SHBG and Insulin resistance: There is compelling data in men that testosterone deficiency predisposed to MetS and in females that estrogen deficiency predisposes to an increase risk of MetS.30,31 Furthermore studies have shown that sex hormone binding globulin (SHBG) also is an important determinant of MetS risk.32,33 In future studies this important area needs to be investigated in relationship to insulin resistance and inflammation and dysbiosis of gut microbiota.30