What this test measures
Testosterone is the principal androgen in men (made by testicular Leydig cells under LH drive) and is present in much smaller amounts in women (made by the ovaries, adrenal glands, and peripheral conversion of precursors). Total testosterone measures the sum of free, albumin-bound and SHBG-bound testosterone.
Testosterone follows a strong diurnal rhythm with peak in the early morning — so all samples should be drawn between 8 and 10 am. The Endocrine Society recommends two morning low values (along with consistent symptoms) before diagnosing male hypogonadism.
Why it matters
In men, total testosterone is the first-line marker for hypogonadism, which causes fatigue, low libido, erectile dysfunction, decreased muscle mass, mood changes, anaemia and reduced bone density. Symptomatic hypogonadism is increasingly recognised in Indian men, particularly with rising obesity and type 2 diabetes. A low total testosterone confirmed on a repeat morning sample, paired with LH and FSH, classifies it as primary (testicular failure: high LH/FSH) or secondary (pituitary / hypothalamic: low or inappropriately normal LH/FSH).
In women, total testosterone is part of the standard hirsutism / PCOS / virilisation workup. Mild raises (up to 1.5× normal) are common in PCOS; substantial rises (> 2× normal) raise concern for an androgen-producing tumour (ovarian or adrenal) and need urgent imaging.
How to prepare
Morning sample (between 8 and 10 am) — testosterone has a strong diurnal rhythm. Fasting not required. Avoid acute illness — testosterone falls sharply during illness. Stop biotin for 48–72 hours. Tell the lab if you are on testosterone replacement, anabolic steroids, or "T-booster" supplements.
Markers & reference ranges
Reference ranges below are typical adult values. Your lab's reported range may differ slightly based on the assay platform and patient demographics — always read your report against the range printed on it.
| Marker | Normal range | If low | If high |
|---|---|---|---|
| Total Testosterone (ng/dL)[1][2] | Adult male: 280 – 1100 ng/dL · Adult female: 15 – 70 ng/dL · Postmenopausal female: 5 – 51 ng/dL | In a symptomatic man, two morning total testosterone values < 300 ng/dL (with calculated free T below assay cut-off) confirms hypogonadism. Causes: primary (testicular) failure — Klinefelter, post-mumps, post-chemo, varicocele; secondary — pituitary tumour, hyperprolactinaemia, obesity, opioids, glucocorticoids, severe illness. | In a woman, a total testosterone > 200 ng/dL with rapidly progressive virilisation raises strong suspicion of an androgen-producing tumour — image the ovaries and adrenals. Mild raises (50–100 ng/dL) are typical of PCOS. In men, raised testosterone usually reflects exogenous androgen use (anabolic steroids, OTC supplements) or rare androgen-secreting tumour. |
Testosterone — interpretation patterns
| Patient | Total T | LH/FSH | SHBG | Likely picture |
|---|---|---|---|---|
| Symptomatic man | Low (< 300) | High | Normal | Primary hypogonadism |
| Symptomatic man | Low | Low/normal | Variable | Secondary hypogonadism |
| Obese diabetic man | Borderline | Normal | Low | Often normal free T — check free T |
| Older healthy man | Borderline | Mildly high | High | Age-related decline — calculate free T |
| PCOS woman | Mildly raised | LH:FSH > 2 | Low | Biochemical hyperandrogenism |
| Virilising woman | Very high (> 200) | Suppressed | Variable | Tumour — image ovaries / adrenals |
Frequently asked questions
Why does testosterone have to be drawn in the morning?
Testosterone follows a strong diurnal rhythm — values peak around 8 am and can be 30–40% lower by late afternoon. Reference ranges are based on morning samples.
My testosterone came back low — should I start testosterone gel?
Not on a single low value. Endocrine Society guidelines require two morning low values plus consistent symptoms (fatigue, low libido, erectile dysfunction) before starting therapy. The workup also includes LH, FSH, prolactin, ferritin and a discussion of fertility, cardiovascular and prostate considerations.
I am overweight — would weight loss raise my testosterone?
Yes — meaningful weight loss in obese men raises SHBG and free testosterone, sometimes substantially, and is the first-line treatment for obesity-related low testosterone. It also improves insulin sensitivity and reduces cardiovascular risk.
I am a woman with hirsutism — what testosterone level matters?
Mild raises (up to 1.5× the upper limit) are common in PCOS and respond to lifestyle, OCPs and anti-androgens. A total testosterone > 200 ng/dL or rapidly progressive virilisation requires urgent imaging to rule out an androgen-producing tumour.
Do over-the-counter "T-booster" supplements actually raise testosterone?
Most do not — large clinical studies of common ingredients (tribulus, fenugreek, zinc, vitamin D in non-deficient men) show minimal effect. Some products contain undeclared anabolic steroids — be cautious.
How is testosterone different from free testosterone?
Total testosterone includes hormone bound to carrier proteins (SHBG, albumin); free testosterone is the unbound fraction (about 2%) that is biologically active. In obesity, diabetes, ageing and thyroid disease, total and free testosterone can disagree — measuring both gives the truer picture.
Will illness affect the result?
Yes — acute illness can lower testosterone substantially. If you are unwell, defer the test until you have recovered. A low testosterone during severe illness is usually transient.
Related Hormones / Endocrine tests
Tests commonly ordered alongside TESTOSTERONE, or that help interpret an unexpected result.
Sources & references
- Endocrine Society — Testosterone Therapy in Men with Hypogonadism · accessed 2026-05-30T00:00:00.000Z
- Endocrine Society — Hirsutism in Premenopausal Women · accessed 2026-05-30T00:00:00.000Z
- NIH MedlinePlus — Testosterone Test · accessed 2026-05-30T00:00:00.000Z
- NCBI StatPearls — Testosterone · accessed 2026-05-30T00:00:00.000Z
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