Sexual Health

What Is Free Testosterone?

Hormones are part of the endocrine system in the human body. Several hormones are needed for the body to function normally.

Among men, one of the most referenced hormones would be testosterone. This hormone helps a boy develop certain features. This includes a deep voice and the growth of his testes and penis. Body hair also starts to grow due to testosterone.

In adult men, the sex hormone continues to play a crucial role. A lack of testosterone is rather common among middle-aged men and older male patients1.

When total testosterone levels are low, a man is at risk of certain complications. This can lead to the development of hypogonadism too. Thus, understand how serum testosterone plays a role in male health is essential.

We turn our focus to free testosterone in this post. We consider what free or bioavailable testosterone is. The post also looks at the difference between free and total testosterone. Furthermore, we look at how hypogonadal men can recover with different treatments and remedies.

What Is Free Testosterone?

Testosterone is produced by both the adrenal glands and the testes. The production of testosterone is regulated by a small part of the endocrine system known as the pituitary gland.

When a man is suspected of having low testosterone, a test needs to be taken. The results need to be understood by the patient. When presented with the results, there will be different measurements.

One of these measurements is called free testosterone. Sometimes, it may also be referred to as bioavailable testosterone. This is a term used to refer to the testosterone that is freely roaming in the patient’s blood circulatory system.

When testosterone is produced, it generally tends to attach to one of two proteins.

The two hormones that testosterone attaches to include2:

  • Sex Hormone Binding Globulin, also known as SHBG levels.

  • Albumin

Some of the testosterone that the endocrine system produce will not connect to either of these proteins. These hormones continue to circulate in the blood circulatory system – and are referred to as free testosterone.

Free testosterone can be easily used by a patient’s body. This is why tests generally consider the level of bioavailable testosterone in a man’s body significant. It tells a physician how much testosterone is readily available for the tissue and various systems in the body to utilize.

It should be noted that the body can easily use the testosterone attached to albumin. The hormone is referred to as albumin-bound testosterone.

The Difference Between Free Testosterone And Total Testosterone

When a man gets tested for serum testosterone, the test will show various measurements. These generally include total and free testosterone. Another measurement for albumin-bound testosterone will usually also be provided as part of the test results.

Men need to understand how these measurements differ from each other.

Total testosterone is a measurement that provides details of all testosterone hormones in the patient’s body. This includes free testosterone and albumin-bound testosterone. Additionally, this test result also includes information on the testosterone that has been bound to SHBG.

Free testosterone does not look at all of the testosterone hormones in the system. Instead, it only indicates the testosterone that is available for the body to utilize. This is one of the most important factors to look at. Even when total testosterone levels are considered normal, some factors can adversely affect free testosterone levels.

When men experience signs of androgen deficiency, all three testosterone measurements must be taken. This provides a more accurate overview of whether their testosterone production may be contributing to the symptoms experienced.

How Are Testosterone Levels Tested?

Testing for testosterone is important for men over 40. This is because the prevalence of testosterone deficiency is more common among men at this age. The risk of andropause also dramatically increases with age. By the age of 65, over 60% of male patients have low testosterone levels3.

A test for testosterone levels is generally straightforward. A man may be provided instructions to follow before the test is conducted. In many cases, a physician may order multiple tests to get an average.

Testosterone levels often tend to be highest in the morning too. For this reason, the test may be conducted as early as possible.

Testing for testosterone is often part of a screening test for men. This will most often be included in the process for men who are older than the age of 40.

A testosterone test measures levels of the hormone in the blood circulatory system. For this reason, a blood sample needs to be collected from the patient.

A doctor may often draw blood in his office. In such a case, the blood will be added to a specialized tube, which will then be sent to a laboratory. There are also cases where a physician may ask the patient to visit the laboratory themselves. In these scenarios, the doctor will not draw the blood in their office. Instead, professionals at the laboratory will collect a blood sample from the male patient.

Scientists at the laboratory will conduct tests on the blood sample provided. They will then be able to provide a reading on the testosterone that is found in the blood.

The test will provide different values. This is because testosterone is processed in different ways in the male patient’s body.

The test will contain data for total testosterone. This is not the only value that should be taken into consideration. The analysis also provides data for the following4:

  • Free testosterone

  • albumin-bound testosterone

  • Testosterone bound to SHBG

Bioavailable testosterone may also be provided. In most scenarios, this refers to both free testosterone and albumin-bound testosterone levels combined.

Once the test results are obtained, a physician will analyze them. This allows the physician to determine if the man has normal levels of sex hormones. It also helps them identify if problems may be present with testosterone levels. This may include high or low testosterone. Both of these cases can cause complications in the patient.

An appropriate treatment program would then be developed to help restore normal levels of the hormone. The treatment program will generally be personalized according to the findings of the testosterone test.

What Are Considered Normal Testosterone Levels?

When a man undergoes a test for their testosterone levels, they must understand what the results mean. As noted previously, testosterone tests provide different values. Each value should be appropriately interpreted.

The test results tell the patient if there are too many or too few of these hormones in their blood. In cases where normal results are found, it can also indicate that the symptoms experienced are related to another potential cause.

It should be noted that the test will often also include readings for sex hormone-binding globulin in the blood. This result is taken into account when calculating the free testosterone in the patient’s body.

Normal testosterone levels will fall within the following criteria ranges5:

  • Total testosterone in adult men between 19 and 49 years should be between 249 ng/dL and 836 ng/dL.

  • Total testosterone in men over the age of 50 should fall between 193 ng/dL and 740 ng/dL.

  • Free testosterone levels in adult men older than 18 years should be between 32 and 168 pg/mL.

  • Sex hormone-binding globulin levels in men should always fall between 10 and 80 nmol/L.

In younger children, a tanner stage is applied. This accounts for boys and girls before they reach the age of puberty. The advised level of free testosterone in tanner stages ranges from 3 pg/mL to 165 pg/mL. This does depend on age and the appearance of signs that are related to puberty.

What Role Does Testosterone Play In Men’s Health?

Men need to understand the important roles that testosterone plays. When free or bioavailable testosterone is deficient, the systems that rely on the sex hormone will not function correctly. This can lead to several potential adverse effects on the human body.

To provide a better view of why testosterone is important, we will consider some of the most crucial functions that the hormone has in the body below.

Some of the bodily functions and features that are regulated by testosterone include:

  • The strength and size of muscles. Men with low testosterone will often find that they experience a decrease in muscle mass. Physical muscle strength may also decline.

  • Sex drive is regulated by testosterone. Men who have low testosterone levels may have poor libido. This can cause symptoms of erectile dysfunction too.

  • The production of sperm also depends on testosterone. Thus, when there is an imbalance in testosterone levels, a man is at risk of infertility. A reduction in sperm volume causes this.

  • Bone health also relies on testosterone. Both bone strength and growth rely on a healthy level of testosterone.

  • The hormone also has an essential function in the production of red blood cells. Low levels of testosterone can lead to poor red blood cell production.

  • Testosterone assists with the distribution of body fat. Low levels of the hormone can interfere with fat distribution. This is why many men with andropause tend to experience an increase in abdominal fat.

    This leads to a higher risk of obesity and increased waist circumference. Abdominal fat has also been linked to more serious health complications compared to the fat that is distributed to other regions of the male body.

Testosterone also plays a role in mental health. A healthy level of the sex hormone helps with the regulation of a male patient’s mood.

How Can You Balance Testosterone Levels?

A normal balance in testosterone levels is essential. This can help to avoid serious complications that have been associated with an imbalance in sex hormones. It is important to understand that both high or low testosterone can be problematic.

Several strategies have been suggested to help men balance their testosterone levels. There are medical treatments available, as well as certain natural remedies. Men need to understand all the available options. This will help them realize which treatment would be most appropriate for them. It is important to look at both the pros and cons of each treatment too.

Medications/Surgery

Medical treatment for andropause generally involves the use of testosterone replacement therapy. This treatment uses synthetically produced testosterone. There are different forms of administration for this synthetic testosterone.

In many cases, an injection is used to provide an increase in testosterone. There are also patches available that are replaced at certain intervals.

These patches gradually release testosterone into the man’s body. Injections are often still preferred since they push the testosterone directly in the patient’s body. A gel is also available that can help in boosting testosterone levels in the patient.

There are side-effects associated with testosterone replacement therapy. Some side-effects are mild and not something to be concerned about. There are, however, a few serious side-effects that may be harmful to the male patient’s general well-being.

Some common side-effects that people may experience when they undergo testosterone replacement therapy include:

  • The development of acne

  • The skin may become oily

  • Some men find that their breasts become enlarged.

  • The risk of developing blood clots increases, which is a severe complication that needs to be taken into consideration.

  • Men with existing sleep apnea may experience an increase in the symptoms.

  • Some men experience an increase in mood swings. There may also be problems with aggression.

  • In some cases, the testicular size of a man may also decrease.

  • There have been reports of a higher risk related to stroke and heart attacks among men who receive testosterone replacement therapy.

Certain laboratory abnormalities have been associated with testosterone replacement therapy. This includes changes in lipid levels, as well as cholesterol balance. There also seems to be an increase in the number of red blood cells in the body. Some men experience a reduction in their sperm count with this medical treatment. A higher PSA score has also been detected in men undergoing this therapy.

Lifestyle Changes

The risks associated with medical treatment for low testosterone are worrisome. This is why a lot of men are seeking alternative ways to restore a better balance in their sex hormone levels. Many lifestyle changes have been shown to produce impressive results.

We should start by considering the link between obese men and low testosterone. Men who are obese have a higher risk of developing low testosterone. This is a fact that has been proven by several scientific studies too6.

Thus, making lifestyle changes to fight against obesity should gain priority in this case. When excess fat in the body is reduced, there is a good chance that testosterone levels may become more balanced.

Many of the lifestyle changes needed to lose weight can also directly benefit the balance of testosterone levels in the patient’s body. Exercise, for example, is critical for men with an imbalance in their sex hormones. Various types of exercises may help, with an emphasis placed on weight lifting.

Diet should be adjusted too. An increase in the consumption of high-quality proteins can help. Good sources of carbs and healthy fats should be included too. This helps with the balance of testosterone also.

It is also vital for men to get enough sleep and to control their stress levels. High-stress levels cause an increase in the secretion of cortisol. This is a hormone that has been found to interfere with testosterone. A high cortisol level leads to problems with testosterone balance. This has been found to cause a decline in sex hormone levels.

Natural Supplements

There are a few natural supplements that may also help men with an imbalance in testosterone levels. It is important to note that not all of the supplements promoted have been scientifically proven to yield an improvement in testosterone balance.

Some supplements that men should look for include:

  • DHEA

  • Fenugreek

  • D-Aspartic Acid

These supplements may help restore a better balance in testosterone levels in men.

Conclusion

Testosterone production helps adult men maintain a healthier bone mineral density and cardiovascular system. It also contributes to improvements in the man’s sex drive.

Both low and high testosterone can cause problems in male patients. Men may experience issues with their erectile function, among other complications. Testosterone therapy is a standard treatment option for low levels of the hormone. Side-effects have been linked to these treatments, however.

Alternative treatment options have been recommended to help restore normal levels of testosterone. This includes a few important lifestyle changes and a look at the potential causes behind the problem. Natural supplements have also been suggested in some cases.

Sources

  1. Translational Andrology And Urology. (2017) Testosterone deficiency in adults and corresponding treatment patterns across the globe. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422691/ 
  2.  University of Rochester Medical Center. Free Testosterone. [online] Available at: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=testosterone_free 
  3. Boston University School of Medicine. Prevalence, Diagnosis, and Treatment of Hypogonadism in Men. [online] Available at: https://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/ 
  4.  WebMD. What Is a Testosterone Test? [online] Available at: https://www.webmd.com/a-to-z-guides/testosterone-test#1 
  5.  University of IOWA Health Care. Testosterone, Free and Total, Adult. [online] Available at: https://www.healthcare.uiowa.edu/path_handbook/handbook/test1802.html 
  6. Asian Journal of Andrology. (2014) Lowered testosterone in male obesity: mechanisms, morbidity, and management. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955331/ 

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