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Last updated: Mar 01, 2022
9 min read

Testosterone test kit: how accurate are they?

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

Even before the COVID-19 pandemic moved many provider visits to your living room couch, at-home health testing was a booming industry. Today, test kits allow you to check everything from your food sensitivities to fertility. One test you can do at home is for your testosterone levels, which you may be interested in if those TV commercials have you worried about “low T.” Read on to learn more about these testing kits, signs of low testosterone levels, and what you can do about it.

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What is a testosterone test? 

Testosterone tests check your testosterone levels. There are a few different options available. 

Home test kits

Several testosterone test kits are available for purchase online and in stores. With home testing kits, you collect a sample and mail it back to a lab (via a prepaid shipping label). After you mail the kit back, your results are usually provided by email or online within a few business days.

There are three main types of at-home tests for testosterone:

  • Saliva – This is one of the most common at-home test approaches. You collect your saliva in a tube and mail it back to the lab. Unfortunately, the use of saliva testing for testosterone is controversial. Some studies have found that salivary and blood testosterone levels are closely correlated, while others found they didn’t match up at all (Arregger, 2007; Adebero, 2020; Fiers, 2014). One review noted that sample collection methods and storage of salivary tests can have a significant impact on accuracy, and any small amounts of blood in your saliva can also impact the results (Groschl, 2008).
  • Dried blood spot (DBS) – With DBS testing, you prick your finger with the supplied tool and apply the blood to testing paper. After you mail it in, the dried blood on the paper is evaluated by the lab. A small study has shown DBS testing to be as accurate as traditional blood testing for hormones like testosterone (Salamin, 2021).
  • Microtainer – With this approach, you prick your finger with the supplied tool and add a few drops of blood to a small tube. Just like the venous tubes in phlebotomy labs, these tubes are designed for transporting a blood sample to a lab for testing. This approach is intended to replicate traditional in-lab or in-clinic testing as closely as can be done with a finger prick at home, although available peer-reviewed research regarding the accuracy of such tests is limited.

At your healthcare provider’s office

You can also get your testosterone level checked at a healthcare provider’s office or certified lab with a blood test. The provider draws a blood sample and follows up with you about the test results. Healthcare providers generally require two tests taken on two separate days (before noon, because testosterone levels fall throughout the day) before they’ll make a diagnosis of low T.

At your visit, your healthcare provider may recommend the following blood tests (UCF, n.d.):

  • Total testosterone level. Your total testosterone level includes testosterone that’s bound to sex hormone-binding globulin (SHBG)—known as bound testosterone and not available to the body)–and free testosterone, the amount of testosterone circulating freely in the blood.  
  • Luteinizing hormone (LH). This hormone controls how you make testosterone, and abnormal levels may signal a problem with the pituitary gland.
  • Blood prolactin level. A high prolactin level may indicate pituitary problems or tumors, which could be affecting your testosterone level.
  • Blood hemoglobin (Hb or Hgb). Testosterone levels affect your hemoglobin and may lead to anemia.

Testosterone levels vary throughout the day, so it’s important to follow the instructions given by your healthcare professional or those provided in the test kit on when to test.

What is testosterone?

Testosterone is an androgen, or male sex hormone, present from birth in both men and women. Males typically have 20–25 times the amount of testosterone as females. Testosterone is produced by the testicles and adrenal glands (Fabbri, 2016).

In females, testosterone is made by the theca cells of the ovary, but most of it is converted to estrogen by an enzyme called aromatase.

Testosterone is important to overall wellness for both men and women at every age. It regulates many key bodily functions like libido, sexual response, bone density, muscle development, and mood (Fabbri, 2016).

What is a normal testosterone level?

For men

According to the standard set by the American Urological Association (AUA), a total testosterone hormone level below 300 ng/dL indicates low testosterone in men, also known as hypogonadism (Mulhall, 2018).

Total testosterone is the number most often used to diagnose low testosterone. But a free testosterone level below 50–65 pg/mL may indicate that testosterone replacement therapy is indicated. However, levels of free testosterone are not always accurate and are often evaluated in the setting of low total testosterone (Trost, 2016).

For women

In women, low testosterone is known as androgen deficiency. Unfortunately, testosterone deficiency and replacement therapy haven’t been thoroughly studied in women, and the threshold for low testosterone hasn’t been conclusively defined as it has for men. Your healthcare provider can check your testosterone level with blood testing. Some women with low testosterone levels have found testosterone therapy to be effective in restoring sexual desire (Davis, 2016).

For women not in menopause, the normal range for total testosterone is around 15 to 46 ng/dL. For free testosterone, up to 6.0–6.5 ng/d is considered normal, but there are no universally accepted ranges (Kanakis, 2019).

Conversely, women can suffer from hyperandrogenism, where testosterone or other androgen levels are too high. This has several potential causes, including  (Rasquin, 2021):

  • Polycystic ovary syndrome (PCOS)
  • Late-onset congenital adrenal hyperplasia
  • Ovarian or adrenal tumors
  • Cushing syndrome
  • Certain medications
  • Idiopathic hyperandrogenism (no known cause)

Symptoms of low testosterone

In men

In men, the symptoms of low testosterone can include (Sizar, 2021):

Low T is more common as men get older. Testosterone levels start to fall about 1% to 2% a year, starting around age 40 (Miah, 2019).

In women

For women, the symptoms of low testosterone can include (Wierman, 2014):

  • Decreased sexual desire
  • Decreased sexual sensitivity
  • Decreased arousal and ability to orgasm
  • Fatigue

Because low testosterone in women hasn’t been well studied, it’s unclear how many women have the condition (Davis, 2016).

Symptoms of overly high testosterone

In men

Having too much testosterone is not a good thing, either. In men, the most common cause is abusing anabolic steroids or taking too much testosterone prescribed by a healthcare provider. Symptoms of having too much testosterone include (Ganesan, 2021):

  • Acne on the face or body acne
  • Enlarged prostate
  • Gynecomastia (male breast tissue development)
  • Worsening of sleep apnea 
  • Fluid retention
  • Testicular shrinkage 
  • Low sperm count
  • Increase in red blood cells (erythrocytosis)

In women

In women, high testosterone levels are most commonly caused by polycystic ovary syndrome (PCOS), which occurs in up to 12% of women and is the most common female hormone disorder. Signs of hyperandrogenism in females include (Rasquin, 2021):

  • Irregular periods
  • Hair loss on the scalp
  • Excess facial and body hair (hirsuitism)
  • Acne
  • Deepening of the voice, growth of the larynx (or Adam’s apple), and clitoral enlargement—these symptoms may also indicate a tumor and should be investigated ASAP.

Testosterone replacement therapy

Your healthcare provider may recommend testosterone replacement therapy (TRT) if your testosterone levels are low. Options for testosterone replacement therapy include topical patches and gels, injections, oral patches, pellets, and nasal gels.

Topicals

These common treatments are applied to the skin: the testosterone patch (brand name AndroDerm), testosterone gels (brand names AndroGel, Testim, and Fortesta), and testosterone solutions (brand name Axiron).

Injections

Several injectable versions of testosterone are available; they’re administered by a healthcare provider. Depending on the formulation, an injection lasts from a week to a few months before a new shot is necessary.

Buccal (cheek)

Buccal testosterone therapy (brand name Striant) is an oral patch designed to stick to the gums above your incisors. It is usually applied twice a day.

Pellets

Testosterone pellets (brand name Testopel) are implanted under the skin near the hips. They slowly release testosterone for three to six months. 

Nasal gel

Nasal testosterone gel (brand name Natesto) is applied to the inside of the nose three times a day in each nostril. 

Most healthcare providers will suggest trying topical gels for TRT first because they provide stable testosterone levels and are relatively easy to use. In a study of patient satisfaction with TRT, there wasn’t a significant difference among gels, injections, or pellets (Kovac, 2014).

TRT isn’t for everyone—it can cause side effects, like infertility, and may interact with some medications. If you have certain medical conditions, you may not be a good candidate for these treatments. TRT may also increase your risk of developing certain health conditions; ask your healthcare provider if testosterone therapy makes sense for you. 

Other treatments for low testosterone

If TRT is not the best option for you, you may want to consider other treatments for low testosterone, like clomiphene citrate or hCG. 

Clomiphene

Clomiphene citrate (brand name Clomid) is a treatment for low testosterone that can preserve your ability to have children. It is a selective estrogen receptor modulator (SERM) drug that works by tricking the body into making more testosterone. Clomiphene citrate tells the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH), two hormones that affect testosterone and sperm production in testicles (Krzastek, 2019).

hCG

Human chorionic gonadotropin (hCG) may also help restore your T levels. You’ll find high levels of hCG during pregnancy (it’s what makes a pregnancy test positive), and taking it may increase testosterone in people with low T and functioning testicles (Salonia, 2019).

Lifestyle changes

It may be possible to support your testosterone levels naturally by making lifestyle changes like improving your diet, getting regular exercise, sleeping well, and not drinking alcohol to excess.

References

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