- Measure Your Free Testosterone Level
- What’s the difference between a testosterone blood test and a saliva test?
- So how is testosterone measured by this test?
- What’s the difference between a total testosterone test and a free testosterone test?
- Why is testosterone considered a male sex hormone?
- Can this test help me see if my testosterone supplements (like gels or implants) are working?
- Can this test check if I have low testosterone?
- How is testosterone related to polycystic ovary syndrome (PCOS) in women?
- Testosterone Levels Test
- What is a testosterone levels test?
- What is it used for?
- Why do I need a testosterone levels test?
- What happens during a testosterone levels test?
- Will I need to do anything to prepare for the test?
- Are there any risks to the test?
- What do the results mean?
- Is there anything else I need to know about a testosterone levels test?
- Low Testosterone Diagnosis
- Healthdirect 24hr 7 days a week hotline
- What is being tested?
- Why would I need this test?
- How to prepare for the test
- Understanding your results
- More information
- Testosterone Test
- Symptoms of Low Testosterone: When Should You Get Checked Out?
- What to Do if You Have Low Testosterone
- The Seven Most Common Signs of Low Testosterone
- Should You Check Your Testosterone Levels?
- Could you have low testosterone?
- Alternative Names
- How the Test is Performed
- How to Prepare for the Test
- How the Test will Feel
- Why the Test is Performed
- Normal Results
- What Abnormal Results Mean
Measure Your Free Testosterone Level
What’s the difference between a testosterone blood test and a saliva test?
Both blood tests and saliva tests are well-established techniques for clinically measuring testosterone levels in men and women. But there are a few differences between these two testing methods:
- Sample type – Testosterone is circulated throughout your body by the bloodstream, and a fraction of it enters your saliva. Blood tests measure testosterone levels in a sample of blood, but saliva tests use a sample of saliva.
- Collection process – Blood samples are often collected through a blood draw (venipuncture), while saliva samples are often much easier to collect: you just spit into a tube, for example.
- Units of measure – Blood tests use nanograms per deciliter (ng/dL). Saliva tests (like EverlyWell’s Testosterone Test) use picograms per milliliter (pg/mL). For comparison, 1 ng/dL = 10 pg/mL, so the numerical results from two different tests that use different types of samples (and different units of measurement) will look completely different. It doesn’t mean either test is inaccurate.
So how is testosterone measured by this test?
The EverlyWell at-home Testosterone Test uses a saliva sample – not a blood sample – and reports results in picograms per milliliter (pg/mL). This test measures your free testosterone levels, instead of total testosterone.
What’s the difference between a total testosterone test and a free testosterone test?
Some of the testosterone in the body circulates freely, but much of it is bound to other proteins in the bloodstream. Testosterone that circulates freely is known as free testosterone.
Total testosterone, on the other hand, represents the total amount of testosterone in the blood – both free and bound. So your total testosterone level should be higher than your free testosterone level.
While a total testosterone test measures your total testosterone, the EverlyWell Testosterone Test measures your free testosterone. Research shows that free T levels can be a better predictor of testosterone deficiency symptoms compared to total testosterone levels.
For example, in one study, “free testosterone correlated with erectile dysfunction severity among young men with normal total testosterone.” (Source: International Journal of Impotence Research, 2019)
Learn more: Testing Your Testosterone Levels? Know The Difference Between Free T And Total T
Why is testosterone considered a male sex hormone?
Testosterone is widely regarded as a “male sex hormone.” This is because testosterone drives the development of many sexual characteristics in men, such as testes and sperm – as well as secondary characteristics like male hair patterns on the body.
However, testosterone is also a very important hormone for women. For example, testosterone in women can contribute to the maintenance and growth of bones, increases in muscle mass, decreases in body fat, and more.
Learn more about testosterone in men: Low Testosterone Levels in Men: Causes and Symptoms
Learn more about testosterone in women: Unhealthy Testosterone Levels In Women: Causes and Symptoms
Can this test help me see if my testosterone supplements (like gels or implants) are working?
This test can help you monitor your testosterone levels, so it’s an easy, reliable way to track the effectiveness of different kinds of testosterone treatments you may be undergoing.
Can this test check if I have low testosterone?
Yes, a low testosterone test (or “low T test”) like this one can help you check if your circulating (free) testosterone levels fall below the normal range for your age and biological sex.
Polycystic ovary syndrome, or PCOS, is associated with high levels of testosterone in women. PCOS is a health condition that affects up to 1 in 10 women between the ages of 15 and 44. Symptoms can include irregular menstrual periods, abnormal amounts of hair on the face or chin, acne, hair loss and male-pattern baldness, weight gain, and more.
Testosterone Levels Test
What is a testosterone levels test?
Testosterone is the main sex hormone in males. During a boy’s puberty, testosterone causes the growth of body hair, muscle development, and deepening of the voice. In adult men, it controls sex drive, maintains muscle mass, and helps make sperm. Women also have testosterone in their bodies, but in much smaller amounts.
This test measures the levels of testosterone in your blood. Most of the testosterone in the blood is attached to proteins. Testosterone that is not attached to a protein is called free testosterone. There are two main types of testosterone tests:
- Total testosterone, which measures both attached and free testosterone.
- Free testosterone, which measures just free testosterone. Free testosterone can give more information about certain medical conditions.
Testosterone levels that are too low (low T) or too high (high T) can cause health problems in both men and women.
Other names: serum testosterone, total testosterone, free testosterone, bioavailable testosterone
What is it used for?
A testosterone levels test may be used to diagnose several conditions, including:
- Decreased sex drive in men and women
- Infertility in men and women
- Erectile dysfunction in men
- Tumors of testicles in men
- Early or delayed puberty in boys
- Excess body hair growth and development of masculine features in women
- Irregular menstrual periods in women
Why do I need a testosterone levels test?
You may need this test if you have symptoms of abnormal testosterone levels. For adult men, it’s mostly ordered if there are symptoms of low T levels. For women, it’s mostly ordered if there are symptoms of high T levels.
Symptoms of low T levels in men include:
- Low sex drive
- Difficulty getting an erection
- Development of breast tissue
- Fertility problems
- Hair loss
- Weak bones
- Loss of muscle mass
Symptoms of high T levels in women include:
- Excess body and facial hair growth
- Deepening of voice
- Menstrual irregularities
- Weight gain
Boys may also need a testosterone levels test. In boys, delayed puberty can be a symptom of low T , while early puberty may be a symptom of high T.
What happens during a testosterone levels test?
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.
Will I need to do anything to prepare for the test?
You don’t need any special preparations for a testosterone levels test.
Are there any risks to the test?
There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.
What do the results mean?
Results mean different things depending on whether you are a man, woman, or boy.
- High T levels 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 bodily functions.
- Low T levels may mean a genetic or chronic disease, or a problem with the pituitary gland. The pituitary gland is a small organ in the brain that controls many functions, including growth and fertility.
- High T levels may indicate a condition called polycystic ovary syndrome (PCOS). PCOS is a common hormone disorder affecting women of childbearing age. It is one of the leading causes of female infertility.
- It may also mean cancer of the ovaries or adrenal glands.
- Low T levels are normal, but extremely low levels may indicate Addison disease, a disorder of the pituitary gland.
- High T levels may mean cancer in the testicles or adrenal glands.
- Low T levels in boys may mean there is some other problem with the testicles, including an injury.
If your results are not normal, it doesn’t necessarily mean you have a medical condition needing treatment. Certain medicines, as well as alcoholism, can affect your results. If you have questions about your results, talk to your health care provider.
Is there anything else I need to know about a testosterone levels test?
Men who are diagnosed with low T levels may benefit from testosterone supplements, as prescribed by their health care provider. Testosterone supplements are not recommended for men with normal T levels. There is no proof they provide any benefits, and in fact they may be harmful to healthy men.
Low Testosterone Diagnosis
To diagnose low testosterone (male hypogonadism)—and what’s causing it—your doctor will do several exams and tests. These will help him/her make an accurate diagnosis.
Blood Test to Check Testosterone Levels
A simple blood test can reveal your testosterone level. The normal range is 300 ng/dL to 1,000 ng/dL—remember that testosterone levels fluctuate throughout the day. Because they are normally highest in the morning, your doctor will probably want to do the blood test in the morning.
Your doctor will examine you to look for signs of low testosterone levels. He or she will look at:
- your amount of body hair
- the size of your breasts, testes, scrotum, and penis
- the consistency of your testes and scrotum (are there any lumps?)
- how well you can see to the side (loss of peripheral vision may indicate that you have a pituitary tumor, which can cause low testosterone levels)
The doctor will most likely talk to you about your medical history and your family’s medical history. Discussing your current symptoms will give the doctor a more complete picture of the effects low testosterone is having on you.
The doctor may want to know about:
- your sex drive
- if you’ve experienced erectile dysfunction or impotence
- any current or past illnesses
- any genetic conditions in your family
Low Testosterone Diagnosis
Generally, by combining the results from the blood tests, physical exam, and medical history, the doctor can make a diagnosis of low testosterone (male hypogonadism). To figure out what’s causing your low testosterone, he or she may want to do additional tests, such as:
- MRI or CT scan: If the doctor thinks it could be a pituitary tumor causing male hypogonadism, he or she may order a MRI or CT scan of your brain.
- genetic studies: You may have an inherited condition that’s decreasing your testosterone levels. A genetic test can help the doctor understand your DNA make-up.
- hormone tests: If the doctor suspects that it’s a pituitary abnormality leading to low testosterone, he or she may have you undergo other hormone tests to check your levels of other pituitary hormones.
With an accurate diagnosis of low testosterone, the doctor can start developing a treatment plan.
Updated on: 10/07/11 Continue Reading Low Testosterone Treatments View Sources
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What is being tested?
Testosterone is the main sex hormone produced in men. It helps make sperm, and it influences men’s sex drive. It also helps create facial and body hair, and plays a part in the development of muscles. Men make testosterone mainly in their testes, but also in their adrenal glands.
Women make a much smaller amount in their ovaries, adrenal glands and other body tissues. Some of this breaks down to form a type of oestrogen called oestradiol.
Some testosterone is found in the blood both of men and women. A blood test for testosterone will show how much is in your body.
Why would I need this test?
Your doctor might suggest a blood test for testosterone if:
- you are having problems conceiving a child – both men and women can be tested
- you are a man with a low sex drive
- you are a man with problems getting an erection
- you are a woman with masculine features, such as a lot of body hair or a low voice
- you are a boy and puberty has come very early, or is very late
Some diseases can also affect the amount of testosterone in your blood. These include diabetes, mumps, and tumours on the testicles or ovaries. People who drink too much alcohol can also have low testosterone levels.
How to prepare for the test
You might be asked to have a fasting test early in the morning. In that case, you should stop eating by midnight, then only have sips of water in the morning. You can usually continue to take any medications you need, but check with your doctor.
Understanding your results
Many things can affect your testosterone blood test results, including your age, your health, and what’s happening with your body.
You will need to discuss the results with your doctor, what they mean, and what comes next.
- Read the healthdirect Guide to blood testing
- Lab Tests Online has more information on blood tests in general and testosterone in particular
- myVMC has more information about testosterone
- Pregnancy Birth and Baby has more information on blood tests during pregnancy
- Healthdirect’s Question Builder can help you prepare for a doctor’s appointment
- What is a testosterone test?
- When is a testosterone test used?
- Types of testosterone tests
- Total testosterone
- Liquid or gas chromatography-tandem mass spectrometry
- Radioimmunoassay test kit
- Automated immunoassay systems
- Bio-available testosterone
- Ammonium sulphate precipitation
- Calculated bio-available testosterone
- Free testosterone
- Equilibrium dialysis
- Centrifugal ultrafiltration
- Direct immunoassay test kits
- Calculated free testosterone
- Total testosterone
- Performing a testosterone test
- Interpreting the result of a testosterone test
- Accuracy of testosterone tests
- Young men (<40)
- Ageing men (≥40)
- Associated healthcare
What is a testosterone test?
A testosterone test is a test which measures the amount of testosterone in a person’s blood or saliva.
When is a testosterone test used?
A testosterone test is used when it is necessary to assess a person’s testosterone levels. This is usually when a doctor suspects that the individual has a health condition which affects their testosterone and needs to confirm whether or not the person’s testosterone level is normal, in order to make a diagnosis. The conditions for which a testosterone test may be used as a diagnostic tool differ between men and women.
In men, testosterone tests are used to:
- Confirm a suspected diagnosis of primary or secondary hypogonadism, a condition characterised by abnormally low testosterone levels;
- Monitor the effect of testosterone replacement therapy in men with testosterone deficiency;
- Evaluate the causes underlying delayed puberty in boys.
|More information on hypogonadism.|
In women, testosterone tests may be used to:
- Evaluate the causes underlying hyperandrogenism (a condition characterised by abnormally high testosterone levels), which may include:
- Idiopathic hirsutism (unexplained, excessive, male pattern hair growth, for example growth of excessive facial hair);
- Congenital adrenal hyperplasia (a birth defect in which the adrenal gland grows excessively);
- Polycystic ovarian syndrome (a condition of hormonal imbalance in which cysts grow on the ovaries and testosterone levels are abnormally elevated);
- Testosterone-producing tumours in the adrenal gland (a gland which produces hormones) or ovaries.
- Assess testosterone levels in women with suspected testosterone deficiency.
In women, testosterone tests are not usually used for monitoring the effects of testosterone replacement therapy.
Types of testosterone tests
Most of the testosterone in the body binds to carrier proteins (proteins which transport other substances such as hormones through the blood). These carrier proteins are called sex hormone binding globulin (SHBG) and albumin.
Some 44% of testosterone in the blood binds tightly to SHBG and this proportion of testosterone cannot bind to cells in the body which use testosterone (e.g. cells in the testes) because it is bound tightly to and cannot separate from SHBG. This proportion of testosterone is also known as unavailable testosterone, as it is unavailable to the body’s cells.
A further 54% of testosterone in the blood binds loosely to albumin, but remains available to the body’s cells, because it can separate from the albumin and bind to cells which use testosterone. This portion of testosterone is also called bio-available testosterone.
The remaining 2% of testosterone in the blood remains unbound and is also available to testosterone-using cells in the body. It is referred to as free testosterone.
Testosterone levels can be measured in terms of total, bio-available or free testosterone and there are various tests which can be used to measure levels of each type of testosterone.
|More information on Testosterone.|
Total testosterone measures free, albumin bound and SHBG bound testosterone in the blood and is the most commonly used measure of testosterone levels. It is the test usually used to assess testosterone levels in men with suspected hypogonadism or testosterone deficiency. There are several methods available to measure total testosterone.
Liquid or gas chromatography-tandem mass spectrometry
Liquid or gas chromatography, tandem mass spectrometry is the most accurate test or gold standard for measuring total testosterone. Unlike most testosterone tests, it is accurate enough to measure testosterone concentrations in women who have relatively low levels compared to men. However, the test is very complex to perform and although some laboratories in Australia do the test, it is not often used by doctors wishing to assess testosterone levels as it is too costly and time consuming.
Radioimmunoassay test kit
Radioimmunoassay test kits provide a relatively simple means of assessing testosterone levels. However, they are less accurate than liquid or gas chromatography-tandem mass spectrometry and unsuitable for assessing testosterone levels in women.
The test kits contain reagents which are added to an individual’s blood sample. Testosterone antibodies with radioactive particles in the reagent bind to testosterone in the sample and the testosterone level is determined by counting the number of testosterone molecules bound to testosterone antibodies. They can be easily counted because of the radioactive particles to which they are attached.
Automated immunoassay systems
Automated platform immunoassay systems are testosterone tests in which most steps (e.g. adding the blood sample, adding reagents) are performed automatically by a machine, rather by people in the laboratory. These tests are the fastest method of assessing testosterone levels. They are considered accurate enough for assessing testosterone levels in men but not in women.
Bio-available testosterone is a measure of both free and albumin-bound testosterone, both of which are bio-available, or available for use by cells in the body.
Ammonium sulphate precipitation
The ammonium sulphate precipitation method is a test which measures bio-available testosterone. To perform this test, a chemical called aluminium sulphate is added to a blood sample. This causes SHBG-bound testosterone to precipitate (separate out and form a solid substance) from the sample. Bio-available testosterone (free and albumin-bound) remains in the sample. The total testosterone level of the sample (after precipitation of the SHBG-bound testosterone) is then measured. Aluminium sulphate precipitation is considered the gold standard (most accurate) measure of bio-available testosterone. It is however impractical for routine use by doctors, as it is too time-consuming and costly to perform.
Calculated bio-available testosterone
It is also possible to calculate bio-available testosterone using an equation, if total testosterone, SHBG and albumin levels are known.
A test for free testosterone measures only the 2% of testosterone which remains unbound to proteins in blood. Tests are also available to measure free testosterone in saliva, however these are relatively new, require further testing and are currently only recommended for use in research studies and not for use by doctors for diagnosing patients.
Free testosterone levels may be measured in men whose total testosterone test results showed testosterone levels which are on the borderline of levels considered to indicate testosterone deficiency. Free testosterone levels are often assessed in women with suspected testosterone abnormalities. Free testosterone can be measured by a number of methods.
Equilibrium dialysis is a complex measure of free testosterone in which a blood sample is diluted and passed through a special semi-permeable membrane into a buffer solution. Only some of the testosterone in the sample can pass through the membrane- the rest remains in the blood sample. After filtering the sample through the semi-permeable membrane, the amount of testosterone in the buffer solution and the sample is measured and used to calculate the concentration of free testosterone This test is considered the gold standard for measuring free testosterone but is impractical for routine use.
Centrifugal ultrafiltration is also an accurate measure of free testosterone, however considered impractical for routine use. The method involves adding a substance called testosterone tracer (usually a coloured substance which binds to testosterone and can then be easily identified because of its colour) to blood samples, which are then incubated at 37oC and centrifuged (spun at a high speed) to separate the testosterone in the sample. The concentration of free testosterone can then be measured by examination of the filtrate (the separated portion of the sample).
Direct immunoassay test kits
Direct immunoassay test kits are the easiest and fastest available methods of assessing free testosterone. They are test kits in which reagents containing testosterone antibodies and tracer particles (either radioactive or non-radioactive) which bind to free testosterone in the sample. The tracer particles are easily identifiable and can be counted to measure the concentration of free testosterone in the sample. The results are less accurate than other methods though and lower results are typically obtained compared to equilibrium dialysis.
Calculated free testosterone
There are also a number of equations for calculating the concentration of free testosterone in a blood sample, without making an actual measurement of free testosterone. Other substances in the blood which interact with testosterone are measured instead. For example, measuring total testosterone and sex hormone binding globulin allows a measure of total testosterone called the Free Androgen Index to be calculated.
Performing a testosterone test
Testosterone tests for men are performed using a morning blood sample, as testosterone levels in men fluctuate throughout the day and are highest in the morning. All abnormal results should be confirmed with repeat testing as testosterone levels also fluctuate considerably from day to day, within individual men. As some illnesses affect testosterone production, the tests should not be performed when a man is ill.
Women also experience testosterone level fluctuations throughout the day and a morning blood sample should be used to assess women’s testosterone levels. In addition, women’s testosterone levels fluctuate throughout the menstrual cycle and thus testosterone tests performed at different stages of the menstrual cycle could be expected to give different results. However, as testosterone tests are only useful for identifying abnormally high testosterone levels in women, fluctuations due to different stages of the menstrual cycle are unlikely to be great enough to affect the clinical meaning of test results. When women’s testosterone levels are tested for research purposes (e.g. to compare the accuracy of different types of testosterone tests) multiple measures may be taken for each woman, at different stages of the menstrual cycle.
Interpreting the result of a testosterone test
The interpretation of test results varies depending on the condition being diagnosed and the age of the man being tested. An experienced health professional will need to interpret the test results.
Total testosterone is usually used to determine whether or not testosterone levels are normal, too high or too low. Levels of bio-available or free testosterone are not used to assess whether or not testosterone levels are sufficient or deficient, but may be used to help a doctor determine the underlying cause of an abnormal total testosterone level, as the relative proportions of total, bound and unbound testosterone are different for different conditions.
Interpreting the results of testosterone tests performed for women is difficult, as there is no agreed upon testosterone concentration which indicates testosterone deficiency or excessive testosterone. The results of blood testosterone tests are usually considered in conjunction with clinical symptoms which may indicate testosterone abnormalities (e.g. reduced libido indicates deficiency while excessive hair growth indicates elevated testosterone levels).
For women, the results of a total testosterone test are usually also interpreted in conjunction with the results of tests for free or bio-available testosterone, as female conditions associated with hyperandrogenism (excessive testosterone levels) as well as ageing and pregnancy affect SHBG concentrations and therefore influence the relative proportions of testosterone in the blood which are free, albumin-bound and SHBG-bound.
Accuracy of testosterone tests
Young men (< 40)
Simple tests for total testosterone (immunoassay, automated platform immunoassays) are generally considered accurate enough for detecting testosterone deficiency in men, as their results are similar to those obtained using liquid or gas chromatography, tandem mass spectrometry (the gold standard or most accurate measure of total testosterone). However, these simple tests consistently return lower results than the gold standard measure, which may make diagnosing men with mild hypogonadism (testosterone levels in the upper range of hypogonadal levels) challenging.
Ageing men (≥ 40)
Total and free testosterone measures are no more accurate than total testosterone for predicting testosterone deficiency in men. As total testosterone is a more simple test to perform it is the test usually used by doctors to diagnose testosterone deficiency.
Most testosterone tests are insensitive for assessing low levels of testosterone, such as may be found in pre-menopausal women with testosterone deficiency. The only sufficiently sensitive test (liquid chromatography-tandem mass spectrometry) is impractical for use in routine clinical practice. Simple tests for measuring testosterone levels in women at various life stages are needed.
For a diagnosis of hypogonadism, luteinising hormone and follicle stimulating hormone (two hormones produced by the pituitary gland) levels are often also tested to distinguish primary and secondary causes of testosterone deficiency. Low levels of the hormones produced by the pituitary gland indicate secondary hypogonadism, as this condition is caused by a dysfunction in the pituitary gland which inhibits its ability to produce luteinising hormone and follicle stimulating hormone. Men who are diagnosed with hypogonadism are often offered testosterone replacement therapy.
|More information on Testosterone replacement therapy in men.|
A test for total testosterone levels in women is generally combined with a measurement of SHBG levels, as these measures allow the calculation of the proportions of bio-available testosterone. Women who are found to be testosterone deficient may benefit from testosterone replacement therapy, although this therapy is currently not approved by the government for use in women. Women who have excessively high testosterone levels are likely to undergo further tests in order to identify the condition causing excessive androgen levels.
Symptoms of Low Testosterone: When Should You Get Checked Out?
Medically reviewed by Ho Anh, MD Written by Our Editorial Team Last updated 9/15/2017
Low testosterone, or “Low-T,” is a surprisingly common condition that affects tens of millions of men around the world.
Testosterone is an essential hormone for men (and women, albeit in very small amounts). At healthy levels, testosterone is responsible for everything from controlling your sex drive and energy levels to helping you gain strength and develop muscle tissue.
It also has a range of effects on your brain, helping to make you feel more confident, assertive and masculine. Testosterone even affects things like your bone and heart health, making it an essential hormone not just for physical and mental performance, but also for general health.
There are numerous symptoms of low testosterone, ranging from lethargy to a decline in your physical strength. Below, we’ve listed the seven most common signs of low testosterone, all of which can indicate a potential testosterone deficiency.
We’ve also explained what you can do to treat your low testosterone, including testing options and common treatments for men with Low-T.
What to Do if You Have Low Testosterone
Low testosterone can occur for a variety of reasons. Sometimes, it’s a result of hypogonadism — a male sex hormone deficiency that’s caused by issues in the testes (primary hypogonadism) or in parts of the brain responsible for controlling hormone production (secondary hypogonadism).
Since these parts of the body control testosterone production, even minor issues can cause a noticeable decline in your testosterone levels.
Testosterone production can also drop as a result of lifestyle and dietary issues. If you work in a stressful environment, don’t get enough sleep or eat a diet that’s lacking essential nutrients and vitamins, there’s a chance that these could affect your ability to produce testosterone.
The first step in treating low testosterone is verifying that your testosterone levels are actually lower than normal. Doctors that specialize in treating Low-T will usually do this using a blood test, which checks both your total testosterone and free testosterone levels.
The normal range for testosterone in men is 280 to 1,100 ng/dL. Most doctors consider a total testosterone level that’s either below or close to the bottom of the normal range to indicate low testosterone.
If either your free or total testosterone level is low, treatment options can range from changing your habits and diet to applying gels, patches or injections to bring your testosterone up to a healthy level.
The Seven Most Common Signs of Low Testosterone
Below, we’ve listed seven of the most common physical and mental symptoms that are used to diagnose low testosterone in men.
Because testosterone is a hormone with several functions, low levels can often result in multiple symptoms. If you’ve noticed several of the symptoms below, it’s best to talk to your doctor about getting a blood test to check your testosterone levels.
Testosterone is one of the primary hormones responsible for making you feel motivated, alert and energetic. When testosterone production is too low, it’s easy to feel fatigued and lethargic, even when you would normally be full of energy.
Low levels of testosterone are linked to chronic fatigue in men. If you often feel overly tired and lethargic, even after eating energy-rich foods or drinking coffee, there’s a chance that low levels of testosterone could be the culprit.
Smaller, Weaker Muscles
Testosterone is a powerful steroid, meaning it has a serious effect on your ability to gain muscle mass and improve your strength levels.
When your testosterone levels are low, it’s common for your muscles to shrink and your strength levels to decline. Worse yet, low levels of testosterone make it far more difficult than usual to get back the strength and muscular size you’ve lost.
Studies of testosterone show that it produces a 27% increase in muscle protein synthesis when administered to men. Simply put, the more testosterone your produce, the easier it becomes for your body to develop muscle.
If you’ve noticed your strength levels declining, the sleeves of your shirts fitting loosely or your progress stalling in the gym, it could be because of low testosterone production.
More Body Fat
As well as stimulating muscle growth, testosterone is also closely correlated with lower levels of body fat. People with high testosterone tend to be leaner; people with low testosterone usually have a higher body fat percentage, especially around the abdominals.
A study of men on androgen deprivation therapy, which involves reducing testosterone levels to almost zero, showed a 22% increase in visceral fat around the abdominals.
In simple terms, low testosterone will give you a little more weight around the midsection. It can also increase your risk of developing heart disease, as visceral fat can often collect around your organs.
Combined with muscle wasting, this can have a serious effect on your physique, making it worth getting your testosterone levels checked if you notice this symptom.
Low Sex Drive
Another common symptom of low testosterone is a weaker-than-normal sex drive. When your testosterone levels are low, it’s easy to lose interest in sexual activity, even in situations when you would normally be highly interested.
The sex drive effects of low testosterone affect sexual intercourse and masturbation, meaning you might not think about sex much at all. As you’d expect, this can have a major effect on your relationships and personal life.
Luckily, this symptom is usually the fastest to reverse when your testosterone levels get back to normal, meaning you should notice an improvement soon after starting treatment.
Testosterone triggers the release of nitric oxide, which is an essential molecule for developing and maintaining an erection. This means that when your testosterone levels are low, it’s more difficult to get and keep an erection than normal.
It can also mean that spontaneous erections — the erections you get while sleeping, for example — don’t happen anymore, or at least not as frequently as they normally would.
Since erectile dysfunction can occur for a variety of reasons, you shouldn’t rush to assume you have low testosterone if you have erection difficulties. However, combined with the other signs listed above and below, erectile dysfunction could be a sign of a testosterone-related issue.
Testosterone is responsible for more than just physical effects; in men, it affects a huge range of brain functions, including memory. In fact, one of the most noticeable effects of low testosterone in men is “brain fog,” or a general decline in memory and focus.
One study of men aged 70 years and above shows that age-related decreases in testosterone levels were closely correlated with cognitive decline. As testosterone levels declined, men were more likely to suffer from negative effects on cognitive functions such as memory.
This doesn’t mean that forgetfulness is a sure-fire sign of low testosterone. However, if you’ve noticed a decline in your memory, it could potentially be a signal that your testosterone level is lower than it once was.
Finally, testosterone levels are closely correlated with confidence, mood and general quality of life for men of all ages.
One study from 2012 shows that treatment naïve hypogonadal men (men with low testosterone levels that did not seek treatment) showed more severe symptoms of depression, anxiety, poor quality of life and sexual dysfunction than similar men assigned to a testosterone treatment.
Other studies show similar results — that testosterone improves mood by a significant amount in men, with measurable decreases in negative emotional responses such as anger, irritability, and nervousness.
As always, a poor mood doesn’t necessarily mean you have low testosterone. However, if you frequently feel tired, irritated, anxious or depressed and also have some of the other symptoms of low testosterone, it could be worth getting your testosterone levels checked.
Should You Check Your Testosterone Levels?
Many of the symptoms above can occur without being caused by a testosterone deficiency. For example, it’s normal to feel tired or frustrated sometimes, especially if events in your personal or professional life have an effect on your mood.
It’s also normal to occasionally feel physically weaker than you normally would, especially if you make a change to your diet, lifestyle or physical activity levels.
As a general rule, you should consider getting your testosterone levels checked if you notice any of the symptoms listed above occurring frequently enough that you feel they aren’t just a normal occurrence.
Checking your testosterone levels is a quick and simple process. Most of the time, your levels can be verified with a simple blood test that measures your free testosterone, total testosterone, and other hormones.
Could you have low testosterone?
Your provider will likely have you get a blood test to check your testosterone level. You will also be checked for other causes of your symptoms. These include medicine side effects, thyroid problems, or depression.
If you have low testosterone, hormone therapy may help. The medicine used is man-made testosterone. This treatment is called testosterone replacement therapy, or TRT. TRT can be given as a pill, gel, patch, injection, or implant.
TRT may relieve or improve symptoms in some men. It may help keep bones and muscles strong. TRT seems to be more effective in young men with very low testosterone levels. TRT can also be helpful for older men.
TRT has risks. These may include:
- Enlarged prostate leading to difficulty urinating
- Blood clots
- Worsening heart failure
- Sleep problems
- Cholesterol problems
At this time, it is unclear whether TRT increases the risk of heart attack, stroke, or prostate cancer.
Talk with your provider about whether TRT is right for you. If you do not notice any change in symptoms after treatment for 3 months, it is less likely that TRT treatment will benefit you.
If you decide to start TRT, be sure to see your provider for regular checkups.
A testosterone test measures the amount of the male hormone, testosterone, in the blood. Both men and women produce this hormone.
The test described in this article measures the total amount of testosterone in the blood. Much of the testosterone in the blood is bound to a protein called sex hormone binding globulin (SHBG). Another blood test can measure the “free” testosterone. However, this type of test is often not very accurate.
As men age, their testosterone levels may drop.The correct answer is fact. Testosterone levels may drop over time as a man ages. This drop is normal and many men don’t even notice it. But if levels get too low, some symptoms may develop. See your doctor if you notice changes in your mood or sex drive. Which physical change could be a sign of low testosterone?The correct answer is swollen breasts. Men with low testosterone also may lose body hair and muscle mass. Their testicles may shrink. See your doctor if you notice any of these changes in your body. It is normal for older men to lose all interest in sex.The correct answer is myth. It is normal for older men to have less interest in sex compared to when they were younger. But it is not normal to lose all interest in sex. This could be a sign of low testosterone levels. Tell your doctor if you have lost interest in sex. Treatment may help. Low testosterone can cause trouble getting an erection.The correct answer is fact. Low testosterone can make it difficult to get or keep an erection. It can also lead to low sperm counts. Erection problems are also called erectile dysfunction, or ED. Health problems, such as high blood pressure, and many medications can also cause ED. See your doctor to find out may be causing ED. Which emotional change could be a sign of low testosterone?The correct answer is all of the above. Some men also have hot flashes as testosterone levels drop. Emotional changes can make it hard to work, sleep, or do things you enjoy. Be sure you talk with your doctor if these symptoms occur. A simple blood test can detect low testosterone.The correct answer is fact. If you have ED, have lost interest in sex, or have other symptoms such as swollen breasts, your doctor may check for low testosterone. To do the test, your doctor will draw a sample of blood. Sometimes, more than one blood test is needed to accurately diagnose low testosterone. Aging is the only cause of low testosterone.The correct answer is false. Some medications, some cancers, problems with genes, injury to the testicles and other health problems can cause low testosterone. Your doctor can do tests to find out what is causing low testosterone. Low testosterone can make a man’s bones weaker.The correct answer is fact. Low testosterone can lead to osteoporosis, a condition that causes thinner bones that may break more easily. If you have low testosterone, your doctor may recommend a bone density test see if you have osteoporosis. Testosterone therapy can help:The correct answer is all of the above. Testosterone therapy means taking testosterone to bring levels closer to normal. This can reduce the changes caused by low testosterone, but not everyone responds to testosterone therapy. Testosterone therapy is a good idea for all older men.The correct answer is myth. Some men don’t need treatment for low testosterone because they don’t have symptoms. Testosterone therapy isn’t good idea for healthy older men who don’t have low testosterone. It may increase the risk of prostate cancer. Your doctor can help you decide if testosterone therapy is right for you.
How the Test is Performed
A blood sample is taken from a vein. The best time for the blood sample to be taken is between 7 a.m. and 10 a.m. A second sample is often needed to confirm a result that is lower than expected.
How to Prepare for the Test
The health care provider may advise you to stop taking medicines that may affect the test.
How the Test will Feel
You may feel a slight prick or sting when the needle is inserted. There may be some throbbing afterward.
Why the Test is Performed
This test may be done if you have symptoms of abnormal male hormone (androgen) 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 (in boys)
- Infertility, erectile dysfunction, low level of sexual interest, thinning of the bones (in men)
In females, the ovaries produce most of the testosterone. The adrenal glands can also produce too much of other androgens that are converted to testosterone. Levels are most often checked to evaluate signs of higher testosterone levels, such as:
- Acne, oily skin
- Change in voice
- Decreased breast size
- Excess hair growth (dark, coarse hairs in the area of the moustache, beard, sideburns, chest, buttocks, inner thighs)
- Increased size of the clitoris
- Irregular or absent menstrual periods
- Male-pattern baldness or hair thinning
Normal measurements for these tests:
The examples above are common measurements for results for these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different specimens. Talk to your provider about the meaning of your specific test results.
What Abnormal Results Mean
Certain health conditions, medicines, or injury can lead to low testosterone. Testosterone level also naturally drops with age. Low testosterone can affect sex drive, mood, and the body in men.
Decreased total testosterone may be due to:
- Chronic illness
- The pituitary gland does not produce normal amounts of some or all of its hormones
- Problem with areas of the brain that control hormones
- Low thyroid function
- Delayed puberty
- Diseases of the testicles (trauma, cancer, infection, immune)
- Benign tumor of the pituitary cells that produce too much of the hormone prolactin
- Too much body fat (obesity)
Increased total testosterone level may be due to:
- Resistance to the action of male hormones (androgen resistance)
- Tumor of the ovaries
- Cancer of the testes
- Congenital adrenal hyperplasia
- Taking medicines or drugs that increase testosterone level
Rey RA, Josso N. Diagnosis and treatment of disorders of sexual development. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 119.