Taking a Testosterone Test to Know Your Levels

Benefits and Limitations of At-Home Tests

Medically reviewed by Steffini Stalos, DO

Testosterone tests are used to check blood levels of the sex hormone testosterone. This test is typically performed on a sample collected at a clinic or lab. However, self-test kits are increasingly available online and at select pharmacies and big box stores. People of any sex can use the tests. The results can determine if your testosterone levels are normal or abnormal.

On their own, results are not diagnostic of any medical condition, but having an abnormally high or low testosterone level may indicate a medical condition in need of treatment. These include testicular dysfunction, polycystic ovary syndrome (PCOS), adrenal tumors, and Cushing's disease. Low testosterone levels may also account for problems with fertility or sexual function.

This article explains what at-home testosterone kits are used for, how they work, and what they can and cannot do. It also explains possible causes of high and low testosterone levels and what to do if an abnormal result is returned.

A Note on Gender and Sex Terminology

Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To reflect our sources accurately, this article uses terms like “female,” “male,” “woman,” and “man” as the sources use them.

Reasons to Use Testosterone Test Kits

At-home medical tests are increasingly common among U.S. consumers, offering autonomy, privacy, and convenience, often at a lower cost than a medical visit. They are largely regarded as "gateway" tests because abnormal results can prompt a user to seek medical care.

With an at-home testosterone kit, a person can detect if their body is making too little or too much testosterone, referred to as:

• Hypogonadism (low testosterone)

• Hyperandrogenism (high testosterone)

At-home testosterone tests can be used in males and females. Although testosterone is typically higher in males due to production in the testes, it is also produced at lower levels in females and people without testes. It has functions in the female body, including sex drive, bone and muscle health, and mental sharpness and performance.

People often purchase an at-home test if they have infertility, sexual dysfunction, or other symptoms suggestive of low or high testosterone.

Blood Draw Is Most Accurate

Testosterone testing is best performed on a venous blood sample collected at a clinic or lab and tested by a certified laboratory. Results should be interpreted by a healthcare provider with consideration of your symptoms, medical history, and other tests. Home collection kits cannot diagnose any condition.

Symptoms of Low Testosterone

Hypogonadism can affect males, females, and people who are intersex. In males, the prolonged effects of low testosterone can lead to the development of secondary sexual characteristics more typical of females, sometimes referred to as feminization.

Low testosterone may have no symptoms. Symptoms of abnormally low testosterone levels include:

• Fatigue

• Depression

• Loss of concentration

• Forgetfulness

• Deceased energy
  

• Loss of armpit and pubic hair
  

• Low libido (sex drive) in males and females

• Hot flashes in females

• Erectile dysfunction in males

• Irregular periods and impaired fertility

• Low sperm count and impaired fertility

• Testicular atrophy (shrunken testicles)
  

• Gynecomastia (enlarged male breasts)
  

• Loss of muscle mass in males

Symptoms of High Testosterone

Hyperandrogenism is more common in females and can manifest with virilization (the developmental secondary sexual characteristics more typical for males) and other symptoms. Males can also be affected, but symptoms are often non-specific or only appear when testosterone levels are excessively high.

Symptoms in Males

• Acne

• Aggressiveness

• Mood swings
  

• Increased body hair

• Increased appetite

• High libido

• Headaches

• Insomnia
  

• Enlarged penis
  

• Urination problems (due to an enlarged prostate)

Symptoms in Females

• Irregular or no periods

• Weight gain

• Acne

• Facial or body hair growth

• Thinning scalp hair

• Infertility

• Depression

• Skin tags
  

• Enlarged clitoris
  

• Dark skin patches in the armpits or under the breast

Potential Causes of High and Low Testosterone

At-home testosterone tests can only tell if your testosterone levels are low or high. While they cannot tell you what exactly is causing the problem, any changes in testosterone ultimately involve one of two things:

• Problems with the testicles and ovaries where testosterone is produced and secreted

• Problem with the hypothalamus, pituitary gland, and adrenal glands, which regulate testosterone production (also known as the HPA axis)

The dysfunction of these organs has many possible causes.

Causes of Hypogonadism

Hypogonadism is categorized as either being primary or secondary. Primary hypogonadism is when something is wrong with your testicles or ovaries, while secondary hypogonadism involves problems with the hypothalamus, pituitary gland, or adrenal glands.

The causes can also be congenital (something you are born with) or acquired (something that occurs after birth).

Congenital causes of primary hypogonadism include:

• Anorchism: The absence of testicles at birth

• Ovarian agenesis: The absence of ovaries at birth
  

• Ovarian dysgenesis: The abnormal development of ovaries

• Cryptorchidism: Undescended testicles
  

• Leydig cell hypoplasia: The underdevelopment of cells in the testicles that produce testosterone

• Klinefelter syndrome: A genetic condition in males characterized by low testosterone and an extra X chromosome

• Turner syndrome: A genetic condition in females characterized by the abnormal development of the reproductive organs and a missing X chromosome

• Noonan syndrome: A genetic condition more common in males that stops typical development in many parts of the body, including the reproductive organs

Acquired causes of primary hypogonadism include:

• Testicular injury: Including testicular torsion and crush injuries

• Ovarian injury: Including ovarian torsion and pelvic trauma

• Orchitis: Inflammation of the testicles most often caused by a sexually transmitted infection

• Pelvic inflammatory disease (PID): Inflammation of the reproductive tract in females most often caused by a sexually transmitted infection (STI)

• Varicocele: Abnormal swelling of veins inside the scrotum

• Chemotherapy: Including drugs like cyclophosphamide, cisplatin, and chlorambucil

• Radiation therapy: Used to treat cancers of the reproductive tract
  

• Bilateral orchiectomy: Surgical removal of both testicles

• Bilateral oophorectomy: Surgical removal of both ovaries

• Autoimmune orchitis: An autoimmune disease that attacks the testicles

• Autoimmune oophoritis: An autoimmune disease that attacks the ovaries

• Hemochromatosis: Iron overload which can lead to testicular and ovarian failure
  

Congenital causes of secondary hypogonadism include:

• Kallman syndrome: A genetic condition that causes the abnormal development of the hypothalamus
  

Acquired causes of secondary hypogonadism include:

• HIV/AIDS: In which chronic inflammation can impair the function of the hypothalamus
  

• Pituitary tumors: Mostly benign tumors like pituitary adenomas but occasionally cancerous tumors like pituitary carcinomas

• Sarcoidosis: An inflammatory disease that can involve the hypothalamus and pituitary gland
  

• Traumatic brain injury: Directly damaging the hypothalamus and adjacent pituitary gland

• Meningitis: Inflammation of the membrane surrounding the brain and spinal cord that can severely impact the hypothalamus

• Opioid drugs: A class of prescription painkillers that can suppress the hypothalamus, adrenal glands, and pituitary gland

• Anorexia nervosa: An eating disorder that can disrupt the normal balance of sex hormones, including testosterone

Causes of Hyperandrogenism

Hyperandrogenism is more common in females because testosterone levels considered normal in males can be 15 times higher than what would be normal in females.

Common causes include:

• Polycystic ovary syndrome (PCOS): A disease characterized by the formation of fluid-filled cysts on the ovaries and the increased production of testosterone

• Congenital adrenal hypoplasia: A genetic disorder that causes the dysfunction of the adrenal glands, usually later in life

• Cushing's disease: A condition characterized by a benign tumor of the adrenal gland that triggers the overproduction of hormones, including cortisol and testosterone

• Androgen-secreting tumors: Rare adrenal gland or ovarian tumors, both benign and cancerous, that produce excess testosterone

• Acromegaly: An enlargement of the pituitary gland that triggers the overproduction of testosterone

• Certain medications: Including anabolic steroids, hormonal contraceptives, anticonvulsant drugs, and testosterone

• Obesity: Caused when excess fat and changes in insulin levels stimulate the adrenal gland and the production of testosterone

Types of Testosterone Tests

Various at-home kits can measure different forms of testosterone in your blood or saliva. "Finger-prick" blood tests tend to be the most accurate, but saliva-based tests are painless and ideal for people who are squeamish about blood.

In general practice, there are three types of testosterone tests:

• Free testosterone (FT): This measures the most active form of testosterone unattached to any protein. FT makes up around 2% of testosterone in your body. This test can give more information about possible problems, particularly when the overall level is low.

• Bioavailable testosterone (BT): This test measures free testosterone and another form called bioavailable testosterone. Together, they make up half of the testosterone in your body. BT is loosely bound to a protein called albumin and can become unattached and "free."

• Total testosterone (TT): This is the most common test that measures free testosterone, bioavailable testosterone, and a third, inactive form called bound testosterone that is attached to a protein called sex hormone-binding globulin (SHGB).

While older at-home tests measured only total testosterone, newer-generation blood and saliva tests can also measure free and bioavailable testosterone.

How to Take a Testosterone Test

At-home testosterone tests are available without a prescription. The kits are mail-in tests, meaning that you take a sample of blood or saliva at home and mail it to a lab for testing.

When you first receive the kit, you will register on a secure website with the manufacturer. Once the sample has been processed, the results will be returned via the website, usually within a few days.

The kits contain everything you need to collect a sample and a prepaid, certified shipping envelope to return the sample. Some manufacturers offer step-by-step instructions on their website.

Are There Food Restrictions?

Testosterone tests are most accurate when taken in a fasted state. This means stopping all food and drink for 12 hours before the test. For instance, if you intend to take the test at 9:00 a.m., stop eating and drinking anything other than a sip of water by 9:00 p.m. the night before.

Saliva Tests: Step-by-Step

Saliva tests for testosterone vary. Some require an oral swab, while others ask that you spit into a test tube. The most accurate request several samples throughout the day.

What follows is an example of instructions for a multiple-sample saliva-based test:

1. Do not brush your teeth or eat or drink anything (except water) after you awaken.

2. Take your first sample within 30 minutes of waking up, ideally before 10:00 a.m. This is when testosterone levels are generally at their highest.

3. Allow the saliva to pool in your mouth for several moments before filling the first tube at least halfway or to the designated line.

4. Close the tube and write your name and the collection time on the tube label.

5. Repeat steps 3 and 4 before lunch, dinner, and bedtime. Be sure not to brush your teeth or eat or drink anything except water two hours before the collection.

6. Ship the sample within 24 hours. If it cannot be shipped within that time, freeze the sample and ship it to the manufacturer as soon as possible.

Finger-Prick Blood Tests: Step-by-Step

Many testosterone blood tests are finger-prick tests that draw a drop of blood using a spring-loaded cutting device called a lancet. The tests are generally performed by placing drops of blood onto a collection card covered with circles.

What follows is an example of instructions for an at-home testosterone blood test:

1. Do not eat or drink anything (except water) after awakening.

2. Take the test before 10:00 a.m. when testosterone levels are at their highest.

3. Wash your hands with soap and water.

4. Remove the collection card from the kit box.

5. Fold back the cover without touching the face of the card.

6. Choose a finger from your non-dominant hand to draw blood from.

7. Clean the finger with the alcohol swab provided.

8. Remove the cap of the lancet and press it against the pad of your finger until it clicks.

9. Wipe away the first drop with the piece of gauze provided.

10. Let the blood drop from your finger onto the center of each circle. Do not squeeze your finger.

11. If the blood stops, you can press your finger—away from the card—until the blood flows again.

12. Continue filling each circle until all circles are filled.

13. Let the card dry for at least four hours.

14. Once dry, replace the cover and put the collection card into the prepaid return envelope until it is ready to ship.
    

Do I Need to Stop Medications?

Testosterone tests can be affected by certain topical or oral drugs, including steroids, DHEA, growth hormone, testosterone gel, and estrogen cream. These would need to be stopped several days in advance to avoid tainting the results,

If you are on oral contraceptives, you would need to take the test midway between doses (such as at 8:00 a.m. if you take an 8:00 p.m. dose). Call the manufacturer to ensure you are taking the test correctly if you are on any medications.

Blood Testosterone Test

A venous blood draw testosterone test will be performed at a clinic or lab. You will receive instructions as to fasting and preparation.

The technician will identify you. You will be seated, and a tourniquet will be placed on your arm. The blood draw site will be sterilized.

The technician will insert a needle into a vein, and blood will be drawn into a tube. The needle is removed and a bandage is placed. The tubes are labeled with your identification and sent to the lab for testing.

Testosterone Test Results: What's Normal vs. Abnormal?

Testosterone test results are described on a reference range of values, meaning a high and a low value between which testosterone levels are considered normal. Different testosterone tests have different normal values. The values also differ by a person's age and sex.

Normal Testosterone Levels

Total testosterone (TT) and bioavailable testosterone (BT) are both measured in nanograms per deciliters (ng/dL). Free testosterone (FT) is measured in picograms per deciliters (pg/dL).

Abnormal Testosterone Levels

Any value that falls above or below the reference range of value is considered abnormal. With that said, reference ranges can vary from one lab to the next, and expert interpretation may be needed.

Generally speaking, an early morning total testosterone result below the reference range indicates hypogonadism. People with symptomatic hypogonadism may benefit from testosterone replacement therapy. However, there are times when treatment is contraindicated and also times when treatment will not result in any changes.

By contrast, an early morning total testosterone above the reference range generally indicates hyperandrogenism. In females particularly, this could suggest a need for hormonal therapy (such as birth control pills) to correct the imbalance of sex hormones.

Treatment of the underlying cause may also be needed, along with treatment for symptoms like hormone-induced feminization and virilization.

Related: Can Supplements Boost Testosterone?

Are Testosterone Test Kits Reliable?

It is difficult to assess how accurate at-home testosterone kits are because most studies evaluate the technology and/or method of testing in a clinic rather than in the home. But, even when used in clinics, there is a wide range of variability in the accuracy of these tests.

The Centers for Disease Control and Prevention states that while such tests are "critically important," they also tend to be "unreliable." This is especially true when testosterone levels are low.

A 2016 study in the Journal of Sexual Medicine found that the variability of testosterone test results can be as high as 40% when levels are below 100 ng/dL. And that's a problem because even subtle differences in hormone levels can indicate a health concern, particularly in females.

When the tests are used in a home setting, the risk of user error or improper preparation, collection, storage, handling, or shipping only adds to these concerns.

The interpretation of test results can also vary dramatically based on whether you have obesity, diabetes, or heart disease or even take cholesterol medications. So, the results may only have real value when taken and interpreted in the proper context.

None of this is meant to suggest that at-home testosterone kits have no value. If performed correctly with a full understanding of the test's limitations, they may prompt you to seek medical care if you suspect something is wrong and the test results are abnormal.

How Much Do Testosterone Kits Cost?

Commercial testosterone test kits cost between $70 and $120, not including sales tax. At-home tests aren’t generally covered by insurance, but some manufacturers accept HSA/FSA cards.

When choosing a test, opt for those that are CLIA-certified. These are considered the gold standard because their testing facilities adhere to the same regulations as hospital labs.

Related: 7 At-Home Testosterone Test Kits We Recommend in 2024

Seeing a Provider

At-home testosterone tests should not be used to determine if you need testosterone shots or to see if you have infertility or PCOS. It takes much more than a single test to determine that.

The tests can provide a starting point to discuss a medical concern with a healthcare provider. If you have symptoms that concern you—such as chronic fatigue, low sex drive, gynecomastia, or sudden hair thinning—an abnormal test result may provide evidence of concern and allow your provider to repeat the test and order others.

In the end, if you suspect you have a hormonal problem of any sort, speak with a healthcare provider. A testosterone test may help but is not necessarily needed.

Summary

At-home testosterone kits are mail-in tests that can tell you if you have high or low testosterone levels. The tests can be used in males and females and involve a blood or saliva sample.

Testosterone tests cannot diagnose any medical condition but can point a healthcare provider in the direction of a medical concern if testosterone levels are abnormally high or low.

Read the original article on Verywell Health.