By Jennifer Chesak
Medically Reviewed by Adrienne Mandelberger, M.D.You can guess all you want, but the only way to know if your testosterone levels are where they should be is to test them. Maybe you’re feeling sluggish, struggling to add muscle, or your sex drive isn’t what it used to be. Or maybe you just want a baseline, to have something to measure against if issues arise. Whatever your reason, testing gives you hard data—the first step in taking control of your health.
But not all testosterone tests are created equal. Pick the wrong method, and you could end up with bad data, wasted time, and money down the drain. Worse, you might miss a real issue—or think you have one when you don’t.
A proper testosterone test, done in a certified lab, gives you precise, actionable numbers. With the right data, you and your doctor can make informed decisions—whether that means dialing in your training, optimizing your diet, managing stress, or considering testosterone replacement therapy (TRT).
About the Experts
Joshua Calvert, M.D., a board-certified urologist specializing in male infertility and low testosterone management.
Justin Houman, M.D., is a board-certified urologist specializing in men’s health and an assistant professor of urology at Cedars-Sinai Medical Center.
How to Get Testosterone Levels Tested
You can check your testosterone levels in a lab or with an at-home kit. Home testosterone tests (which you can order without a prescription) analyze saliva, urine, or blood. Lab tests measure blood only. And when it comes to testosterone, blood is the only way to go.
Skip saliva and urine tests
Urine tests for testosterone aren’t reliable; they only measure the breakdown of testosterone, not the hormone itself, and your hydration level can skew results. 1
Saliva tests aren’t reliable, either. “They aren’t considered reliable for testosterone measurement due to fluctuations throughout the day and inconsistencies in lab processing,” Calvert says.
“Blood tests, particularly morning measurements of total and free testosterone, are the gold standard.” A 2022 study confirmed baseline testosterone levels in saliva aren’t consistent, making them an unreliable option. 2
Blood tests: the gold standard for testosterone
Blood tests offer a more accurate way to check your testosterone levels. They typically analyze total, free, and bound testosterone levels. 3
Knowing the values of each is vital to getting a precise reading and diagnosis, says urologist Justin Houman, M.D.“This test quantifies a comprehensive view of a patient’s hormonal status,” he says.
How to get a testosterone test you can trust
The best way to get an accurate testosterone reading is to make sure the lab performing the analysis is certified by the CLIA ( Clinical Laboratory Improvement Amendments)which ensures federal testing standards are met.
If your doctor is drawing your blood—and potentially treating you for low T—make sure they’re board-certified and specialize in men’s health. “They have the expertise to manage hormonal health issues effectively,” says Houman.
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Let’s Get StartedAt-Home vs Lab Testing
The primary differences between at-home and lab blood tests for low testosterone include who collects the sample, convenience, and cost.
At-home testosterone tests
At-home blood testosterone tests come with a kit for a simple finger prick. Mail in your sample, and you’ll get results through a secure portal. They’re convenient—no lab visits, no time off work.
Health insurance companies generally don’t cover at-home testosterone tests, which can cost around $45. But you can use a health savings account (HSA) or flexible spending account (FSA) to pay for your test.
If an at-home testosterone test suggests that you have low testosterone, Hourman recommends following up with a blood test at a lab. “Laboratories often use standardized methods and are subject to quality controls that ensure more precise measurements,” he says.
Testosterone tests at the lab
To get your testosterone tested at a lab, you’ll need a physician’s order. A trained technician draws your blood at a clinic, hospital, or diagnostic center (like Quest or LabCorp). The sample is sent to a lab, and results are available within days.
You have to go somewhere for the test, but the results will be more accurate than a home urine or saliva test. The technician who draws your blood is skilled, so the procedure has little room for error.
Lab tests offer higher accuracy, and insurance may cover them. If not, expect to pay $60 to $150, depending on the lab. You can also use HSA or FSA funds.
Preparing for Your Test
A testosterone test requires little preparation, but timing and certain factors such as food, exercise, and sex can impact accuracy.
Timing
Testosterone levels peak in the early morning. Get your blood drawn between 7 and 10 a.m.—when they’re at their highest—for the most accurate reading. 4 This applies to in-home tests, lab visits, or blood drawn at a doctor’s office.
What to avoid before your test
If you’re getting your testosterone tested for the first time, follow these guidelines to get an accurate reading.
- Fast for 8 hours. Eating before the test can lead to inaccurate results, according to the Endocrine Society. 5 However, Calvert noted that some doctors may not require fasting, so follow your provider’s guidelines.
- Drink plenty of water. Being well-hydrated makes blood draws easier.
- Avoid strenuous exercise. Physical activity like sex or riding a bicycle, motorcycle/ATV, or horse can temporarily raise testosterone. Avoid them for 2-3 days before your test. 6
If you’re already taking TRT, follow the below guidelines—in addition to the above— before your next test:
- If you take injectable testosterone one or more times per week, collect your lab sample the morning before your injection.
- If you apply testosterone cream once daily (in the morning), collect your sample as late in the evening as possible.
- If you apply testosterone cream twice daily, collect your sample 12-16 hours after application (usually in the AM before the next application)
- If you take testosterone troches daily (in the morning), collect your sample 8-12 hours after ingestion (in the evening).
- If you consume testosterone troches twice daily, collect your sample before ingestion (in the morning).
What Do Testosterone Tests Measure?
Testosterone tests measure total testosterone and bound testosterone. Your doctor may also test additional biomarkers.
Total testosterone
This number measures all of the testosterone in your bloodstream. A healthy total testosterone level for adult men is between 300 to 1000 nanograms per deciliter (ng/dL). 7
However, that number can vary widely based on age, says urologist Joshua Calvert, M.D. “Some guidelines suggest under 300 as a threshold for low testosterone,” he says. “A man in his 40s may have levels in the midrange, while levels in men over 60 tend to be lower.”
Free testosterone
Free testosterone is the amount of the hormone that’s readily available for the body to use. Bound testosterone is attached to proteins like sex hormone-binding globulin (SHBG) and albumin, which transport it through the body.
Sex hormone binding globulin (SHBG) and albumin
About 45 percent of men’s bound testosterone is bound to SHBG and 50 percent is bound to albumin. In women those numbers look different: About 70 percent of women’s testosterone is bound SHBG and 25 percent to albumin. 8
Your body can’t use testosterone bound to SHBG.
- A low SHBG level means there’s more free testosterone available for your body to use.
- High levels of SHBG mean there’s less free testosterone, which may impact energy levels, muscle development, sex drive, and bone health. 9
Albumin-bound testosterone, however, can easily detach for use when needed, making it bioavailable.
- Low albumin levels may indicate kidney or liver disease or nutrient deficiencies.
- High albumin can signal dehydration or a high-protein diet. 10
Because both free and albumin-bound testosterone are accessible to the body, they are considered bioavailable testosterone.
Other biomarkers
In addition to testosterone levels, some tests—including Hone’s—also assess:
- Prolactin: A hormone secreted by your pituitary gland, affects sperm production. Elevated levels may signal liver damage, which low testosterone is suspected to contribute to.
- Luteinizing hormone (LH): Stimulates testosterone production in the testes. Both low and high LH levels can indicate hypogonadism (testosterone deficiency).
- Hematocrit: The percentage by volume of red blood cells in your blood. Low levels are linked to low free testosterone levels and high SHBG levels.
- Estradiol: A common form of estrogen. High estradiol can contribute to gynecomastia (breast tissue growth), testosterone production issues, tumors in the testes or adrenal glands, and fertility concerns. 11
- Alanine Aminotransferase (ALT): A liver enzyme. Low ALT levels may be a sign of nonalcoholic fatty liver disease (NAFLD), particularly in those with high testosterone 12.
- Aspartate Transaminase (AST): Another liver enzyme. Low AST levels are associated with high testosterone, NAFLD, and heart disease. 13
Who Needs a Testosterone Test?
Men should get a testosterone test if they’re experiencing symptoms of low testosterone.
Women may need a testosterone test if they have polycystic ovary syndrome (PCOS). Many women in menopause also get tested since testosterone can improve some menopause symptoms.
Symptoms of low testosterone in men
The most common symptoms of low testosterone in men include:
- Erectile dysfunction (ED)
- Enlarged breasts (gynecomastia)
- Feeling low energy
- Infertility
- Lack of face or body hair
- Loss of exercise performance
- Loss of muscle mass
- Low sex drive
- Thinning bones
- Unexplained anemia
Testosterone tests for women
Women can experience low testosterone during menopause, says Calvert. The primary symptom of low testosterone for women is low libido, but that isn’t the only perk women may get from testosterone therapy. “Since testosterone plays a role in bone density and cognitive function, some women may benefit from testing and treatment.”
Why Repeat Testosterone Tests are Important to Prescribe TRT
Testosterone levels fluctuate due to stress, illness, and medications. That’s why doctors require two separate morning tests—on different days—before diagnosing low testosterone. Calver says insurance companies often require the extra testing.
Additional Testing
If a test indicates you have low testosterone, your doctor might want to measure other biomarkers like luteinizing hormone (LH) and follicle stimulating hormone (FSH) to see whether the issue originates in the testes or the brain.
A semen analysis may be ordered if fertility is a concern, Calvert says. “Thyroid function, prolactin levels, and metabolic markers may also be checked to rule out underlying conditions like pituitary disorders, diabetes, or metabolic syndrome.”
The Bottom Line
A proper testosterone test—done in a certified lab—is the only reliable way to check your levels. At-home tests can be a starting point, but lab tests remain the gold standard. And when testing, look beyond total testosterone—free testosterone and other biomarkers give a fuller picture of your hormonal health.
