Subscribe to the Magazine for free
Subscribe for free to keep reading! If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.

What is Free Testosterone?

Medically reviewed by 
 
What is Free Testosterone?

Testosterone, known for being the dominant male hormone, is also a key hormone for women, playing a crucial role in everyone’s health. It’s involved in a wide range of body functions, including managing libido, muscle strength, mood, and energy levels.

When we talk about testosterone, there’s a critical distinction between what’s known as total and free testosterone. Total testosterone measures the overall level in the blood. But a tiny portion, about 2-3% in males and 1-2% in females, is what's called free testosterone, which is unbound and active, ready for the body to use. It’s this free testosterone that really helps us understand someone’s hormone health.

Abnormal levels of free testosterone are linked with various health problems, underscoring its importance in overall health. So, accurately measuring and interpreting free testosterone levels is critical.

If you are hoping to better understand the complexities of free testosterone, keep reading! Covering its role, measurement techniques, factors affecting its levels, and the health implications for both men and women, the article aims to equip healthcare professionals with the knowledge necessary for effectively interpreting lab results and managing conditions related to testosterone levels in all patients.

[signup]

What is Testosterone?: A Comprehensive Overview 

Testosterone is a steroid hormone primarily produced in the testes or ovaries and, to a lesser extent, in the adrenal glands. In both males and females, it affects many physiological areas, handling everything from keeping muscles and bones strong to firing up the libido and balancing mood and energy levels. 

For men and individuals Assigned Male At Birth (AMAB), testosterone is integral for the development of male reproductive tissues, such as the testes and prostate, and it's essential for the onset of secondary sexual characteristics during puberty, like a deeper voice and facial hair. Its functions extend to promoting muscle mass, bone density, and red blood cell production (erythropoiesis) and influencing mood and cognitive abilities

In women and individuals Assigned Female At Birth (AFAB), testosterone, although present in smaller amounts, is no less crucial. It contributes to bone strength and muscle mass and is believed to play a role in ovarian function. It also influences sexual desire and may impact mood and cognitive function. Its balance is vital for overall health, and imbalances can lead to various clinical symptoms such as fatigue, mood disturbances, and metabolic syndrome. 

When it comes to understanding testosterone, differentiating between total and free levels is essential. Total testosterone includes testosterone that is bound to proteins like sex hormone-binding globulin (SHBG) or albumin and unbound testosterone, which is also known as free testosterone. When testosterone is bound to a protein, it is unable to be readily used by the body. Free testosterone, on the other hand, is considered bioavailable, meaning it is active and ready for uptake by various tissues.

Free testosterone levels are more indicative of hormonal activity than total testosterone levels. The distinction between total and free testosterone is particularly important in cases where SHBG levels are altered, such as in obesity, hypothyroidism, or the use of certain medications, which can skew total testosterone readings. Evaluating free testosterone provides a clearer understanding of an individual's androgen status and is crucial in diagnosing conditions like androgen deficiency or hyperandrogenism.

Measuring Free Testosterone

Accurate measurement of free testosterone levels is crucial in diagnosing and managing hormonal imbalances. Serum testing is the most common method for measuring testosterone levels. It involves a blood test to evaluate both total and free testosterone. Serum testing can be further categorized into the following:

Direct Measurement: 

Directly assessing the free testosterone in the serum via a blood test provides a clear view of bioavailable testosterone.

Calculated Free Testosterone: 

This approach estimates free testosterone based on total testosterone (also simply known as “testosterone” on testing menus), SHBG, and albumin levels. Algorithms are used to calculate the bioavailable testosterone, offering a balance between accuracy and convenience. Using an online calculator can be helpful since the mathematical equation is quite complex.

[signup]

Interpreting Free Testosterone Test Results

Understanding free testosterone test results requires considering both the absolute values and the clinical context:

Males and AMAB Individuals: 

In males, normal free testosterone levels range widely, but significantly low levels can indicate androgen deficiency. Symptoms such as fatigue, decreased libido, and muscle weakness might corroborate these findings.

Females and AFAB Individuals: 

For females, the reference range for free testosterone is lower. Elevated levels can be indicative of conditions like PCOS, whereas low levels might contribute to reduced libido and energy.

Male & Female Reference Ranges for Free Testosterone

Source: https://pathlabs.ufl.edu/tests/test-directory-t/testosterone-free-direct/

Other Interpretation Tips: 

Testosterone levels naturally decline with age, so results should be interpreted in the context of age-related norms. It’s also important to always correlate lab findings with clinical symptoms. For instance, high testosterone levels in male individuals with signs of prostate enlargement require careful evaluation by a physician.

In cases of abnormal test results, repeat testing or additional hormonal evaluations may be necessary to confirm a diagnosis. A more thorough hormone panel may be beneficial.

Factors Influencing Free Testosterone Levels

Free testosterone levels in the body are influenced by a combination of biological and lifestyle factors. For males, the natural decline can start as early as the 30s, leading to potential androgen deficiency symptoms in later years. Female individuals may experience a decrease in testosterone around menopause.

Genetic factors can predispose individuals to variations in testosterone levels. Certain genetic conditions can affect hormone production and metabolism, leading to either elevated or reduced levels of testosterone.

Nutrition also plays a crucial role. Diets rich in processed foods and low in essential nutrients can negatively impact testosterone levels. Conversely, diets high in protein, healthy fats, and certain vitamins and minerals can support optimal hormone production.

Several health conditions can also influence testosterone levels. For example, conditions like hypogonadism, hyperthyroidism, or hypothyroidism can directly affect testosterone production and metabolism. Obesity, diabetes, and insulin resistance have also been shown to lead to lower testosterone levels, contributing to a cycle of hormonal imbalance and further metabolic disturbances.

Long-term illnesses have been found to suppress the hypothalamic–pituitary–gonadal (HPG) axis, leading to reduced testosterone production. There are even certain medications, including opioids, glucocorticoids, and others, that can impact testosterone levels.

Addressing Testosterone Imbalances

Addressing low testosterone involves a multifaceted approach:

Lifestyle Modifications

Encouraging a balanced diet rich in nutrients, including zinc and vitamin D, is crucial for testosterone production. Regular physical activity, especially strength training and High-Intensity Interval Training (HIIT), can also boost testosterone levels. Stress management through techniques like mindfulness or yoga is essential, as chronic stress can suppress testosterone production.

Herbal Supplements

Certain herbs, like ashwagandha (at a dosage of about 21 mg per day) and fenugreek (at a dosage of 600 mg per day), have been studied for their potential to naturally enhance testosterone levels. Please always consult with your healthcare provider prior to beginning any herbal product.

Sleep Optimization

It is important to emphasize quality sleep, as poor sleep patterns can significantly impact testosterone production. Healthy sleep hygiene practices can support better sleep. These practices can include keeping your room cool, quiet, and dark and going to bed/waking up at the same time each night/morning for consistency.

Testosterone Replacement Therapy (TRT)

TRT can be a valuable treatment for androgen deficiency but should be considered after a thorough evaluation. TRT may be appropriate for patients with persistent low testosterone symptoms and clinically low testosterone levels, such as conditions like primary hypogonadism or testosterone decline due to aging.

There are various forms of TRT, including transdermal gels, patches, injections, and subcutaneous pellets. The choice of therapy depends on patient preference, absorption rates, and potential side effects.

Regular monitoring of testosterone levels, prostate health, and hematocrit is vital to mitigate risks like erythrocytosis, prostate enlargement, or cardiovascular issues. TRT is not recommended for patients with a history of prostate or breast cancer, severe urinary tract symptoms, or uncontrolled heart failure. This therapy should always be used under the direction of a qualified practitioner.

[signup]

Free Testosterone Key Takeaways

Understanding free testosterone is vital for maintaining overall hormone health in both men and women. Grasping the nuances of how much bioavailable testosterone is present in the body and the implications of these levels is key to addressing a range of health concerns. Recognizing the signs of imbalances and the appropriate measures to take, whether through lifestyle changes or therapies like TRT, can significantly impact one's well-being. This knowledge is essential not just for managing hormone-related conditions but also for ensuring optimal health and vitality. Keeping testosterone levels in check is, therefore, an important aspect of holistic healthcare.

The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.
Learn More
No items found.

Lab Tests in This Article

  1. Ambroży, T., Rydzik, Ł., Obmiński, Z., Błach, W., Serafin, N., Błach, B., Jaszczur-Nowicki, J., & Ozimek, M. (2021). The effect of high-intensity interval training periods on morning serum testosterone and cortisol levels and physical fitness in men aged 35–40 years. Journal of Clinical Medicine, 10(10), 2143. https://doi.org/10.3390/jcm10102143
  2. Anderson, A. (2021, November 22). What is sex hormone binding globulin? WebMD. https://www.webmd.com/a-to-z-guides/what-is-sex-hormone-binding-globulin
  3. Antonio, L., Pauwels, S., Laurent, M. R., Vanschoubroeck, D., Jans, I., Billen, J., Claessens, F., Decallonne, B., De Neubourg, D., Vermeersch, P., & Vanderschueren, D. (2018). Free testosterone reflects metabolic as well as ovarian disturbances in subfertile oligomenorrheic women. International Journal of Endocrinology, 2018, 7956951. https://doi.org/10.1155/2018/7956951
  4. Baxter, R. (2013, April 30). Can prescription medications affect testosterone levels? International Society for Sexual Medicine. https://www.issm.info/sexual-health-qa/can-prescription-medications-affect-testosterone-levels
  5. Cai, Z., & Li, H. (2020). An updated review: Androgens and cognitive impairment in older men. Frontiers in Endocrinology, 11. https://doi.org/10.3389/fendo.2020.586909
  6. Cleveland Clinic. (2022, September 10). Testosterone test: Levels, how it’s done & results. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/24215-testosterone-test
  7. Cloyd, J. (2023, September 25). An integrative medicine approach to understanding sleep’s role in a healthy immune system. Rupa Health. https://www.rupahealth.com/post/an-integrative-medicine-approach-to-understanding-sleeps-role-in-a-healthy-immune-system
  8. Dumoulin, S. C., Perret, B. P., Bennet, A. P., & Caron, P. J. (1995). Opposite effects of thyroid hormones on binding proteins for steroid hormones (sex hormone-binding globulin and corticosteroid-binding globulin) in humans. European Journal of Endocrinology, 132(5), 594–598. https://doi.org/10.1530/eje.0.1320594
  9. Easthope, A. (2022, May 3). A functional medicine approach to low female testosterone. Rupa Health. https://www.rupahealth.com/post/a-functional-medicine-approach-to-low-female-testosterone
  10. Free & bioavailable testosterone calculator. (n.d.). The International Society for the Study of the Aging Male (ISSAM). Retrieved November 22, 2023, from https://www.issam.ch/freetesto.htm
  11. Free testosterone - Health encyclopedia - University of Rochester Medical Center. (2019). University of Rochester Medical Center. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=testosterone_free
  12. Greenhill, C. (2020). Genetic analysis reveals role of testosterone levels in human disease. Nature Reviews Endocrinology, 16(4), 195–195. https://doi.org/10.1038/s41574-020-0338-8
  13. Hu, T.-Y., Chen, Y. C., Lin, P., Shih, C.-K., Bai, C.-H., Yuan, K.-C., Lee, S.-Y., & Chang, J.-S. (2018). Testosterone-Associated dietary pattern predicts low testosterone levels and hypogonadism. Nutrients, 10(11). https://doi.org/10.3390/nu10111786
  14. Krakowsky, Y., & Grober, E. D. (2015). Testosterone deficiency - Establishing A biochemical diagnosis. EJIFCC, 26(2), 105–113. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975356/
  15. Leonard, J. (2020, May 28). High testosterone in men: Signs and symptoms. Medical News Today. https://www.medicalnewstoday.com/articles/signs-of-high-testosterone
  16. Lopresti, A. L., Drummond, P. D., & Smith, S. J. (2019). A randomized, double-blind, placebo-controlled, crossover study examining the hormonal and vitality effects of Ashwagandha (Withania somnifera) in aging, overweight males. American Journal of Men’s Health, 13(2), 155798831983598. https://doi.org/10.1177/1557988319835985
  17. Low total testosterone in men widespread, linked to chronic disease. (2018, April 12). University of Michigan Institute for Healthcare Policy & Innovation. https://ihpi.umich.edu/news/low-total-testosterone-men-widespread-linked-chronic-disease
  18. Maholy, N. (2023, April 14). How to reduce stress through mind-body therapies. Rupa Health. https://www.rupahealth.com/post/how-to-reduce-stress-through-mind-body-therapies
  19. McMillen, M. (2012, February 6). Low testosterone: How do you know when levels are too low? WebMD. https://www.webmd.com/men/features/low-testosterone-explained-how-do-you-know-when-levels-are-too-low
  20. Mehta, P. H., & Josephs, R. A. (2010). Testosterone and cortisol jointly regulate dominance: Evidence for a dual-hormone hypothesis. Hormones and Behavior, 58(5), 898–906. https://doi.org/10.1016/j.yhbeh.2010.08.020
  21. Meikle, A. W. (2004). The interrelationships between thyroid dysfunction and hypogonadism in men and boys. Thyroid: Official Journal of the American Thyroid Association, 14 Suppl 1, S17-25. https://doi.org/10.1089/105072504323024552
  22. Nassar, G. N., Raudales, F., & Leslie, S. W. (2020). Physiology, testosterone. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526128/
  23. Petering, R. C., & Brooks, N. A. (2017). Testosterone therapy: Review of clinical applications. American Family Physician, 96(7), 441–449. https://www.aafp.org/pubs/afp/issues/2017/1001/p441.html
  24. Salvio, G., Martino, M., Giancola, G., Arnaldi, G., & Balercia, G. (2021). Hypothalamic–Pituitary diseases and erectile dysfunction. Journal of Clinical Medicine, 10(12), 2551. https://doi.org/10.3390/jcm10122551
  25. Schwenkhagen, A. (2007). Hormonal changes in menopause and implications on sexual health. The Journal of Sexual Medicine, 4, 220–226. https://doi.org/10.1111/j.1743-6109.2007.00448.x
  26. Sex hormone binding globulin (blood) - health encyclopedia. (n.d.). University of Rochester Medical Center. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=shbg_blood
  27. Sweetnich, J. (2023, February 28). Testosterone testing 101. Rupa Health. https://www.rupahealth.com/post/testosterone-testing-101
  28. Testosterone, free, direct» pathology laboratories. (n.d.). University of Florida College of Medicine. Retrieved November 22, 2023, from https://pathlabs.ufl.edu/tests/test-directory-t/testosterone-free-direct/
  29. Testosterone levels test: MedlinePlus medical test. (2022, September 12). Medlineplus.gov. https://medlineplus.gov/lab-tests/testosterone-levels-test
  30. Vermeulen, A., Verdonck, L., & Kaufman, J. M. (1999). A critical evaluation of simple methods for the estimation of free testosterone in serum. The Journal of Clinical Endocrinology and Metabolism, 84(10), 3666–3672. https://doi.org/10.1210/jcem.84.10.6079
  31. Wankhede, S., Mohan, V., & Thakurdesai, P. (2016). Beneficial effects of fenugreek glycoside supplementation in male subjects during resistance training: A randomized controlled pilot study. Journal of Sport and Health Science, 5(2), 176–182. https://doi.org/10.1016/j.jshs.2014.09.005
Subscribe to the Magazine for free to keep reading!
Subscribe for free to keep reading, If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
See All Magazine Articles