FSH, SHBG, and Testosterone: The Hormone Markers No One Explains

Vitality
16 minutes ago
3 min read

If you’ve ever looked at your lab results and thought, “I have no idea what I’m looking at—but my provider said everything is normal,” you’re not alone.

At Vitality Natural Wellness, many of our patients come in feeling dismissed, confused, or frustrated because their symptoms don’t match what their labs are telling them. One of the most common reasons? Key hormone markers are misunderstood, oversimplified, or never fully explained.

Three of the biggest culprits: FSH, SHBG, and testosterone (free and total).

Let’s break them down—what they actually mean, why they matter, and how we interpret them clinically.

FSH: More Than a “Menopause Hormone”

FSH (Follicle-Stimulating Hormone) is often thought of as a marker for menopause—but that’s only part of the story.

FSH is a brain-signaling hormone released by the pituitary gland. Its job is to communicate with the ovaries (or testes) and stimulate hormone production.

What FSH Can Tell Us:

How strongly the brain is signaling the ovaries
Ovarian responsiveness and reserve
Whether symptoms may be driven by declining ovarian function
How the body is compensating hormonally

Why “Normal” Isn’t Always Helpful

FSH fluctuates throughout the menstrual cycle and can appear “normal” even when hormone signaling is already strained—especially in perimenopause. A single lab value without context often misses the bigger picture.

At Vitality, we don’t use FSH to label menopause—we use it to understand patterns and trajectory.

SHBG: The Hormone You’ve Probably Never Heard Of (But Should)

SHBG (Sex Hormone-Binding Globulin) is a protein made by the liver that binds to sex hormones—primarily estrogen and testosterone.

Think of SHBG as a hormone gatekeeper.

High SHBG = more hormones bound and inactive
Low SHBG = more hormones available, but often unstable

Why SHBG Matters So Much

You can have perfectly “normal” total hormone levels and still feel awful if SHBG is off.

SHBG is influenced by:

Insulin resistance
Thyroid function
Liver health
Inflammation
Stress hormones
Hormonal contraceptives

Common Patterns We See:

High SHBG → fatigue, low libido, low testosterone symptoms
Low SHBG → estrogen dominance, androgen excess, blood sugar issues

This is why we never interpret estrogen or testosterone in isolation.

Testosterone: Free vs. Total (Yes, There’s a Difference)

Testosterone is not just a “male hormone.” It plays a critical role in women’s energy, strength, mood, metabolism, and libido.

But here’s where things get tricky.

Total Testosterone

Measures all testosterone in the bloodstream
Includes both bound and unbound hormone
Often appears normal—even when symptoms exist

Free Testosterone

Represents the hormone that’s biologically active
Strongly influenced by SHBG levels
More closely tied to symptoms

Why We Look at Both

Two people can have the same total testosterone level and feel completely different depending on:

SHBG
Stress hormones
Thyroid function
Metabolic health

Symptoms of low functional testosterone may include:

Fatigue
Low motivation
Decreased strength or muscle mass
Low libido
Brain fog

Why These Markers Are Interpreted Together

FSH, SHBG, and testosterone don’t operate independently. They’re part of a complex feedback loop between the brain, ovaries, liver, and metabolic system.

Looking at just one marker often leads to:

Missed diagnoses
Dismissed symptoms
“Everything looks fine” answers

At Vitality, we assess:

Hormone relationships, not just ranges
Symptom alignment with labs
Root drivers like stress, insulin resistance, inflammation, and nutrient status

When Labs Look Normal—but You Don’t Feel Normal

This is one of the most common reasons patients seek functional medicine care.

If you’re experiencing:

Persistent fatigue
Weight changes that don’t respond to diet or exercise
Low libido or mood changes
Cycle changes or perimenopausal symptoms

…there may be early hormone dysregulation that standard interpretations miss.

The Bottom Line

Hormone testing isn’t just about what is tested—it’s about how it’s interpreted.

FSH, SHBG, and testosterone offer powerful insight when evaluated together, in context, and alongside your symptoms.

At Vitality Natural Wellness, our goal isn’t to chase numbers—it’s to help you understand your body and feel better in it.

If you’re ready for deeper answers, we’re here to help.

If you haven’t joined our Private Facebook Group, please do HERE.

If you’re ready to take the next step in your journey toward optimal health, please contact us for a discovery call.

This information is for educational purposes only and is not intended as medical advice or a substitute for individualized care. Always consult with a qualified healthcare provider before starting or changing any supplement, medication, or lifestyle program — especially if you are pregnant, nursing, or have a medical condition.