Sex steroids, SHBG and type 2 diabetes in women: what do we really know? – Published online 16/01/2026

Nicolette J. D. Verhoog, Donita Africander, Karl-Heinz Storbeck

Type 2 diabetes in women is shaped by ongoing changes in circulating sex steroids, which influence insulin-sensitive tissue in distinct ways. Oestrogens generally support glucose homeostasis in premenopausal women by improving insulin sensitivity in organs involved in energy balance. In contrast, decreased oestrogen levels, as experienced by postmenopausal women, and elevated androgen levels can disrupt these processes and increase diabetes risk. Both hormones act through molecular pathways that regulate genes critical for metabolic control. Their activity is further modified by sex hormone-binding globulin (SHBG). However, this carrier protein not only regulates hormone availability but also contributes directly to the pathogenesis of type 2 diabetes, independent of sex steroids. In this review, Verhoog et al (https://doi.org/10.1007/s00125-025-06647-5) summarise current insights and present an integrated framework that connects clinical observations with in vitro studies. Mechanisms driven by sex steroids and SHBG-independent effects are discussed, highlighting the importance of further research to define the interactions among androgens, oestrogens, SHBG and type 2 diabetes, ultimately supporting improved health outcomes for women. The figures from this review are available as a downloadable slideset.

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