Accurate measurement of total and free testosterone levels for the diagnosis of androgen disorders - 01/09/22

Doi : 10.1016/j.beem.2022.101683

Ezgi Caliskan Guzelce ^a : Clinical/Research Fellow, Francesca Galbiati ^a : Clinical/Research Fellow, Anna L. Goldman ^a,^b,^⁎ : Instructor of Medicine, Arijeet K. Gattu ^a : Instructor of Medicine, Shehzad Basaria ^a,^b : Professor of Medicine, Shalender Bhasin ^a,^b,^c : Professor of Medicine, Director
^a Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA
^b Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Boston, MA, USA
^c Boston Claude D. Pepper Older Americans Independence Center, Boston, MA, USA

^∗Corresponding author. Division of Endocrinology, Diabetes and Hypertension, Harvard Medical School, Brigham and Women's Hospital, 221 Longwood Avenue, RFB-2, Boston, MA, 02115, USA.Division of EndocrinologyDiabetes and HypertensionHarvard Medical SchoolBrigham and Women's Hospital221 Longwood Avenue, RFB-2BostonMA02115USA

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.

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