Testosterone Testing for Men: What You Need to Know

Written by: Gillian (Gigi) Singer, MPH, Sexuality Educator & Certified Sexologist

Table of Contents

 
• Introduction
 
• Why Should Men Get Their Testosterone Levels Tested?
 
• Who Should Get a Testosterone Test?
 
• Testosterone Testing
 
• Interpreting Your Testosterone Test Results
 
• Final Thoughts: Should You Get Tested?

Introduction

Testosterone plays a crucial role in men’s health, affecting muscle mass, libido, energy levels, mood, and overall well-being. While hormone fluctuations are a normal bodily process and are a natural part of aging, if you’re experiencing abnormal symptoms of low or high testosterone, testing your testosterone levels can help identify hormonal imbalances and help you and your healthcare provider figure out the right course of treatment, if one is necessary.

Testosterone is found in all bodies, regardless of assigned sex at birth or gender identity. This guide will focus on its role in people assigned male at birth (AMAB). We’ll use the terms “man” and “men” throughout to refer to AMAB individuals, but it’s important to acknowledge that not all AMAB people identify as men—and not all men are AMAB. We’ll also explore why testosterone testing matters, who should consider it, the different types of testosterone and tests available, and how to understand your results.

Why Should Men Get Their Testosterone Levels Tested?

Testosterone naturally declines with age, dropping by about 1% every year after the age of 30.¹ Some men can develop clinically low testosterone (called hypogonadism), leading to:^{2, 3}

 
• Low energy & chronic fatigue
 
• Loss of muscle mass & increased body fat
 
• Low sex drive & erectile dysfunction
 
• Depression, irritability & brain fog

On the other hand, high testosterone, which can be caused by a number of things (like steroid use or underlying medical conditions) can lead to:^{3, 4}

 
• Acne and oily skin
 
• Mood swings
 
• Excessive muscle growth & fluid retention
 
• Testicular shrinkage
 
• Infertility

If you’re experiencing any of these symptoms, a testosterone blood test can help determine if hormone levels are abnormally high or low.

Who Should Get a Testosterone Test?

You should consider testing if you have:^{1, 5}

 
• Persistent low libido or erectile dysfunction
 
• Unexplained fatigue or weakness
 
• Difficulty gaining muscle & increased body fat
 
• Mood changes, depression, or brain fog
 
• Sleep disturbances or poor recovery from workouts

Routine testing is recommended for:^{2, 5}

 
• Men over 40 to monitor age-related testosterone decline
 
• Athletes & bodybuilders using supplements or anabolic steroids
 
• Men undergoing testosterone replacement therapy (TRT)

Testosterone Testing

There are different ways to measure testosterone levels, but not all tests are equally reliable. Similarly, different tests measure different types of testosterone. These different types and tests can provide different insights into your health.

Types of Testosterone

There are three types of testosterone: total, free, and bioavailable.

Total testosterone makes up the largest amount of testosterone in your body. Most of it—about 70%—sticks to a protein called SHBG. Another 20% to 30% attaches to a different protein called albumin. This is called bioavailable testosterone (BT).¹ A very small amount, about 1% to 2%, floats around freely without sticking to anything. This is called free testosterone.

Healthcare providers might check either free testosterone or total testosterone, depending on what they need to learn about your health.

Types of Testosterone Tests

There are five common types of testosterone tests: a total testosterone test, a free testosterone test, a bioavailable testosterone test, a SHBG (sex hormone-binding globulin) test, and DHEA and LH tests.

 
• Total Testosterone Test:⁶ Measures all testosterone in the bloodstream (both bound and free). The standard test for diagnosing low testosterone. Normal range: 300 ng/dL to 1,000 ng/dL (nanograms per deciliter).⁵ Issue: Total testosterone includes inactive, bound testosterone, which may not reflect symptoms.
 
• Free Testosterone Test:⁶ Measures only the active, unbound testosterone that your body can use. Useful for men with normal total testosterone but symptoms of low T. Normal range: 66 pg/mL to 309 pg/mL (picograms per milliliter).⁷ Best for: Men with symptoms but normal total testosterone levels.
 
• Bioavailable Testosterone Test:⁶ Measures free testosterone and testosterone loosely bound to albumin. More accurate than total testosterone for diagnosing hormonal imbalances. Best for: Men on TRT or those needing a deeper hormonal assessment.
 
• SHBG (Sex Hormone-Binding Globulin) Test:⁸ SHBG binds to testosterone, making it unavailable for use. High SHBG can cause low free testosterone, even if total T is normal. Best for: Men with unexplained symptoms of low testosterone but normal total testosterone levels.
 
• DHEA & LH Tests:⁹ DHEA (dehydroepiandrosterone): precursor to testosterone, produced by adrenal glands. LH (luteinizing hormone): Signals the testes to produce testosterone. Low LH can suggest a problem with the pituitary gland, not the testes. Best for: Diagnosing whether low T is due to testicular failure or pituitary dysfunction.

Best Time to Test for Testosterone

Testosterone levels fluctuate throughout the day, so timing matters.

Harvard Health recommends testing for total testosterone between 7:00 am and 10:00 am.¹⁰ This timing applies to men under 45; however, since testosterone levels fluctuate less with age, men 45 and older can have their test done at any time before 2:00 p.m.¹¹

Interpreting Your Testosterone Test Results

An unusual testosterone test result doesn’t necessarily mean you have a health problem. Factors such as medications, existing conditions, or even a testing error can impact your results. Your healthcare provider will review your medical history and any medications you’re taking before interpreting the results. If needed, they’ll let you know if further testing is necessary.⁴

Treatment Options for Abnormal Testosterone Levels

You have options, and your health care provider can help you decide what is best for you.

Treating Low Testosterone

HCPs treat low testosterone with testosterone replacement therapy, which comes in different forms:¹²

 
• Skin gel: Rub this gel on clean, dry skin every day. Be careful not to let it touch other people’s skin.
 
• Shots: A doctor or you can give a shot in a muscle every 1 to 2 weeks. Some last longer and are given every 10 weeks. There are also shots you can take under the skin.
 
• Patches: You stick a patch on your skin every day, but you need to switch spots to avoid skin problems.
 
• Pellets: A doctor puts small pellets under your skin every few months to release testosterone slowly.
 
• Gum tablets: These are tiny pills that stick to your gums and release testosterone into your body. You use them twice a day.
 
• Nasal gel: You put this gel inside your nose three times a day.
 
• Pills: Some people take a special testosterone pill if they have certain medical conditions.

According to Harvard Health, natural ways to prevent natural declines in testosterone include:¹³

 
• Maintain a healthy weight and lose weight if needed
 
• Get regular exercise
 
• Keep a well-rounded diet full of healthy fats, proteins, and nutrient-dense fruits and vegetables
 
• Limit alcohol and tobacco use
 
• Be mindful of Environmental toxins

Treating High Testosterone

If your testosterone is too high, your HCP will investigate potential causes with you. They may also recommend different courses of treatment.

Final Thoughts: Should You Get Tested?

If you have symptoms of hormone imbalance, a testosterone test can provide answers and inform a course of action when treatment is necessary. Testosterone is an important building block in overall health, so consulting an HCP is a great idea if you have concerns.

 
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