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Anti-aging Research > SHBG
Sex Hormone Binding Globulin (SHBG)
Alternative News:
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Men’s Sexual Health: Testosterone & Nitric Oxide Modulation - Huntington
University of Health Sciences - "it is significant
to note that the human clinical research has been done on a specific
proprietary extract known as LJ100. This is important since the LJ100
extract of E. longifolia has been standardized for ... eurypeptides,
naturally-occurring compounds which may be the active phytochemicals in E.
longifolia, or at least serve as a marker for extract quality ... Human
clinical studies on LJ100 have ... been conducted at different dosage
levels, but 200 mg/day showed the most benefits. Studies included both
controlled trials and open-label trials. It will not be possible to provide
a detailed review all of the studies; however, here ...is a synopsis of the
research results: Depending on the study, T increased 16.4-71.5 percent
11-13 ... Depending on the study, cortisol decreased 16-32 percent14,11 ...
DHEA increased 47 percent9 ... Sexual health scores improved
significantly10,15, as much as 91 percent9 ... It appears that at least one
of the mechanisms of action for LJ100 is the reduction of sex
hormone-binding globulin (SHBG) levels. SHBG is a glycoprotein that binds to
sex hormones. While bound to SHBG, T cannot bind to cellular androgen
receptors—which means that it won’t have any of the valuable effects of T in
this form. Of course, SHBG-bound T can be unbound, but it can take a while
for this to happen. Furthermore, SHBG levels increase as we age.2 In one of
the studies, LJ100 was shown to reduce SHBG levels in 36 percent of the
cases after one week, and 66 percent after three weeks" - See
LJ100 at Amazon.com.
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Male Hormonal Health and the Role of Eurycoma longifolia Herb in Enhancing
Free Testosterone in Ageing Men - Rainforest Herbs, 8/13/17 -
"In their follow-up study the effects of Tongkat Ali
extract on testosterone, dehydroepiandrosterone (DHEA) and sex hormone
binding globulin (SHBG) were investigated over a 3 week period using an
intermediate dosage of 50 mg extract capsules, with 4 capsules taken each
day. Also a questionnaire to determine improvement in quality of life and
sexual response was given to the participants. The final results showed that
82% of the participants experienced improvements in physical, sexual and
psychological well-being. While total testosterone was not significantly
different, the DHEA levels had increased by 26% after one week to 47% after
3 weeks. SHBG levels had reduced in 66% of cases after 3 weeks. When SHBG
decreases the free testosterone index (FTI) increases. The FTI analysis
showed an increase in 39% of participants after 1 week and 73% of
participants after 3 weeks."
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Effect of
Tongkat Ali on stress hormones and psychological mood state in moderately
stressed subjects - J Int Soc Sports Nutr. 2013; 10: 28 -
"The effects of tongkat ali in restoring normal
testosterone levels appears to be less due to actually “stimulating”
testosterone synthesis, but rather by increasing the release rate of “free”
testosterone from its binding hormone, sex-hormone-binding-globulin (SHBG)
[17,18]. In this way, eurycoma may be considered not so much a testosterone
“booster” (such as an anabolic steroid), but rather a “maintainer” of normal
testosterone levels and a “restorer” of normal testosterone levels (from
“low” back “up” to normal ranges) [19]. This would make eurycoma
particularly beneficial for individuals with sub-normal testosterone levels,
including those who are dieting for weight loss, middle-aged individuals
suffering with fatigue or depression, and intensely training athletes who
may be at risk for overtraining ... Salivary cortisol levels were
significantly lower (−16% compared to placebo, PL) following tongkat ali
(TA) supplementation (200 mg/day for 4 weeks) ... Daily supplementation
(200 mg/day for 4 weeks) with tongkat ali (TA) resulted in significant
improvements compared to placebo (PL) for indices of Tension (−11%), Anger
(−12%), and Confusion (−15%) in moderately stressed adults ... Tongkat ali
has been referred to as Malaysia’s “home-grown Viagra” [4] with the
Malaysian government investing considerable effort to license, develop, and
sustain research into the potential health benefits of Eurycoma longifolia
through a variety of governmental organizations, including the Forest
Research Institute of Malaysia" - See
tongkat at Amazon.com.
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Cross-Sectional
Association of Coffee and Caffeine Consumption With Sex Hormone-Binding
Globulin in Healthy Nondiabetic Women - Medscape, 1/23/18 -
"High coffee (≥3 cups/day) and caffeine (≥265
mg/day) intakes were associated with a reduced risk of being in the 1st
quartile of the SHBG level distribution (<46.3 nmol/L) in a multivariate
adjusted model (OR: 0.72 ... Consumption of high coffee and caffeine is
associated with a reduced risk of low SHBG, an established risk marker for
T2DM, which might contribute to the protective effects of coffee for type 2
diabetes"
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Vitamin D Supplements
May Raise Sex Hormone Levels in Men - Medscape, 6/1/17 -
"Testosterone is converted to estradiol, and SHBG
binds testosterone and estradiol, Dr Lerchbaum observed, but only the
unbound fraction of hormones is biologically active. Effectively, the lower
SHBG levels result in more bioavailable testosterone. "We think that low
SHBG levels should be an advantage for these men because they have more
biologically active hormone." ... Maybe. Sufficient estradiol levels are
important for the feedback mechanism with hypothalamus and the pituitary
gland (LH and FSH levels) ... It may be speculated that the decrease in SHBG
and the resultant increases in free testosterone levels might help improve
the hypogonadism problem and fertility in these" - See
vitamin D at Amazon.com
.
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Oleic
acid increases hepatic sex hormone binding globulin production in men -
Mol Nutr Food Res. 2013 Oct 20 - "Low circulating
sex hormone-binding globulin (SHBG) is an independent risk factor for
cardiovascular disease ... A total of 315 men were included. In these
patients, nutrition data and plasma samples for SHBG assessment were
obtained. In vitro studies to examine the effects of oleic and linoleic acid
on SHBG production using HepG2 cells were performed. We provided evidence
that SHBG serum levels were significantly higher in subjects using olive oil
for cooking in comparison with subjects using sunflower oil ... MUFA were
independently associated with SHBG levels and accounted for the 20.4% of
SHBG variance ... Olive oil consumption is associated with elevated SHBG
serum levels"
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Tongkat Ali as a Potential Herbal Supplement for Physically Active Male and
Female Seniors-A Pilot Study - Phytother Res. 2013 Jun 11 -
"Tongkat Ali (Eurycoma longifolia; TA) is known to
increase testosterone levels and alleviate aging males' symptoms. This study
aimed at investigating TA as an ergogenic supplement for elderly people.
Thirteen physically active male and 12 physically active female seniors
(57-72 years) were supplemented with 400-mg TA extract daily for 5 weeks ...
Treatment resulted in significant increases in total and free testosterone
concentrations and muscular force in men and women. The increase in free
testosterone in women is thought to be due to the significant decline in sex
hormone-binding globulin concentrations" - See
Tongkat Ali products at iHerb.
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Association of vitamin D status with serum androgen levels in men - Clin
Endocrinol (Oxf). 2009 Dec 29 - "Men with sufficient
25(OH)D levels (>/=30 mug/l) had significantly higher levels of testosterone
and FAI and significantly lower levels of SHBG when compared to 25(OH)D
insufficient (20-29.9 mug/l) and 25(OH)D deficient (<20 mug/l) men (p<0.05
for all). In linear regression analyses adjusted for possible confounders,
we found significant associations of 25(OH)D levels with testosterone, FAI,
and SHBG levels (p<0.05 for all). 25(OH)D, testosterone, and FAI levels
followed a similar seasonal pattern with a nadir in March (12.2 mug/l, 15.9
nmol/l, and 40.8, respectively) and peak levels in August (23.4 mug/l, 18.7
nmol/l, and 49.7, respectively) (p<0.05 for all). Conclusion: Androgen
levels and 25(OH)D levels are associated in men and reveal a concordant
seasonal variation" - See
vitamin D at Amazon.com
.
News & Research:
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Serum testosterone is
inversely, and sex hormone-binding globulin directly, associated with all-cause
mortality in men - J Clin Endocrinol Metab 2020 Oct 16 -
"Lower serum testosterone is independently associated
with higher all-cause and cancer-related, but not CVD-related, mortality in
middle-aged to older men. Lower SHBG is independently associated with lower
all-cause, CVD-related and cancer-related mortality"
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Testosterone,
Dihydrotestosterone, Bone Density, and Hip Fracture Risk among Older Men: The
Cardiovascular Health Study - Metabolism 2020 Oct 12 -
"In older men, DHT was inversely associated with hip
fracture risk and SHBG was positively associated with hip fracture risk, while T
was not"
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Serum SHBG is associated
with the development and regression of non-alcoholic fatty liver disease: a
prospective study - J Clin Endocrinol Metab. 2019 Dec 3 -
"Sex hormone-binding globulin (SHBG), a homodimeric
glycoprotein produced by hepatocytes has been shown to be associated with
metabolic disorders. Whether circulating SHBG levels are predictive of later
risk of non-alcoholic fatty liver disease (NAFLD) remains unknown ... Basal SHBG
was negatively associated with NAFLD development, with a fully adjusted odds
ratio (OR) and its 95% confidence interval (CI) of 0.22 (0.12-0.40) (P-trend <
0.001). In contrast, basal SHBG was positively associated with NAFLD regression,
with a fully adjusted OR of 4.83 (2.38-9.81) (P-trend < 0.001).
Multiple-stepwise logistic regression analysis showed that SHBG concentration
was an independent predictor of NAFLD development (OR, 0.28 [0.18-0.45]; P <
0.001) and regression (OR, 3.89 [2.43-6.22]; P < 0.001). In addition, the area
under the receiver operating characteristic curves were 0.764 (95% CI,
0.740-0.787) and 0.762 (95% CI, 0.738-0.785) for the prediction models of NAFLD
development and regression, respectively"
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SHBG, Sex Steroids and
Kyphosis in Older Men: The MrOS Study - J Bone Miner Res. 2016 Jun 29 -
"Accentuated kyphosis is associated with adverse health
outcomes including falls and fractures. Low bone density is a risk factor for
hyperkyphosis, and each vertebral fracture adds roughly 4 degrees to forward
spine curvature. Sex steroids, in particular low bioavailable estradiol and high
SHBG, are associated with bone loss and high SHBG is associated with vertebral
fractures in older men ... After adjustment for age and other confounding
variables, no association was found between bioavailable estradiol or
testosterone and Cobb angle, either when kyphosis was analyzed as a continuous
variable or dichotomized into highest vs. lower three quartiles. In linear
regression models adjusted for age and clinic site, there was a significant
association between SHBG and kyphosis (parameter estimate = 0.76 per SD
increase, p = 0.01). In the fully adjusted model, this association was weakened
and of only borderline statistical significance ... High SHBG is associated with
bone loss and vertebral fractures. Our results suggest that high SHBG may also
be a risk factor for hyperkyphosis"
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Sex
steroids, sex hormone-binding globulin and cardiovascular health in men and
postmenopausal women: the Rotterdam Study - J Clin Endocrinol Metab. 2016
May 10 - "estradiol (E2), testosterone (T), sex
hormone-binding globulin (SHBG), and free androgen index (FAI) ... optimal
cardiovascular health (OCH ... After adjustment for confounders, OCH was
associated with lower T [OR (95%CI): 0.69 (0.48-1.00)] and lower FAI [0.43
(0.32-0.57)] and higher levels of SHBG [4.55 (2.99-6.94)] among women and with
higher levels of SHBG [2.56 (1.45-4.49)] in men"
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Sex
steroids, sex hormone-binding globulin and cardiovascular health in men and
postmenopausal women: the Rotterdam Study - J Clin Endocrinol Metab. 2016
May 10 - "estradiol (E2), testosterone (T), sex
hormone-binding globulin (SHBG), and free androgen index (FAI) ... optimal
cardiovascular health (OCH ... After adjustment for confounders, OCH was
associated with lower T [OR (95%CI): 0.69 (0.48-1.00)] and lower FAI [0.43
(0.32-0.57)] and higher levels of SHBG [4.55 (2.99-6.94)] among women and with
higher levels of SHBG [2.56 (1.45-4.49)] in men"
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Association
of Sex Hormone Binding Globulin and Free Testosterone with Mortality in Men with
Type 2 Diabetes Mellitus - Eur J Endocrinol. 2015 Oct 19 -
"Low circulating testosterone levels have been
associated with increased mortality in men. We hypothesized that the prognostic
role of testosterone in men with type 2 diabetes mellitus (T2DM) is influenced
by its carrier protein sex hormone binding globulin (SHBG) ... higher SHBG
(Hazard Ratio (HR) 1.012 [95% Confidence Interval (CI) 1.002-1.022], p=0.02) and
lower calculated free testosterone (cFT) (HR 0.995 [95% CI 0.993-0.998],
p=0.001) were risk factors for all cause mortality ... By contrast, the inverse
association of total testosterone (TT) with mortality weakened after these
adjustments (p=0.11). SHBG remained associated with mortality (p<0.001) both if
substituted for or added to TT in the multivariable model. In the fully adjusted
model, an increase of SHBG by 17.3 nmol/L (1 SD) increased mortality by 22% and
a decrease in cFT by 81 pmol/L (1 SD) increased mortality by 45%"
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The
Association of Obesity with Sex Hormone Binding Globulin is Stronger than the
Association with Aging - Implications for the Interpretation of Total
Testosterone Measurements - Clin Endocrinol (Oxf). 2015 Mar 16 -
"Total testosterone concentrations are influenced by sex
hormone binding globulin (SHBG) concentrations, which are decreased by obesity
and increased with aging ... the association between obesity and lowered SHBG is
greater than the association of aging with increased SHBG. These competing
effects may impact total testosterone measurements for the diagnosis of low
testosterone, particularly in obese men"
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Genetic and
environmental influence on the association between testosterone, sex hormone
binding globulin, and body composition in Korean men - Clin Endocrinol (Oxf).
2015 Jan 19 - "Each 1-SD increase in age-adjusted levels
of TT, cFT, and SHBG were associated with lower levels of adiposity measures and
absolute measures of lean body mass. On the other hand, percentage total lean
mass increased with increasing levels of TT, cFT, and SHBG (P <0.05)"
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Low serum
sex hormone-binding globulin is associated with nonalcoholic fatty liver disease
in type 2 diabetic patients - Clin Endocrinol (Oxf). 2013 Nov 4 -
"One hundred and twenty patients with NAFLD and 120
age-, sex- and BMI-matched patients with non-NAFLD were enrolled into a
case-control study ... Serum SHBG levels were significantly lower in NAFLD group
than in non-NAFLD group (24.5 ± 11.0 vs 37.6 ± 14.4 nm, P < 0.001)"
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Risk of
Myocardial Infarction in Older Men Receiving Testosterone Therapy - Ann
Pharmacother. 2014 Jul 2 - "Older men who were treated
with intramuscular testosterone did not appear to have an increased risk of MI.
For men with high MI risk, testosterone use was modestly protective against MI"
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Total
testosterone is the most valuable indicator of metabolic syndrome among various
testosterone values in middle-aged Japanese men - Endocr J. 2014 Oct 23 -
"TT and SHBG were significantly lower in men with MetS
than in men without MetS. All testosterone values gradually decreased as the
number of MetS components increased"
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Both total
testosterone and sex hormone-binding globulin are independent risk factors of
metabolic syndrome: results from Fangchenggang Area Male Health and Examination
Survey in China - Diabetes Metab Res Rev. 2013 Mar 6 -
"Men with MetS had a lower level of TT, BT, FT or SHBG
than those without MetS (all p < 0.001). Both TT and SHBG were inversely
correlated with body mass index (BMI) or homeostasis model assessment of insulin
resistance (HOMA-IR) (all age-adjusted p < 0.001). Men within the lowest
quartile of TT (OR = 4.86, 95%CI = 2.72-8.68), BT (OR = 3.04, 95%CI =
1.81-5.10), FT (OR = 3.08, 95%CI = 1.81-5.27) or SHBG (OR = 4.28, 95%CI =
2.52-7.27) had a risk of MetS after adjusting for age, smoking, HOMA-IR and BMI.
TT remained inversely associated with MetS after further adjusting for SHBG (OR
= 0.95, 95%CI = 0.92-0.99), while SHBG remained inversely associated with MetS
after further adjusting for TT (OR = 0.99, 95%CI = 0.97-1.00)"
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The
relationship between sex hormones, sex hormone binding globulin and peripheral
artery disease in older persons - Atherosclerosis. 2012 Oct 3 -
"Low SHBG and high T levels are significantly and
independently associated with the presence of PAD in older men and women,
respectively"
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Blood
hormone levels predicted long-term breast cancer risk for postmenopausal women
- Science Daily, 10/18/12 - "Women with hormone levels
in the highest 25 percent for estradiol, testosterone and dehydroepiandrosterone
sulfate (DHEAS) had a 50 percent to 107 percent greater chance for developing
breast cancer compared with women in the lowest 25 percent. Relative risks for
developing breast cancer were similar at one to 10 years versus 11 to 20 years
(also 16 to 20 years) after blood collection ... Women in the highest 25 percent
of SHBG levels had a 30 percent lower risk for breast cancer compared with women
in the lowest 25 percent for SHBG levels"
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High Serum
Testosterone Is Associated With Reduced Risk of Cardiovascular Events in Elderly
Men The MrOS (Osteoporotic Fractures in Men) Study in Sweden - J Am Coll
Cardiol. 2011 Oct 11;58(16):1674-81 - "During a median
5-year follow-up, 485 CV events occurred. Both total testosterone and SHBG
levels were inversely associated with the risk of CV events (trend over
quartiles: p = 0.009 and p = 0.012, respectively). Men in the highest quartile
of testosterone (≥550 ng/dl) had a lower risk of CV events compared with men in
the 3 lower quartiles (hazard ratio: 0.70, 95% confidence interval: 0.56 to
0.88). This association remained after adjustment for traditional CV risk
factors and was not materially changed in analyses excluding men with known CV
disease at baseline (hazard ratio: 0.71, 95% confidence interval: 0.53 to 0.95).
In models that included both testosterone and SHBG, testosterone but not SHBG
predicted CV risk"
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Sex
Hormone-Binding Globulin, But Not Testosterone, Is Associated Prospectively and
Independently With Incident Metabolic Syndrome in Men: The Framingham Heart
Study - Diabetes Care. 2011 Sep 16 -
"Cross-sectionally, testosterone and SHBG were more strongly associated with
metabolic syndrome than free testosterone in the training sample. SHBG, but not
testosterone or free testosterone, was significantly associated with metabolic
syndrome after adjusting for age, smoking, BMI, and insulin sensitivity
(homeostasis model assessment of insulin resistance [HOMA-IR]). These findings
were confirmed in a validation sample. Longitudinally, SHBG at examination 7,
but not testosterone or free testosterone, was associated with incident
metabolic syndrome at examination 8 after adjusting for age, smoking, BMI, and
HOMA-IR. Multivariable analyses suggested that age, BMI, and insulin sensitivity
independently affect SHBG and testosterone levels and the risk of metabolic
syndrome and its components"
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Serum sex
hormone-binding globulin levels are independently associated with nonalcoholic
fatty liver disease in patients with type 2 diabetes - Diabetes Res Clin
Pract. 2011 Aug 19
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SHBG, Sex
Hormones, and Inflammatory Markers in Older Women - J Clin Endocrinol Metab.
2011 Jan 14 - "In premenopausal and older women, high
testosterone and estradiol (E2) and low SHBG levels are associated with insulin
resistance and diabetes, conditions characterized by low-grade inflammation ...
SHBG was negatively associated with CRP (P = 0.007), IL-6 (P = 0.008), and
sIL-6r (P = 0.02). In addition, testosterone was positively associated with CRP
(P = 0.006), IL-6 (P = 0.001), and TNF-α (P = 0.0002). The negative relationship
between testosterone and sIL-6r in an age-adjusted model (P = 0.02) was no
longer significant in a fully adjusted model (P = 0.12). E2 was positively
associated with CRP (P = 0.002) but not with IL-6 in fully adjusted models. In a
final model including E2, testosterone, and SHBG, and all the confounders
previously considered, SHBG (0.23 +/- 0.08; P = 0.006) and E2 (0.21 +/- 0.08; P
= 0.007), but not testosterone (P = 0.21), were still significantly associated
with CRP. Conclusion: In late postmenopausal women not on hormone replacement
therapy, SHBG and E2 are, respectively, negative and positive, independent and
significant correlates of a proinflammatory state"
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Why
coffee protects against diabetes - Science Daily, 1/12/11 -
"A protein called sex hormone-binding globulin (SHBG)
regulates the biological activity of the body's sex hormones, testosterone and
estrogen, which have long been thought to play a role in the development of type
2 diabetes. And coffee consumption, it turns out, increases plasma levels of
SHBG"
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Sex Hormones
and the Risk of Incident Prostate Cancer - Urology. 2010 May 6 -
"Serum testosterone, estradiol, estrone, and sex
hormone-binding globulin were assayed at baseline ... the mean age was 73 years.
Higher serum estrone was strongly related to an increased risk of prostate
cancer: compared with men in the lower quartile, the risk of prostate cancer
among those in the highest 3 quartiles (>24.9 pg/dL) was nearly 4-fold higher
(adjusted heart rate = 3.93, CI: 1.61-9.57). Other sex hormones were not
associated with the risk of prostate cancer" - The following results for
estrone are for women. I didn't find any results for men but see the
"For Aromatization (in males):" section on my letrozole page.
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Letrozole
suppresses plasma estradiol and estrone sulphate more completely
than anastrozole in postmenopausal women with breast cancer - J
Clin Oncol. 2008 Apr 1;26(10):1671-6 -
"Letrozole reduces plasma E2 and E1S levels to a significantly
greater extent than anastrozole" - See
Femara (letrozole)at
OffshoreRX
.
- Influence of
letrozole and anastrozole on total body aromatization and plasma
estrogen levels in postmenopausal breast cancer patients evaluated in a
randomized, cross-over study - J Clin Oncol. 2002 Feb 1;20(3):751-7
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"estrone (E(1)), estradiol (E(2)), and estrone
sulfate (E(1)S) ... Treatment with anastrozole suppressed plasma levels
of E(1), E(2), and E(1)S by a mean of 81.0%, 84.9%, and 93.5%,
respectively, whereas treatment with letrozole caused a corresponding
decrease of 84.3%, 87.8% and 98.0%, respectively. The suppression of
E(1) and E(1)S was found to be significantly better during treatment
with letrozole compared with anastrozole"
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Association of Testosterone and Sex Hormone-Binding Globulin with Metabolic
Syndrome and Insulin Resistance in Men - Diabetes Care. 2010 Apr 5 -
"men in the first quartile (lowest) (PR, 2.16; 95%
CI, 1.53-3.06) and second quartile of total testosterone (PR, 2.51; 95% CI,
1.86-3.37) were more likely to have metabolic syndrome than men in the
fourth quartile ... Similarly, men in the first quartile of SHBG (PR, 2.17;
95% CI, 1.32-3.56) were more likely to have metabolic syndrome than men in
the fourth quartile ... Low concentrations of total testosterone and SHBG
were strongly associated with increased likelihood of having metabolic
syndrome, independent of traditional cardiovascular risk factors and insulin
resistance"
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Low
testosterone levels and SHBG levels and high estradiol levels are
independent predictors of type 2 diabetes in men - Eur J Endocrinol.
2010 Jan 8 - "There was a significantly lowered
multi-adjusted risk for later diabetes with higher normal total testosterone
levels, both linearly per SD increase (HR 0.71, CI 0.54-0.92) and in the
higher quartiles of total testosterone compared to the lowest (HR 0.53, CI
0.33-0.84). A reduced multi-adjusted risk for incident diabetes was also
found for men with higher SHBG levels, both linearly per SD increase (HR
0.55, CI 0.39-0.79) and when comparing the third (HR 0.38, CI 0.18-0.81) and
the fourth quartile (HR 0.37, 0.17-0.82) to the lowest. The associations
with total testosterone and SHBG were no longer significant after inclusion
of waist circumference to the multivariate models. Estradiol was positively
associated with incident diabetes after multivariate adjustments including
waist circumference, when comparing the second (HR 0.49, CI 0.26-0.93) and
the third (HR 0.51, CI 0.27-0.96) quartile to the highest Conclusion. Men
with higher estradiol levels had an increased risk of later diabetes
independent of obesity, while men with lower total testosterone and SHBG had
an increased risk of diabetes that appeared dependent of obesity"
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Association of sex hormones and C-reactive protein levels in men - Clin
Endocrinol (Oxf). 2009 Sep 21 - "A robust, inverse
dose-response correlation between testosterone and SHBG levels with CRP
levels provides further evidence of a potential role of androgens in
inflammatory processes"
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New Sign of Diabetes Risk - WebMD, 9/16/09 -
"People with the lowest SHBG levels have a tenfold higher risk of type 2
diabetes than those with the highest SHBG levels"
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Sex
Hormones Associated With Broken Bones In Older Men - Science Daily,
8/3/09 - "Low levels of estradiol or high levels of
sex hormone binding globulin (SHBG) are associated with an increased risk of
osteoporotic fracture in older men"
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