Total and free testosterone: what is the difference, what to give to a man, in women, what is the difference between the analysis

Total and free testosterone is measured in case of suspicion of the development of a pathological process in the body of men and women. Laboratory testing is necessary for hormonal disorders, infertility, decreased libido and changes in behavior. This is due to the fact that androgens are involved in the work of the organs of the reproductive and endocrine systems. They have an indirect effect on mood and blood pressure readings.

What is Total Testosterone

Total testosterone shows the entire volume of male sex hormones in the blood plasma. Androgens are of 2 types:

1. Connected. Does not participate in the work of the endocrine, reproductive and circulatory systems. It is an internal supply of male hormones that are released as needed. The rest of the time they form a complex, i.e. associated with plasma proteins. 60-70% of the total amount of bound testosterone is bound to globulins, from 25 to 40% - to albumin.
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2. Unrelated. It is a free form of androgens circulating in the blood.

What is Free Testosterone

Free testosterone not connected by protein molecules, therefore it retains high activity.

This form of androgen regulates the functioning of the reproductive system, affects blood pressure and hormonal balance in a man's body.

The pure hormone accounts for 1-4% of the total serum androgens. Thanks to it, hair on the chest and face grows, skeletal muscles develop, and muscle mass is built up.

What is the difference

Total testosterone differs from free testosterone in that the latter is an active form responsible for the state of the following body systems:

• Central nervous system;
• cardiovascular;
• endocrine;
• reproductive.

With its lack, weight loss is observed, pressure surges appear, hormonal levels are disturbed, depression and uncertainty develop. An increase in the hormonal connection leads to the manifestation of aggression, a rapid build-up of muscles, and increased physical activity.

The main difference between generic and free testosterone is that unbound androgens are part of it. These forms are the total amount of male hormones in the body. For the diagnosis of diseases during the examination, it is important to determine both indicators, because the serum level of fractions changes in different ways. The content of the total increases with:

• pregnancy;
• increased activity of the thyroid gland;
• improper intake of antispasmodic drugs, oral contraceptives;
• cirrhosis.

The indicator decreases against the background of kidney inflammation, hormonal imbalance and obesity. Fluctuations in the plasma concentration of free-form androgens are reflected in behavior, genital function, and pressure.

The level of free and total testosterone may differ depending on the time of day - in the morning, the content of unbound androgens rises.

What testosterone to take: total or free

Some patients mistakenly believe that it is necessary to determine only one indicator of testosterone: total or free. If there is a suspicion of the presence of a pathological process, for a diagnosis, it is necessary to pass an analysis for both forms. To determine the amount of androgens in a man and a woman, venous blood is taken from the cubital vein.

The indications for the study are:

• hormonal imbalance;
• infertility in one of the sexual partners who have been trying to conceive a child for a long time;
• decrease in sexual arousal in men;
• malignant neoplasms of the adrenal glands, testes;
• benign prostatic hyperplasia;
• erectile dysfunction;
• changing the timbre of the voice;
• violation of the psycho-emotional state in men: depression, neuroses, increased irritability, outbursts of aggression;
• in women: menstrual disorder, decreased libido, cystic fibrotic diseases of the genital organs;
• decrease in muscle mass in men, obesity, displacement of fat masses to the thighs, an increase in the size of the mammary glands;
• memory impairment, decrease in the speed of physical reaction;
• premature puberty in boys from 7 to 12 years old;
• delayed puberty.

Testosterone test free form is carried out separately in case of underdevelopment of the reproductive organs in boys, chronic inflammation of the prostate gland.

Laboratory research for men for free and total testosterone is carried out strictly in the morning, when their indicator rises. In women, the plasma concentration of the hormonal compound depends on the phase of the menstrual cycle. Blood donation is carried out on an empty stomach.

Interpretation of results

When deciphering the test results, the doctor compares the obtained indicators with the reference values ​​or the norm. If you donate blood in different clinics, you may be faced with the fact that the content of androgens will be shown in different units of measurement: pg / ml, ng / dl, nmol / l.

Most often, normal values ​​are indicated on the forms next to the indicators. The patient can compare the results himself and make a preliminary conclusion. It should be remembered that minor deviations from the norm are not always signs of a disease. In the male body, natural fluctuations in testosterone are observed.

In addition to the daily rhythms, the season of the year affects the hormone content: in the spring the amount of androgens increases, in the autumn-winter period it decreases. Also, the concentration of a substance is influenced by:

• stress;
• depression;
• plentiful meals;
• heavy physical activity;
• a sharp jump in adrenaline in the blood.

These are natural physiological processes that are not a sign of pathological changes in health.

The norm of testosterone in the body of men and women changes with age:

Age	Men, nmol / l	Women, nmol / l
Under 18	0,2-38	0-4
18-50	5,76-30	0,3-3,78
Elderly	5,4-20	until 3
Pregnancy	—	12-16
Postmenopause	—	0,4-4,5

With an increase in the concentration of total testosterone in women, the following are possible:

• pregnancy;
• chromosomal abnormalities;
• hyperfunction of the adrenal glands;
• malignant neoplasms: uterine fibroids, breast cancer;
• endometriosis;
• disruption of the pituitary gland;
• ovarian damage;
• abuse of oral contraceptives.

Regardless of gender, an increase in the total number of androgens in the blood indicates an increased hormonal activity of the thyroid gland, epilepsy.

In the male body, a high level of unbound hormone indicates the abuse of anabolic steroids, as well as the development of the following pathological processes:

• liver damage;
• malignant tumor of the prostate gland;
• Reifenstein's disease;
• a brain tumor that compresses or affects the pituitary gland.

If the level of free hormone is low, it may be due to aging of the body. Strong deviations from the norm, in comparison with the average values, indicate severe disorders of the endocrine system, cirrhosis or dysfunction of the testes. In rare cases, damage to the hypothalamus, pituitary gland is possible. A low concentration of the total hormone is observed with obesity, abuse of alcoholic beverages, foods with trans fats.

Low serum levels are characteristic of Down syndrome patients. A decrease in testosterone levels with age in women is considered a normal physiological phenomenon. The amount of androgens decreases with the development of menopause. A sharp drop in testosterone in the female body up to 50 years old indicates the development of renal failure, improper intake of hormonal drugs. The latter include glucocorticosteroid drugs, opioid medicines, Ketoconazole.

You can suspect a deviation of the hormone from the norm by the following symptoms:

• psychoemotional disorders: with a decrease, depression, apathy, and complexes occur; increase - aggression, irritation;
• changes in blood pressure;
• decrease in sexual arousal.

Hormone therapy is prescribed to stabilize low testosterone levels. The drugs contain an artificial analogue of the hormone. At a high concentration of androgens, medications are taken that suppress the activity of the hypothalamus and pituitary gland.