Testosterone in Women: Optimal Testing Recommendations

  • Measurement of total testosterone in women (and children) should be performed by a sensitive liquid chromatography/tandem mass spectrometry (LC/MS)-based assay. 
  • Immunoassay-based testosterone tests perform best at higher concentrations of testosterone and therefore work well for those with testosterone levels in the adult-male range.

Guidelines for Test Utilization

What does the test tell me?

This test, when measured by LC/MS, produces an accurate and sensitive quantitation of testosterone in circulation. If above the sex- and age-appropriate reference interval, this may be an indicator of androgen excess, though moderate androgen excess may not be detected with a total testosterone measurement alone.

When should I order this test?

Testosterone by LC/MS in women should be used to evaluate women with symptoms of androgen excess (e.g., hirsutism, oligo amenorrhea, virilization, or infertility) or androgen deficiency (decreased libido). However, FDA-approved testosterone formulations for women are unavailable at this time.

When should I NOT order this test?

Do not order testosterone by immunoassay on women and children.

How should I interpret the result?

Total testosterone in women should be interpreted in light of sex- and age-appropriate reference intervals. Values above or below the reference interval likely indicate androgen excess or deficiency, respectively.

Is the test result diagnostic/confirmatory of the condition? If not, is there a diagnostic/confirmatory test?

Mild to moderate testosterone excess should not be excluded based solely on a total testosterone within the reference interval. Free and/or bioavailable testosterone tests should be used to confirm. Similarly, a low total testosterone should be verified with a free and/or bioavailable testosterone.

Are there factors that can affect the lab result?

Testosterone is subject to diurnal variation, and is highest in the morning to early afternoon and declines thereafter. It is best to collect the sample between 6-10 am, if possible.

Are there considerations for special populations?

Children also have low circulating testosterone and therefore require testing by LC/MS, similar to women.

What other test(s) might be indicated?

Free and bioavailable testosterone may be useful in cases of mild testosterone abnormalities. Luteinizing hormone (LH) and/or follicle-stimulating hormone (FSH) may be also useful for elucidating the cause of androgen abnormalities.

References

Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H. Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. J Clin Endocrinol Metab. 2007;92(2):405-413.

Davis SR, Wahlin-Jacobsen S. Testosterone in women—the clinical significance. The Lancet Diabetes & Endocrinology. 2015;3(12):980-992.

Wierman ME, Arlt W, Basson R, et al. Androgen Therapy in Women: A Reappraisal: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism. 2014;99(10):3489-3510.



Last reviewed: June 2020. The content for Optimal Testing: AACC's Guide to Lab Test Utilization has been developed and approved by the AACC Academy and AACC's Science and Practice Core Committee.

As the fields of laboratory medicine and diagnostic testing continue to grow at an incredible rate, the knowledge and expertise of clinical laboratory professionals is essential to ensure that patients received the highest quality and most useful laboratory tests. AACC's Academy and Science and Practice Core Committee have developed a test utilization resource focusing on commonly misused tests in hospitals and clinics. Improper test utilization can result in poor patient outcomes and waste in the healthcare system. This important resource geared toward medical professionals recommends better tests and diagnostic practices. Always consult your laboratory director to make sure these recommendations are appropriate for your patient population.