Hormones · Anabolic foundation

Testosterone Total(TT)

Total testosterone is the headline male performance biomarker — but the number alone tells you less than you think. Free testosterone, SHBG, and estradiol together complete the picture.

Female testosterone is roughly one-tenth of male levels. ~50% circulates bound to SHBG, ~50% to albumin, < 2% free. Mass spectrometry (LC-MS/MS) is the gold standard; immunoassays are unreliable at the low female range. Levels decline gradually with age (no abrupt menopausal drop unlike estradiol).

Optimal range (women)

reproductive · perimenopause · postmenopause

25–70ng/dL

Cycle: Measure on cycle day 2-5 for PCOS workup. Morning draw preferred (diurnal variation persists in women).

Clinical "normal"

8–60 ng/dL

Avg. cost (US)

$75

Test frequency

Every 3–6 months while optimizing; annually at maintenance

When to measure

Cycle day 2-5 for cycling women (for PCOS workup); any day for postmenopausal women. Morning draw (08:00-10:00). Confirm any abnormal value on a second sample by LC-MS/MS.

How to measure

Standard venous blood draw. Most labs measure total T via immunoassay; LC-MS/MS is more accurate and worth asking for if results are borderline.

Average cost

≈ $75 cash price. Often covered by insurance with relevant ICD-10.

Signs your level is off

Symptoms if low

Low libido / hypoactive sexual desire disorder (HSDD), fatigue, depressed mood, loss of lean mass, sparse pubic/axillary hair, reduced sense of well-being (particularly after surgical menopause/oophorectomy).

Symptoms if high

Hirsutism (Ferriman-Gallwey > 4-6), acne, oligo/amenorrhea, androgenic alopecia, virilization (clitoromegaly, deepening voice). Workup PCOS, late-onset CAH (21-hydroxylase deficiency), Cushing's, ovarian/adrenal androgen-secreting tumor — total T > 150-200 ng/dL warrants imaging.

If your level is low

Zinc >50 mg: nausea

Supplement

DHEA (low-dose)· 10-25 mg/day, physician-directed; reserved for adrenal insufficiency or selected postmenopausal HSDD

Form: micronized oral DHEA

Peripheral conversion to androgens and estrogens; modest rise in total/free testosterone

Foods

adequate protein (1.2-1.6 g/kg)
zinc-rich foods (oysters, beef, pumpkin seeds)
healthy fats supporting steroidogenesis

Lifestyle

resistance training 2-3x/week
prioritize sleep 7-9 hours
manage chronic stress (HPA suppression lowers DHEA/T)

Medication (if prescribed)

Transdermal testosterone (off-label for HSDD)· ~5 mg/day transdermal; titrate to female physiologic range

Form: compounded 1% cream or approved Androfeme 1% (AU/UK)

Reference only. Speak with a licensed clinician before any prescription intervention.

Caution: Only evidence-based indication is HSDD (IMS 2019 Global Consensus). Avoid pellets/IM testosterone (supraphysiologic). Do not use for fatigue, bone, mood, or general well-being alone — guidelines recommend against.

If your level is high

DIM: headaches

Supplement

Myo-inositol + D-chiro-inositol (40:1)· 2 g myo-inositol + 50 mg D-chiro twice daily

Form: powder/capsule

Improves insulin sensitivity and ovarian insulin signaling; lowers free testosterone in PCOS by 20-30% over 3-6 months

Foods

low-glycemic Mediterranean pattern
reduce refined carbs and added sugar
increase fiber (>25 g/day) and omega-3

Lifestyle

5-10% weight loss if BMI > 25
resistance + zone-2 cardio
sleep optimization
stress reduction

Medication (if prescribed)

Combined oral contraceptive (ethinyl estradiol + anti-androgenic progestin) or spironolactone· COC daily; spironolactone 50-200 mg/day

Form: Oral

Reference only. Speak with a licensed clinician before any prescription intervention.

Caution: Spironolactone is teratogenic (Category C) — reliable contraception required. Workup for late-onset CAH (17-OHP), Cushing's, and androgen-secreting tumor if T > 150 ng/dL or rapid virilization.