International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 07 Issue 07, April, 2015

Pages: 18-21

Date of Publication: 30-Nov--0001

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Author: Kamal Eldin Ahmed Abdelsalam

Category: Healthcare

Abstract:Background: Breast cancer is the most frequent cancer and the second leading cause of cancer deaths among women worldwide and an increasing incidence rate has been observed in Sudan. Objective: this study was aimed to determine the effect of breast cancer on testosterone and sex hormone binding globulin inSudanese female patients. Materials: This study included 120 untreated breast cancer patients with clinical and histopathological evidence and 100 healthy volunteers as a control. Venous blood was drawn from the cases and controls. Methods: Testosterone and sex hormone binding globulin were estimated in blood samples by using radio-immune assay. Paired t-test was used to compare the mean serum levels of testosterone and sex hormone binding globulin between patients and controls. Results: In the present study there were significant high levels of serum testosterone in premenopausal lady patients with breast cancer as compared to control group (p value < 0.05). On the other hand, there were significant low levels of sex hormone binding globulin in ladies with breast cancer when compared to controls (p value< 0.05).
A significant high level of testosterone and low level of sex hormone binding globulin were found in this study.

Keywords: Testosterone, Sex hormone binding globulin, Breast cancer

Full Text:


Breast cancer is a malignant tumor starts from the breast tissues and cells. Breast cancer affects 13% of women during their lives. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas [1]. In 2008 breast cancer caused 458,503 deaths worldwide, it is compromises 13.7% of the total cancer deaths among women. Breast cancer is more than 100 times more common in women than breast cancer in men, although males tend to have poorer outcomes due to delays in diagnosis [2]. The primary risk factors for breast cancer are sex, age, lack of childbearing or breastfeeding, higher estrogen levels, race, socioeconomic status and dietary iodine deficiency [3]. Testosterone is a steroid hormone and is found in mammals, and other vertebrates. In human, testosterone is originally secreted in male testes and female ovaries. It is the major male sex hormone and an stimulating steroid [4]. In men, testosterone plays a major role in the developing of the male reproductive system particularly testis and prostate as well as progressing the secondary sexual characteristics like increased muscle, bone mass and the growth of body-hair. In addition, testosterone has important role in human health and well-being addition to the prevention of osteoporosis [5]. On average, an adult human male produces about ten times more testosterone than an adult human female, but females are more sensitive to the hormone [6]. About sixty to seventy percent of secreted testosterone is bound to special type of protein so named sex hormone binding globulin (SHBG). Sex hormone binding globulin (SHBG) is a glycoprotein which possesses high affinity for 17 beta-hydroxysteriod hormones such as testoster one and oestradiol. It is synthesized in the liver, plasma concentrations being regulated by, mainly androgen/oestrogen balance along with other factors such as thyroid hormones, insulin and dietary factors. The main function of this protein is transporting of sex steroids in plasma. The concentration of sex hormone binding globulin is a major factor regulating their distribution between the protein-bound and free states. The exact role of the protein in the submission of hormones to target tissues is not yet clear. Measurement of sex hormone binding globulin is used to evaluate androgen metabolism disorders and in identification of women with hirsutism who are more likely to respond to estrogen therapy [7]. Testosterone/ sex hormone binding globulin ratios correlate well with both measured and calculated values of free testosterone and help to differentiate subjects with excessive androgen activity from normal individuals [4]. Sex hormone binding globulin levels is controlled by feedback mechanism factors. The negative feedback factors include insulin, insulin-like growth factor 1, transcortin and hyperandrogenism. Whereas, the positive feedback factors of sex hormone binding globulin levels include high levels of growth hormone, estrogen and thyroxin hormone [7]. Increased sex hormone binding globulin level results in increasing of total testosterone level. Reference ranges for serum sex hormone binding globulin is ranged between 40 to 120 n.mol/L for premenopausal females, and 28 to 112 n.mol/L for postmenopausal females [8]. True androgen status can be determined by measuring the free testosterone or by calculating total testosterone / sex hormone binding globulin ratio, which known as the free androgen index (FAI) [9]. The expected testosterone levels for women are lower than the normal levels for men. The testosterone levels in women are set according to the stages of life [3]. Girls before puberty comprise the minimum levels of testosterone due to their body’s stage of development. Then, during puberty, testosterone is started to be produced from adrenal glands with other sex hormones and making pre-menopausal women have the second-highest levels of testosterone [10]. As a woman begins being aged, she produces more testosterone, less estrogen and other female sex hormones. Therefore, menopausal and postmenopausal women have the highest levels of testosterone [11]. High testosterone levels in women can cause many problems including growth of facial and body hair, deep voice, and aggressiveness [12]. The aim of this study is to examine the role of alterations in testosterone and SHBG in woman developing breast cancer.


This was a cross sectional case-control study conducted period between 2011and 2014 in Khartoum State, Sudan. The study included 100 normal healthy persons (control) and 120 untreated breast cancer patients with clinical and histopathological evidence, from the out patients and hospital admissions of the Radiation and Isotopes Center Khartoum (RICK). All selected participants were premenopausal women, and the ages of them were 28-50 years, and all of them with no history of smoking or biochemical evidence of diabetes, hormonal disorders, hypertension, hyperlipidaemia, renal or liver disease or family history of the breast cancer. This study was approved by the ethical committee of Omdurman Islamic University. Informed consent was obtained from each participant. Fasting 10ml venous blood was drawn between 6-10 a.m. and serum was separated and analyzed within 3 hours after collection. Then testosterone and sex hormone binding globulin tests were estimated by radioimmunoassay (RIA) an automated techniques as described by Choudhury et al [13]. Statistical analyses were performed using SPSS (Statistical Package for Social Sciences). Differences in mean values between groups were evaluated by a one-way analysis of variance (ANOVA) and Student’s t-test. Statistical analysis where the value of p<0.05 was considered as significant.


Table 1 showed comparison the mean serum levels of testosterone between patients and control groups. Serum testosterone level was increased significantly in breast cancer when compared with the controls.


Like other cancers, breast cancer, exists due to an interaction between a defective gene and the environment. Normal cells divide as many times as needed and stop. They attach to other cells and stay in place in tissues [14]. Sex hormones play an important role in etiopathogenesis of breast cancer. Sex hormone binding globulin modulates the functions of testosterone and estradiol by altering their bioavailability to target tissues. Recently, it has been suggested that sex hormone binding globulin also functions as a regulator of the steroid hormone signaling system in the cells, by binding to its specific membrane receptor [8]. In the present study, there were significant high levels of serum testosterone (p value<0.05) in premenopausal ladies patients (61.5±5.4 ng/dl) with breast cancer compared to controls (40.6 ± 10.7 ng/dl). Different studies have provided evidence that hormonal environment can be altered with changes in lifestyle factors. Sedentary lifestyle, characterized by reduced physical activity and a diet rich in fat, refined carbohydrates, and animal protein is associated with high prevalence of overweight, metabolic syndrome, insulin resistance, and high plasma levels of several growth factors and sex hormones, most of these factors are associated with breast cancer risk [15]. Also in this study there were significant low levels of sex hormone binding globulin (p value<0.05) in premenopausal ladies patients (33.3±7.6 nmol/l) with breast cancer compared to controls (57.1±9.9 nmol/l). Many studies showed positive associations between sex hormones and breast cancer risk. Bhaskaran et al [16] reported that the contribution of androgens to breast cancer risk is increased their role as a substrate for estrogen production. Biro et al [17] also found that low levels of sex hormone binding globulin may indicate high levels of bioavailable steroid hormones.


Breast cancer was significantly increased the levels of testosterone and low level of sex hormone binding globulin significantly in Sudanese patients.


Authors are grateful to the V R Center to provide automated analyzer and its reagents. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.



1. Veljkovic M, Veljkovic S. The risk of breast cervical, endometrial and ovarian cancer in oral contraceptive users. Med Pregl 2010,63:657-661.

2. Goncalves V, Sehovic I, Quinn G. Childbearing attitudes and decisions of young breast cancer survivors: a systematic review. Hum Reprod Update 2014,20:279-292.

3. Maggio M, Cattabiani C, Lauretani F, Mantovani M, Butto V, De Vita F, et al. SHBG and endothelial function in older subjects. Int J Cardiol 2013,168:2825-2830.

4. Saad F. The role of testosterone in type 2 diabetes and metabolic syndrome in men. Arq Bras Endocrinol Metabol 2009,53:901-907.

5. Smith LB, Walker WH. The regulation of spermatogenesis by androgens. Semin Cell Dev Biol 2014,30:2-13.

6. Yasui T, Uemura H, Irahara M, Arai M, Kojimahara N, Okabe R, et al. Associations of endogenous sex hormones and sex hormone-binding globulin with lipid profiles in aged Japanese men and women. Clin Chim Acta 2008,398:43- 47.

7. Sun L, Jin Z, Teng W, Chi X, Zhang Y, Ai W, et al. SHBG in GDM maternal serum, placental tissues and umbilical cord serum expression changes and its significance. Diabetes Res Clin Pract 2013,99:168-173.

8. Perry JR, Weedon MN, Langenberg C, Jackson AU, Lyssenko V, Sparso T, et al. Genetic evidence that raised sex hormone binding globulin (SHBG) levels reduce the risk of type 2 diabetes. Hum Mol Genet 2010,19:535-544.

9. Wei S, Schmidt MD, Dwyer T, Norman RJ, Venn AJ. Obesity and menstrual irregularity: associations with SHBG, testosterone, and insulin. Obesity (Silver Spring) 2009,17:1070- 1076.

10. Kumsar S, Kumsar NA, Saglam HS, Kose O, Budak S, Adsan O. Testosterone levels and sexual function disorders in depressive female patients: effects of antidepressant treatment. J Sex Med 2014,11:529-535.

11. El Khoudary SR, McClure CK, VoPham T, Karvonen-Gutierrez CA, Sternfeld B, Cauley JA, et al. Longitudinal assessment of the menopausal transition, endogenous sex hormones, and perception of physical functioning: the Study of Women’s Health Across the Nation. J Gerontol A Biol Sci Med Sci 2014,69:1011-1017.

12. Jukic AM, Weinberg CR, Wilcox AJ, McConnaughey DR, Hornsby P, Baird DD. Accuracy of reporting of menstrual cycle length. Am J Epidemiol 2008,167:25-33

. 13. Choudhury BK, Choudhury SD, Saikia UK, Sarma D. Gonadal function in young adult males with metabolic syndrome. Diabetes Metab Syndr 2013,7:129-132.

14. Abdelsalam KE, Hassan IK, Sadig IA. The role of developing breast cancer in alteration of serum lipid profile. J Res Med Sci 2012,17:562-565.

15. Halava H, Korhonen MJ, Huupponen R, Setoguchi S, Pentti J, Kivimaki M, et al. Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities. CMAJ 2014,186:E449-456.

16. Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5.24 million UK adults. Lancet 2014,384:755-765.

17. Biro FM, Pinney SM, Huang B, Baker ER, Walt Chandler D, Dorn LD. Hormone changes in peripubertal girls. J Clin Endocrinol Metab 2014,99:3829-3835.


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A Study by M. Muthu Uma Maheswari et al. entitled "A Study on C-reactive Protein and Liver Function Tests in Laboratory RT-PCR Positive Covid-19 Patients in a Tertiary Care Centre – A Retrospective Study" is awarded Best Article of Vol 13 issue 06 Special issue Modern approaches for diagnosis of COVID-19 and current status of awareness
A Study by Gainneos PD et al. entitled "A Comparative Evaluation of the Levels of Salivary IgA in HIV Affected Children and the Children of the General Population within the Age Group of 9 – 12 Years – A Cross-Sectional Study" is awarded Best Article of Vol 13 issue 05 Special issue on Recent Advances in Dentistry for better Oral Health
A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" is awarded Best Article of Vol 13 issue 06
A Study by Chen YY and Ghazali SRB entitled "Lifetime Trauma, posttraumatic stress disorder Symptoms and Early Adolescence Risk Factors for Poor Physical Health Outcome Among Malaysian Adolescents" is awarded Best Article of Vol 13 issue 04 Special issue on Current Updates in Plant Biology to Medicine to Healthcare Awareness in Malaysia
A Study by Kumari PM et al. entitled "Study to Evaluate the Adverse Drug Reactions in a Tertiary Care Teaching Hospital in Tamilnadu - A Cross-Sectional Study" is awarded Best Article for Vol 13 issue 05
A Study by Anu et al. entitled "Effectiveness of Cytological Scoring Systems for Evaluation of Breast Lesion Cytology with its Histopathological Correlation" is awarded Best Article of Vol 13 issue 04
A Study by Sharipov R. Kh. et al. entitled "Interaction of Correction of Lipid Peroxidation Disorders with Oxibral" is awarded Best Article of Vol 13 issue 03
A Study by Tarek Elwakil et al. entitled "Led Light Photobiomodulation Effect on Wound Healing Combined with Phenytoin in Mice Model" is awarded Best Article of Vol 13 issue 02
A Study by Mohita Ray et al. entitled "Accuracy of Intra-Operative Frozen Section Consultation of Gastrointestinal Biopsy Samples in Correlation with the Final Histopathological Diagnosis" is awarded Best Article for Vol 13 issue 01
A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
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A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Leow Jun Xian and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
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A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
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A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
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A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award

Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

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Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19

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