Whats The Difference Between Total Testosterone And Free Testosterone
When something does not seem to be working quite right most men have a predisposition toward finding the cause so the problem can be fixed. Men who are having issues in the bedroom may devote time to searching the web for answers. And sooner or later, those searches will wind up focused on testosterone levels in men. If one digs a little more deeply, they will encounter the term free testosterone. From here it should be quite simple to figure out, right?
Well, not exactly. Some things are clearly easier to understand than others. And testosterone levels in men fits into the category of things that are more difficult to understand. In fact, it can be downright confusing. So, heres a guide to the differences between total and free testosterone, what the numbers may mean and why it matters.
Testosterone Vs Free Testosterone:
Theres a good reason why testosterone is often referred to as The King of Hormones. It plays a vital role in a bunch of crucial bodily processes such as maintaining our libido, muscle mass, bone mass etc. But did you know that there are actually different types of testosterone coursing through our veins? Well, there are. So, what about the difference between testosterone vs free testosterone?
Testosterone is the main sex hormone in men, while free testosterone is the free or unbound type of the total testosterone thats found in the body.
Free T makes up approximately 2% of all testosterone in the bloodstream.
About 98% of all testosterone is the bound version of our primary male hormone.
Basically, this is the most easy-to-digest explanation of the difference between the two.
But there are actually 3 different forms of testosterone in the human body, so lets take a look at the differences between each.
Is There Anything Else I Need To Know About A Testosterone Levels Test
At-home test kits for checking your testosterone levels are available without a prescription. The kits provide everything you need to collect a blood or saliva sample to send to a lab for testing. Talk with your provider if you think you need to be tested. If you do a home test, share the results with your provider.
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Free Testosterone And Total Testosterone Tests
You can also go to a medical clinic and just test levels of total testosterone levels. The free testosterone test makes sense when levels of total testosterone have significantly low T. When there are high levels of SHBG, you can have low free and total testosterone at the same time.
It is crucial to understand that many symptoms are attached to low-free testosterone. Ideally, individuals get tested for low-free and total testosterone to check complete blood work and make detailed health assessments.
What Do Free Testosterone Levels Mean
Free testosterone level shows the amount of the hormone active in your body. If you have normal T levels, but most of it is bound, youll still experience low testosterone symptoms. This is because bound T is practically unavailable to the processes that need it.
At what age do you think free testosterone levels begin to dip?
The amount of testosterone in your blood is measured in nanograms per deciliter . It can help doctors identify the causes of various conditions such as erectile dysfunction, hair loss, and osteoporosis .
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Testosterone Testing In Prostate Cancer
Total testosterone testing is indicated to confirm adequacy of androgen deprivation therapy in men with prostate carcinoma. Only tandem mass spectrometry is sufficiently sensitive to accurately measure the low total testosterone seen in men rendered chemically castrate for treatment of prostate carcinoma.15 In BC, testosterone analysis by tandem mass spectrometry is not routinely available and should be specifically requested on the requisition. Testosterone should be tested 3 months after initiating ADT, and in the event of any increase in PSA levels.
What Happens During A Testosterone Levels Test
A blood sample for a testosterone test should be taken in the morning between 7 and 10. During these hours, your testosterone levels are typically the highest.
A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
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Free Vs Total Testosterone: Whats The Difference
Approximately 98% of the testosterone the body produces is bound to either sex-hormone binding globulin , or albumin. This is referred to as bound testosterone. The 2% thats left is known as free testosterone.
This unbound or free testosterone is what connects with testosterone receptors within the bodys cells. When a cell absorbs free testosterone, it enables its functionality, such as cell replication in the bones and muscles. Free testosterone is also responsible for the creation of what are known as secondary sexual characteristics in men. These include things like facial hair and a deeper voice.
As the name suggests, total testosterone is the grand total of all the hormone available in the bloodstream. While some testosterone tests only account for total testosterone, they might not be as helpful as once thought. Heres why.
A 98% proportion is normal for bound testosterone but obviously, anomalies can occur. Limiting testing to total testosterone levels overlooks the possibility of excessive bondage to either SHBG or albumin. Heres why it matters. The possibility of excessive bondage means that it is possible to have normal levels of total testosterone but still have insufficient free testosterone to perform its essential functions. Too little free testosterone can lead to poor muscle development, irritability, lowered sex drive and a host of other issues that one may not readily associate with too little free testosterone.
What Do The Results Mean
Your test results may mean different things depending on which test was done, your age, your symptoms, the results of other tests, and other conditions you may have. So, it’s best ask your provider to explain your test results.
A testosterone level test alone can’t diagnose any health conditions, but abnormal results with symptoms may be a sign of a health problem.
- In males, low T levels may be caused by different conditions, including:
If your results are not normal, it doesn’t always mean you have a medical condition that needs treatment. It’s normal for testosterone levels to decrease with age. And certain medicines can affect your results. If you have questions about your results, talk to your health care provider.
Learn more about laboratory tests, reference ranges, and understanding results.
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Experiencing Symptoms Of Testosterone Deficiency Or Imbalance
The Everlywell at-home Testosterone Test is a quick and easy way to check free T levels to see how your levels compare to normal free testosterone levels for your age. Everything you need to take the test from the comfort of home is included with the kit, and you can easily view your results on our secure, online platform. If your testosterone is too low or high, talk with your healthcare provider to learn more about treatment options. Your healthcare provider might recommend testosterone replacement therapy to help get your levels back to normal.
Testing By Clia Approved Lab: Quest Diagnostics
Testosterone is a primary sex hormone that is found in both men and women’s systems. While being in charge of developing male traits, this protein has many other functions as well, such as the ability to control our sex drive, regulating the production of sperm, increasing energy, and promoting the development of muscle mass. Testosterone concentrations decline naturally with age, which may lead to physiological changes such as low sex drive.
Testosterone can be either free testosterone or bound testosterone, and the cumulative total of both is the total testosterone in the body.
Bound testosterone – Around 98% of the testosterone that our body produces is bound to SHBG and albumin. SHBG carries testosterone in the blood This is referred to as bound proteins. The binding between testosterone and albumin is not very strong and is easily reversed.
Free testosterone – The remaining 2% are free and unbound, circulating in the bloodstream and ready to be used by the system as needed. Free testosterone is responsible for numerous functions including the development of male characteristics, cell replication in bones and muscles and others.
Total testosterone – The total testosterone level is the sum of both free and bound testosterone.
Bioavailable testosterone– This is the level of Free testosterone and weakly bound testosterone. This is an assessment of biologically active/available testosterone in the blood.
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Why You Need Free Testosterone
We tend to think of free T in an Arnold Schwarzenegger-type way: It helps you build and maintain muscle mass. But free T works in other ways, too, notes Dahl.
Free testosterone is responsible for the creation of secondary sexual characteristics in men, like facial hair and a deeper voice.
On a muscular level, free T helps muscles contract. For an organ like the heart, free T helps muscles pump more efficiently. Some research suggests that men with congestive heart failure who also have low free T have poorer health prognoses. If your free testosterone levels are normal, you might have a lower risk of clogged arteries or a heart attack, he adds.
Because free T helps you maintain muscle mass, when your numbers are higher you wont gain as much fat, he adds. Free T also helps men with issues such as erectile dysfunction , aiding in relational health.
Dahl also notes that people with low free testosterone levels tend to report issues with mental clarity they feel foggy. The research on testosterones impact on the brain is unclear, but there are androgen receptors in the brain, which suggests hormones like testosterone can play a role in brain functioning.
Monitoring Of Antiandrogen Therapy:
The goal of anti-androgens in therapy is usually to suppress testosterone levels to castrate levels or below but no more than 25% of the lower reference range value.
Antiandrogen therapy is most commonly employed in the management of mild-to-moderate idiopathic female hyperandrogenism, as seen in polycystic ovarian syndrome. Total testosterone levels are a relatively crude guideline for therapy and can be misleading. Therefore, bioavailable or free testosterone also should be monitored to ensure treatment adequacy. However, there are no universally agreed biochemical endpoints and the primary treatment end point is the clinical response.
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Where Does Testosterone Come From
As with most hormonal pathways in the body, testosterone production is a bit complex. Heres the general process:
- A part of your brain called the hypothalamus releases the gonadotropin-releasing hormone .
- GnRH tells the pituitary gland to release luteinizing hormone into your bloodstream.
- In males, once LH reaches the testicles through the blood, it stimulates special cells in the testes, called Leydig cells these Leydig cells are ultimately responsible for producing testosterone.
- In females, specialized cells in the ovaries called theca cells make testosterone.
- As serum testosterone levels rise, signals are sent to the pituitary gland and hypothalamus to stop stimulating testosterone production.
Its a complex process, but this feedback loop is the bodys way of trying to keep hormone levels in check.
Monitoring Of Womens Testosterone Replacement Therapy:
The efficacy of testosterone replacement in females is under study but much clinical evidence shows that testosterone supplementation can help improve libido and treat vaginal discomfort. If it is used, total testosterone levels should be kept within the normal female range at all times. Bioavailable or free testosterone levels also should be monitored to avoid overtreatment.
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Female Low Testosterone Levels:
Increased Female testosterone levels may be seen in:
Congenital adrenal hyperplasia: nonclassical variants may not present in childhood but during or after puberty. In addition to testosterone, multiple other androgens or androgen precursors are elevated, such as 17OH-progesterone , often to a greater degree than testosterone.
Prepubertal girls: analogous to males, but at lower levels, increased levels of testosterone are seen in precocious puberty.
Ovarian or adrenal neoplasms: high estrogen values also may be observed, and LH and FSH are low or normal. Testosterone-producing ovarian or adrenal neoplasms often produce total testosterone values > 200 ng/dL.
Polycystic ovarian syndrome: hirsutism, acne, menstrual disturbances, insulin resistance and, frequently, obesity, form part of this syndrome. Total testosterone levels may be normal or mildly elevated and, uncommonly, > 200 ng/dL.
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Hormonal Imbalances And Erectile Dysfunction
Testosterone clearly plays a key role in a mans sexual function. Imbalances in testosterone levels can cause erectile dysfunction and decreased libido. However, testosterone may be only one of a large number of factors contributing to ED. In future articles we will continue to explore more of those factors.
Be sure to join us for future articles as we discuss this and other topics related to how men can gain and retain vitality at any age.
Analysis Sample And Statistical Analysis
Of the 2301 male participants, blood samples were obtained on 1899 . Twenty-eight subjects were excluded for reporting current treatment for cancer, and one subject was removed for reporting cancer but not current treatment status. Of the remaining 1870 men, we excluded eight men who were missing testosterone or SHBG, 29 men on medications known to affect sex steroid levels , and nine men with extreme outlying values of testosterone or SHBG. Two men were missing per-capita income due to missing household size. Other missing data were replaced by plausible values using multiple imputation . This left 1822 men as a base analysis sample.
To account for the complex sampling design, analyses were conducted using SUDAAN . Prevalence estimates were weighted inversely proportional to the probability of selection . The distribution of covariates was examined within three groups , and tests for significant differences by these groups were conducted .
Finally, backwards elimination at Wald test significance level of P 0.15 was used to reach a parsimonious final model. Age and race/ethnicity remained in the final models, regardless of significance level.
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When Considering A Workup For Low Testosterone Weigh The Utility Of Different Biomarkers
Age-related decline of testosterone has been confirmed in several cross-sectional and longitudinal studies, and results from dysfunction in the hypothalamic-pituitary-testicular axis.1-3 While the clinical relevance of this decline is variable, testing for testosterone deficiency has become increasingly common given some possible therapeutic options. Some clinicians start their evaluation for hypogonadism by ordering total testosterone , while others order free T, and others order both. In addition to the operating characteristics of these tests, patient factors play a role in the utility of using each test as a basis for diagnosis. This review will examine recent biomarker data and offer a practical approach to use.
- Total testosterone measurement is a good initial diagnostic test in the evaluation of hypogonadism, but it has its limitations.
- Reserve use of free T for patients whose total T is between 150 and 350 ng/dL, or in obese or older men whose total T may be erroneously low.
Consider a few other important points about ordering total Ttime and reproducibility. Total T has diurnal variation, especially in younger men, with the highest readings tending to occur in the morning, around 8 AM.6 As it is easier to see a difference between normal and subnormal when normal is maximal, an 8 AM test is recommended. If the result is borderline low, the test should be repeated before making a definitive diagnosis of androgen deficiency.
Free Testosterone Vs Total Testosterone In Protection From Sexual Symptom Impairment
- The Journal of Sexual Medicine
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Signs And Symptoms Of Hyperandrogenism In Women
A range of symptoms and signs from hirsutism to virilisation may occur. The Endocrine Society recommends testing for hyperandrogenism in women with hirsutism that is moderate or severe, of rapid onset, or accompanied by menstrual dysfunction, obesity or clitoromegaly.18 Other indications for referral are outlined at the end of this document.
Why The Test Is Performed
This test may be done if you have symptoms of abnormal male hormone production.
In males, the testicles produce most of the testosterone in the body. Levels are most often checked to evaluate signs of abnormal testosterone such as:
- Early or late puberty
- Change in voice
- Excess hair growth
- Increased size of the clitoris
- Irregular or absent menstrual periods
- Male-pattern baldness or hair thinning
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