SHBG blood test: what high and low sex hormone-binding globulin levels mean
Sex hormone-binding globulin (SHBG) · Reproductive hormone panel (ordered with total testosterone to calculate free testosterone) · reported in nmol/L (a few labs report µg/mL; multiply µg/mL by about 10.5 to get nmol/L)
Sex hormone-binding globulin (SHBG) is a protein made by the liver that carries testosterone and estradiol around the bloodstream. Hormone that is bound to SHBG is locked away; only the small unbound (free) fraction, about 1 to 3 percent of total testosterone, can enter cells and act. An SHBG test is therefore ordered alongside total testosterone to work out how much hormone is actually available: a man with a normal total testosterone but a high SHBG can have a low free testosterone and symptoms of deficiency, and a woman with a normal total testosterone but a low SHBG can have androgen excess. Typical adult ranges are about 10 to 57 nmol/L in men and 18 to 144 nmol/L in premenopausal women.
SHBG is also one of the most sensitive markers on a blood panel of what is happening in the liver's metabolic environment. Insulin drives it down, so a low SHBG is a reliable signal of insulin resistance, excess weight, fatty liver, type 2 diabetes and polycystic ovary syndrome, and large cohort studies show low SHBG predicts future diabetes independently of weight. Estrogen, thyroid hormone and liver disease push it up, so SHBG roughly doubles to quadruples on the combined pill or oral HRT, rises in hyperthyroidism and cirrhosis, and climbs steadily with age in men.
Because SHBG moves for so many reasons, the number is read with total testosterone and the clinical picture rather than on its own. In women the two are combined into the free androgen index (total testosterone divided by SHBG, times 100); in men they are used to calculate free or bioavailable testosterone. A high or low SHBG rarely needs treating in its own right. It is the pointer to whatever is driving it: insulin resistance, thyroid disease, liver disease, medicines or hormone therapy.
SHBG at a glance
- What it is: a liver-made carrier protein that binds testosterone (tightly) and estradiol (less tightly); only the unbound fraction is active.
- Normal (adult men): about 10–57 nmol/L, rising with age. Normal (premenopausal women): about 18–144 nmol/L; after menopause the range narrows to roughly 15–80. Labs differ.
- High SHBG: oral estrogen (pill, HRT), hyperthyroidism, liver cirrhosis or hepatitis, low body weight, older age in men, anticonvulsants, pregnancy (5 to 10 fold). Effect: less free testosterone.
- Low SHBG: insulin resistance, obesity, type 2 diabetes, fatty liver, PCOS, hypothyroidism, androgens or anabolic steroids, glucocorticoids, acromegaly, nephrotic syndrome. Effect: more free testosterone, and a marker of metabolic risk.
- Free androgen index (women) = total testosterone (nmol/L) ÷ SHBG (nmol/L) × 100; above about 5 (some labs 4.5 to 8) suggests androgen excess.
- Next step: interpret with total testosterone (morning, fasting, repeated), and check fasting insulin or A1C, TSH and liver tests for the cause.
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What SHBG measures
SHBG is a glycoprotein secreted by liver cells. In the blood it binds dihydrotestosterone most tightly, then testosterone, then estradiol, each about half as strongly as the one before. Roughly 40 to 60 percent of circulating testosterone is bound to SHBG, most of the rest is loosely bound to albumin, and only 1 to 3 percent is free. The SHBG-bound fraction cannot enter tissues, while the albumin-bound and free fractions can, which together are called bioavailable testosterone. Because SHBG binds testosterone more strongly than estradiol, a rise in SHBG lowers free testosterone proportionately more than free estradiol, shifting the balance towards estrogen; a fall does the opposite.
The gene for SHBG in the liver is switched on by estrogen and thyroid hormone and switched off by insulin and by androgens. The insulin effect is the one that matters most in everyday medicine: in the fed, insulin-resistant state the liver makes fat (de novo lipogenesis), and the same signalling that drives fat synthesis suppresses the SHBG gene. That is why SHBG tracks insulin resistance so faithfully and why it falls with fructose and sugar intake, weight gain and fatty liver, and rises with weight loss. Growth hormone and IGF-1 also lower it, and prolactin, cortisol and inflammatory signals have smaller effects.
The lab measures SHBG by immunoassay in nmol/L. It is stable through the day, not pulsatile and barely affected by food, which makes it a steadier number than the hormones it carries. From total testosterone, SHBG and albumin the lab calculates free testosterone using the Vermeulen equation, or in women the free androgen index (FAI). Direct free testosterone immunoassays are unreliable and are not recommended; calculated free testosterone or equilibrium dialysis are the accepted methods. To convert testosterone from ng/dL to nmol/L for the FAI, multiply by 0.0347.
Normal range for SHBG
Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.
| Group | Typical range (nmol/L (a few labs report µg/mL; multiply µg/mL by about 10.5 to get nmol/L)) | Notes |
|---|---|---|
| Men, adult (20 to 49) | 10–57 nmol/L | Typical mid-range is 30 to 40. Labs differ widely (another common range is 16–56); use the printed range. |
| Men, over 50 | Upper limit rises to about 70–90 nmol/L | SHBG increases 1 to 2 percent a year, so older men with a normal total testosterone often have a low free testosterone. |
| Women, premenopausal (not on hormonal contraception) | 18–144 nmol/L | Wide range; typical mid-value 50 to 70. Values under about 30 are often seen with PCOS and insulin resistance. |
| Women on the combined pill or oral HRT | Often 100–300 nmol/L | Oral estrogen raises SHBG 2 to 4 fold (ethinylestradiol pills most; transdermal estradiol much less). Stop for 3 months before testing for androgen excess if possible. |
| Women, after menopause | 15–80 nmol/L | Falls after menopause as estrogen declines, then drifts up with age. |
| Pregnancy | Up to 5 to 10 times non-pregnant values (often 300–600 nmol/L) | Placental estrogen; returns to baseline within weeks of delivery. |
| Children before puberty | Roughly 50–180 nmol/L | High in childhood and falls through puberty, more in boys (as testosterone rises) than in girls. |
| Free androgen index (women) | Below about 5 (labs vary from 4.5 to 8) | Total testosterone (nmol/L) ÷ SHBG × 100. Above the cut-off supports biochemical hyperandrogenism in suspected PCOS. |
High SHBG
A high SHBG means more of your testosterone is bound and inactive, so free testosterone is lower than the total suggests. In men this is the usual explanation for symptoms of low testosterone with a total testosterone that looks fine. The commonest causes are age, a low body weight or recent weight loss, an overactive thyroid, liver disease, certain medicines (particularly older anticonvulsants) and, in women, oral estrogen. Guidelines recommend that when total testosterone is borderline (roughly 200 to 400 ng/dL in men) or SHBG is outside the normal range, a calculated free testosterone should be used to decide whether a deficiency is real.
In women a high SHBG is rarely a problem in itself. It is almost always from the combined pill or oral HRT, which raise it two to four fold, or from pregnancy. Off hormones, a high SHBG can reflect hyperthyroidism, liver disease, a very low BMI or anorexia nervosa, or simply the upper end of a wide normal range. A high SHBG lowers free testosterone and is one reason some women on the pill notice reduced libido; it also makes a total testosterone look normal when free testosterone is low, which can hide androgen deficiency in women after oophorectomy or with pituitary disease.
In both sexes a high SHBG is also a window into the liver and thyroid. Hyperthyroidism raises SHBG so consistently that it was once used as a marker of thyroid hormone action; cirrhosis and chronic hepatitis raise it because the diseased liver clears estrogen poorly. Observationally, higher SHBG is associated with lower risk of type 2 diabetes and, in older men, with greater frailty and lower bone density because of the lower free testosterone it implies.
Common causes
Oral estrogen: combined pill, patch, ring and oral HRT
Estrogen passing through the liver switches on SHBG production; ethinylestradiol pills raise SHBG 2 to 4 fold (to 100 to 300 nmol/L), oral estradiol HRT about 1.5 to 2 fold. Transdermal estradiol has a much smaller effect, and progestin-only methods have little.
Ageing in men
SHBG rises about 1 to 2 percent a year from the 30s, so by 70 it is typically 50 to 100 percent higher than at 30. This, more than the fall in total testosterone, drives the decline in free testosterone with age.
Hyperthyroidism
Thyroid hormone directly stimulates the SHBG gene; untreated Graves' disease often doubles SHBG and it normalises with treatment. A high SHBG with weight loss, palpitations and heat intolerance should prompt a TSH.
Liver disease
Cirrhosis, alcoholic hepatitis and chronic viral hepatitis raise SHBG, partly through reduced estrogen clearance; men with cirrhosis commonly have high SHBG, low free testosterone and gynecomastia.
Low body weight, anorexia nervosa and rapid weight loss
Low insulin and low energy availability release the brake on SHBG; values well above 100 nmol/L are typical in anorexia and fall as weight is regained.
Anticonvulsants and some other medicines
Phenytoin, carbamazepine and phenobarbital induce liver enzymes and raise SHBG, lowering free testosterone in men on long-term treatment. Tamoxifen and raloxifene raise it through estrogen-like liver effects; thyroxine over-replacement does the same.
Pregnancy
Placental estrogen raises SHBG 5 to 10 fold by the third trimester; results in pregnancy cannot be compared with non-pregnant ranges.
Male hypogonadism of any cause
Testosterone suppresses SHBG, so when testosterone falls (testicular failure, pituitary disease), SHBG often rises, further lowering free testosterone.
HIV infection and chronic illness
Untreated HIV and some chronic inflammatory conditions raise SHBG; the mechanism is not fully understood.
Genetic variation
Common variants in the SHBG gene shift baseline levels by 10 to 20 percent and account for some healthy people sitting persistently above or below the range.
Symptoms that can go with it
- Often none; the SHBG itself causes no symptoms
- In men: low libido, erectile difficulty, fatigue, reduced muscle mass and strength, low mood, breast tissue, with a total testosterone that may look normal
- In women: reduced libido and energy on the combined pill, which may improve on switching method
- Weight loss, tremor, palpitations, heat intolerance and anxiety if the cause is hyperthyroidism
- Jaundice, easy bruising, swollen abdomen or spider veins if the cause is liver disease
- Very low body weight, absent periods and feeling cold if the cause is under-nutrition
- Low bone density or fractures in older men from long-standing low free testosterone
Low SHBG
A low SHBG is, above all, a metabolic signal. Insulin suppresses SHBG production in the liver, so a low value (below about 20 to 30 nmol/L in women, below about 15 to 20 in men) usually means insulin resistance, whether from excess weight, fatty liver, prediabetes, type 2 diabetes or PCOS. In large cohorts such as the Women's Health Study and the Physicians' Health Study, men and women in the lowest SHBG quartile had several times the risk of developing type 2 diabetes over the following decade compared with those in the highest, independent of body mass index, and genetic studies suggest the link is partly causal. A low SHBG in someone who feels well is a reason to check fasting glucose or A1C, fasting insulin, triglycerides and liver enzymes.
In women a low SHBG raises the free fraction of testosterone, so even a normal total testosterone can produce acne, excess facial and body hair, scalp hair thinning and irregular periods. This is why SHBG and the free androgen index are part of the PCOS work-up: around half of women with PCOS have a low SHBG, and in many the free androgen index rather than total testosterone is what is abnormal. Low SHBG in PCOS also marks the women at highest metabolic risk.
In men a low SHBG means free testosterone is higher than the total implies, so a man with a borderline total testosterone and a low SHBG often has a normal free testosterone and does not have a true deficiency; this is the common situation in obesity, where total testosterone is low mainly because SHBG is low. Low SHBG also occurs with androgen or anabolic steroid use, hypothyroidism, growth hormone excess, Cushing's syndrome, nephrotic syndrome (where the protein is lost in urine) and on some progestins.
Common causes
Insulin resistance, obesity and type 2 diabetes
High insulin suppresses the liver's SHBG gene; SHBG falls roughly in step with waist circumference and fasting insulin, and rises again with weight loss. It is one of the earliest blood markers to move in developing metabolic syndrome.
Polycystic ovary syndrome
Both insulin resistance and raised androgens lower SHBG, which further raises free testosterone in a self-reinforcing loop. Values under 30 nmol/L are common, and a free androgen index above about 5 supports the diagnosis.
Non-alcoholic fatty liver disease
Fat synthesis in the liver and SHBG production are controlled by the same pathway in opposite directions, so SHBG falls as liver fat accumulates, often before liver enzymes rise.
Hypothyroidism
Low thyroid hormone removes a stimulus to the SHBG gene; SHBG falls and recovers with thyroxine replacement.
Testosterone therapy, anabolic steroids and other androgens
Androgens suppress SHBG, so men on testosterone, and women with androgen-secreting tumours or on DHEA, have low values. Progestins with androgenic activity (levonorgestrel, norethindrone) lower SHBG when not combined with estrogen.
Glucocorticoids and Cushing's syndrome
Excess cortisol, from prednisone or from Cushing's, lowers SHBG and worsens insulin resistance.
Acromegaly and growth hormone treatment
Growth hormone and IGF-1 suppress SHBG; it rises when acromegaly is controlled.
Nephrotic syndrome
Heavy protein loss in the urine includes SHBG, lowering the blood level along with albumin.
High prolactin
Prolactin modestly lowers SHBG and is checked when low SHBG accompanies irregular periods or low libido.
Genetic variation and ethnicity
SHBG gene variants shift the baseline; some healthy lean people run below the reference range without any metabolic problem.
Symptoms that can go with it
- Often none; low SHBG is a lab finding rather than a condition
- In women: acne, oily skin, excess facial or body hair, scalp hair thinning, irregular or infrequent periods
- Weight carried around the abdomen, skin tags, darkened velvety skin in the neck or armpit folds (acanthosis nigricans) with insulin resistance
- Fatigue after meals, increased thirst or urination if glucose is also raised
- Tiredness, weight gain, feeling cold and dry skin if the cause is hypothyroidism
- Swelling of the legs and frothy urine if the cause is nephrotic syndrome
- Enlarging hands, feet and jaw, sweating and headaches if the cause is acromegaly
Read it alongside
- Total testosterone — the two are read together; the lab calculates free testosterone (men) or the free androgen index (women) from them.
- Calculated free or bioavailable testosterone — the number that reflects biological activity when SHBG is high or low; direct free-testosterone immunoassays are unreliable.
- Fasting insulin, glucose and A1C — a low SHBG usually signals insulin resistance; these show how far it has progressed.
- TSH and free T4 — hyperthyroidism raises SHBG, hypothyroidism lowers it.
- ALT, AST, GGT and liver ultrasound — fatty liver lowers SHBG; cirrhosis and hepatitis raise it.
- Triglycerides and HDL — low SHBG clusters with high triglycerides and low HDL in metabolic syndrome.
- LH and FSH — in men with low free testosterone, these show whether the problem is testicular or pituitary.
- DHEA-S and 17-hydroxyprogesterone (women) — locate the source of androgen excess when the free androgen index is high.
What usually happens next
- Ask for free testosterone to be calculated from total testosterone, SHBG and albumin rather than interpreting SHBG alone; in men, testosterone should be a morning, fasting sample repeated on a second day before any conclusion.
- If SHBG is low and you are not on androgens, expect fasting glucose or A1C, fasting insulin or a lipid panel and liver enzymes, because insulin resistance is the usual driver.
- If SHBG is high and unexplained, expect TSH (hyperthyroidism), liver tests, a review of medicines (anticonvulsants, estrogen, tamoxifen) and questions about weight loss and eating.
- Women being assessed for PCOS or androgen excess should ideally stop combined hormonal contraception for 3 months before testing, since the pill raises SHBG and masks a high free androgen index.
- Recheck after the driver changes: SHBG typically rises within 3 to 6 months of meaningful weight loss or thyroid correction and falls within weeks of stopping oral estrogen.
- Treat the cause, not the SHBG: there is no medication indicated purely to raise or lower it.
Diet, lifestyle and natural levers with evidence
What can move SHBG once the cause is known. Nothing here replaces finding the cause.
Weight loss and reduced waist circumference
Strong evidenceWeight loss is the most reliable way to raise a low SHBG because it lowers insulin. In trials of diet and exercise in people with obesity, a 5 to 10 percent weight loss raised SHBG by roughly 15 to 30 percent, and after bariatric surgery SHBG often doubles within a year; in women with PCOS a meta-analysis of lifestyle trials showed a significant rise in SHBG and fall in the free androgen index. The effect appears within 3 to 6 months and tracks fasting insulin.
Cutting added sugar and fructose
Moderate evidenceFructose and glucose switch on liver fat synthesis, and the same pathway directly suppresses the SHBG gene in human liver cells. In cross-over feeding studies, diets high in added sugar or fructose lowered SHBG within weeks, and in observational studies sugar-sweetened drink intake is associated with 10 to 20 percent lower SHBG independent of weight. Low-glycaemic and Mediterranean-style patterns are associated with higher SHBG in both sexes.
Regular exercise, aerobic and resistance
Moderate evidenceExercise training raises SHBG mainly through improved insulin sensitivity and fat loss. In a 12-month randomised trial of moderate aerobic exercise in 173 postmenopausal women, SHBG rose significantly in exercisers who lost body fat, and meta-analyses in women with PCOS show 3 to 6 months of structured exercise raises SHBG and lowers the free androgen index even with modest weight change. Effects in men are smaller and depend on fat loss.
Boron
Preliminary evidenceA small study in 8 healthy men found that 10 mg of boron a day for one week lowered SHBG and raised free testosterone by about 28 percent, and a six-month study of 3 mg a day in postmenopausal women reported higher estradiol and testosterone. The studies are tiny and uncontrolled, so boron cannot be recommended as a way to lower SHBG; dietary intake from fruit, nuts and legumes is typically 1 to 3 mg a day.
Keep supplemental intake under the 20 mg a day tolerable upper limit; higher doses cause nausea, dermatitis and in excess are toxic.
Vitamin D repletion
Preliminary evidenceObservational studies link low vitamin D with low SHBG, and in women with PCOS a meta-analysis of randomised trials found vitamin D supplementation (typically 1,000 to 4,000 IU a day or weekly high doses for 8 to 12 weeks) raised SHBG modestly and lowered total testosterone compared with placebo. Trials in men have not shown a consistent effect on SHBG or testosterone.
Doses above 4,000 IU a day long-term without monitoring can raise blood calcium; discuss if you take thiazide diuretics or have kidney stones.
When to see a clinician promptly
- A low SHBG with symptoms of diabetes (thirst, frequent urination, blurred vision, unexplained weight loss) or a random glucose above 200 mg/dL: same-week assessment.
- A high SHBG with weight loss, palpitations, tremor, heat intolerance or an irregular heartbeat: possible hyperthyroidism, which needs prompt treatment; a resting heart rate persistently above 120 or chest pain is urgent.
- A high SHBG with jaundice, abdominal swelling, confusion or vomiting blood: possible decompensated liver disease, an emergency.
- In women, rapid onset of excess hair, deepening voice, clitoral enlargement or a total testosterone above about 150 to 200 ng/dL, whatever the SHBG: an androgen-secreting tumour must be excluded.
- In men, a low calculated free testosterone with symptoms, to discuss causes and whether treatment is appropriate rather than self-treating with testosterone or over-the-counter boosters.
- A very low body weight with high SHBG and absent periods, which suggests an eating disorder needing specialist care.
Frequently asked questions
What is a normal SHBG level?
Reference ranges vary considerably by lab, but typical adult values are about 10 to 57 nmol/L in men (higher with age) and 18 to 144 nmol/L in premenopausal women, falling to roughly 15 to 80 after menopause. On the combined pill, 100 to 300 is usual. Because the range is so wide, the useful number is often not SHBG itself but the free testosterone or free androgen index calculated from it.
What does a high SHBG mean in a woman?
Most often that you are taking an estrogen-containing contraceptive or oral HRT, which raise SHBG two to four fold, or that you are pregnant. Off hormones, a high SHBG can reflect an overactive thyroid, liver disease, low body weight or simply the upper end of the normal range. It lowers free testosterone, which can reduce libido in some women, but it is not itself a disease and does not usually need treatment beyond finding the cause.
What does low SHBG mean?
Usually insulin resistance. Insulin suppresses SHBG production, so low values go with excess weight, fatty liver, prediabetes, type 2 diabetes and PCOS, and low SHBG predicts future diabetes even in people of normal weight. Other causes include an underactive thyroid, androgen or steroid use, growth hormone excess and nephrotic syndrome. In women it raises free testosterone and can cause acne and excess hair; in men it means free testosterone is higher than the total suggests.
How do I lower my SHBG?
Ask first whether it needs lowering; a high SHBG from age, the pill or genetics is not harmful in itself, and the symptom that matters is low free testosterone. Treating hyperthyroidism or liver disease, switching from oral to transdermal estrogen, reviewing anticonvulsants and regaining weight if underweight all lower SHBG. Supplements marketed to lower SHBG (boron, nettle root, tongkat ali) have little or no reliable human evidence. In men with confirmed low free testosterone, the discussion is about treating the deficiency, not the SHBG.
How do I raise a low SHBG?
Lower your insulin. Losing 5 to 10 percent of body weight, cutting added sugar and sugary drinks, and regular exercise each raise SHBG by about 15 to 30 percent over 3 to 6 months by improving insulin sensitivity, and metformin and treatment of hypothyroidism do the same. Vitamin D repletion has modest supporting evidence in women with PCOS. SHBG is best thought of as a readout of metabolic health; it rises as that improves.
What is the free androgen index and what is normal?
The free androgen index (FAI) estimates how much testosterone is active in women: total testosterone in nmol/L divided by SHBG in nmol/L, multiplied by 100. To convert testosterone from ng/dL to nmol/L, multiply by 0.0347. Most labs regard a value under about 5 as normal, with cut-offs ranging from 4.5 to 8; above the cut-off supports biochemical hyperandrogenism in suspected PCOS. It is not valid on the combined pill and is not used in men.
Does high SHBG mean low testosterone?
It means a smaller share of your testosterone is free to act, so a total testosterone that looks normal can go with a low free testosterone. Whether that amounts to a real deficiency depends on the calculated free testosterone and your symptoms. Guidelines recommend measuring SHBG and calculating free testosterone whenever total testosterone is borderline (about 200 to 400 ng/dL) or SHBG is likely to be abnormal, as in older men, obesity, diabetes, liver disease and thyroid disease.
Do I need to fast for an SHBG test?
SHBG itself is stable and does not require fasting, but it is almost always drawn with total testosterone, which should be a morning sample (before 10 am) taken fasting, because food lowers testosterone by 10 to 25 percent for a few hours. Mention hormonal contraception, HRT, testosterone, anabolic steroids, thyroid medication and anticonvulsants, all of which move SHBG, and if you are being assessed for PCOS, ask whether to pause the pill for 3 months first.
References
- SHBG blood test. MedlinePlus, US National Library of Medicine (2023)View source
- Sex hormone-binding globulin (SHBG), serum: clinical and interpretive information. Mayo Clinic Laboratories (2024)
- Goldman AL, Bhasin S, Wu FCW, Krishna M, Matsumoto AM, Jasuja R. A reappraisal of testosterone's binding in circulation: physiological and clinical implications. Endocrine Reviews (2017)
- Simó R, Sáez-López C, Barbosa-Desongles A, Hernández C, Selva DM. Novel insights in SHBG regulation and clinical implications. Trends in Endocrinology and Metabolism (2015)
- Selva DM, Hogeveen KN, Innis SM, Hammond GL. Monosaccharide-induced lipogenesis regulates the human hepatic sex hormone-binding globulin gene. Journal of Clinical Investigation (2007)
- Ding EL, Song Y, Manson JE, et al.. Sex hormone-binding globulin and risk of type 2 diabetes in women and men. New England Journal of Medicine (2009)
- Bhasin S, Brito JP, Cunningham GR, et al.. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism (2018)
- Teede HJ, Tay CT, Laven JJE, et al.. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism (2023)
- Camacho EM, Huhtaniemi IT, O'Neill TW, et al.. Age-associated changes in hypothalamic-pituitary-testicular function in middle-aged and older men are modified by weight change and lifestyle factors: longitudinal results from the European Male Ageing Study. European Journal of Endocrinology (2013)
- Naghii MR, Mofid M, Asgari AR, Hedayati M, Daneshpour MS. Comparative effects of oral boron supplementation on steroid hormones and inflammatory cytokines in healthy men. Journal of Trace Elements in Medicine and Biology (2011)
- Lim SS, Hutchison SK, Van Ryswyk E, Norman RJ, Teede HJ, Moran LJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews (2019)
- Male hypogonadism. Merck Manual Professional Version (2024)
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