The Problem With Testosterone Testing

If you think you have a testosterone imbalance and you want to be tested, the first order of business is to not put too much stock in the number. The results of a testosterone test can be a moving target because of three complicating factors.

1. There is no agreed-upon definition of a “normal” testosterone level. Every person is different. A testosterone level that prompts symptoms, such as low libido, in one person may not faze someone else. Likewise, for men there is no guideline as to what constitutes “low testosterone.” The bottom threshold ranges from 200 to 350 nanograms per deciliter (ng/dL) of blood all the way up to 1000 nanograms per deciliter.
2. Testosterone levels fluctuate throughout the day. The best time to get tested is between 7 and 10 a.m. That’s when testosterone levels peak in both men and women. For good measure, don’t eat or drink anything but water before the test. New evidence shows that glucose can suppresses testosterone, says Bradley Anawalt, MD, an endocrinologist and chief of medicine at University of Washington Medical Center in Seattle. “If you have a borderline T level and you ate sugar at breakfast, you may be diagnosed with low T when in fact your levels are normal.”
3. Results vary from lab to lab. Every lab in the country measures testosterone levels a little differently, says Anawalt. He likens it to a bathroom scale vs. a doctor’s scale, which may be a few pounds off. “The only way to correct the inconsistency is to calibrate the scales, and we have yet to calibrate our testosterone tests around the country.”

Given the complexity of testing T, if your score comes back unusually low (for men) or high (for women) number or even borderline (both sexes), it’s worth taking it again just to be on the safe side. While conventional docs rely on blood tests, functional-medicine providers often test saliva, which can indicate how much testosterone the body is actually using, says Erin Lommen, a naturopath in Portland, Oregon. “Saliva shows me the body’s hormonal fingerprint.”

Keep in mind that some men do suffer from a physiological hormonal imbalance that leads to non-weight-related low testosterone (aka hypogonadism). Signs include muscle wasting, thinning body hair, low libido, and fatigue. But these men are in the minority. Researchers estimate that hypogonadism affects between 0.1 and 3.2 percent of all men.

A word of caution: With so much fuzziness inherent in the diagnosis, practitioners have a lot of leeway when prescribing testosterone, so see a health care provider you trust — not someone in a pop-up hormone clinic who seems out to make a buck.

This originally appeared in “Testosterone Tweaks” in the November 2014 issue of Experience Life.