Low Testosterone: Free vs. Total Testosterone Levels
Posted: June 9, 2022
Low testosterone is a common but serious health condition where you don’t have enough of the hormone testosterone. It is more common among men as they age and can cause frustrating symptoms that interrupt everyday life. If you think you have low testosterone, visit our health care providers for diagnosis and treatment to take the first step toward better health. It’s important to understand that both low total testosterone and low free testosterone can play a role in your symptoms and overall health. In this article, we’ll discuss the differences between free and total testosterone.
What is Low Testosterone?
Low testosterone, also known as low T or hypogonadism, is where you have testosterone levels that are lower than normal. This is usually adjusted by age, as men naturally lose about 1% of testosterone per year after you reach your 30s. Testosterone deficiency can cause many different symptoms, such as:
- Low sex drive
- Erectile dysfunction
- Low energy
- Mood changes
- Reduced muscle mass
- Unexpected weight gain
As you can see, the symptoms of low testosterone can seriously affect your life. What’s more, low T levels can also increase your risk for many other health conditions, like obesity, osteoporosis, metabolic syndrome, and diabetes.
What many people don’t know is that there are two main types of testosterone levels that our doctors can check: total testosterone and free testosterone. If either one is low, you might experience symptoms and health complications.
Low Total Testosterone
Total testosterone is the total amount of testosterone in your blood. This includes both bound and unbound testosterone. Bound testosterone is attached to proteins like sex hormone binding globulin (SHBG) and albumin. Unbound or free testosterone isn’t bound to any proteins and simply circulates in the blood. Total testosterone is important to look at if you’re experiencing symptoms of low testosterone, as it offers a big picture of overall testosterone production. If you have low levels of total testosterone, then your body may not have enough to perform important functions like making red blood cells, regulating sex drive, or increasing muscle mass.
Low Free Testosterone
Free testosterone is a measurement of how much testosterone is free for your body to use. Also known as bioavailable testosterone, this is the amount of testosterone that your cells can use easily. When testosterone is bound to proteins in the blood like SHBG, it’s not available for your cells. SHBG’s primary role is to bind to sex hormones like testosterone. It carries hormones through the bloodstream and regulates how much your cells can use at any given time. Normally, the amount of free testosterone in your body is anywhere from 2% to 5% of your total testosterone. Low levels of free testosterone can also cause symptoms of testosterone deficiency.
You Can Have Low Free Testosterone and Normal Total Testosterone Levels
As you may have guessed, if you have low total testosterone levels, then your free testosterone levels are also likely low. However, you can also have low free testosterone while having normal total testosterone levels in your blood. This is generally due to high amounts of SHBG in your blood. As we age, total testosterone production decreases and SHBG increases. This can put you at risk for low free testosterone, often leading to symptoms of low testosterone despite having normal ranges of total testosterone in your blood.
How do Doctors Diagnose Low Testosterone?
If you think you might be suffering from low T, then you should make an appointment with one of our providers. Diagnosing low testosterone involves a few steps, customized to you and your health history. However, it typically starts with a physical exam and discussing your symptoms with our provider. Our providers can request a blood test to look at many different markers of health, including cholesterol levels, blood counts, and testosterone levels. The doctor then uses this information to identify underlying causes of your symptoms.
Testing for Low Testosterone Levels
Testing your testosterone levels involves a simple blood test. Usually, we take this blood draw in the morning when testosterone levels are at their highest. The blood goes to a lab where they determine if you have normal levels of testosterone. If you have lower testosterone levels in your blood, then we confirm with a second blood draw, as testosterone levels can fluctuate day to day.
Total Testosterone vs. Free Testosterone Tests
As part of a testosterone test, we typically test for total testosterone as well as SHBG levels. This allows the lab to look at both total testosterone levels and free testosterone levels, since most bound testosterone is attached to SHBG proteins.
Other clinics often only test total testosterone levels. Most only order a free testosterone test if total testosterone levels are borderline for low T. However, as we mentioned in an earlier section, you can have normal total testosterone and low free testosterone due to high SHBG levels. Therefore, we test for both in a full blood panel during our comprehensive health assessments.
Low Free Testosterone Can Cause Symptoms
Even if you have normal total testosterone levels, low free testosterone can still cause symptoms of hypogonadism. In fact, a 2016 study published in the Journal of Clinical Endocrinology & Metabolism found that men with low free testosterone and normal total testosterone still experienced symptoms of hypogonadism. The researchers looked at testosterone levels and symptoms in over 3,000 men aged 40 to 79 and found that the men who had normal total testosterone and low free testosterone still experienced symptoms such as sexual dysfunction, worse general health, and poor physical function. Therefore, free testosterone plays an important role in your health. The good news is, testosterone replacement therapy (TRT) can help relieve your symptoms and restore normal testosterone levels in your body.
Treating Low Testosterone Levels with TRT
Whether you have low total testosterone or low free testosterone, TRT can help with your symptoms. Testosterone replacement therapy comes in many forms to help increase testosterone levels in your body to normal, healthy ranges. Our providers typically prescribe testosterone injections, which offer many benefits. Injectable testosterone replacement medicines are mess-free and administered typically every seven to 14 days for convenience. Testosterone injections also allow our providers to make easy dosage adjustments to optimize your treatment.
When you begin a TRT program through our clinics, we provide comprehensive management to help you stay healthy. Whether you choose at-home or in-office testosterone injections, our team monitors things like your symptoms, blood pressure, testosterone levels, and blood counts to help with health management and tailor your treatment program to you.
Low T Center: Complete Men’s Health Management to Improve Your Life
Our professionals at Low T Center are here to help you improve your health. We offer a wide range of treatment services to help you feel your best. Our process begins with a comprehensive health assessment to identify underlying conditions and causes of your symptoms so we can design customized, holistic treatment solutions for your needs. Make an appointment today to start improving your health.
Disclaimer: This article is made available for general, entertainment and educational purposes only. The opinions expressed herein do not necessarily reflect those of Low T Center. You should always seek the advice of a licensed healthcare professional.