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Testosterone

SI UNITS (recommended)

CONVENTIONAL UNITS

(Primary Male Sex Hormone - Essential for Puberty, Sexual Function, Fertility, Muscle Mass & General Metabolism)

Synonyms

  • Testosterone
  • Total testosterone
  • Free testosterone (FT)
  • Bioavailable testosterone
  • Serum testosterone
  • Androgen hormone

Units of Measurement

  • nmol/L
  • ng/mL
  • ng/dL
  • ng/100 mL
  • ng%
  • ng/L
  • µg/L

Unit Conversions

Molecular Weight of Testosterone = 288.42 g/mol

nmol/L ↔ ng/mL

1 nmol/L=0.288 ng/mL1\ \text{nmol/L} = 0.288\ \text{ng/mL}1 nmol/L=0.288 ng/mL 1 ng/mL=3.47 nmol/L1\ \text{ng/mL} = 3.47\ \text{nmol/L}1 ng/mL=3.47 nmol/L

nmol/L ↔ ng/dL

1 nmol/L=28.8 ng/dL1\ \text{nmol/L} = 28.8\ \text{ng/dL}1 nmol/L=28.8 ng/dL 1 ng/dL=0.0347 nmol/L1\ \text{ng/dL} = 0.0347\ \text{nmol/L}1 ng/dL=0.0347 nmol/L

ng/mL ↔ ng/L

1 ng/mL=1000 ng/L1\ \text{ng/mL} = 1000\ \text{ng/L}1 ng/mL=1000 ng/L 1 ng/mL=1 µg/L1\ \text{ng/mL} = 1\ \text{µg/L}1 ng/mL=1 µg/L

ng/dL = ng%

(Older units.)

Description

Testosterone is the main circulating androgen produced primarily by:

  • Leydig cells of testes (95%)
  • Ovaries (small amounts)
  • Adrenal glands (minor contribution)

It circulates in three forms:

  • Free testosterone (~1–2%)
  • Albumin-bound (~30–40%)
  • SHBG-bound (~60%)

Only free + albumin-bound testosterone is bioavailable, capable of entering cells and exerting biological effects.

Physiological Role

1. Male Sexual Development

  • Puberty initiation
  • Testis & penis growth
  • Voice deepening
  • Facial/body hair

2. Reproductive Function

  • Libido
  • Erectile function
  • Spermatogenesis

3. Metabolic & Body Composition Effects

  • Increases muscle mass
  • Reduces visceral fat
  • Enhances erythropoiesis
  • Maintains bone density

4. Mood & Cognition

  • Affects confidence, motivation, memory

Clinical Significance

LOW TESTOSTERONE

Primary Hypogonadism

  • High LH/FSH
    Causes:
  • Klinefelter syndrome
  • Testicular injury
  • Chemotherapy
  • Radiation
  • Orchitis

Secondary Hypogonadism (Pituitary/Hypothalamic)

  • Low/normal LH/FSH
    Causes:
  • Pituitary tumors
  • Hyperprolactinemia
  • Systemic illness
  • Chronic opioid use
  • Obesity
  • Type 2 diabetes

Symptoms of Low Testosterone

  • Reduced libido
  • Erectile dysfunction
  • Fatigue
  • Loss of muscle mass
  • Central obesity
  • Depression
  • Low bone density
  • Infertility

HIGH TESTOSTERONE

Men

  • Rare unless exogenous supplementation
  • Adrenal tumors
  • Testicular tumors
  • Androgen insensitivity (high T with feminization)

Women

  • PCOS
  • Congenital adrenal hyperplasia (CAH)
  • Ovarian/adrenal androgen-secreting tumors
  • Severe insulin resistance
  • Hirsutism, acne, menstrual irregularities

Reference Intervals

(Tietz 8E + Endocrine Society + Mayo + ARUP)
Values depend on age, sex, and assay (LC–MS/MS preferred).

Adult Men (Morning Sample, 7–10 AM)

  • Total Testosterone: 300 – 1000 ng/dL
    (= 10.4 – 34.7 nmol/L)

Adult Women

  • Total Testosterone: 15 – 70 ng/dL
    (= 0.5 – 2.4 nmol/L)

Children

  • Prepubertal: very low
  • Puberty staging: Tanner-based values used

Free Testosterone (by Equilibrium Dialysis or Calculation)

  • Men: 5 – 25 ng/dL
  • Women: 0.1 – 0.9 ng/dL

Bioavailable Testosterone

  • Men: 100 – 300 ng/dL

Diagnostic Uses

1. Evaluation of Male Hypogonadism

Repeat testosterone measurement required:

  • Early morning
  • Fasting
  • Confirm with SHBG & LH/FSH

2. PCOS Evaluation (Women)

High testosterone → androgen excess workup.

3. Infertility

Low T affects spermatogenesis.

4. Monitoring Testosterone Replacement Therapy

Ensure physiologic levels, avoid supraphysiologic ranges.

5. Suspected Androgen-Secreting Tumors

Markedly elevated levels.

6. CAH Evaluation

Part of androgen pattern (with DHEA-S, androstenedione).

Analytical Notes

  • Morning sample mandatory in adult men
  • Fasting sample improves binding-protein consistency
  • LC–MS/MS is gold standard
  • SHBG assay required for accurate free T calculation
  • Avoid testing during acute illness (suppresses T)

Clinical Pearls

  • Testosterone should always be interpreted with LH, FSH, SHBG, and clinical context.
  • Obesity lowers SHBG → low total T but normal free T.
  • Aging decreases free testosterone more rapidly than total T.
  • Women with PCOS often have normal total T but high free T due to low SHBG.
  • Very high testosterone (>1500 ng/dL) strongly suggests exogenous use or tumor.

Interesting Fact

Women produce three times more testosterone than estrogen daily - most is converted peripherally to estradiol or inactivated.

References

  1. Tietz Clinical Chemistry & Molecular Diagnostics, 8th Edition - Endocrine Chemistry
  2. Endocrine Society - Clinical Practice Guideline for Hypogonadism (2018)
  3. AACE Guidelines - Testosterone Therapy
  4. Mayo Clinic Laboratories - Testosterone
  5. ARUP Consult - Androgen Testing
  6. NIH / MedlinePlus - Testosterone

Last updated: January 27, 2026

Reviewed by : Medical Review Board

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