How Your Liver Shapes Your Hormones: Cholesterol, Estrogen and SHBG

When people think about hormones, they think about the ovaries, the thyroid or the adrenal glands. Dr. Jarod Ward thinks about the liver too. Your liver makes the raw material many hormones are built from, clears hormones once your body is done with them, and makes the protein that carries them through your blood.

The liver makes about half of the cholesterol your hormones are built from

Dr. Jarod describes the liver as an organ of conversions:

"It also is very foundational in doing conversions, and by conversions I mean like taking a fat and turning it into a hormone."

The starting material is cholesterol. Cholesterol gets a bad reputation, but it "serves as a raw material for the synthesis of bile acids, vitamin D, and steroid hormones," according to a 2024 review in Hepatology Communications. The same review notes that "the majority of biosynthesis takes place in the liver (about 50%)," with the intestine making about 24%.

Dr. Jarod puts cholesterol at the center of the liver's hormone work:

"The liver is great at converting things into other things, and one of those things is cholesterol. The liver is involved in conversion of cholesterol to usable hormone."

That is part of why he looks at the liver when a patient's cholesterol runs high. That topic has its own post: The Liver and Cholesterol.

Estrogen is mainly broken down in the liver

Making hormones is half the job. Clearing them is the other half. Estrogens are eliminated by converting them into inactive forms that leave in urine or stool, and the enzymes that do much of that work are concentrated in the liver. A review in Cancer Letters states it directly: "the metabolism of estrogens mainly occurs in the liver."

After that first step, the liver tags estrogen so it can leave. Researchers list sulfate, glucuronide, methyl and glutathione tags as potential "detoxification" reactions for estrogen and its byproducts. These are the same phase 2 steps your liver uses on other compounds, explained in Phase 1 and Phase 2 Liver Detox.

Some of those tagged estrogens leave through bile. In the gut, some can be untagged and absorbed again, which researchers call enterohepatic circulation. So bile flow and gut health are part of how estrogen moves out of the body. How bile works is covered in What Is Bile?

Your liver makes SHBG, the protein that carries sex hormones

Sex hormones travel through your blood on carrier proteins, and your liver makes one of them: SHBG, or sex hormone-binding globulin. "The liver produces plasma sex hormone-binding globulin (SHBG), which transports sex steroids and regulates their access to tissues," researchers wrote in the Journal of Clinical Investigation.

SHBG is tied to liver health. A meta-analysis of 16 observational studies found SHBG levels were lower in people with fatty liver than in people without it, and that link was stronger in women than in men. The same analysis found that higher testosterone in women went with higher odds of fatty liver, the opposite of the pattern in men.

Sugar plays a part here. In transgenic mice and in human liver cells grown in the lab, glucose and fructose reduced how much SHBG liver cells made. It's one more way the sugar load reaches your hormones, which we explain in What Does Sugar Do to Your Liver?

Why Dr. Jarod looks at the liver in women's hormone cases

Dr. Jarod works with women through every stage of life and the hormone shifts that come with each one. When hot flashes or night sweats come up, he looks at three areas:

"I always say there's three potential root causes for hot flashes, feeling warm, night sweats, whatever. That's estrogen imbalance, cortisol, and insulin resistance or blood sugar issues. And the liver is involved a lot in the estrogen imbalance and the blood sugar issues."

That's his clinical lens, and it lines up with what the research shows the liver does: it supplies the raw material, clears estrogen, makes SHBG and helps keep blood sugar steady between meals. In Dr. Jarod's view, when the liver is busy with a heavy load from alcohol, sugar and processed food, those jobs share its attention. That's the thinking behind giving it three weeks with a lighter load. If you're curious what a cleanse feels like day to day, start with What to Expect on a Liver Cleanse.

The full plan comes with the cleanse

Love Your Liver is Dr. Jarod's 21-day guided liver cleanse, and it's self-paced. The full meal plan, supplement schedule, shopping list and daily texts come with the cleanse. Your supplements ship to your door, and Day 1 starts the moment you tap start.

Prefer to start with a conversation? Dr. Jarod runs functional medicine and lab testing at Crown Chiropractic in Fort Myers. Call (239) 441-2275 to book a consultation.

Sources

• Dr. Jarod Ward, Crown Chiropractic. Liver episode on YouTube.
• Zhang L, Shi Y, Liang B, Li X. An overview of the cholesterol metabolism and its proinflammatory role in the development of MASLD. Hepatology Communications 2024;8(5):e0434.
• Tsuchiya Y, Nakajima M, Yokoi T. Cytochrome P450-mediated metabolism of estrogens and its regulation in human. Cancer Letters 2005;227(2):115-124.
• Raftogianis R, et al. Estrogen metabolism by conjugation. Journal of the National Cancer Institute Monographs 2000;(27):113-124.
• Adlercreutz H, Martin F. Biliary excretion and intestinal metabolism of progesterone and estrogens in man. Journal of Steroid Biochemistry 1980;13(2):231-244.
• Selva DM, et al. Monosaccharide-induced lipogenesis regulates the human hepatic sex hormone-binding globulin gene. Journal of Clinical Investigation 2007;117(12):3979-3987.
• Agius L. Role of glycogen phosphorylase in liver glycogen metabolism. Molecular Aspects of Medicine 2015;46:34-45.
• Jaruvongvanich V, et al. Testosterone, sex hormone-binding globulin and nonalcoholic fatty liver disease: a systematic review and meta-analysis. Annals of Hepatology 2017;16(3):382-394.