Free Testosterone Test: What does it mean?

September 11, 2023

Mira's piece that covers the basics of testosterone, emphasising its role in both genders and its conversion to estrogen in women is an eye opening read. The spotlight on free testosterone, its measurement, and diagnostic significance adds depth to understanding hormonal health. The breakdown of the purpose behind performing free testosterone tests is clear and insightful. It effectively communicates how such tests can aid in identifying symptoms related to hormonal imbalances, especially in women. Thank you Mira!

Written by Crystal for Mira

What is free testosterone?

Testosterone is a hormone that both men and women have in their bodies. Testosterone is also produced in the ovary, adrenal cortex, and placenta during pregnancy. Testosterone is important for many things in women, like keeping their sex drive healthy and strengthening their bones and muscles. Testosterone can also be turned into estrogen, which is the main sex hormone in women.

Blood tests for testosterone measure different forms, including free testosterone, which is the active form not bound to other molecules. This test helps diagnose specific medical conditions.

What is the purpose of performing a free testosterone test?

Testing free testosterone levels can assist in diagnosing symptoms related to hormonal imbalances. In women, testosterone plays a crucial role in maintaining a healthy sex drive, promoting bone health, and enhancing bone strength and growth.

What does it mean if my free testosterone results are low?

Low levels of testosterone in women can lead to symptoms such as sluggishness, mood swings, muscle weakness, fatigue, sleep disturbances, lack of concentration, reduced sex drive and sexual satisfaction, weight gain, hair thinning, fertility issues, irregular menstrual cycles, and vaginal dryness.

Please note: Low testosterone symptoms in women can be mild and similar to other conditions such as hypothyroidism or iron deficiency anemia. Multiple tests are necessary to distinguish between these conditions.

Low results cause:

Testosterone levels naturally decrease as women age, especially after menopause.
Medications that manage menopause side effects can lower testosterone levels, such as oral estrogen.
Women undergoing ovary removal surgery or chemotherapy may experience low testosterone levels.
Eating disorders, like anorexia, can disrupt testosterone production due to a lack of fatty tissue involvement in hormone development.
Birth control pills can decrease testosterone levels by increasing sex hormone-binding globulin (SHBG).
Adrenal or pituitary gland conditions, like tumors, can reduce testosterone production in women.

What does it mean if my free testosterone results are high?

High levels of testosterone in women can be associated with symptoms including irregular or absent periods, excess facial and body hair growth, blood sugar imbalances, difficulty getting pregnant, thinning hair on the scalp, and excessive acne.

High results cause:
The leading causes of high testosterone levels in women are:

Polycystic ovary syndrome (PCOS). A hormonal disorder characterized by elevated levels of androgens, including testosterone. This can result in disrupted ovulation and a range of symptoms such as excessive facial and body hair growth, irregular or absent menstrual cycles, acne, and hair thinning or loss. PCOS can also make it difficult for women to get pregnant.
Congenital adrenal hyperplasia (CAH). A genetic disorder affecting the adrenal glands, located on top of the kidneys, that produce hormones regulating metabolism, the immune system, and other functions. Women with CAH produce excess androgens leading to symptoms similar to those of PCOS, such as irregular menstrual cycles, increased facial and body hair growth, and infertility.
Thyroid problems. Research has shown that hypothyroidism, a condition where the thyroid gland is underactive, is indirectly connected to high testosterone levels in women. This is because hypothyroidism can lead to reduced production of the sex hormone-binding globulin (SHBG), which is important in balancing sex hormones in the blood. If SHBG levels decrease excessively, it can result in an increase in testosterone levels, leading to associated symptoms.
Insulin resistance happens when the body becomes less responsive to the effects of insulin, resulting in elevated blood sugar levels. This, in turn, can trigger testosterone production in the ovaries, as insulin levels rise and remain unused in the bloodstream.
Cushing syndrome. A condition that can potentially cause high testosterone levels in women. This syndrome leads to the adrenal glands’ overproduction of hormones such as androgens and cortisol, resulting in increased testosterone levels. Additionally, tumors in the adrenal or ovarian glands that produce excess androgens can also lead to high testosterone levels.
Hormone therapies—such as anabolic steroids, testosterone replacement therapy, and DHEA supplementation, can elevate testosterone levels in women.