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Current controversies in testosterone testing: aging and obesity.

Ronald J Elin1, Stephen J Winters

  • 1Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, 512 South Hancock Street, #203, Louisville, KY 40202, USA. rjelin01@gwise.louisville.edu

Clinics in Laboratory Medicine
|May 26, 2004
PubMed
Summary

Interpreting total serum testosterone is difficult due to its relation with sex hormone-binding globulin (SHBG). Calculated free testosterone or the bioactive assay (BAT) are recommended for assessing biologically active testosterone levels.

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Area of Science:

  • Endocrinology
  • Clinical Chemistry

Background:

  • Total serum testosterone interpretation is challenging due to its direct relationship with sex hormone-binding globulin (SHBG) concentration.
  • Estimating serum free testosterone is frequently employed to improve clinical status assessment.

Purpose of the Study:

  • To review and analyze five distinct methods for determining free testosterone or its surrogate indices.
  • To identify and discuss the inherent problems associated with these measurement techniques.

Main Methods:

  • Review of five established methods for free testosterone determination.
  • Comparative analysis of calculated free testosterone and the bioactive assay (BAT).

Main Results:

  • Calculated free testosterone and BAT are highly positively correlated.

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  • These methods are recommended as preferred tests for assessing biologically active testosterone.
  • Interlaboratory variability exists due to the lack of available standards.

    • Conclusions:

    • The interpretation of gonadal function is complex, as exemplified by conditions like andropause (elevated SHBG) and obesity (decreased SHBG).
    • Calculated free testosterone and BAT offer valuable insights into biologically active testosterone levels despite standardization challenges.