Total Testosterone: What It Is, Normal Levels, and Why It Matters

Total Testosterone refers to the entire amount of testosterone circulating in your bloodstream, encompassing both forms that are bound to proteins and those that are unbound [1]. This hormone is pivotal for various physiological processes in both sexes, though its roles and concentrations differ significantly.

Role and function in the body:

• In men and people assigned male at birth: Testosterone is fundamental for male sexual development, including the growth of reproductive organs, sperm production, and the development of secondary sexual characteristics like increased muscle mass, bone density, and facial and body hair. It also supports red blood cell production, mood regulation, and energy levels [2].
• In women and people assigned female at birth: While present in smaller amounts, it plays an important role in bone strength, ovarian function, libido, and energy [3].
• In both sexes: It influences mood, cognitive function, libido, and overall well-being [4].

Defining "normal" testosterone levels can vary slightly based on the laboratory and individual factors, but general ranges are well-established. Total Testosterone is typically measured in nanograms per deciliter (ng/dL) [4].

Group	Typical Total Testosterone Range
Adult Males	300 to 1,000 ng/dL [5]
Adult Females	15 to 70 ng/dL [6]

Total vs. free/active forms: It is important to understand the difference between Total vs. Free Testosterone. Total Testosterone measures all the testosterone in your blood, including the portion bound to proteins like sex hormone-binding globulin (SHBG) and albumin. Free Testosterone, however, is the unbound form that is biologically active and available for your body to use. While Total Testosterone provides an overall snapshot, Free Testosterone can offer additional insight—especially if symptoms are present despite normal total levels.

Factors that affect levels:

• Age: Levels naturally decline as you get older.
• Time of day: Levels are typically highest in the morning.
• Underlying medical conditions: Certain health conditions can impact hormone production and balance.
• Medications: Some medications can increase or decrease levels.
• Lifestyle choices: Factors like diet, exercise, sleep, and stress can all influence hormone levels [4].

Factors that affect levels:

• Age: Levels naturally decline as you get older.
• Time of day: Levels are typically highest in the morning.
• Underlying medical conditions: Certain health conditions can impact hormone production and balance.
• Medications: Some medications can increase or decrease levels.
• Lifestyle choices: Factors like diet, exercise, sleep, and stress can all influence hormone levels [4].

Testosterone levels can become either too low or too high, leading to various health concerns.

Low Total Testosterone

• Primary hypogonadism: Occurs when the testicles (in men) or ovaries (in women) do not produce enough testosterone. Causes may include genetic conditions (eg, Klinefelter syndrome), injury, infection, or cancer treatments like chemotherapy or radiation [8].
• Secondary hypogonadism: Develops when the pituitary gland or hypothalamus does not properly signal testosterone production. Causes may include pituitary tumors, chronic illnesses (eg, kidney failure, liver disease, HIV/AIDS), and certain medications [8].
• Aging: Levels naturally decline over time, typically beginning around age 30 [8].
• Lifestyle factors: Obesity, uncontrolled type 2 diabetes, chronic stress, and excessive alcohol consumption can contribute to lower levels [8].
• Risk factors: Age, obesity, chronic diseases (such as diabetes or kidney disease), and certain medical treatments may increase risk.

High Total Testosterone

• In men: May be caused by anabolic steroid use, adrenal or testicular tumors, or rare genetic conditions [9].
• In women: Polycystic ovary syndrome (PCOS) is a common cause. Other causes include adrenal hyperplasia, ovarian tumors, and anabolic steroid use [9].
• Risk factors: PCOS in women and the use of performance-enhancing drugs (such as anabolic steroids) in both men and women [9].

Recognizing the symptoms of imbalanced testosterone levels is crucial for seeking timely medical attention.

Symptoms of Deficiency [10,11]

In Men	In Women
Reduced libido and erectile dysfunction	Low libido
Fatigue and decreased energy	Fatigue and low energy
Loss of muscle mass and increased body fat	Difficulty concentrating and “brain fog”
Decreased bone density (osteoporosis)	Muscle weakness
Mood changes (depression, irritability)	Bone loss
Hair loss (body and facial hair)	Depressed mood
“Brain fog” and difficulty concentrating	Irregular periods (though less common than excess)

Symptoms of Excess [12,13]

In Men	In Women
Acne	Hirsutism (excess body and facial hair)
Sleep apnea	Acne
Increased aggression/irritability	Irregular menstrual periods or amenorrhea
Hair loss (on scalp, male pattern baldness)	Deepening of the voice
Fluid retention	Increased muscle mass
Testicular atrophy (especially from steroid use)	Scalp hair loss (male pattern baldness pattern)

Managing testosterone imbalances often involves a combination of lifestyle changes, dietary adjustments, and, when necessary, medical interventions.

Approach	Low Testosterone	High Testosterone
Dietary Changes	A diet rich in nutrients that support hormone production can help. Foods high in zinc (e.g., oysters, beef, pumpkin seeds) and vitamin D (e.g., fatty fish, fortified dairy, sunlight exposure) are often recommended. Healthy fats (avocados, nuts, olive oil) and lean proteins also play an important role [11].	Diet is usually not the primary treatment, as elevated levels often signal an underlying condition. However, maintaining a balanced diet supports overall health.
Medications & Treatment	Testosterone Replacement Therapy (TRT) is a common treatment and may be delivered via gels, patches, injections, or pellets. It can be effective but should be discussed with a healthcare provider due to potential risks [14].	Treatment depends on the underlying cause. Options may include medications to regulate hormone production or addressing conditions such as PCOS. In some cases, surgery (e.g., tumor removal) may be required [9].
Lifestyle Changes	Regular exercise: Combine aerobic activity with strength training to support hormone balance Adequate sleep: Aim for 7–9 hours per night to support healthy hormone production Stress management: Practices like meditation, yoga, or time outdoors can help regulate hormones Maintain a healthy weight: Body composition plays a key role in hormone balance Limit alcohol intake: Excessive consumption can disrupt hormone production Avoid endocrine disruptors: Reduce exposure to chemicals in plastics and pesticides that may interfere with hormones [14]

Always consult a healthcare professional before starting any new supplements or treatments.

Testing testosterone levels is a straightforward process, primarily done through a blood test.

How It’s Tested

• Blood test: The most common and accurate method. Samples are typically drawn in the morning when levels are highest [7].
• Saliva and urine tests: Available but generally less commonly used than blood testing.

When and Why to Test

• To evaluate symptoms of low or high testosterone
• To monitor testosterone replacement therapy
• As part of a comprehensive health check-up to assess hormonal balance [7]

At-Home Testing Options

At-home testing kits provide a convenient way to measure testosterone levels without a traditional lab visit. These typically involve a simple finger-prick blood sample that is sent to a certified lab, with results delivered digitally along with personalized insights.

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