About Our Total Testosterone Test
Purpose of the test
The total testosterone test gives you and your provider a starting point in determining whether your hormone levels are in a healthy range. Testosterone is produced mainly in the testes in males and in the ovaries and adrenal glands in females. When levels fall outside the expected range, the test helps point toward what might be going on.
- Screening: Adults with symptoms of hormone imbalance, such as low energy, changes in sex drive, or irregular periods, may benefit from a baseline check before a diagnosis is made.
- Diagnosis: Low testosterone symptoms in males may include fatigue, erectile dysfunction, or reduced muscle mass. High testosterone symptoms in females may result in excess facial hair growth, irregular periods, acne, or polycystic ovary syndrome.
- Monitoring: People on testosterone replacement therapy (TRT) or androgen deprivation therapy use this test to track whether levels stay in the target range.
In males, low testosterone naturally occurs with aging; approximately 1% drop per year after the age of 30, thus a lower result may reflect normal aging rather than a medical condition. Hypogonadism is a condition where the body doesn’t make enough testosterone and can stem from testicular failure, where the testes aren’t producing enough on their own (primary hypogonadism). Low testosterone may also be a result of the pituitary gland or hypothalamus failing to signal the testes to correctly regulate testosterone production (secondary hypogonadism). According to the Endocrine Society’s hypogonadism guidance, the total testosterone test alone can’t tell you which type you have — that requires follow-up testing.
In females, high testosterone is more common than low. Polycystic ovary syndrome (PCOS), a hormone disorder affecting roughly 8 to 13% of women of reproductive age according to the American College of Obstetricians and Gynecologists, is the most common cause.
What does our total testosterone test measure?
Total testosterone circulates in several forms: most is bound to sex hormone-binding globulin (SHBG), with smaller amounts bound to albumin and some, as free testosterone. Total testosterone is a screening test that is used in conjunction with clinical symptoms, health conditions, or other problems to reach a diagnosis. On its own, it is not diagnostic. A diagnosis is reached with follow-up testing. The MedlinePlus testosterone test overview describes both approaches and how results are used clinically.
Most CLIA-certified (Clinical Laboratory Improvement Amendments) laboratories measure the total testosterone in a blood serum sample using an immunoassay. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a second technique that is more accurate and may be used when testosterone levels are anticipated to be low, as seen in pediatric patients or females.
If your total testosterone is either low or high, that’s enough to require further testing. Free testosterone is slightly more than 2-3% of total testosterone and is not bound to any proteins. This free form makes it available to bind to body tissues and exert its effect. Low levels of free testosterone may indicate hypogonadism, or if high in females, suggests PCOS. Research published in the Journal of Clinical Endocrinology and Metabolism found that low free testosterone is associated with hypogonadal signs and symptoms in men with normal total testosterone. If that sounds like your situation, ask about free testosterone testing as a follow-up.
When should I get a total testosterone test?
Consider testing if any of these apply:
- Erectile dysfunction, low sex drive, or reduced muscle mass in males
- Excess facial or body hair, persistent acne, or irregular periods in females
- Fertility concerns
- Low energy, unexplained mood changes, or hair thinning
- Tracking hormone levels while on testosterone replacement therapy (TRT) or androgen deprivation therapy
- Checking hormone levels as part of a PCOS workup
- Tracking hormone levels during gender-affirming hormone therapy
This test works for anyone who wants to check or track testosterone levels, regardless of sex or gender identity.
How It Works
How to get tested
You can order this total testosterone blood test through Testing.com. We connect you with CLIA-certified labs, including LabCorp and Quest Diagnostics, at thousands of locations across the country. No doctor’s visit is required. You can compare tests by cost, turnaround time, and privacy before you order.
Here’s how it works:
- Order online
- Use the lab locator to find a nearby collection site
- Walk in for your blood draw: no appointment needed at most locations
- Get an email when your results are ready in your secure online account
This test is also available through a provider’s office, if you prefer that route.
Before the test
Schedule your blood draw between 7 and 10 a.m. Testosterone follows a daily rhythm, peaking early and dropping through the afternoon. In younger men, levels can be 20 to 25% lower by late afternoon than at the morning peak. As one ages, the difference becomes smaller. An afternoon draw might look low when it’s actually fine.
Fast for eight to 12 hours before your draw. Water is fine. Fasting cuts variability in your result. Requirements can vary by lab, so follow the instructions you receive when you order.
Stop taking biotin supplements (also called vitamin B7, found in many hair, nail, and skin products) at least 72 hours before the test. The FDA has warned that biotin may interfere with lab tests, including immunoassays used for hormone testing. This is easy to miss if you don’t think of your hair supplement as something that affects a hormone test.
Avoid intense exercise the day before your draw. Hard workouts can temporarily raise testosterone and skew your results.
Tell your provider about all medications you’re taking, especially corticosteroids (like prednisone) and opiate pain medications. Both can lower testosterone levels.
During the test
A phlebotomist (the technician who draws blood) will bring you to a collection area and ask you certain questions (fasting, health insurance, etc.)
The draw takes a few minutes. The phlebotomist cleans a small area on the inside of your arm, usually near the elbow, and inserts a thin needle into a vein. You’ll feel a brief pinch. A small tube of blood is collected, the needle comes out, and a bandage goes on.
Keep the bandage on for at least 15 minutes. Mild bruising is normal. It clears up on its own within a few days.
Call your provider if you notice lasting pain, swelling, or signs of infection at the site after you leave.
After the test
Results are ready within one to three business days after the lab receives your sample. You’ll get an email when they’re in your secure online account.
If your test was ordered through a provider’s office, timing may differ. Check with them if you haven’t heard back within a few days.
What do my results mean?
Total testosterone is reported in ng/dL (nanograms per deciliter; ng/dL). Because labs may differ in reference intervals, your lab report will include reference intervals specific to that lab. The ranges below are an example from one lab, thus your lab numbers may differ slightly.
| Result | Adult males (typical) | Adult females (typical) |
|---|---|---|
| Normal | 300 to 1,000 ng/dL | 15 to 70 ng/dL |
| Low | Below 300 ng/dL | Below 15 ng/dL |
| High | Above 1,000 ng/dL | Above 70 ng/dL |
Several factors affect your result beyond the number itself: time of collection, fasting status, age, obesity, diabetes, liver disease, kidney disease, sleep disorders, HIV, and certain medications. In males, testosterone drops roughly 1% per year after age 30 to 40. A low-normal result at 55 may reflect normal aging.
If your results are normal
Your testosterone is within the expected range for your age and sex. That’s reassuring. But it doesn’t rule out every possible cause of your symptoms.
Some people have normal total testosterone but low free testosterone because high SHBG is binding most of it. Low free testosterone can cause symptoms like low energy, reduced sex drive, and mood changes, even when total testosterone looks fine. SHBG tends to run higher in older males, in people with hyperthyroidism, and in those taking certain medications.
If your symptoms continue despite a normal result, discuss with your provider about free testosterone testing.
If your results are low
Low total testosterone may point to hypogonadism, but the test alone doesn’t tell you why. That distinction matters because the cause shapes the treatment.
Primary hypogonadism means the testes aren’t producing enough testosterone on their own. LH (luteinizing hormone) and FSH (follicle-stimulating hormone) run high in this case because the pituitary is working overtime trying to signal the testes to produce more testosterone. Secondary hypogonadism means the pituitary or hypothalamus isn’t sending the right signals, so LH and FSH are low or normal even though testosterone is low.
Prolactin is produced by the pituitary gland. Elevated levels can suppress LH and FSH, resulting in low testosterone.
Conditions that can push testosterone lower include obesity, diabetes, high blood pressure, liver disease, kidney disease, sleep disorders, HIV, corticosteroids, and opiate pain medications. A low result in a male over 40 may reflect normal age-related decline. The Mayo Clinic’s overview of testosterone therapy outlines how providers weigh these factors when interpreting results and considering treatment. Your provider can help you put the number in context.
If your results are high
High total testosterone is less common in males and more common in females.
In males, causes include anabolic steroid use, TRT at doses above the therapeutic range, adrenal tumors, or testicular tumors. Symptoms can include high blood pressure, headaches, acne, excessive body hair, prostate enlargement, lower sperm production, and insomnia. It can also initiate aggressive or risk-taking behaviors.
In females, PCOS is the most common cause. Other causes include adrenal tumors and congenital adrenal hyperplasia (a genetic condition affecting the adrenal glands). Symptoms can include acne, hair loss, excess facial or body hair (hirsutism), high blood pressure, irregular periods, and insulin resistance.
Follow-up testing depends on the clinical picture. If a tumor is suspected, imaging may be needed. In females with irregular periods and high testosterone, a PCOS workup is a common next step. Talk with your provider to figure out what comes next.
FAQs
Sources
Endocrine Society. Hypogonadism in Men. Updated January 24, 2022.
MedlinePlus. Testosterone Levels Test. Updated 2023.
FDA. The FDA Warns that Biotin May Interfere with Lab Tests. 2017.
American College of Obstetricians and Gynecologists (ACOG). Polycystic Ovary Syndrome (PCOS). 2022.