The Essential Testosterone Test Guide: What Every Man Needs to Know

Talks of testosterone (T) surround many male-centered health discussions. This androgen (male sex hormone) is vital in the development of male characteristics like the testes, sperm count, and voice deepening. Its additional role in muscle mass, bone health, sex drive, and other body functions explains why both men and women require different levels. Testosterone testing can ensure that a man knows where he stands when it comes to this important hormone to reduce his risk of health-related issues.

What many men don’t know

Testosterone levels change throughout the life cycle. From the womb to the tomb, there are many reasons why the body produces it at different levels. According to the American Urological Association (AUA), low testosterone begins at 300 ng/dL in men. Normal testosterone levels in adult men range from 300–1,000 ng/dL. As important as this number is, many men are unaware of where to get started regarding their testosterone levels.

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Understanding testosterone levels

In a boy’s adolescent and early adult years, testosterone is at its peak. Think about it: puberty occurs, which causes the maturation of his voice, testes, sperm cells, muscle mass, and more. Once the adult male reaches his late 20s, his testosterone levels begin to slowly decline naturally. Besides this, there are other factors that can make or break your testosterone levels.

Symptoms of low T vary. Some included decreased sex drive, muscle mass, confidence, mental focus, and overall energy levels. Symptoms also include increased fat mass, gynecomastia ('man boobs'), hot flashes, and mood swings. Often, low T is coupled with increased estrogen (estradiol) in men, but this is not always the case.

The types of testosterone tests

A few common ways to measure testosterone levels are through the blood, saliva, and even through urine. Even though these various ways of measurement exist, research shows that the blood serum testosterone test is the most accurate way to get results.

Blood serum testosterone tests are ordered and administered at a medical office. Blood is drawn by a sterile needle placed into a vein on the inside of the elbow. The sample is then sent off to a lab for analysis.

At-home saliva, urine, and finger prick blood tests are available and can be a more convenient way to test testosterone levels. However, these are not as reliable and can yield faulty results if done incorrectly. Men should visit a trusted medical provider to learn more about the best ways to obtain their T levels.

How to prepare for a testosterone test

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Here are a few things to keep in mind before doing a testosterone test:

  • Be aware of the costs associated with testing for testosterone. Preparation for a testosterone test is not difficult. First, it is important to know how much the test will cost. The most common option includes out-of-pocket pay for a testosterone test. Depending on the individual’s insurance plan, the test can be covered by his carrier either fully or at a percentage.
  • Make a list of medications and supplements you are taking. Certain medications and supplements may interfere with testosterone test results. Some medications that may affect testosterone levels include statins, opioids, beta-blockers, and others. It is important to inform your medical provider of any medications or supplements you are taking before conducting a testosterone test. Biotin (vitamin B7) is an important supplement to take note of. It can interfere with testosterone test results, yielding false highs or lows. Your provider may ask that you suspend this supplement or any supplement containing biotin for at least a week leading up to your testosterone test.
  • Fast from all food/beverage the night before and the morning of a testosterone test. It is recommended that a man should receive a testosterone test after an evening fast from food and beverages other than water. However, this is not always required. Research states that the best time for a man to test his testosterone is in the morning between 7–10 a.m. These are peak testosterone hours and will yield the most reliable results that may inform a provider’s interpretation and treatment.

Testosterone testing in women

Both the role of testosterone and testing methods are similar between men and women. Its role in women includes supporting bone health, libido, red blood cell formation, and reproductive health. While the reference range for testosterone in men is 300–1,000 ng/dL, the reference range in women is 15–70 ng/dL.

Symptoms of elevated testosterone levels in women include excess body hair growth, irregular periods, and even infertility. Other conditions like polycystic ovarian syndrome (PCOS) are also associated with high testosterone levels. If a woman is experiencing some of these symptoms and complications, a healthcare provider may order a testosterone test for her and advise on the best treatment methods.

Interpreting testosterone test results

There are a few factors to consider when interpreting testosterone results. These test results can provide a medical provider insight into risks and treatment methods for any low or high levels. For this reason, a man must avoid interpreting results alone. Men should work with a medical provider to interpret lab results.

Total testosterone, free testosterone, and bioavailable testosterone are different tests that inform a medical provider about your testosterone status. Reference ranges are also present on the testosterone tests. These ranges correspond to normal levels that inform a provider about whether the test values are elevated, normal, or low. If your levels are outside of these reference ranges, the provider may recommend certain medications or lifestyle interventions.

  1. Total testosterone represents the combination of free testosterone and all-bound testosterone. Bound testosterone refers to testosterone that is bound to albumin or sex hormone-binding globulin (SHBG). Roughly 44% of a man’s total testosterone is bound to SHBG. The main function of SHBG is to control the amount of testosterone that is available in the blood. SHBG prevents too much testosterone from becoming available.
  2. Free testosterone represents 1–3% of the total amount of testosterone in a man’s body. This type of testosterone is not bound to any protein and can be used in different body areas for different functions. Some of these functions include helping the body regulate metabolism, muscle protein synthesis, sexual/reproductive health, and other important cellular functions.
  3. Bioavailable testosterone. Another 50% of a man's total testosterone is bound to albumin. Depending on the physiological conditions, testosterone that is weakly bound to albumin can become free and exert its functions. This means that it can be readily available for use by the body, thus named bioavailable testosterone.

Working with a healthcare provider is extremely important. A man may present with high total testosterone levels but low free testosterone or bound testosterone. The healthcare provider can address these specific concerns and provide a plan of action for balancing testosterone levels for optimal health.

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Next steps

If you are feeling symptoms of low T, like low sex drive, increased fat mass, decreased muscle mass, fatigue, and low confidence, it may be time to get a testosterone test. Many men do not know what their testosterone levels are and/or don’t know how to get them checked. Men should aim to get their levels checked at least once a year unless a medical provider advises differently. In such cases, more or less frequent testing may be recommended depending on a person's medical history and risk factors.

If you are unsure of how to get your levels checked, ask your healthcare provider about your options. This can limit your risk of chronic disease and other health-related issues that may arise from deficient or excessive testosterone levels.

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