Most testosterone in the bloodstream is bound to proteins, primarily sex hormone-binding globulin (SHBG) and albumin, and only the small unbound fraction is freely available to act on tissues. Conditions like obesity, thyroid disease, liver disease, and aging can shift binding protein levels and distort total testosterone readings.
This test is used to evaluate suspected low testosterone in men with symptoms like low libido, fatigue, and erectile dysfunction; investigate hyperandrogenism in women with hirsutism, acne, or irregular periods (such as in polycystic ovary syndrome); and monitor testosterone replacement therapy. Free testosterone is often interpreted alongside total testosterone for the most accurate picture. Sample type is serum, typically drawn in the morning.
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