Testosterone test for women: which one to order

Testosterone is often called a male hormone, but women make it too, in smaller amounts. A testosterone test measures how much is in your blood. Most women who order one are looking into hair growth, acne, hair thinning or irregular periods.

This page explains the versions of the test, which one to pick, and what a published range for women looks like.

Total testosterone

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Total, free and bioavailable testosterone

MedlinePlus explains that the testosterone in your blood is either bound to proteins or unbound (free). Most of it is bound to proteins such as SHBG and albumin. It lists three ways to measure it:

Total testosterone measures bound and free testosterone together. MedlinePlus calls it the most common type of test.
Free testosterone measures only the unattached form. It is less common but may help a provider diagnose certain conditions.
Bioavailable testosterone measures free testosterone plus testosterone attached to proteins other than SHBG. It is not commonly done.

For women, the choice is simple. Total testosterone is the usual starting point. Free and total testosterone adds the free number. For PCOS and other signs of high androgens, the international guideline says clinicians should use total and free testosterone. See the PCOS tests page for how that fits into a diagnosis.

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Why women get tested

MedlinePlus says that in women the test is mostly used for symptoms of high testosterone. These include:

Excess hair growth on the face or body
Hair loss on the head that looks like male-pattern baldness
Voice changes
Irregular or absent periods
Difficulty getting pregnant
Acne

The Endocrine Society’s hirsutism guideline suggests testing for high androgen levels in all women with an abnormal hirsutism score. It suggests against testing in women with regular periods who have unwanted hair in one area only.

MedlinePlus adds that the test can help find the cause of abnormal levels, and can be used to monitor people who had an abnormal result before or who take medicine or hormone therapy that may affect testosterone.

A published range for women

Ranges differ between labs and methods, so the range on your own report is the one that counts. For a published example, a study of 985 women aged 20 to 80 (the Study of Health in Pomerania) reported the middle 95% of results, with the lowest and highest 2.5% left out:

Measure	Middle 95% of results in the study
Total testosterone	0.35 to 1.97 nmol/L (about 10 to 57 ng/dL)
Free testosterone, as calculated in the study	0.0025 to 0.0253 nmol/L (about 0.7 to 7.3 pg/mL)

Source: Haring et al., J Clin Endocrinol Metab, 2012. The study found that total and free testosterone fall with age across those years. It also gave separate ranges for premenopausal and postmenopausal women, which are in the full paper.

The PCOS guideline adds a caution: reference ranges vary widely between methods and labs, and are often built from groups that may include women with PCOS.

Getting ready for the test

Time of day. MedlinePlus says a testosterone blood draw is usually done in the morning, between 7 and 10, when levels are typically highest.
Fasting. The seller’s page says fasting is not required for its testosterone orders. MedlinePlus says some people are asked to fast. If you have a lab order, follow it.
Medicines. Tell the person who orders or reads your test about everything you take. Do not stop a medicine unless your clinician says to.
The combined birth control pill. The PCOS guideline says the pill raises SHBG and lowers androgen production, which makes androgens very difficult to judge. Mention it to your clinician.

What the result can mean

MedlinePlus is clear that a testosterone test alone cannot diagnose any health condition. Abnormal results alongside symptoms may point to a problem.

High results in women can be linked to PCOS, ovarian problems, adrenal gland disorders such as congenital adrenal hyperplasia, or a pituitary disorder. See high testosterone in women.
Low results are normal in women. MedlinePlus says only extremely low levels may point to an adrenal, pituitary or ovarian disorder. See low testosterone in women.

Testosterone also falls with age, which MedlinePlus calls normal. Most testosterone is bound to SHBG and albumin, which is why SHBG is sometimes looked at alongside it.

When to see a clinician

Take your result to a clinician if it is outside the range on your report, or if you have symptoms that bother you, whatever the number says. Symptoms that start suddenly or worsen fast, such as a deepening voice or rapidly increasing hair growth, are worth raising soon, because the guideline says new-onset, severe or worsening signs need further investigation.