Insulin does not work in isolation

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Most of us think about blood sugar in terms of energy. You eat, glucose rises, insulin helps move that glucose out of the blood and into cells, and somewhere in that process we might experience an energy spike or crash.

But insulin doesn’t work in isolation. It also talks to our sex hormones.

One of the ways it does this is through something called sex hormone-binding globulin, or SHBG. SHBG is a protein made mainly by the liver that travels through the blood and binds to sex hormones such as testosterone and estrogen. Think of it almost like a transport and holding system: hormones attached to SHBG are less readily available to tissues, while the unbound or “free” fraction is more biologically available.

When insulin levels are chronically elevated, the liver tends to produce less SHBG. Less SHBG changes the balance between bound and available sex hormones. In women, this can be particularly important for testosterone: lower SHBG can mean a greater proportion of testosterone is free and biologically active.

This is one reason insulin resistance can show up in places that don’t immediately make us think about blood sugar. It is strongly connected with conditions such as PCOS, where we can see irregular ovulation and periods, acne, increased facial or body hair and other signs of excess androgen activity. Metabolic health can also intersect with sexual function and libido, although those are influenced by many other things too.

So when researchers talk about the metabolic–endocrine connection, it really means something quite simple: the systems controlling our metabolism and our hormones aren’t separate systems.

Blood sugar affects insulin.
Insulin can affect SHBG.
SHBG influences the availability of our sex hormones.

The body doesn’t know that we’ve put “blood sugar,” “hormones,” “reproductive health” and “sexual health” into different boxes.

It is all one body.

When you think about managing blood sugar, do you think about energy and diabetes or would you ever have connected it to your sex hormones too?