--- title: "Low Testosterone: What Blood Tests to Order" type: condition url: "https://www.test-well.com/conditions/low-testosterone" date_published: 2026-04-13 date_modified: 2026-05-04 reviewed_at: 2026-09-14 --- # Low Testosterone: What Blood Tests to Order *Comprehensive testosterone testing with Total, Free, and supporting hormones — at a fraction of what clinics charge.* > The Men's Health Panel ($139.99) covers Total/Free Testosterone, SHBG, PSA, Thyroid, and metabolic markers. For focused testing, start with Testosterone Total ($33.99). ## Recommended tests | Recommended | Type | Price | Why | | --- | --- | --- | --- | | [Men's Health Panel](https://www.test-well.com/tests/mens-health-panel) | Panel (8 tests) | $139.99 | Comprehensive male hormone, metabolic & PSA panel | | [Testosterone, Total](https://www.test-well.com/tests/testosterone-total) | Test | $33.99 | First-line screening test for low T | | [Testosterone, Free & Total](https://www.test-well.com/tests/testosterone-free-and-total) | Test | $54.99 | Includes calculated free testosterone | | [SHBG (Sex Hormone Binding Globulin)](https://www.test-well.com/tests/shbg-sex-hormone-binding-globulin) | Test | $34.99 | Determines how much testosterone is bioavailable | | [LH (Luteinizing Hormone)](https://www.test-well.com/tests/luteinizing-hormone) | Test | $36.99 | Distinguishes primary vs secondary hypogonadism | | [PSA, Free & Total](https://www.test-well.com/tests/psa-free-and-total) | Test | $48.99 | Prostate screening — required before starting TRT | All prices are cash-pay plus one $6 lab processing fee per order; physician authorization is included. ## Essential Testosterone Blood Tests Testosterone evaluation requires more than just a single number. The Endocrine Society guidelines recommend a thorough workup that includes multiple markers to confirm the diagnosis, determine the cause, and rule out contraindications to treatment. **The core testosterone panel should include:** - **Total Testosterone** — the primary screening test. Normal range for adult men is approximately 264–916 ng/dL (Endocrine Society), though many experts consider optimal to be 500–900 ng/dL. Two morning measurements below 300 ng/dL on separate days are required for a formal diagnosis of hypogonadism. - **Free Testosterone** — only 2–3% of testosterone is "free" (unbound) and biologically active. Calculated from total testosterone, SHBG, and albumin. Free T can be low even when total T is normal if SHBG is elevated. - **SHBG (Sex Hormone-Binding Globulin)** — this protein binds testosterone and makes it inactive. High SHBG (common with aging, liver disease, hyperthyroidism) artificially inflates total T while reducing free T. Low SHBG (common with obesity, insulin resistance, diabetes) does the opposite. - **LH (Luteinizing Hormone)** — produced by the pituitary gland to stimulate testosterone production. LH distinguishes between primary hypogonadism (testicular failure — high LH) and secondary hypogonadism (pituitary/hypothalamic dysfunction — low or normal LH). - **PSA (Prostate-Specific Antigen)** — a baseline PSA is essential before starting testosterone replacement therapy (TRT), as exogenous testosterone is contraindicated with untreated prostate cancer. **Timing matters:** Testosterone follows a circadian rhythm, peaking between 7–10 AM and declining 20–25% by the afternoon. Always draw testosterone labs in the early morning (before 10 AM) for the most accurate reading. ## Total vs Free Testosterone Understanding the distinction between total and free testosterone is essential for accurate diagnosis. In your blood, testosterone exists in three forms: - **SHBG-bound (60–70%)** — tightly bound to Sex Hormone-Binding Globulin. This fraction is biologically inactive and cannot enter cells. - **Albumin-bound (25–35%)** — loosely bound to albumin. This fraction can dissociate and become available at tissue level. It's considered "bioavailable." - **Free (2–3%)** — completely unbound and immediately active. This is the fraction that binds to androgen receptors and produces effects. **When the numbers disagree:** The most common clinical scenario is a man with symptoms of low T whose total testosterone is in the low-normal range (350–450 ng/dL) but whose free testosterone is below normal. This typically happens when SHBG is elevated — something that increases with age, liver disease, hyperthyroidism, and certain medications (anticonvulsants, estrogen). Conversely, obese men often have low SHBG (driven by insulin resistance), which artificially depresses total testosterone while free testosterone may still be adequate. Losing weight often normalizes SHBG and total testosterone in these cases. **Reference ranges for free testosterone** vary significantly by lab and method. Direct analog assays (common at commercial labs) are less accurate than equilibrium dialysis or calculated free T from total T + SHBG. Generally, free testosterone below 5–9 ng/dL (50–90 pg/mL) in men suggests deficiency, depending on the assay used. Bottom line: always interpret total testosterone alongside SHBG and free testosterone. Any one of these numbers in isolation can be misleading. ## Supporting Hormones That Matter (LH, FSH, SHBG) Testosterone doesn't exist in a vacuum — several interconnected hormones regulate its production and activity. Testing these supporting markers is what separates a thorough evaluation from a superficial one. **LH (Luteinizing Hormone):** LH is the signal from your pituitary gland telling your testes to produce testosterone. It's the most important test for determining the *cause* of low testosterone: - **Low T + High LH (above 10 mIU/mL)** = Primary hypogonadism. Your testes are failing despite adequate stimulation. Causes include Klinefelter syndrome, prior testicular injury, mumps orchitis, varicocele, and aging. Treatment is testosterone replacement. - **Low T + Low or Normal LH** = Secondary (central) hypogonadism. Your pituitary isn't sending enough signal. Causes include pituitary tumors, obesity, opioid use, sleep apnea, stress, and overtraining. Treatment may involve addressing the underlying cause, clomiphene citrate, or TRT. **FSH (Follicle-Stimulating Hormone):** FSH drives sperm production (spermatogenesis). Elevated FSH with low testosterone suggests primary testicular failure. FSH is especially important to check if fertility is a concern, because TRT suppresses sperm production — sometimes to zero. Men who want to preserve fertility should discuss alternatives like clomiphene or hCG with their provider. **Estradiol:** Men produce estradiol through aromatization of testosterone, primarily in fat tissue. Estradiol in men should typically be 20–40 pg/mL. Elevated estradiol (common in obesity) can cause gynecomastia (breast tissue growth), water retention, and mood changes. It can also suppress LH production through negative feedback, worsening low T. **Prolactin:** If LH and testosterone are both low, some providers will check prolactin to screen for a prolactinoma (a benign pituitary tumor that suppresses LH). Elevated prolactin (above 20–25 ng/mL) warrants an MRI of the pituitary. ## TRT Monitoring If you're on testosterone replacement therapy (TRT), regular blood work is non-negotiable. The Endocrine Society recommends the following monitoring schedule: **Before starting TRT:** - Confirm low testosterone on two separate morning draws - Baseline PSA and digital rectal exam (if age ≥40) - Baseline hematocrit/hemoglobin (CBC) - Baseline lipid panel - Assess for sleep apnea, fertility goals, and cardiovascular risk **Monitoring on TRT — check at 3, 6, and 12 months, then annually:** - **Total testosterone** — target mid-normal range (500–700 ng/dL for most protocols). Draw at trough (right before next injection for IM; any time for daily topicals). - **Hematocrit (CBC)** — testosterone stimulates red blood cell production. Hematocrit above 54% increases blood viscosity and clotting risk. If this happens, your dose may need to be reduced or you may need to donate blood. - **PSA** — monitor for prostate changes. A rise greater than 1.4 ng/mL within 12 months or above 4.0 ng/mL warrants urology referral. Note: testosterone does not *cause* prostate cancer, but it can accelerate growth of an existing cancer. - **Estradiol** — monitor for symptoms of excess estrogen (water retention, breast tenderness, mood). An aromatase inhibitor may be added if estradiol climbs above 40–50 pg/mL with symptoms. - **Lipid panel** — TRT can lower HDL cholesterol. Monitor and manage cardiovascular risk factors proactively. **Important note:** If you started TRT and want to discontinue, taper under medical supervision. Abrupt cessation can cause a prolonged period of very low testosterone while your hypothalamic-pituitary-gonadal axis recovers — a process that can take weeks to months. ## Frequently asked questions ### What testosterone level is considered low? The Endocrine Society defines low testosterone (hypogonadism) as a total testosterone below 300 ng/dL on two separate morning blood draws. However, symptoms can occur at higher levels if free testosterone is low due to elevated SHBG. Many clinicians consider the 300–400 ng/dL range as a "gray zone" where treatment may be warranted if symptoms are significant and free testosterone is also low. ### Why do I need to get blood drawn in the morning? Testosterone follows a circadian rhythm — levels are highest between 7–10 AM and decline by 20–25% by the afternoon, with even larger drops in younger men. An afternoon draw can make your testosterone look 100–200 ng/dL lower than your true peak, potentially leading to a false diagnosis. Always draw before 10 AM for the most accurate result. ### Will TRT affect my fertility? Yes. Exogenous testosterone suppresses LH and FSH production through negative feedback, which in turn suppresses sperm production. In some men, sperm counts can drop to zero (azoospermia). This effect is usually reversible upon stopping TRT, but recovery can take 6–12 months or longer. If fertility is a current or future goal, discuss alternatives like clomiphene citrate or hCG with your doctor before starting TRT. ### What's the difference between the Men's Health Panel and just a testosterone test? A standalone testosterone test gives you one number — total testosterone. The Men's Health Panel provides a comprehensive picture: Total and Free Testosterone, SHBG (to explain discrepancies between total and free T), PSA (prostate safety), thyroid function (TSH), metabolic markers (glucose, lipids, CBC), and more. For a first-time evaluation, the panel is strongly recommended because low T often coexists with thyroid issues, metabolic dysfunction, or other conditions that a single test would miss. ### Can lifestyle changes raise testosterone without TRT? Yes, particularly for secondary hypogonadism driven by lifestyle factors. Evidence-based strategies include: losing excess body fat (especially visceral fat — each point of BMI reduction can increase testosterone by ~10 ng/dL), resistance training (heavy compound lifts boost acute and chronic T levels), improving sleep quality and duration (sleeping less than 6 hours can reduce testosterone by 10–15%), reducing alcohol consumption, managing chronic stress, and ensuring adequate zinc, vitamin D, and magnesium intake. These strategies can meaningfully raise levels in the 50–150 ng/dL range for many men. --- Medically reviewed by Youmna DiStefano, MD (Medical Reviewer, TestWell); last reviewed 2026-09-14. 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