How Do We Test For Testosterone Levels
If your doctor suspects that you have low testosterone, he or she will most likely run a blood test that tests for your total testosterone. The normal testosterone ranges mentioned above are based on your total testosterone level. Most of the testosterone in your bloodstream is what is known as bound testosterone, and a smaller percentage exists in the blood stream as free testosterone. Total testosterone refers to all of the testosterone in your blood at a given time.
The following chart illustrates the normal total testosterone levels for men and women by Tanner Stage and age. The Tanner Scale breaks down the observable signs of puberty into 5 stages, running from Stage I from about age 10 to Stage V at 15 for boys, and about age 8 to 15 for girls.
|> 49 y: 341|
By way of comparison, the following chart gives the so-called normal testosterone levels by another quality testing lab Quest Diagnostics. Quest does not use the Tanner Scale, but rather indicates the normal ranges for males and females by age.
However, by comparing to the chart above, you can see how the normal ranges differ.
Testosterone Testing In Women
Testosterone testing is indicated for investigation of signs and symptoms of hyperandrogenism in women based on medical history and clinical examination. Testosterone testing is not indicated for the investigation of women with low libido.17
The upper limit of normal for testosterone in women is approximately 2-3 nmol/L, or slightly higher depending on menstrual phase and use of oral contraceptive medications.18In polycystic ovarian syndrome, total testosterone concentrations are within the normal reference interval or slightly higher. Consequently, testosterone concentrations greater than twice the upper limit of normal suggest an alternate etiology, such as an androgen-secreting tumour.
Risks Of High Or Low Testosterone
Abnormal levels of testosterone can carry risks for both women and men. In men, may mean a tumor in the testicles or adrenal glands. Adrenal glands are located above the kidneys and help control heart rate, blood pressure, and other body functions.
In women, high T may be associated with PCOS, or much higher levels can potentially signal ovarian cancer or cancer of the adrenal glands. Low testosterone levels are normal in , but extremely low levels may indicate a disorder where the adrenal glands dont produce enough hormones.
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Testosterone Deficiency: Practical Guidelines For Diagnosis And Treatment
Testosterone deficiency in men is a common but often-missed diagnosis. After confirmation of the diagnosis, exclusion of any reversible causes, or contraindications to the use of testosterone, replacement therapy may be offered. Methods of replacement include injectable testosterone esters, transdermal testosterone , or oral testosterone in the form of testosterone undecanoate. Men receiving testosterone therapy should be followed according to a standardized monitoring plan testosterone levels should be assessed 2 to 3 months after therapy is initiated, followed by annual examinations to assess whether symptoms have improved and whether the patient is experiencing adverse events.
Testosterone can be administered orally, transdermally, or by injection to improve a hypogonadal mans sense of well-being, sexual function, bone density, and muscle strength.
Hypogonadism affects approximately 40% of men aged 45 or older, although less than 5% of these men are actually diagnosed and treated for the condition. Despite some controversy, testosterone therapy has been established as a safe and effective principal treatment for hypogonadism for nearly 70 years.
In the last decade, studies have improved our understanding of hypogonadism and have helped clarify its prevalence and associated comorbid illnesses.
CausesThe principal causes of hypogonadism are testicular failure , pituitary and/or hypothalamic failure , and age-related dysfunction .
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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What Is A Testosterone Levels Test
A testosterone levels test measures the amount of testosterone in a sample of your blood. Testosterone is known as a “male” sex hormone, but females have testosterone in smaller amounts.
Testosterone is made by:
- The testicles , the part of the male reproductive system that makes sperm
- The ovaries, the part of the female reproductive system that makes eggs
- The adrenal glands, organs on top of each kidney that make several hormones
During male puberty, testosterone causes body hair, muscle growth, and a deepening voice. In adult life, it controls sex drive, maintains muscle mass, and helps make sperm. In females, testosterone is important for the growth of bones and muscles, and healthy organs.
There are different forms of testosterone in your blood that may be measured to help diagnose certain health problems. Most of your testosterone is attached to proteins. The proteins prevent your tissues from using the testosterone right away, which helps control the amount of “active” testosterone in your body. Testosterone that’s not attached to proteins is called free testosterone. Free testosterone acts on your tissues.
Three types of blood tests measure these different forms of testosterone:
Other names: serum testosterone, total testosterone, free testosterone, bioavailable testosterone
A Note About Free Testosterone
When we are testing for and diagnosing someone with low testosterone, it is always our goal to find what it the optimal or normal range for their individual needs, goals and lifestyle. As you can see from the charts above, even a respected testing lab such as LabCorp can say that for a 60 year old man, a level of 6.6 pg/mL of free testosterone can be normal, and yet our doctors know that we see patients in that range that feel far from normal. Over the years of treating a variety of men between the ages of 35 and 65 with the symptoms of low testosterone, our doctors have discovered what we believe to be the optimal and not necessarily the normal level of free testosterone in the blood. We strive to get most patients regardless of age into a range of from 20 25 pg/mL, and find that most men can enjoy a great quality of life, free from the symptoms of low testosterone at that level.
Most of the testosterone in your bloodstream is what is known as bound testosterone, and a smaller percentage exists in the blood stream as free testosterone.
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How Testosterone Levels Fluctuate Through Life
In boys, testosterone levels ramp up during puberty, generally peaking in the late teens. In men, testosterone levels begin gradually declining after age 30. The slow decrease is considered part of normal aging unless problematic symptoms develop. For instance, 50% of men over 80 have total testosterone levels that fall below the normal range for young men.
Some medical conditions are linked to low testosterone levels. The American Diabetes Association notes that men with are twice as likely to have low T compared to men without diabetes. Alcoholism in men can also reduce their testosterone levels.
In women, most testosterone is converted to estradiol, a form of estrogen and the main sex hormone in females. Testosterone levels begin declining when a woman enters her 40s and drop more after.
Why Would Someone Need A Testosterone Test
The test is generally ordered when men have symptoms of low T or women have symptoms of high T. For example, tests may be used in the following scenarios:
Infertility for either sex
Early or delayed puberty in boys
Excess body hair and deepening of the voice in women
Irregular menstrual periods or difficulty getting pregnant
Fatigue, weakness, or other nonspecific symptoms
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What Can I Expect During A Testosterone Level Test
Testosterone tests are blood tests. During the test, your healthcare provider:
Testosterone blood tests are quick and relatively painless. You may feel a slight sting when the needle goes in or out of your arm. The test usually takes less than five minutes.
Total And Free Testosterone Levels
Before we begin, I want to reiterate a fact weve previously discussed in this series: there are three different types of testosterone floating in your body: free testosterone, SHBG-bound testosterone, and albumin-bound testosterone. When you get tested, there are two tests you can get: total testosterone and free testosterone.
Total testosterone is the total amount of T floating in your blood at the time of the test: free, SHBG-bound, and albumin-bound combined. Total testosterone is typically measured in ng/dl, or nanograms per decilitre.
Free testosterone is the measurement of you guessed it free testosterone . Free T is typically measured in picograms per milliliter. As well discuss later in this post, because free testosterone makes up such a tiny, tiny percentage of your total T, its really hard to measure accurately. So, when you see research on normal testosterone levels, it usually focuses on total testosterone. Consequently, most of the numbers in this post will be about total T levels. With that said, I do include some references to research that indicates what average and optimal free testosterone levels are.
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Average Testosterone Levels By Age
When determining whats considered a normal testosterone level, its best to look at what the reference range is for men your age. Researchers have known for years that T levels typically drop by about 1% every year after you hit your mid-30s. So if youre 35, comparing yourself to a bunch of 80-year-old men isnt very useful because they likely have really low T levels.
Unfortunately, many labs dont break down reference ranges by age. However, studies have been done in which researchers do just that. Below, I include the results from two such studies.
|Measurements in Conventional Units , SHBG in|
The above chart groups men into seven 10-year age increments. Its based on results from this 1996 study. According to this chart, my T level at the beginning of the experiment was closer to the average of an 85-100-year-old man. Yikes! This chart also lists the average free testosterone levels of the subjects. My beginning free testosterone was below the average of men my age and my end level was above average.
In a study done that same year by another team of researchers, they produced the following chart of testosterone levels broken down by age:
|Measurements in Conventional Units|
While this chart doesnt show average free testosterone levels, I like the fact that it shows the T levels of men in the bottom five and ten percentiles as well as the T levels of the men in the top 95%. You can see how you compare to men with the lowest and highest T 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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Appropriate Testosterone Testing For Male Hypogonadism
By Dr. Breay Paty on January 21, 2020
Breay W. Paty, MD Disclosures: Dr. Paty has received speaking fees and/or sat on advisory boards for Abbott, Astrazeneca, BI/Lilly Alliance and Novo Nordisk related to diabetes monitoring and treatment. No conflict of interest involving testosterone testing or products. Recommendations in this article are consistent with current practice patterns. Treatments or recommendations in this article are unrelated to products/services/treatments involved in disclosure statements.
What have I have noticed
The therapeutic use of testosterone has increased dramatically in the last two decades. The reasons for this increase appear to be due to the frequency of testing and marketing of testosterone replacement for middle-aged and older men. While men with unequivocally low testosterone levels usually benefit from hormone replacement, the risk/benefit ratio for men with equivocal levels is not clear, especially in men who desire fertility. Testosterone therapy suppresses endogenous hormone production and reduces fertility. Also, once men start treatment, they may find it difficult to stop because of prolonged hypogonadism during recovery of the hypothalamic-pituitary-testicular axis. For these reasons, it is particularly important to have a rational approach to testing and diagnosis of hypogonadism in men.
What I recommend
When assessing for male hypogonadism, consider the following:
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Blood Testing For Testosterone Levels
- The most accurate way to determine your testosterone levels is with a simple blood test.
- Women may also experience Low T
- The so-called normal testosterone levels for men and women changes as you age.
- There is no special preparation required for either a total testosterone test, or a free testosterone test.
Testosterone is the most important male hormone. Womens bodies also make and need testosterone. Which means that both men and women can and do suffer from low testosterone, a condition also known as Low-T.
Both men and women produce less testosterone the older they get. In some people, age-related testosterone decline is well-tolerated. In others, it can lead to the many debilitating systems of low testosterone.
If you are a man or woman over 40, and are feeling sluggish, worn-out, putting on weight, having cognitive difficulties, and/or are putting on weight you may be suffering from low testosterone.
The only way to know for sure is to have you testosterone levels checked. The most accurate way to determine your testosterone levels is with a simple blood test.
Risks Of Testosterone Blood Tests
Risks for a testosterone blood test are minimal but may include:
- Implantable pellet
Your healthcare provider can help you determine which formulation of testosterone is most suitable for you.
Recent studies have shown that the use of TRT is increasing, and more than half of prescriptions for testosterone are written by primary healthcare providers.
Treatments for high testosterone levels may include lifestyle changes, including exercise to improve symptoms. Healthcare providers may also prescribe antiandrogen medications like Aldactone , diabetes drugs like Actos , or oral contraceptives to help lower testosterone levels or relieve symptoms of high testosterone.
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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.16In BC, testosterone analysis by tandem mass spectrometry is available upon request and should be specifically indicated on the requisition. Testosterone should be tested three months after initiating ADT, and in the event of any increase in PSA levels.
Testosterone What It Does And Doesn’t Do
When you think of testosterone, what comes to mind? Macho men? Aggressive, impatient, type A behavior? Road rage? Violence?
Testosterone’s role in bad behavior is largely a myth. What’s more, testosterone plays other important roles in health and disease that may surprise you. For example, did you know that testosterone is a key player in prostate cancer? Or, that women need testosterone, too? There’s more to testosterone than guys behaving badly.
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What Are The Normal Testosterone Levels For Men And Women
The so-called normal testosterone levels for men and women changes as you age. Also, depending on age, weight, overall fitness and lifestyle, what is considered a normal testosterone level for one man, could be low for another. However that having all been said, the normal range of testosterone levels for adult men is from about 270 to 1070 nanograms per deciliter .
The normal range for women of age 19 and up, is from 8 to 60 ng/dL.
The following graphic illustrates the decline in testosterone levels in men as they age.
The Guidelines And Protocols Advisory Committee
The principles of the Guidelines and Protocols Advisory Committee are to:
- Encourage appropriate responses to common medical situations
- Recommend actions that are sufficient and efficient, neither excessive nor deficient
- Permit exceptions when justified by clinical circumstances
Contact Information:Guidelines and Protocols Advisory CommitteePO Box 9642 STN PROV GOVTVictoria BC V8W 9P1Website: www.BCGuidelines.ca
DisclaimerThe Clinical Practice Guidelines have been developed by the Guidelines and Protocols Advisory Committee on behalf of the Medical Services Commission. The Guidelines are intended to give an understanding of a clinical problem, and outline one or more preferred approaches to the investigation and management of the problem. The Guidelines are not intended as a substitute for the advice or professional judgment of a health care professional, nor are they intended to be the only approach to the management of clinical problem. We cannot respond to patients or patient advocates requesting advice on issues related to medical conditions. If you need medical advice, please contact a health care professional.
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