Free Testosterone Test

Testosterone, a sex hormone, plays an important role in both men and women. In men, it regulates sex drive, bone mass, muscle mass, and the production of sperm. Women also make testosterone but in a small amount. They produce testosterone in their ovaries that maintains hormone balance and other body functions.

During puberty, testosterone is produced in large amounts in the male, which regulates secondary sexual characteristics like the development of muscle, body hair growth, deepening of the voice, enlargement of the penis and sperm production in the testes.

In adult males, testosterone plays an important role in regulating the sex drive and maintaining muscle mass. In adult females, testosterone is converted to estradiol, the main sex hormone.

This testosterone in the blood attaches to two proteins named albumin and sex hormone-binding globulin. But some of the testosterone is freely present in the body and not attached to proteins. This is named Free testosterone which is easily used by the body.

This Free Testosterone blood test measures the amount of unattached free testosterone in your blood. The high or low of free testosterone in both men and women has a health problem.

It is often unclear what exactly causes mild-to-moderate testosterone elevations in the blood. But the common causes of elevated testosterone are genetic conditions like congenital adrenal hyperplasia, tumours of reproductive organs like adrenal, testicular and ovarian tumours, and excessive use of testosterone supplements. In addition, testosterone production declines with age between the fourth and sixth decades of life.

In women, excess testosterone leads to hirsutism, acne, menstrual problems, and infertility as well. As testosterone levels decline, females may experience subtle symptoms like a decrease in libido or mood changes.

In men, low free testosterone can lead to partial or complete degrees of hypogonadism. It is characterized by changes in male secondary sexual characteristics and reproductive function. When testosterone levels are mild to moderate, they produce little or no symptoms in men, but they can cause distress in women.

So if your doctor thinks that the problem you are facing correlates with abnormalities in testosterone, then they recommend a Free Testosterone Test for more information.

Moreover, testosterone levels are diurnal in nature, meaning the level of testosterone changes two times in a day, the highest (peak) levels in the morning (about 4:00 to 8:00 am) and the lowest levels in the evening (about 4:00 to 8:00 pm). Testosterone levels also increase after exercise and decrease with age.

Other names of the Free testosterone test:

• Bioavailable testosterone test, serum testosterone, total testosterone, free testosterone

What does the Free Testosterone test/measure, and who is this prescribed for?

The Free-Testosterone Test measures the level of free testosterone (unbound testosterone) in the blood in both men and women. Your doctor recommends the free-testosterone test when an individual is suffering from a low sexual drive or suffering from any hormonal change symptoms.

Some of the common symptoms of abnormality in testosterone in men are:

• Low sexual drive
• Loss of muscle mass
• Erectile dysfunction
• Swollen breast
• Lack of energy, fatigability
• Testicular lesions
• Delayed or Early Puberty in Boys
• Trouble with concentration
• Hair loss, weak bone

In females, this test can help in finding the reason behind missing periods and irregular periods. Some other symptoms of getting testosterone testing in women are-

• Excess body and facial hair growth
• Deepening of voice
• Menstrual irregularities
• Excessive oily skin
• Recurrent Acne
• Low sex drive
• Dryness in the vaginal region
• Enlarged clitoris
• Weight gain

Here are some disease conditions that show a variation in testosterone:

• Infertility
• Osteoporosis
• PCOS in women
• Congenital disease
• Tumours of the adrenal gland, testes, or ovaries

So if you are suffering from the above symptoms and diseases, you should check your free testosterone levels.

However, abnormal testosterone levels in the blood do not always indicate medical problems. In older age, men and excessive exercise cause lower testosterone levels.

The normal testosterone level for you depends on both your gender and age.

In males

0-9 years- Less than 1 pg/mL

10-11 years-Less than 4 pg/mL

12-13 years- Less than 68 pg/mL

14-15 years- 2-95 pg/mL

16-17 years- 26-119 pg/mL

18 years and older- 32-168 pg/mL

In females

 0-9 years- Less than 1 pg/mL

 10-11 years- Less than 3 pg/mL

 12-13 years- Less than 5 pg/mL

 14-15 years- Less than 6 pg/mL

 16-17 years- Less than 7 pg/mL

 18-30 years- 1-5 pg/mL

 31-40 years- 1-6 pg/mL

 41-50 years- 1-4 pg/mL

 51 years and older- Less than 3 pg/mL

Increased or decreased levels of Free Testosterone in the blood are responsible for various problems in males and females.

In males, abnormal levels of free testosterone are indicative of these conditions.

Decreased level of testosterone:

• Partial or Complete hypogonadism- It is a condition in which there is decreased functional activity of the gonads leading to a decrease in the production of hormones like testosterone, estradiol, progesterone, etc.

• Primary testicular failure- In this condition, the testes fail to produce sperm despite adequate hormonal support. It is associated with increased levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) and decreased levels of free testosterone.

• Testicular cancer- A cancer of the testicle occurs at a young age and is highly curable. During the diagnosis and screening of testicular cancer, a low level of testosterone is seen as well.  

Increased testosterone levels:

• In boys, increased levels of testosterone are seen in the pre-puberty stage, excessive supplements of testosterone are suspected for the high levels of testosterone.  However, further workup is necessary to determine the cause of increased testosterone levels.

• In adult men, testicular or adrenal tumours or a history of orchiectomy or chemotherapy can present with a lower testosterone level.

In females, abnormal levels of free testosterone are indicative of these conditions.  

Decreased testosterone levels may be observed:

• Primary or secondary ovarian failure- In this condition, the ovaries stop functioning normally and don't produce normal levels of oestrogen or testosterone, leading to a low level of testosterone in the body.

Increased testosterone levels may be seen in:

• Congenital adrenal hyperplasia: A genetic disorder affecting the adrenal glands. As a result of this condition, the adrenal glands increase testosterone production and produce ambiguous genitalia, such as an enlarged clitoris or genitals that look more like those of a male child.

• Prepubertal girls - The stage before puberty in females is analogous to males. At this stage, increased levels of testosterone are seen.

• Adrenal tumours- They are tumors on the adrenal glands. The hormones produced by the tumor are responsible for the symptoms of adrenal tumours. Their most common symptoms are excessive growth of facial and body hair (such as in the pubic and underarm areas), enlarged clitoris, etc., due to the increased level of testosterone produced by the tumour.

• Ovarian tumours- The cancerous growth of the ovaries can also affect the level of hormones secreted in the body leading to an increased level of testosterone in a female body.

• Polycystic ovarian syndrome: PCOS and hyperandrogenism go hand in hand. Elevated androgens are one of the three possible defining signs of the polycystic ovarian syndrome. The classic features of PCOS are hirsutism, acne, menstrual disturbances, insulin resistance, and, frequently, obesity. Total testosterone levels are elevated in this condition.

The Free testosterone test is performed on a blood sample. For Free Testosterone Testing, no fasting and no other special preparations are required.

Test Preparation

The Free-Testosterone Test is a simple blood test that doesn’t require fasting and other special preparation. But before the testing, make sure to tell your doctor if you are taking any medications. Your doctor may suggest performing the test in the morning because testosterone levels vary between the day and evening, and its values are usually higher in the morning.

What are the parameters included in the test?

The Free Testosterone Test values give an idea about the decrease and increase in the level of free testosterone in the blood. In general, for adult men, a free-testosterone test is mostly recommended if there are symptoms of low testosterone, but for women, it is mostly prescribed if there are symptoms of high testosterone levels.

How frequently should you take this test?

Like most chronic conditions, testosterone low-level treatment takes time. Therefore, to monitor the level and to keep a check on the treatment plan, your doctor is most likely to repeat your test after 3 months.

This 3-month check-up will give a sign if the level is increased, lowered, or maintained.

However, if your free testosterone level was fine in a previous report, and you have not been taking any treatment, then your doctor will repeat this test annually.

Sexual disorders, Infertility, Hypogonadism