind and body. Nevertheless, androgen replacement may be a reasonable therapy for patients with high SHBG levels, especially if androgen deficiency is documented. Remember, psychological factors must be addressed before embarking on a lengthy and expensive endocrine workup (Larsen PR, Kronenberg HM, Melmed S, Polonsky KS. Williams Textbook of Endocrinology. Philadelphia, Pa.: WB Saunders; 2002:771-790).
—Reuben W. Zimmerman, PA-C (100-23)

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