Testosterone levels decline steadily with an increase in age. Though not always prominent in every individual, some may find their daily lifestyle affected by symptoms like reduced libido, delayed ejaculation, erectile dysfunction, depression, osteoporosis, loss of secondary sexual characteristics, or reduced muscle bulk or strength.

If symptoms become too evident and affect daily life, one should take a testosterone blood test to check testosterone levels. They should always consult a licensed practitioner to assess their condition and avoid self-medication.

The normal testosterone levels for men are 300-1000 ng/dL or 10 to 35 nmol/L and that for females is 15 to 70 ng/dL or 0.5 to 2.4 nmol/L. Testosterone levels in men are optimal during the morning. Hence tests should be undertaken between 7-11 AM.

What Are Testosterone Tests? Why Does One Need To Undergo Testosterone Tests?

Testosterone is a crucial androgenic hormone that defines the overall male phenotype. Optimum testosterone levels regulate fertility, development, maintenance of the male reproductive system’s organs, and sexual function. Lean muscle mass and muscle strength enhancement, bone density maintenance, cardioprotection, and cognitive functions are other important aspects governed by testosterone. (1)

Testosterone tests can be either blood or serum-based and are used to determine the total amount of testosterone in the system (total testosterone/total T), either bound to a protein called sex hormone binding globulin (SHBG) or bound to albumin or available freely (bioavailable testosterone).(2)

Getting testosterone levels checked is crucial, especially when people reach a certain age when hormone deficiency symptoms keep affecting their daily lives. It is estimated that 12%, 19%, 28%, and 49% of men older than 50, 60, 70, or 80 years of age, respectively, are diagnosed with hypogonadism, which has also led to an increase in the number of testosterone diagnostic tests by 43%.(3)

As per the current guidelines from the Endocrine Society, one should get their testosterone levels checked only if they face symptoms like reduced libido, delayed ejaculation, erectile dysfunction, infertility, depression, osteoporosis, loss of secondary sexual characteristics, or reduced muscle bulk or strength. (4) Practice guidelines also suggest testosterone screening patients suffering from depression refractory to standard treatment, men on glucocorticoid or opioid therapy, men with HIV infection if experiencing weight loss, or failure to respond to phosphodiesterase type 5 inhibitors if having erectile dysfunction. (5)

Also Read: Can Low Testosterone Cause Weight Gain?

Also Read: Benefits of Testosterone for Erectile Function

Also Read: How TRT can help with Depression

Patients who are known to have comorbidities and risk factors like type 2 diabetes, obesity, metabolic syndrome, and severe chronic obstructive pulmonary disease, are also advised to take the test. Screening is prohibited in asymptomatic patients and those detected using tools such as the ADAM (Androgen Deficiency in the Aging Male) questionnaire as per the guidelines. (4)(6)

Testosterone assays are used primarily to confirm the diagnosis of hypogonadism in adult men. However, it can also evaluate boys with delayed or precocious (early) puberty and monitor the efficacy and adequacy of testosterone therapy. (4) Testosterone blood test needs blood samples drawn between 7-9 AM and the samples are tested for testosterone levels.

How Does Modern Lifestyle Affect Testosterone?

In a normal course of time, testosterone levels are highest during the morning, between 7-9 AM, especially for men under the age of 45 years. The secretion of testosterone is directly related to the circadian rhythm (the natural/biological clock) of the body.(4) There are genetic and environmental influences on testosterone levels as well, especially in the middle aged and elderly male population.(7) The normal range for early morning total testosterone in healthy adult males ranges from approximately 300 to 1000 ng/dL.

Urban lifestyles, the burgeoning gig economy, extended work hours (especially shift-related work cycles), online entertainment platforms beaming 24/7 have skewed circadian patterns. Light is an important environmental factor that the biological clock takes cues from to stay in sync with circadian rhythm. Testosterone generation is pulsatile, highest amount generated early morning, and follows circadian rhythms. Deprivation from sleep or having a disturbed sleep cycle is also deleterious to overall health and hormone cycles and can affect testosterone levels majorly, especially in the younger male population.

Animal studies have shown that disruptions in the circadian patterns disrupts Leydig cell differentiation (one of the major somatic cell groups to be involved in the fetal development of the reproductive track), eventually causing developmental abnormalities in the testes during puberty, among other negative effects as per a recent study in animal models. Moreover, excess testosterone also leads to disrupted sleep disruptions in people receiving testosterone therapy.(8)

During reproductive maturation, the dynamic interaction between the genetic (genes/DNA that define and environmental factors contribute to Leydig cells acquiring the full endocrine capacity. Constant light was shown to delay Leydig cell maturation by reducing the endocrine and energy capacity of cells and delay in the development and maturity of the male urogenital tract and the gonads.(9)

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What Are The Symptoms Of Abnormal Testosterone Levels In The Human Body?

Low Testosterone/Low T levels in the body are due to hypogonadism which literally translates into the reduced functionality of the gonads (testes in males and ovaries in females). In males, there is a reduction in the production of testosterone and spermatozoa due to genetic abnormalities or acquired diseases of the hypothalamus (the decision-making organ in the body), pituitary gland (which controls the release of different hormones) or gonads.(10) Once a man crosses his thirties, there is a 1% decline in testosterone levels with every passing year.(11)

Also Read: Causes and Symptoms of Low Testosterone Levels

Primary hypogonadism in men refers to an abnormality in the testes. In contrast, secondary hypogonadism refers to a damage or abnormality in the hypothalamus or the pituitary gland, because of which the testes do not secrete enough testosterone.

The symptoms of low testosterone levels in the body include,

1. Fatigue, low energy, brain fog
2. Decreased sex drive/libido
3. Failure to get or sustain erections for a satisfying intercourse
4. Infertility – low sperm count, motility
5. Loss of muscle mass, weak bones, hair loss

Also Read: How Testosterone Therapy can Treat Brain Fog in Men

High testosterone/High T levels in the body can be due to a genetic cause (almost 70% of the serum testosterone levels can be attributed to genetics), the presence of tumors in the adrenal or testicular glands, use of anabolic steroids for bodybuilding and cosmetic purposes, and hyperthyroidism. (12) (13)

Symptoms of high testosterone include,

1. Excessive acne
2. Blood pressure changes
3. Overproduction of red blood cells
4. Chest pain and risks of heart attacks
5. Mood swings, anxiety, panic attacks and depression
6. Male pattern baldness and excess facial hair
7. Reduced sexual drive

How is Testosterone levels in the Body Checked?

A testosterone blood test is the ideal method to detect low testosterone (or high T) levels in the body. A small amount of venous blood is drawn for this test between 7-9 AM (or at max. 11 AM). The major laboratory tests that help in providing a holistic explanation on low T levels include hemoglobin (Hgb), hematocrit (Hct), liver function tests (LFTs), lipid panels, digital rectal exams (DRE), prostate-specific antigen (PSA) level, prolactin, 2-morning testosterone levels, and a bone density (DEXA) scan. (14) Additionally, serum samples can also be checked for testosterone levels.

• Total Testosterone – Measures free and bound T.
• Free Testosterone – Measures only unbound T. This test also gives more information about certain medical conditions

T-levels that are too low(low-T) or too high are concerns of health in both men and women.

Other names used: Testosterone - Serum, Total and Bioavailable.

What Is The Normal Range Of Testosterone Levels? What Do The Test Results Mean?

Analysing the levels of bioavailable testosterone correlates better with potential hypogonadal symptoms than total serum testosterone. Testosterone levels range from 300 to 1000 nanograms per deciliter (ng/dL). Fluctuations are normal depending on the time of testing, the daily activities of the patient, medical histories, age, and phase of life.

If the total amount of serum testosterone is between 230 and 350 ng/dL in males aged below 50 years or between 300 and 500 ng/dL in those above 50 years, it is advisable to repeat the measurement of serum testosterone in addition to the level of sex hormone binding globulin (SHBG) to calculate the amount of bioavailable testosterone via equilibrium dialysis and sulphate precipitation. Additionally, when secondary hypogonadism is suspected or serum testosterone is lower than 150 ng/dl, serum prolactin levels are also measured. (15) These tests are necessary to differentially diagnose low or high levels of testosterone and differentiate it from any other medical conditions.

On a general note, low T levels below 200 ng/dL are a cause for concern and need to be investigated for health issues, as per the practitioner’s assessment and the patient’s health records.

FAQs

What is the correct level of testosterone for males and females?

Testosterone test for male patients should show values between 300-1000 ng/dL or 10 to 35 nmol/L and that for females is 15 to 70 ng/dL or 0.5 to 2.4 nmol/L. Anything lower than these values deserve a differential diagnosis for other conditions and a deep-dive into the patient’s medical history to get a better understanding and prescribe an appropriate course of medication if necessary.

What is the price of a testosterone test?

Testosterone test price varies from CAD 67-170 depending on the type of testosterone measurements undertaken, the kind of samples needed for assessment and the other parameters tested. This may also vary between pharmacies. Tests measuring only bioavailable testosterone or total testosterone cost lesser as compared to test kits measuring all other hormones in the body. In the USA, testosterone tests alone can cost anywhere between USD 46-80.

What is the best low testosterone treatment?

This decision is best left to the licensed practitioner who is assessing the patient. In case there are no comorbidities present, levels of testosterone below 150-200 ng/dL in males are probable to receive testosterone replacement therapy, provided the patient’s age and medical histories allow for it. Self-medication is injudicious.