Testosterone is a hormone made in both male and female bodies, playing a major role in sexual development, energy, and reproduction. While it is best known as the “male hormone,” testosterone is also vital for women, although at lower levels. As men and women age or face health issues, changes in testosterone can disrupt fertility. Many couples struggling to conceive may not realize how important this hormone is for ovulation, sperm health, and sex drive. Testing testosterone levels is one of the first steps doctors take when evaluating fertility problems. A simple blood test can uncover hormone imbalances, point to underlying causes, and help guide the best course of treatment. Understanding what a testosterone test is, how it works, and what your results mean is key to improving your chances of building a family.
What is a Testosterone Test?
A testosterone test is a blood test that measures the amount of testosterone circulating in your bloodstream. This test is performed for both men and women and is critical in evaluating reproductive and overall health. Most commonly, your doctor will order this test if you have symptoms of hormone imbalance or if you’re having trouble conceiving. The test measures total testosterone, and sometimes free or bioavailable testosterone, to get a full picture of your hormonal status.
Blood is usually drawn from a vein in the arm, sent to a laboratory, and analyzed. Results are reported in nanograms per deciliter (ng/dL). This test is often ordered alongside other hormone tests like FSH, LH, and estrogen to identify complex fertility issues. It’s simple, safe, and provides valuable insight into your reproductive health, whether you are a man experiencing low sex drive or a woman with irregular cycles. For older adults, checking testosterone is particularly important, as levels often change with age, affecting fertility and quality of life.
Why Testosterone Testing Matters for Fertility ?
Testing testosterone is central to understanding fertility problems in both sexes. In men, testosterone is vital for sperm production and sexual function. Low levels may mean reduced sperm count, poor sperm quality, or sexual difficulties, all of which lower the chance of fathering a child. For women, abnormal testosterone can disrupt the menstrual cycle, ovulation, and egg quality. High testosterone, common in conditions like polycystic ovary syndrome (PCOS), can block ovulation and make conception difficult.
Clinical studies, such as those published in Fertility and Sterility and The Journal of Clinical Endocrinology & Metabolism, have shown that correcting testosterone imbalances can improve fertility outcomes for many couples. Early testing helps doctors personalize treatment, reduce the time to pregnancy, and avoid unnecessary interventions. Without this crucial test, some hormone disorders go unnoticed, causing frustration and delays. In summary, testosterone testing is a powerful tool that helps pinpoint the cause of fertility challenges and opens the door to effective solutions.
Normal Testosterone Ranges for Men and Women
Knowing normal testosterone levels helps doctors interpret your test and find out if there’s a problem. Levels depend on age, sex, and time of day.
Table: Normal Testosterone Ranges
| Group | Normal Range (ng/dL) |
| Men | 300–1,000 |
| Women | 15–70 |
Men tend to have higher levels, while women require far less for reproductive health. Age can shift these ranges, and each lab may use slightly different reference values. Consistently low or high results, especially alongside symptoms, signal hormone imbalance. For fertility, having testosterone in the right range is crucial, since both too little and too much can block conception.
Symptoms Indicating Need for Testosterone Testing
Symptoms of testosterone imbalance can be subtle or obvious, and they may overlap with other health problems. You might need a testosterone test if you notice:
In Men:
- Decreased sex drive
- Erectile dysfunction or difficulty maintaining an erection
- Low sperm count or infertility
- Fatigue or loss of energy
- Loss of muscle mass or bone density
- Enlarged breasts (gynecomastia)
- Mood changes, depression, or irritability
In Women:
- Irregular or missed periods
- Infertility or trouble getting pregnant
- Increased facial or body hair
- Thinning scalp hair
- Acne or oily skin
- Deepened voice
Both men and women with symptoms that suggest a hormone imbalance should ask their doctor about testosterone testing. Sometimes, other health issues like thyroid disease or pituitary problems can cause similar symptoms, so a full evaluation is often needed.
Types of Testosterone Tests: Total vs Free Testosterone
Testosterone circulates in the blood in two main forms: bound and free. Total testosterone measures both, while free testosterone measures only the active, unbound form.
- Total Testosterone Test: This measures all testosterone in your bloodstream. Most testosterone is bound to proteins such as sex hormone-binding globulin (SHBG) and albumin. This test is the standard first step in evaluating hormone status.
- Free Testosterone Test: A small portion (about 2-3%) is free and active. Measuring free testosterone is helpful if you have symptoms but normal total testosterone, as some medical conditions or age can alter the balance.
Table: Types of Testosterone Tests
| Test Type | What It Measures | When It’s Used |
| Total Testosterone | Bound + Free | Standard screening, most situations |
| Free Testosterone | Unbound only | Complex cases, women, borderline results |
How to Prepare for a Testosterone Test
Preparation affects accuracy. Your doctor will give you instructions, but here are standard steps:
- Test Timing: Testosterone peaks in the morning, so schedule your test between 7 and 10 a.m.
- Medications: Bring a list of medications and supplements. Some, like steroids or seizure drugs, can alter results.
- Exercise and Food: Avoid vigorous exercise for 24 hours before the test. Fasting is usually not needed unless your doctor requests it.
- Illness or Stress: Postpone your test if you are acutely ill, as this can lower testosterone levels.
- Alcohol and Smoking: Limit alcohol and avoid smoking before your test if possible, since both can affect hormones.
How is the Testosterone Test Performed?
The testosterone test is quick and safe, performed in a medical office or lab. Here’s what to expect:
- Blood Draw: A healthcare professional cleans your arm, inserts a small needle into a vein, and collects a blood sample.
- Sample Handling: Your blood is placed in a vial and sent to a lab for analysis.
- Procedure Time: The draw takes about five minutes. Most people only feel a brief pinch.
- Aftercare: You may have a small bruise or mild soreness, which goes away quickly. Serious side effects are extremely rare.
Interpreting Testosterone Test Results
Interpreting your results involves more than just reading the number. Your doctor considers:
- Your Age and Sex: Reference ranges differ for men and women, and testosterone naturally declines with age.
- Your Symptoms: Results must match your physical signs, such as low sex drive, infertility, or irregular periods.
- Total vs Free Testosterone: Both may be needed for a full picture, especially if you have borderline results or unexplained symptoms.
- Other Hormones: Tests like FSH, LH, or estrogen may be ordered to clarify the cause of abnormal results.
Low testosterone in men may suggest testicular dysfunction, pituitary disorders, or the effect of chronic illness. In women, high testosterone may indicate PCOS, adrenal disorders, or tumors. Sometimes, temporary factors like stress, illness, or recent exercise can lower testosterone levels.
Impact of Abnormal Testosterone on Male Fertility
Abnormal testosterone levels have a direct impact on a man’s fertility. Low testosterone is associated with:
- Reduced Sperm Production: Testosterone is needed for healthy sperm. Low levels cause the testes to produce fewer sperm, resulting in low sperm count, known as oligospermia.
- Poor Sperm Quality: Sperm motility and shape are affected, making it harder for sperm to reach and fertilize an egg.
- Erectile Dysfunction and Low Libido: Both lower the chance of conception.
- Testicular Atrophy: Severe or prolonged low testosterone can cause the testicles to shrink, worsening infertility.
On the other hand, excessively high testosterone, often from supplements or steroids, can be just as harmful. Extra testosterone signals the body to reduce its own production, lowering sperm production to the point of temporary or even permanent infertility. A study published in Fertility and Sterility (2018) found that anabolic steroid abuse is one of the leading preventable causes of male infertility . Clinical trials show that sperm counts can drop to zero with prolonged steroid use, and recovery may take months or not occur at all.
Table: Effects of Abnormal Testosterone in Men
| Testosterone Status | Sperm Count | Sperm Quality | Fertility Risk |
| Low | Decreased | Poor | High |
| High (supplements) | Severely reduced | Poor | High |
Impact of Abnormal Testosterone on Female Fertility
In women, abnormal testosterone especially high levels can disrupt the delicate hormone balance needed for ovulation and conception. The most common cause of high testosterone in women is polycystic ovary syndrome (PCOS). PCOS is a leading cause of female infertility, affecting up to 10% of women of reproductive age.
Effects include:
- Irregular or Absent Periods: High testosterone blocks the hormonal signals needed for ovulation, leading to missed or unpredictable periods.
- Poor Egg Quality: Eggs may not mature properly, lowering the chance of successful fertilization.
- Ovarian Cysts: Excess testosterone can trigger cysts, which further disrupt ovulation.
- Signs of Androgen Excess: Increased facial or body hair, scalp hair thinning, acne, and voice changes may signal a hormonal imbalance.
Table: Effects of Abnormal Testosterone in Women
| Testosterone Status | Periods | Ovulation | Fertility Risk |
| High (PCOS) | Irregular/absent | Reduced/blocked | High |
| Low | Normal/low flow | Sometimes reduced | Moderate |
Follow-Up Steps after Abnormal Results
Abnormal results require additional evaluation to pinpoint the cause and guide treatment. Your doctor may:
- Order more hormone tests, such as FSH, LH, prolactin, or thyroid hormones
- Suggest imaging studies, like pelvic ultrasound (for women) or testicular ultrasound (for men)
- Refer you to an endocrinologist or fertility specialist for expert care
- Advise semen analysis for men or ovulation tracking for women
Prompt follow-up ensures that treatable causes of hormone imbalance are addressed quickly, improving fertility outcomes. Treatment may involve medication, surgery, lifestyle changes, or assisted reproduction, depending on your diagnosis.
Lifestyle and Medical Interventions Post-Test
Correcting abnormal testosterone levels often starts with lifestyle changes:
- Maintain a Healthy Weight: Obesity can lower testosterone and block ovulation.
- Eat a Balanced Diet: Focus on whole foods, plenty of protein, healthy fats, and micronutrients.
- Exercise Regularly: Moderate exercise boosts natural testosterone and improves fertility. Avoid excessive endurance training.
- Limit Alcohol and Stop Smoking: Both can disrupt hormones and lower fertility.
- Manage Stress and Improve Sleep: Both are vital for hormone balance.
Medical interventions may include:
- Hormone Therapy: Prescription medications can restore normal testosterone.
- Treat Underlying Conditions: Managing PCOS, thyroid disease, or pituitary disorders is essential for restoring fertility.
- Fertility Treatments: If natural conception is not possible, assisted reproduction techniques, such as IVF, may be recommended.
Risks and Limitations of Testosterone Testing
Although testosterone testing is safe, there are some risks and limitations. The blood draw is minor, but you might experience brief bruising or soreness. Rarely, infection or fainting occurs.
Limitations include:
- Timing Fluctuations: Testosterone levels vary throughout the day, so timing matters for accuracy.
- Temporary Factors: Illness, poor sleep, or stress can alter results.
- Single Test Limitations: Sometimes, one test is not enough, and repeat testing or measuring other hormones is required.
No test is perfect, and results always need expert interpretation. The test alone cannot diagnose all causes of infertility, but it is an essential first step in a thorough fertility evaluation.
Cost and Accessibility of Testosterone Tests
Testosterone tests are widely accessible at clinics, hospitals, and through some at-home test kits.
- Cost: In the US, a standard testosterone test costs $50 to $150, sometimes higher for more comprehensive hormone panels. Insurance often covers the test if ordered for a clear medical reason, especially for infertility or suspected hormone disorders.
- At-Home Testing: These kits are available online and usually cost $80 to $200. While convenient, at-home kits may be less reliable, and samples can be lost or delayed. Lab-based testing is more accurate.
- Discounted and Public Services: Many community health clinics offer sliding scale fees. Some government programs or nonprofit clinics provide reduced-cost tests for those who qualify.
- Access: Most primary care physicians, gynecologists, urologists, and fertility specialists can order this test.
When to See a Specialist
Endocrinologists diagnose and treat hormone problems, while reproductive endocrinologists and urologists focus on infertility. Early intervention by a specialist improves treatment options and the chance for a healthy pregnancy.
See a specialist if you:
- Have abnormal testosterone results and persistent symptoms
- Are trying to conceive for over a year without success (six months for women over 35)
- Experience signs of hormone disorders, like missed periods or erectile dysfunction
- Have a history of cancer, surgery, or genetic disorders affecting reproductive organs
Conclusion
Testosterone testing is a cornerstone of fertility evaluation in both men and women. It helps diagnose hormone imbalances that can block conception, guides treatment, and improves success rates for couples. The process is simple, safe, and widely available. Abnormal testosterone levels whether too low or too high can disrupt sperm production, ovulation, and overall reproductive health. Acting on abnormal test results with lifestyle changes, medical treatment, or specialist care can restore hormonal balance and significantly improve the chances of conception. Always seek expert guidance if you have fertility concerns, persistent symptoms, or abnormal hormone test results. Regular check-ups, healthy habits, and open communication with your healthcare team offer the best pathway to resolving fertility challenges linked to testosterone.
Frequently Asked Questions
What is the best time of day to take a testosterone test?
Testosterone is highest in the morning, so schedule your test between 7 a.m. and 10 a.m. for the most accurate results.
Can stress affect testosterone test results?
Yes, high stress can lower testosterone levels temporarily, so try to be relaxed and well-rested before your test for accuracy.
Is fasting required before a testosterone test?
Fasting is usually not needed unless your doctor orders additional tests, but always confirm specific instructions before your appointment.
How long does it take to get testosterone test results?
Most labs provide results within two to five days, but the timeline may vary depending on the facility and any additional hormone testing.
Do testosterone levels fluctuate throughout the day?
Yes, levels peak in the morning and gradually decrease throughout the day, so time of testing is important for accurate measurement.
What other hormones are checked for fertility assessment?
Doctors often check FSH, LH, estrogen, and prolactin, along with testosterone, to get a complete view of reproductive health.
Can certain medications affect testosterone test results?
Some medications, such as steroids, anticonvulsants, and hormone therapies, can change testosterone readings, so disclose all medications to your doctor.
How often should testosterone levels be checked for fertility concerns?
Testing frequency depends on symptoms and treatment plan, but most people need a baseline test and follow-up after any intervention or change.
Is at-home testosterone testing reliable?
At-home kits can be convenient, but results may be less accurate than those from professional labs, so confirm reliability before choosing this option.
Can a testosterone test diagnose infertility?
No, it cannot diagnose infertility alone, but it identifies hormone problems that may cause infertility, guiding further evaluation and treatment.
References
- Cleveland Clinic – Testosterone Levels Test
- Mayo Clinic – Low Testosterone Diagnosis
- Fertility and Sterility – Anabolic Steroids and Male Fertility
- Obstetrics & Gynecology – Polycystic Ovary Syndrome and Infertility
- Lab Tests Online – Testosterone
- Healthline – Testosterone Tests
- Medical News Today – Testosterone Test
- The Lancet Diabetes & Endocrinology – PCOS and Metabolic Syndrome
- Human Reproduction – Hormonal Imbalance in Women
- Journal of Clinical Endocrinology & Metabolism – Testostero
