Getting a testosterone test sounds simple — but most standard orders only check total testosterone, which leaves out critical information. Here's exactly what to ask for, why each marker matters, and what to do with the results.
The Complete Testosterone Panel
### 1. Total Testosterone (Morning Draw) This is what most GPs order. It measures all testosterone in your blood — bound and free combined.
Key detail: time it correctly. Testosterone follows a strong circadian rhythm, peaking between 7–10 AM and declining 30–40% by afternoon. Always get your blood drawn fasted in the morning. An afternoon draw can make a normal level look low.
Reference range vs. optimal: Most labs flag "normal" as 264–916 ng/dL. That's a huge range. A 28-year-old at 310 ng/dL is technically normal but at the 10th percentile for his age. Look at where in the range you fall, not just whether you're "normal."
### 2. Free Testosterone This is the biologically active testosterone — not bound to SHBG or albumin, directly available to tissues. It's the number that correlates most strongly with symptoms.
Some men have normal total testosterone but low free T because high SHBG is binding most of it. You can feel the full symptom burden of low T even with a "normal" total level.
Always order this alongside total testosterone.
### 3. SHBG (Sex Hormone Binding Globulin) SHBG binds tightly to testosterone, making it unavailable. High SHBG is common in men with thyroid disease, liver disease, and some men as they age.
SHBG explains the gap between total and free testosterone. Without it, you can't fully interpret either number.
### 4. Estradiol (E2) Testosterone aromatizes into estrogen. In men, some estrogen is essential for bone health, mood, and libido. Too much — particularly when starting TRT or in men with higher body fat — causes problems: water retention, mood changes, and reduced libido.
Baseline estradiol tells you where you're starting from. If TRT is started, managing the T:E2 ratio becomes part of the protocol.
### 5. LH and FSH These pituitary hormones tell you *why* your testosterone is low:
- Low T + low LH/FSH = Secondary hypogonadism (pituitary or hypothalamic issue)
- Low T + high LH/FSH = Primary hypogonadism (testicular issue)
This distinction matters for treatment. Secondary hypogonadism often responds well to enclomiphene (which stimulates LH/FSH). Primary hypogonadism typically requires TRT.
### 6. Hematocrit / CBC TRT increases red blood cell production. If hematocrit is already elevated (>50%), TRT can push it into a range that increases clotting risk. This is a safety baseline, not a testosterone-specific marker — but it's critical before starting treatment.
### 7. PSA (Prostate-Specific Antigen) — For Men Over 40 TRT doesn't cause prostate cancer, but it can accelerate pre-existing disease. PSA is a standard baseline for men over 40 considering TRT. Your physician determines whether this applies to you.
Where to Get These Tests
Option 1: Through Marrow When you complete intake with a Marrow physician, they order the appropriate panel and review your results in context of your symptoms and history.
Option 2: Through your GP Ask specifically for: total testosterone (morning), free testosterone, SHBG, estradiol, LH, FSH, and CBC. Many GPs will order this; some require justification. "I've been experiencing symptoms of low testosterone and want a complete hormonal panel" usually works.
Option 3: Direct-to-consumer labs Services like Marek Health, Ulta Lab Tests, or LabCorp patient services allow you to order your own panels without a physician's order. Useful if your GP is reluctant.
What to Bring to the Conversation
If your results show low or borderline testosterone with symptoms, the discussion with your physician should cover: - Whether numbers + symptoms meet the threshold for treatment - Treatment options (TRT vs. enclomiphene vs. lifestyle-first) - Monitoring schedule
Numbers without symptoms context are incomplete. Symptoms without numbers are guesswork. You need both.
[Get your full panel ordered through Marrow →](/start)
Frequently Asked Questions
What time of day should I get my testosterone tested?
7–10 AM, fasted. Testosterone peaks in the morning and declines 30–40% by afternoon. An afternoon draw can make a normal level appear low. Always specify morning when booking lab appointments.
What's the difference between total and free testosterone?
Total testosterone measures all testosterone in the blood (bound to SHBG and albumin plus free). Free testosterone is the small fraction not bound to proteins — directly available to cells. Free T correlates more strongly with symptoms and is often low even when total T is normal.
My total testosterone was 400 ng/dL. Is that low?
It's in the low-normal range by most lab reference ranges (264–916 ng/dL), but whether it's 'low' for *you* depends on your free testosterone, SHBG, age, and symptoms. 400 ng/dL with significant symptoms warrants a full panel and physician consultation.
Does insurance cover testosterone testing?
Usually yes, if ordered by a physician with documented clinical indication. Direct-to-consumer options (Ulta Lab Tests, etc.) cost $80–$150 out of pocket for a comprehensive panel if you're paying cash.
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