Written by Steve Theunissen | ISSA: CPT & Fitness Nutrition
Fact checked by Andrew Lenau, ISSA CPT & Sports Nutritionist
FACT CHECKED
Hormones are essential for controlling many bodily processes, impacting everything from mood to physical growth. Testosterone, the body's primary androgenic hormone, controls vitality, mood, sexual health, male characteristics, and more.
As such, we need it's levels to be balanced to live a healthy, functional life. To fully understand your testosterone levels, however, you need to know the difference between two key measures: free and total testosterone.
Each of these measures sheds light on a different aspect of how testosterone acts in the body and provides diverse insights into hormonal health. This article clarifies the distinction between free vs. total testosterone and explores each one's function, importance, and implications for our overall health.
Here's what we'll cover:
- What Is Free Testosterone?
- What Is Total Testosterone?
- How Free Testosterone vs. Total Testosterone Affects Health
- Symptoms Of Low Testosterone
- How To Test Testosterone Levels
- How To Increase Testosterone
- FAQs
What Is Free Testosterone?
Testosterone controls the development of male reproductive tissue and sexual characteristics, as well as muscle mass and bone density, and can even influence our mood. It is created in the testes in men and the ovaries and adrenal glands in women, though in much smaller amounts.
Understanding the differences between free testosterone versus total testosterone is crucial while researching testosterone. Total testosterone is the total amount of testosterone in the bloodstream. In contrast, free testosterone is a type of testosterone that is unbound and, therefore, able to be used by the body's tissues.
While free testosterone directly affects the testosterone in your body's cells, total testosterone offers insight into the hormone's entire production. Its active ingredient interacts with androgen receptors, affecting several physiological processes, including libido modulation, bone density maintenance, and muscular growth.
What Is Total Testosterone?
Total testosterone is the total amount of testosterone circulating in the bloodstream, including both active and inactive forms. The active form is free of unbound testosterone.
Total testosterone measures give us an overall view of the body's testosterone synthesis. Although bound testosterone is not immediately accessible, it acts as a reservoir and can be released and transformed into free testosterone when necessary.
Analyzing total testosterone levels lets you understand the body's ability to produce androgenic hormones. Normally, follicle stimulating hormone and luteinizing hormone help signal the testes to make testosterone in men. If total 'T' levels are off, it can shed light on potential imbalances that could cause numerous symptoms, like decreased muscle mass, fatigue, mood swings, and impaired sexual function.
Therefore, it allows you to assess overall hormonal health and spot any changes requiring additional investigation. While total testosterone serves as a core measure for the context of hormonal dynamics, free testosterone directly influences body processes.
How Free Testosterone vs. Total Testosterone Affects Health
The free vs. total testosterone ratio must be balanced to maintain optimum health and well-being. Free testosterone, the hormone's unbound and accessible portion, is particularly significant. Research has demonstrated how it affects cardiovascular health, bone density, mood management, and muscle mass.
Low free testosterone levels are directly linked to reduced muscle mass, lowered physical performance, increased osteoporosis risk, and impaired cognitive performance. According to a 2019 study, which followed 440 men over 12 months, low free testosterone serum levels were directly related to frailty, loss of muscle mass, and reduced cognitive performance [1].
Free testosterone also affects mood and mental health. Low levels have been connected with symptoms of depression. A 2019 meta-study analyzed 27 clinical trials involving 1890 men in total and found that free testosterone treatment significantly reduced depressive symptoms [2].
On the other hand, unnaturally high levels of free testosterone can also be harmful to health. For instance, an increased risk of atherosclerosis was related to unusually high free testosterone levels in a study published in the "Journal of Clinical Endocrinology & Metabolism" [3].
Imbalanced total testosterone levels may indicate underlying medical problems and call for additional research. Total testosterone readings are especially crucial for evaluating hormone production potential and spotting patterns that can impact general health.
Free Testosterone vs. Total Testosterone In Males
Free testosterone dramatically affects men's overall vitality, sexual function, bone density, and physical strength. Studies indicate that the reference range for free testosterone levels in adult males is normally in the range of 9 to 30 ng/dL (nanograms per deciliter) [4]. Decreased levels might cause symptoms like weakened muscles, exhaustion, decreased libido, and mood swings.
Bound testosterone is momentarily rendered inactive when it binds to proteins, primarily sex hormone-binding globulin (SHBG). This form acts as a store that can be transformed into free testosterone as necessary. The normal range for total testosterone levels varies depending on age, laboratory reference values, and more. However, according to a landmark 2017 study involving more than 9000 men, the normal total testosterone range for adult males is between 264 and 916 ng/dL [5].
Free Testosterone vs. Total Testosterone In Females
Although frequently linked with male characteristics, testosterone is also present in females, although in much smaller amounts. The interaction between free and total female testosterone levels informs various physiological processes, from reproductive health to general well-being. Free testosterone helps women maintain their libido, muscle mass, bone density, and mood.
According to research, the normal range for free testosterone levels in adult females is roughly 0.2 to 0.64 ng/dL [6]. For women under the age of 50, a free testosterone level of <1.5 pg/mL (0.15 ng/dL), and in women over the age of 50, a level of <1.0 pg/mL (0.1 ng/dL) indicates deficiency.
Most of the testosterone in women's bodies is attached to such proteins as sex hormone-binding globulin (SHBG). When needed, it can be unbound to become free testosterone. The normal range of total testosterone for women is 15 to 70 ng/dL.
Symptoms Of Low Testosterone
Typical signs of testosterone deficiency include the following health issues:
- Weakness and loss of muscle mass, less bone mass, and a higher chance of fractures
- Reduced energy and exhaustion
- Increased body fat and other modifications to the body's composition
- A reduction in the growth of body and facial hair
- Impaired sexual function and a decreased libido
- Fertility issues or alterations
- Shivering during the night or hot flashes
- Problems getting to sleep or insomnia
- Loss of hair and changes to the skin's texture
- Lower capacity for and endurance during exercise
- Fluctuations in mood and irritation
- A reduction in desire and motivation
- Memory problems and difficulty focusing
- Anxiety or depression
- Lower level of self-assurance
- Decline in sociability and social withdrawal
How To Test Testosterone Levels
The first step to knowing your hormonal health is getting tested. The results of a testosterone test can help inform potential therapies and offer insightful information.
Here are four ways to go about it:
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Getting Advice From Your Healthcare Provider: Your doctor is one of the most trustworthy places to get a testosterone test. The required tests, which may also include total and free testosterone readings, can be requested from your doctor. Share your symptoms, worries, and any pertinent medical history with your doctors, as this can influence the testing procedure and the interpretation of the test results.
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Clinics Specializing In Testosterone: Testosterone clinics emphasizing hormonal health evaluations, including testosterone testing, can offer specialized advice depending on your results and frequently have experience in hormone abnormalities. They might provide more thorough testing panels that measure hormone levels other than just testosterone.
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At-Home Test Kits: Some businesses provide at-home testosterone test kits. The standard procedure for these kits entails gathering a sample (commonly via saliva or blood test), which you then send to a lab for analysis. It's crucial to select dependable suppliers who guarantee precise and consistent results.
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TRT Clinics Online: If you're considering testosterone replacement therapy (TRT). Online TRT clinics can offer thorough evaluations and treatment regimens. They can help you get through the testing process remotely and frequently offer the convenience of telemedicine sessions.
Remember that finding a trustworthy online TRT facility is essential for a successful and safe procedure. Check our comprehensive guide to the 8 Best Online TRT Clinics to identify the best providers in the current market.
How To Increase Testosterone
Adopting a holistic strategy incorporating lifestyle, diet, and possibly medicinal interventions is necessary to increase testosterone levels naturally. Here are seven different approaches you can implement to safely and naturally boost your 'T' levels:
1) Physical Activity And Exercise
Regular physical activity is an effective approach to increasing testosterone levels. Hormonal balance has been positively impacted by both strength training and aerobic exercise. Utilize exercises that promote muscular growth and increase testosterone production, such as powerlifting, HIIT, and resistance training.
Read Does Working Out Increase Testosterone? for more information.
2) Nutritional Balance
A balanced diet greatly influences the modulation of hormones. Prioritize protein, healthy fats, and complex carbs. Be sure to also include plentiful amounts of omega-3 fatty acids, zinc, and Vitamin D. To provide these nutrients, include lean meats, fish, nuts, seeds, complete grains, and leafy greens.
3) Restful Sleep
Give quality sleep a high priority to support hormone production. Low testosterone levels might result from sleep deprivation or irregular sleep patterns. Aim for 7-9 hours of sound sleep each night to encourage optimum hormonal health.
4) Stress Management
Constant stress can elevate cortisol levels. Cortisol inhibits testosterone production, so practicing stress-alleviating habits such as deep breathing, toga, mindfulness, and meditation can indirectly boost testosterone levels.
5) Keep Your Weight in Check
Excess body fat, especially in the abdomen area, can result in hormonal imbalances. The combination of exercise and caloric-reduced nutrition can help with weight loss.
6) Lifestyle Habits
Limit alcohol intake and give up smoking: Low testosterone levels have been associated with heavy drinking and smoking. Your hormonal health may benefit from cutting back on alcohol consumption and quitting smoking.
7) Testosterone Booster Supplements
Look for T-boosters that include clinical dosages of such proven ingredients as D-aspartic acid, fenugreek, zinc, and Vitamin D. Go here for an in-depth overview of the 6 Best Herbs That Boost Testosterone.
8) TRT
If your total testosterone levels are diagnosed as being less than 300 ng/dL, your doctor may recommend a course of testosterone replacement therapy.
TRT entails medical intervention to return testosterone levels to normal using injections, gels, patches, or pellets. If you are prescribed a course of TRT, you can only obtain testosterone with a prescription. You will then be able to fill that prescription from online or brick-and-mortar outlets.
For more on the above, check out Testosterone Booster vs TRT: Which Ones Is Best For You? and Where To Buy Testosterone Online.
FAQs
Still, have questions about total testosterone vs. free testosterone? There's a good chance they'll be covered by our roundup of the six most frequently asked online questions on the topic:
What is a normal free testosterone level?
The standard reference range for free testosterone in adult males is in the neighborhood of 9 to 30 ng/dL (nanograms per deciliter).
Due to the differences in hormonal profiles, the normal range for free testosterone in adult females is much lower than in males. Normal testosterone levels for females might be in the vicinity of 2.0 to 6.4. pg/mL (picograms per milliliter).
Can you have normal total testosterone but low free testosterone?
Yes, it is possible to have low free testosterone levels while having normal total testosterone levels. Lower free testosterone levels may happen if a sizable fraction of total testosterone is bound and unavailable for utilization by the body's tissues. Even when total testosterone levels are normal, low free testosterone levels might still cause signs of hormonal imbalance.
What happens if your free testosterone is too high?
Excessively high free testosterone levels, known as hyperandrogenism, may result in aggression and mood shifts, acne and oily skin, and masculinizing, virilization, and polycystic ovary syndrome in women.
Does TRT increase free testosterone?
Yes, TRT can boost free testosterone levels in people with low total testosterone levels. TRT uses exogenous testosterone to increase 'T' levels. Through TRT, total testosterone levels are raised, which causes a corresponding rise in free testosterone levels as well.
Does high free testosterone cause weight gain?
Weight gain is not generally linked to high free testosterone levels. In fact, increasing lean muscle mass and better metabolic health are frequently associated with higher free testosterone levels, which can help with weight loss or maintenance.
Which testosterone is best for fat loss?
When present in normal and healthy levels, free or total testosterone can positively affect fat loss. Remember, though, that testosterone is simply one of several factors affecting fat reduction. Diet, exercise, hormone balance, genetics, and general health are just a few of the complicated elements that go into weight maintenance.
Summary Of The Difference Between Free And Total Testosterone
The difference between free testosterone and total testosterone levels offers unique insight into our bodies' hormonal processes.
Our athletic ability, muscle size and strength, and mental health are all directly influenced by free testosterone, the unbound and active form. Total testosterone, which includes free and bound forms, offers a wider context for assessing the ability to produce hormones and seeing patterns that can affect our health.
Knowing how free and total testosterone interact serves as a testament to the complex and exquisite symphony of your body's hormonal orchestra. The first step to taking control of that orchestra is to find out where your testosterone levels are.
Check out our comprehensive analysis of the 8 Best Online TRT Clinics to find a convenient way to get a testosterone test.
References
- Janet M Chiang and others, Low testosterone is associated with frailty, muscle wasting and physical dysfunction among men receiving hemodialysis: a longitudinal analysis, Nephrology Dialysis Transplantation, Volume 34, Issue 5, May 2019, Pages 802–810, https://doi.org/10.1093/ndt/gfy252
- Walther A, Breidenstein J, Miller R. Association of Testosterone Treatment With Alleviation of Depressive Symptoms in Men: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76(1):31–40. doi:10.1001/jamapsychiatry.2018.2734
- Hak AE, Witteman JC, de Jong FH, Geerlings MI, Hofman A, Pols HA. Low levels of endogenous androgens increase the risk of atherosclerosis in elderly men: the Rotterdam study. J Clin Endocrinol Metab. 2002 Aug;87(8):3632-9. doi: 10.1210/jcem.87.8.8762. PMID: 12161487.
- Jasuja R, Pencina KM, Spencer DJ, Peng L, Privat F, Dhillo W, Jayasena C, Hayes F, Yeap BB, Matsumoto AM, Bhasin S. Reference intervals for free testosterone in adult men measured using a standardized equilibrium dialysis procedure. Andrology. 2023 Jan;11(1):125-133. doi: 10.1111/andr.13310. Epub 2022 Oct 27. PMID: 36251328.
- Thomas G. Travison and others, Harmonized Reference Ranges for Circulating Testosterone Levels in Men of Four Cohort Studies in the United States and Europe, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 4, 1 April 2017, Pages 1161–1173, https://doi.org/10.1210/jc.2016-2935
Steve Theunissen
Author