Accurate measurement of total and free testosterone levels for the diagnosis of androgen disorders

Ezgi Caliskan Guzelce; Francesca Galbiati; Anna L Goldman; Arijeet K Gattu; Shehzad Basaria; Shalender Bhasin

doi:10.1016/j.beem.2022.101683

Accurate measurement of total and free testosterone levels for the diagnosis of androgen disorders

Best Pract Res Clin Endocrinol Metab. 2022 Jul;36(4):101683. doi: 10.1016/j.beem.2022.101683. Epub 2022 Jul 16.

Authors

Ezgi Caliskan Guzelce¹, Francesca Galbiati¹, Anna L Goldman², Arijeet K Gattu¹, Shehzad Basaria³, Shalender Bhasin⁴

Affiliations

¹ Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA.
² Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA; Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: algoldman1@bwh.harvard.edu.
³ Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA; Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, MA, USA.
⁴ Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA; Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, MA, USA; Boston Claude D. Pepper Older Americans Independence Center, Boston, MA, USA.

PMID: 35927159
DOI: 10.1016/j.beem.2022.101683

Abstract

The circulating concentrations of total and free testosterone vary substantially in people over time due to biologic factors as well as due to measurement variation. Accurate measurement of total and free testosterone is essential for making the diagnosis of androgen disorders. Total testosterone should ideally be measured in a fasting state in the morning using a reliable assay, such as liquid chromatography tandem mass spectrometry, in a laboratory that is certified by an accuracy-based benchmark. Free testosterone levels should be measured in men in whom alterations in binding protein concentrations are suspected or in whom total testosterone levels are only slightly above or slightly below the lower limit of the normal male range for testosterone.

Keywords: SHBG; bioavailable testosterone; equilibrium dialysis; hypogonadism; liquid chromatography tandem mass spectrometry; testosterone deficiency.

Publication types

Review

MeSH terms

Androgens*
Humans
Male
Sex Hormone-Binding Globulin / analysis
Sex Hormone-Binding Globulin / metabolism
Testosterone*

Substances

Androgens
Sex Hormone-Binding Globulin
Testosterone