Low SHBG guys, from what I have seen on The Peak Testosterone Forum and read almost universally, are usually miserable. Below is story of one of our posters who was actually able to reverse his condition and raise his SHBG. It wasn't an easy road and I document the basic steps as to how he did it.
For those unaware, low SHBG men seem to usually struggle with many health issues and are often low testosterone. Compounding their issues is the fact that they find HRT (testosterone therapy) ineffective and problematic. And this kind of makes sense, because HRT tends to lower their already low SHBG even further. But let's step back for a second and ask this question:
"Why would a low SHBG guy be miserable?"
I don't think anyone has a definitive answer to that, but I suspect three basic reasons:
a) They have recently found cell receptors for SHBG and, therefore, it is likely that SHBG has some hormone-like actions on many of our tissues.
b) As I document in my page on Low SHBG, levels below 15-18 are often associated with a number of medical conditions, hyperlipidemia, NAFLD and loss of blood glucose / insulin control. Both of these are risk factors for prediabetes (Metabolic Syndrome) and type II, adult onset diabetes.
c) Low SHBG is often associated with liver dysfunction which can also affect other binding proteins (CBG, TBG, etc.), and since SHBG is the sum of hepatic and testicularly produced SHBG, the latter being used to sequester testosterone needed for sperm production, men in these low ranges may actually have very little hepatically produced SHBG.
Furthermore, I have had low SHBG guys tell me that they have never known anyone who has reversed the condition. Well, this is where Sam's story comes in. Sam in one of our senior posters and he was actually able to cure his Low SHBG and, just as important, start to feel good again. And what got me really excited was that he did this largely through natural means.
Sam, his forum name, had a number of issues initially, and commented that "the fatigue, waking at night to urinate, low libido and mental fog hasnï¿½t gone away. Furthermore, I now seem to have developed an unexplained pain in my joints such that when I run and keep my arms bent my left elbow joint stiffens and hurts to extend as well as a non-specific knee pain [which was later determined to be a torn meniscus his then Kaiser insurance put off properly disagnosing for 4 years]. I wake up at night sometimes with an overall sense of pain that keeps me from sleeping so am having to take daily ibuprofen." 
Virtually all of this has now disappeared for him and so, after some long exchanges with him, I have noted that these were his Five Basic Steps to Reverse Low SHBG. He recently wrote me that he was not posting as much, because he was too busy excelling at work, chasing his passions and really enjoying his life and family again!
Now will his strategy work for every Low SHBG man out there? Well, I doubt that. However, I suspect that it will help or even cure a significant percentage of them and so I wanted to document it for all the men suffering from this. My rough guess from the forum is that maybe 5 or 10% of men with low testosterone or erectile dysfunction have low SHBG, so it's a significant subpopulation in my opinion.
1. Low Fat Paleo. Sam eats pretty close to what I call Low Fat Paleo. This is important in my opinion, because lower fat diets allow the free fatty acids to clear out of interior of the cells from higher fat and higher glycemic (refined carb) diets. In this way, lower fat diets can improve insulin resistance, assuming they are low in refined carbs of course, a critical factor if you have a history of elevated triclyerides which could be indicative of glucose / insulin issues and possible NAFLD. Eliminating hepatic fat storage is a logical first step in getting your liver to start working the way its meant to.
As you see from Sam's description below, he eats a lot protein, which is important considering his hard workouts, coupled with a whole food, lower fat diet. He also often sticks to low carb as well.
"I eat lots of green veggies, egg whites, some whole eggs, lean meats, 1cup a day of mixed nuts (walnuts, almonds, pecans, pistachios) low fat cottage cheese, and I try to limit my dairy intake. When I am focused on Paleo I do eat about 1-2 tbsp/day of coconut oil usually as part of a morning egg white omelet made with fresh garlic, turmeric and loads of baby spinach or power greens. Keeping carb consumption under 50g's."
"On high cardio days (over 8 miles running or 40 miles biking) I allow increased carb consumption probably closer to 200g, mostly things like Clif Bars, energy gels and drinks made with maltodextrin not simple sugars. The company HEED makes good products like this but you can also make them yourself by buying bulk maltodextrin."
"I eat a good amount of fruit daily, like apples, bananas, fruit/nut bars like Lara Bars or Trader Joe's fruit/nut bars with a focus on simple and as few ingredients as possible. I avoid Sucralose and other artificial sweeteners like the plague except Stevia which has been shown to be somewhat beneficial in preventing insulin resistance."
NOTE: For another possible cure, see my page on Low SHBG.
2. Weight Training. This guy can bench over 300 lbs and is just naturally strong, but you can see the kind off commitment he has put on fitness in this graph of his flat bench progression:
"For weights I spend 45mins-1hr in the gym 4-5 mornings/week. I focus on 1 body part each day but work in push ups, planks and such most days. Typically I just look to lift to failure for strength gains. Chest day would be:"
"I also will mix things up with dumbbell days etc on occasion. I also do full squats for legs, leg press etc. really just old school lifting."
3. Regular Cardio. Sam's routine is something would make almost any trainer proud:
"Normally I run 5-6miles(1hr) 2-3 times a week and I cycle for 1-2 hrs 2-3 times a week. Once a month I run a half marathon and once a month I do a 80-100mile bike ride (4-5hrs). This is not how I started. I think 1hr of biking or running 4-5times a week is sufficient."
Body Fat To 8%. Sam dropped his body fat percentage down to 8%, which is incredible of course. You can see below how his body composition and shape changed over the period of time he was focused on improving his health. Keep in mind in 2012 he started out at 230 lbs at an estimated 20% body fat. Sam likes to point out that BMI is a bad way to track your body fat and that's why he uses a hydrostatic dunk tank company regularly to track his progress.
4. Berberine (and Liver) Supplements. Sam took a number of extensive male hormone panels that showed that he was clearing many hormones, including testosterone too rapidly. Of course, this is likely due to lower levels of binding hormones. However, the root cause was likely liver dysfunction and so he took a supplement to improve his liver and blood glucose / insulin status. (As mentioned above, low SHBG is often associated with insulin resistance and fatty liver.) Berberine was a particularly important one for him as it seemed to cure a lot of the fatigue that he had.
Please note that Sam checked and found he had some blood glucose and insulin control issues before trying berberine. CAUTION: Please check with your doctor before trying any new supplement. Berberine could interact with some medications and should definitely not be taken by those on diabetes medications.
5. Coffee. Coffee is a proven insulin and blood glucose controller due to its chlorogenic acid content and Green Coffee Bean Extract seek so take advantage of this property. Sam wrote:
"I also increased my consumption of coffee (2-3cups/day) green tea(1cup/day)flax seed 2tbsp daily, cocao 1tbsp daily. Usually these things are mixed in a protein shake. I also use 1tsp of psyllium fiber...Of note: if I listened to my docs when they said I had adrenal fatigue and avoided coffee I don't think I would have ever recovered. Low cortisol does not mean adrenal fatigue if your problem is excessively high clearance of hormones. Coffee can actually be beneficial to help balance the enzymes in your liver. This is why it is so critical to run extensive serum and 24hr urine hormone and binding protein tests on the same day so you can ascertain which pathways are not not functioning properly for you."
CONCLUSION: So what were the results he achieved? When Sam started out, his SHBG was 17.8, TRT brought it down to 14.1 which is likely due to the cessation of sperm production while on TRT and this made TRT very difficult for him. Through his efforts, Sam has been able to get his SHBG while on TRT to increase to 21.4 with calculated values over 30. Of course, there is a large discrepancy between actual measured values and calculated values, but what is important is that 1) when you factor in what his SHBG would likely be if he was not on TRT it puts him squarely in the healthiest ranges of SHBG in men and 2) He has seen marked improvement in symptoms, body composition and responsiveness to TRT therapy. This is a undeniable success and while everyone might not achieve these results I am hard pressed to believe that if you follow this kind of dedication you wonï¿½t see improvements also.
Finally Sam wanted me to stress that you cannot underestimate the value of being physically and mentally healthy in order to get back on track if you have low SHBG. Early in his journey Sam used Cognitive Behavioral Therapy and listened to healing meditation tapes to reinforce the commitments and outcomes he was striving for. Furthermore, he didnï¿½t just accept what his doctors were telling him. He challenged them and did his own research and when necessary paid for his own testing to have the data needed to get proper treatments or refuse treatment from some overzealous doctors. TRT was also a crucial component to his well-being by giving him the energy, and confidence to get up at 5am and go to the gym almost daily, find additional time in the day for cardio, improve at work and raise a family.
So can low SHBG be cured? Well, it seems like with most things if you put in the proper dedication from a diet and lifestyle perspective and you find the appropriate therapeutic treatments to support your goals you can move towards a healthier level of hepatic SHBG, but with most things it takes time and dedication to overcome years of neglect.Donï¿½t expect it to be easy.