Testosterone, Free (Dialysis) and Total MS Most Popular

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Also known as: Testosterone Free Dialysis and Total LCMSMS

Free Testosterone

In many cases, measurement of total testosterone provides the doctor with adequate information. However, in certain cases, for example when the level of SHBG is abnormal, a test for free or bioavailable testosterone may be performed as it may more accurately reflect the presence of a medical condition.


A testosterone test measures the amount of the male hormone, testosterone, in the blood. Both men and women produce this hormone. In males, the testicles produce most of the testosterone in the body. Levels are most often checked to evaluate signs of low testosterone: In boys -- early or late puberty and in men -- impotence, low level of sexual interest, infertility, thinning of the bones In females, the ovaries produce most of the testosterone and levels are most often checked to evaluate signs of higher testosterone levels, such as: decreased breast size, excess hair growth, increased size of the clitoris. irregular or absent menstrual periods and male-pattern baldness or hair thinning.
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The Testosterone, Free (Dialysis) and Total MS test contains 1 test with 2 biomarkers.

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Brief Description: The Testosterone Free and Total test is a laboratory test that measures both the free and bound forms of testosterone in the blood. Testosterone is the primary male sex hormone, although it is also present in females in smaller amounts.

Also Known As: Total Testosterone, Free Testosterone, Testosterone Free and Total

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: No preparation required

When is a Free and Total Testosterone test ordered?

A Testosterone Free and Total test may be ordered in various situations:

  1. Evaluation of Hormonal Imbalances: It may be ordered when symptoms of hormonal imbalances are present, such as low libido, erectile dysfunction, infertility, fatigue, mood changes, or abnormal hair growth. The test helps assess testosterone levels and provides information about the underlying cause of these symptoms.

  2. Diagnosis of Hypogonadism: In males, a Testosterone Free and Total test can help diagnose hypogonadism, a condition characterized by insufficient testosterone production. Symptoms include delayed puberty, decreased muscle mass, decreased bone density, and diminished sexual function.

  3. Assessment of Hormonal Therapy: For individuals undergoing testosterone replacement therapy, regular monitoring of testosterone levels through this test helps ensure appropriate dosing and treatment efficacy.

What does a Testosterone Total and Free blood test check for?

In men, testosterone is the primary sex hormone. It's in charge of a man's physical appearance. Although it is thought to be a "masculine" sex hormone, it is found in both men and women's blood. This test determines the amount of testosterone in a person's blood.

Testosterone is primarily produced in the male testicles by unique endocrine tissue called Leydig cells. It's also made by the adrenal glands in both males and females, as well as the ovaries in females in modest amounts.

In males, testosterone promotes the formation of secondary sex characteristics such as penis size, body hair growth, muscle development, and a deeper voice. It is abundant in males during adolescence and adulthood in order to regulate sex drive and preserve muscle mass. Estradiol is the major sex hormone in females, and testosterone is converted to it in women.

The pituitary gland produces luteinizing hormone, which stimulates and regulates testosterone synthesis. Testosterone functions in a negative feedback loop: when testosterone levels rise, LH production falls, slowing testosterone production; lower testosterone levels cause higher LH production, which promotes testosterone production.

Testosterone levels fluctuate throughout the day, increasing in the early morning hours and dropping in the evening. Levels rise after activity and fall as people get older.

About two-thirds of testosterone is attached to sex-hormone binding globulin in the bloodstream, with the remaining one-third bound to albumin. Only a small percentage of testosterone is released into the bloodstream as free testosterone. The bioavailable fraction is the free plus albumin-bound testosterone, which can act on target tissues.

Lab tests often ordered with a Testosterone Free and Total test:

When ordering a Testosterone Free and Total test, several other tests may be included to provide a comprehensive assessment of hormonal health and related factors. Here are some tests commonly ordered alongside a Testosterone Free and Total test:

  1. Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH):

    • Purpose: LH and FSH are pituitary hormones that regulate the production of testosterone and sperm in men.
    • Why Is It Ordered: To assess pituitary function and differentiate between primary (testicular) and secondary (pituitary/hypothalamic) causes of low testosterone levels.
  2. Sex Hormone Binding Globulin (SHBG):

    • Purpose: SHBG binds to testosterone, affecting its bioavailability.
    • Why Is It Ordered: To understand the balance between free and bound testosterone. High levels of SHBG can lead to lower levels of free testosterone, even when total testosterone levels are normal.
  3. Estradiol:

    • Purpose: To measure the level of estradiol, a form of estrogen that can be produced from testosterone.
    • Why Is It Ordered: Elevated estradiol levels in men can lead to symptoms of excess estrogen and can affect overall hormonal balance and health.
  4. Prolactin:

    • Purpose: To measure the level of prolactin, a hormone that can affect testosterone levels.
    • Why Is It Ordered: Elevated prolactin levels can suppress testosterone production and lead to symptoms of low testosterone.
  5. Complete Blood Count (CBC):

    • Purpose: To provide a broad picture of overall health.
    • Why Is It Ordered: Testosterone levels can affect red blood cell production, and abnormalities in the CBC can provide clues about hormonal status and health.
  6. Liver Function Tests:

    • Purpose: To assess liver health.
    • Why Is It Ordered: Liver disease can affect hormone metabolism, including testosterone.
  7. Kidney Function Tests:

    • Purpose: To evaluate kidney function.
    • Why Is It Ordered: Kidney disease can impact testosterone levels and overall health.
  8. Lipid Profile:

    • Purpose: To measure cholesterol and triglyceride levels.
    • Why Is It Ordered: Testosterone can affect lipid metabolism, and lipid abnormalities can be associated with hormonal imbalances.
  9. Thyroid Function Tests (TSH, Free T3, Free T4):

    • Purpose: To assess thyroid function.
    • Why Is It Ordered: Thyroid disorders can impact testosterone levels and general metabolic health.

These tests, along with the Testosterone Free and Total test, can help in the diagnosis and management of conditions associated with testosterone imbalance. They provide insights into the broader hormonal and health status of the individual, which is crucial for targeted treatment and management strategies. The selection of these tests will depend on the individual's symptoms, clinical history, and the reasons for testing.

Conditions where a Testosterone Free and Total test is recommended:

A Testosterone Free and Total test is helpful in evaluating and managing various conditions, including:

  1. Hypogonadism: Hypogonadism refers to inadequate testosterone production, which can lead to various symptoms in males, such as reduced libido, erectile dysfunction, fatigue, and decreased muscle mass. The test aids in diagnosing and monitoring this condition.

  2. Infertility: In cases of male infertility, assessing testosterone levels is important, as low testosterone can contribute to impaired sperm production and quality.

  3. Delayed or Precocious Puberty: In children and adolescents, measuring testosterone levels can help diagnose and manage conditions related to delayed or precocious puberty.

How does my healthcare provider use a Testosterone Free and Total test?

Healthcare providers use the results of a Testosterone Free and Total test to:

  1. Confirm Diagnosis: Low testosterone levels can help confirm the diagnosis of hypogonadism or other hormonal imbalances, guiding appropriate treatment plans.

  2. Monitor Hormone Therapy: For individuals receiving testosterone replacement therapy, regular monitoring of testosterone levels ensures optimal dosing and helps prevent potential side effects.

  3. Guide Treatment: Testosterone test results assist healthcare providers in determining the need for further investigations, such as imaging or specialist referrals, and in developing individualized treatment plans to address the underlying cause of testosterone imbalance.

It is important to note that the interpretation and use of Testosterone Free and Total test results should be done by a qualified healthcare provider who considers the patient's medical history, symptoms, and other relevant factors. Treatment decisions are individualized based on the specific clinical context.

What does my testosterone test result mean?


Testosterone levels often begin to fall after the age of 30. Testosterone levels may drop more in obese or chronically unwell men, as well as with the use of certain drugs.

Hypogonadism can be caused by a variety of factors, including:

  • Pituitary or hypothalamic illness
  • Reduced testosterone production in young males can be caused by genetic disorders
  • Possible infertility or testicular failure
  • Acquired damage to the testes, such as from drinking, physical injury, or viral infections like mumps, reduces testosterone production.
  • Diabetes

Healthcare practitioners may recommend testosterone replacement therapy to men who have consistently low testosterone levels and associated signs and symptoms. The Food and Drug Administration has not approved testosterone supplements to improve strength, sports performance, or avoid aging disorders. It's possible that using it for these purposes is dangerous.

Increased testosterone levels in men can mean one of several things:

  • Tumors of the testicles
  • Testosterone-producing tumors in the adrenal glands
  • Use of anabolic steroids
  • Early puberty in males due to an unknown cause
  • Adrenal hyperplasia in toddlers and babies


Testosterone levels in women are typically low. Increased testosterone levels can mean one of the following things:

  • Ovarian or adrenal gland tumor
  • PCOS
  • Adrenal hyperplasia that occurs at birth.

Most Common Questions About the Testosterone Free and Total test:

Understanding the Test

What is the Testosterone Free and Total test?

The Testosterone Free and Total test measures the levels of testosterone in the blood, both the testosterone that is bound to proteins (and therefore not bioavailable) and the testosterone that is unbound, or 'free.'

Why would someone need a Testosterone Free and Total test?

A Testosterone Free and Total test is typically ordered when a person has signs and symptoms of abnormal testosterone levels, such as infertility, erectile dysfunction in men, and hirsutism or menstrual irregularity in women.

Interpreting the Results

What do the results of the Testosterone Free and Total test mean?

Results vary between individuals and should be interpreted by a healthcare provider. In general, higher than normal testosterone levels could indicate conditions like polycystic ovary syndrome (PCOS) in women, or testicular tumors in men. Lower than normal levels might indicate hypogonadism, in which the sex glands produce little or no hormones.

How are the results of the Testosterone Free and Total test presented?

The results are reported in nanograms per deciliter (ng/dL), and both the total and free testosterone levels will be reported. The reference range varies depending on the individual's sex, age, and overall health.

About the Test

How is the Testosterone Free and Total test different from other hormone tests?

This test is specific to measuring testosterone, an androgen hormone that plays a key role in reproduction and sexual function in men and women. While other hormone tests may measure estrogens, progesterone, cortisol, etc., this test focuses on testosterone.

What factors can affect the results of the Testosterone Free and Total test?

Several factors can affect the results, including age, the time of day the test is conducted (testosterone levels usually peak in the morning), medical conditions such as liver or kidney disease, and certain medications.

Understanding the Implications

What conditions can cause abnormal testosterone levels as revealed by the Testosterone Free and Total test?

Abnormal testosterone levels can be caused by a variety of conditions. High levels can result from PCOS in women, testicular tumors in men, or congenital adrenal hyperplasia in both sexes. Low levels can result from hypogonadism, Klinefelter syndrome in men, or Turner syndrome in women.

What are the implications of low total testosterone but normal free testosterone levels in the Testosterone Free and Total test?

This could mean that the person has lower levels of sex hormone-binding globulin (SHBG), the protein that binds to testosterone, making it unavailable for the body's use. The condition could be due to obesity, hypothyroidism, or insulin resistance, among other causes.

Risks and Precautions

How do abnormal testosterone levels impact health as revealed by the Testosterone Free and Total test?

Abnormal testosterone levels can impact health in several ways. High testosterone levels can contribute to conditions like heart disease, diabetes, and irregular periods in women, while low testosterone levels can lead to conditions like osteoporosis, depression, and low sex drive.

Dealing with Abnormal Results

What steps should be taken if the Testosterone Free and Total test results are abnormal?

If the test results are abnormal, further investigation is typically needed to determine the underlying cause. This might involve further lab tests, imaging studies, or referrals to specialists like an endocrinologist or urologist.

Interpreting the Test Results

What is the role of free testosterone in the Testosterone Free and Total test?

Free testosterone refers to the testosterone that is not bound to proteins in the blood and is therefore available for the body to use. It's often more clinically relevant than total testosterone, as it represents the active portion of testosterone in the body.

Understanding the Importance of the Test

How does the Testosterone Free and Total test relate to infertility issues?

In men, low testosterone levels can lead to infertility by affecting sperm production. In women, high testosterone levels can interfere with ovulation and lead to infertility. This test can therefore be useful in evaluating infertility in both sexes.

How does the Testosterone Free and Total test relate to bodybuilding and athletic performance?

Testosterone plays a role in muscle growth and physical stamina. Some athletes and bodybuilders have used testosterone or related anabolic steroids to enhance performance. However, inappropriate use can lead to severe health consequences.

Discussion with Healthcare Provider

What questions should I ask my healthcare provider before getting the Testosterone Free and Total test?

You may want to discuss why the test is being ordered, what the results could mean, and how it could impact your overall treatment plan. If you have specific symptoms, discuss how they mightbe related to your testosterone levels.

What questions should I ask my healthcare provider after getting the Testosterone Free and Total test?

Ask about your specific results - whether they're within normal range or if they're high or low. If your levels are abnormal, ask what could be causing this and what the next steps are. Ask if lifestyle changes or treatment are needed.

Future Considerations

How often should the Testosterone Free and Total test be repeated?

The frequency of testing depends on the reason for the initial test. If you're receiving treatment for a condition that affects testosterone levels, your healthcare provider may recommend regular testing to monitor your response.

What future medical tests might be needed if the Testosterone Free and Total test reveals abnormal results?

Depending on the results and your symptoms, further tests may be required to determine the underlying cause of the abnormal testosterone levels. These could include other hormone tests, imaging of the adrenal or pituitary glands, or genetic testing.

General Questions

What role does the Testosterone Free and Total test play in diagnosing polycystic ovary syndrome (PCOS)?

High levels of testosterone on this test, along with symptoms such as irregular menstrual cycles and excess hair growth, can suggest PCOS, a common endocrine disorder in women of reproductive age.

How does the Testosterone Free and Total test assist in diagnosing late-onset hypogonadism in men?

Late-onset hypogonadism, a condition in which the testes produce lower levels of testosterone, can be evaluated with this test. Symptoms may include low libido, erectile dysfunction, and low energy levels.

Can the Testosterone Free and Total test provide insights into behavioral and psychological conditions?

Yes, abnormal testosterone levels have been linked to a variety of behavioral and psychological conditions, such as depression, aggression, and risk-taking behavior.

How can the Testosterone Free and Total test help in understanding a person's sexual development?

In both males and females, testosterone plays a crucial role in sexual development. Abnormally high or low levels of testosterone during puberty can lead to disorders of sexual development.

What does the Testosterone Free and Total test reveal about a person's metabolic health?

Testosterone levels are linked to metabolic health. Low testosterone levels in men have been linked to obesity, diabetes, and metabolic syndrome. Similarly, high levels in women, as seen in PCOS, are also linked to these metabolic conditions.

How does the Testosterone Free and Total test contribute to the understanding of aging in men?

Testosterone levels naturally decline with age in men. The rate of decline can vary, and low levels can contribute to conditions often associated with aging, such as decreased muscle mass, increased body fat, and fatigue.

Can the Testosterone Free and Total test be useful in the evaluation of adrenal gland disorders?

The adrenal glands also produce a small amount of testosterone. Therefore, this test, in conjunction with other hormone tests, can be used in diagnosing and monitoring adrenal disorders.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

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