Can testosterone test be wrong? How accurate are they really?

Do you ever wonder if the results of your testosterone test can be wrong? It’s a question that many people have asked themselves at some point.

After all, testosterone plays a crucial role in various aspects of our lives, from physical health to mental well-being. But can testosterone tests ever be wrong? That’s what we’re going to unravel in this blog post.

When it comes to medical testing, accuracy is paramount. We rely on these tests to provide us with reliable information about our health. However, no test is perfect, and there is always a chance for errors to occur. In the case of testosterone tests, the accuracy can be influenced by various factors, giving rise to potential inaccuracies.

In this blog post, we will delve deep into the intricacies of testosterone testing, exploring the potential for inaccuracies and shedding light on how you can ensure the most accurate results possible.

So, if you’ve ever questioned the reliability of your testosterone test results, this post is a must-read. Let’s uncover the truth together and answer the burning question: can testosterone tests ever be wrong?

How accurate are testosterone tests

There are 2 main ways of testing testosterone; immunoassays (IA) and liquid chromatography tandem mass spectrometry (LC-MS/MS).

MS is the gold standard and the most accurate, but it’s more expensive and requires a higher level of training and competency to handle. Thus most clinics use IS; which is slightly less accurate.

IA is the most accurate when testosterone is in the mid-range of normal with a -14.1 and +19.2% variance. Under <100ng/dl, the error range changes increases to ±40% (R). At lower concentrations, IA demonstrates particularly significant variations among techniques, with equivalent samples resulting in 2.7–14.3 fold variations in reported results

Using a total error target of ±25.1%, which was calculated using the minimum allowable bias and imprecision (R).

Another study found that the imprecision of commercial immunoassays for testosterone was found to be <8% at concentrations of >24 nmol l⁻¹ and between 6.1% and 22% at concentrations <3 nmol l⁻¹.

Let’s say your testosterone is 24.3nmol/L (700ng/dl) then you can expect your sample to vary by 8% each time. At best you’d vary between 644 and 756ng/dl just based on test accuracy. At worst it can be around 25% variation.

The lower your T is, the greater the inaccuracy will be.

This is why it’s so important to go by symptoms as well.

Factors That Can Influence Testosterone Test Results

There are many factors that can influence your testosterone over the year and from test to test. Here are a few.

Acute and chronic disease

With acute illness, testosterone can drop by 10% and up to 30% in some people depending on the severity (R).

On top of that, the medication given to help deal with the illness can also further lower testosterone (R).

Age

If you don’t look after yourself as well as you could, then you can expect that your testosterone will drop with age. Age is not the cause of the drop in testosterone, but rather obesity, diabetes, high blood pressure, poor sleep, lack of appetite, lack of physical activity, medication use, illness, etc (R).

I’ve written an article showing that testosterone doesn’t drop with age in healthy men. So yes, you can have normal/high testosterone in your 80s and 90s.

Assay Techniques (the equipment used to test)

• IA vs MS results in −14.1% to 19.2% variability and ±40% at testosterone <100 ng/dl (R, R)
• At low testosterone, IA varies by 2.7 to 14.3 fold (R)
• Specimen handling, preparation, and commutability, calibration methods, and matrix interference introduce variability
• MS is the gold standard for TT, equilibrium dialysis for fT, but both are expensive and rare to come by

Variations during the day

Testosterone peaks in the AM and declines thereafter.

In young men, testosterone is about 20-25% higher in the AM than the PM. In older men (70+), this variation is only about 10%.

➡️In this article, I discuss daily and seasonal variations more in-depth.

Ethnicity

There is minimal if any difference of ethnicity on testosterone variation.

➡️Testosterone levels across race and country.

Genetics

Genetics accounts for only 42–65% of testosterone variability (R, R). Lifestyle and diet make the biggest difference.

Geography

Depending on the quality of food and lifestyle, certain populations has higher testosterone than others. For example, according to this study, people from Hong Kong and Japan had ~20% higher testosterone compared to those from Sweden, Tobago, and the US (R).

➡️In this article, I explore more in depth the testosterone differences across race and country and the main reason why it varies.

Intra-individual variation

The biggest reason for testosterone fluctuations is within yourself. Every day our testosterone levels are slightly different.

• Repeated measures vary by 65–153% (R).
• Up to 50% of men with T <300 ng/dl will be >300 ng/dl on repeat testing (R).
• Averaging 2–3 tests reduces range variability by 30% and 43%, respectively (R).

Biological variation generally accounted for more of total intraindividual variation than did assay variation. Day-to-day biological variation accounted for more of the total than did long-term biological variation (R).

Now combine your own fluctuations with assay inaccuracy and you can easily fluctuate 100-200ng/dl on a test.

If your results are lower on a test than last time, but you feel better than last time, don’t put too much weight on that test.

Lifestyle Factors

There are a couple of lifestyle factors that can influence testosterone, namely obesity, sleep and activity.

Obesity is inversely associated with testosterone and a 4–5 point increase in BMI is associated with 10-year equivalent testosterone decline (R). Let’s say your BMI is 25 at 174lbs and your testosterone 500ng/dl. Gaining weight to 209lbs can lower your testosterone by 50-100ng/dl if not more.

Losing excess fat is one of the best ways to increase testosterone. You can expect a 100ng/dl increase for each 10% of body weight you lose.

➡️In this article, I discuss more in-depth how much fat loss impacts your testosterone levels.

Exercise has been shown to increase testosterone. Compared to aerobic activity, resistance exercise likely results in greater improvements in T, with untrained men experiencing larger increases compared to those routinely performing resistance exercises (R, R)

Lastly, sleep loss and especially sleep apnea, will significantly lower testosterone. The more severe your sleep apnea is, the lower you can expect your testosterone to be.

Seasonal

In general, testosterone will be higher in the summer compared to the winter, but it all depends on the culture and what is done during the summer. If lots of food is eaten, alcohol is drunk and lots of partying is happening, you’d likely see a drop in testosterone.

➡️In this article, I discuss more in-depth the seasonal changes in testosterone.

Medication use

Many drugs can have a negative impact on testosterone, such as antibiotics, anti-depressants, opioids, drugs for sleep, glucocorticoids, anti-inflammatory (NSAIDs) drugs, etc.

Heavy alcohol consumption

Drinking a little bit of alcohol here and then will not have a negative effect on your testosterone, but heavy drinking will definitely.

Common Misconceptions About Testosterone Tests

Misconception 1: Testosterone tests are always accurate

While testosterone tests can provide valuable information about a person’s hormone levels, it is important to understand that they are not always 100% accurate. There are several factors that can influence the accuracy of these tests. For example, the time of day the test is taken, the individual’s overall health, and even certain medications can impact the results. It is crucial to consult with a healthcare professional who can interpret the test results in the context of the individual’s unique circumstances.

Misconception 2: High testosterone levels always indicate good health

Another common misconception is that high testosterone levels always equate to good health. Very often high testosterone goes in conjunction with high SHBG, which could lead to low bioavailable testosterone. It’s relatively common for people who eat low carb diets to experience low testosterone symptoms despite having very high levels of testosterone.

Misconception 3: Testosterone tests are the only way to diagnose hormonal imbalances

While testosterone tests are a valuable tool in diagnosing hormonal imbalances, they are not the only method available. Healthcare professionals often consider a range of factors, including symptoms, medical history, and physical examinations when assessing hormonal health. Sometimes, additional tests such as thyroid function tests, adrenal hormones (DHEA-S:cortisol ratio), a stool test, a DUTCH test, etc, may be necessary to gain a comprehensive understanding of a person’s hormonal profile.

Misconception 4: Testosterone replacement therapy is the only solution for low testosterone levels

When it comes to addressing low testosterone levels, testosterone replacement therapy is not the only solution. Depending on the underlying cause of the hormonal imbalance, oftentimes lifestyle changes (sleep, exercise, stress management, sunlight, etc.), dietary modifications, and targeted supplements can massively boost testosterone. Smart doctors understand that these changes are essential even for someone on TRT.

When to Seek a Second Opinion for Testosterone Test Results

Not all doctors are equally well-versed in hormonal health (and you can’t expect them to be) and they don’t always know what’s high, low or normal or what to do about it if things are wrong.

One situation where seeking a second opinion for testosterone test results is advisable is when you experience symptoms that do not align with the test results. Testosterone deficiency can lead to a variety of symptoms, including fatigue, decreased libido, and mood swings. If your test results indicate normal testosterone levels but you still experience these symptoms, it may be worth consulting another healthcare professional to ensure an accurate diagnosis.

Another scenario where a second opinion may be warranted is when you have doubts about the accuracy of the initial test. While testosterone tests are generally reliable, errors can occur due to a variety of factors, such as improper sample collection or handling. If you suspect that the test was not conducted correctly or if there were any issues with the laboratory procedures, seeking a second opinion can provide reassurance and ensure accurate results.

Additionally, seeking a second opinion for testosterone test results may be appropriate if you have concerns about the qualifications or expertise of the healthcare professional who administered the test. Different healthcare providers may have varying levels of experience and expertise when it comes to interpreting testosterone test results. Consulting another specialist can provide a fresh perspective and potentially lead to a more accurate diagnosis.

It is also important to consider seeking a second opinion if the initial test results suggest a significant deviation from your previous testosterone levels. Testosterone levels can fluctuate naturally, and a single test may not always be indicative of your overall hormonal balance. By obtaining a second opinion, you can compare and evaluate the results from different tests to ensure a more accurate understanding of your testosterone levels.

Tips for a Reliable Testosterone Test

When it comes to testosterone tests, accuracy is crucial. To ensure you get reliable results, consider the following tips:

1. Choose a reputable lab: The first step in obtaining reliable testosterone test results is to select a reputable laboratory. Look for a lab that is accredited and has a good reputation for accurate and reliable testing. This will give you confidence in the reliability of your results.

2. Follow pre-test instructions: To obtain accurate results, it’s important to follow any pre-test instructions provided by the lab. This may include fasting for a certain period before the test or avoiding certain medications or supplements. By adhering to these instructions, you can minimize the risk of any external factors affecting your test results.

3. Timing is key: Testosterone levels can fluctuate throughout the day, so it’s essential to have your test done at the right time. In most cases, testosterone levels are highest in the morning. To ensure accuracy, schedule your test for this time frame. This will provide a more reliable snapshot of your testosterone levels.

4. Discuss medications or supplements: Some medications and supplements can affect testosterone levels, potentially leading to inaccurate results. By providing this information, the lab can take it into consideration when interpreting your test results.

5. Consider repeat testing: If you have concerns about the accuracy of your testosterone test results, consider repeating the test. Testosterone levels can vary from day to day, so a single test may not provide a complete picture. Repeat testing can help confirm the accuracy of your results and provide a more comprehensive understanding of your hormone levels.

6. Consult a healthcare professional: If you have any doubts or questions regarding your testosterone test results, it’s best to consult a healthcare professional. They can help interpret the results and provide guidance on any further testing or treatment options if necessary.

By following these tips, you can increase the reliability of your testosterone test results. Remember, accurate testing is essential for proper diagnosis and treatment, so taking these steps is crucial for your overall well-being.

➡️What to avoid before a testosterone test

How can testosterone levels be artificially lowered prior to a blood test?

Yes a couple of things can lead to low testosterone, and they include:

• Training like a mad man the day before (e.g. hard Crossfit session). This could tank your T levels.
• Fast for 2+ days
• Drink 1L+ of soy milk for 4+ weeks before your test
• Don’t sleep the night before
• Drink alcohol all day and night beforehand
• Take certain medications (e.g. glucocorticoids, anti-psychotics, spironolactone or ketoconazole, etc.)

All of these methods will only lower natural testosterone production, but have very little effect on your testosterone if you took exogenous testosterone.

Summary – Can testosterone test be wrong

Testosterone tests aren’t perfect, but are still useful. At best, the test will vary by 6-8% and at worst by 25%. The lower your testosterone is, the more inaccurate the test can become.

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FAQ

What does it indicate if total testosterone is near the low end of normal but free testosterone is higher than the normal upper limit?

This usually indicates fatty liver, due to obesity, diabetes and nutritional deficiencies. The liver creates SHBG and when the liver is fatty and inflamed, it can’t do so, thus SHBG levels go down.

Obesity is the main reason for low total testosterone and SHBG. Losing weight has been shown to increase total testosterone and SHBG and improve low testosterone symptoms.

If the blood test for testosterone is normal but low T symptoms are present what else might be going on?

Two things are important here. First, what is “normal” testosterone and how high is your SHBG?

Since the lower end of the range is 300ng/dl, if you’re 330ng/dl, some doctors will consider you to have “normal” testosterone. Most men don’t feel normal until their testosterone is >600ng/dl.

The other thing that could be wrong is high SBG and low free testosterone. This is very common when people are doing fasting, intermittent fasting or low carb diets for too long. Low DHEA can also cause bioavailable testosterone, so be sure to have that one tested as well.

Lastly, if the blood test for testosterone and SHBG are normal but low T symptoms are present, it’s important to consider other factors that may be contributing to the symptoms. While a normal blood test result may indicate that testosterone levels are within the normal range, it doesn’t necessarily rule out other underlying causes.

One possible explanation could be that the symptoms are not solely caused by low testosterone levels. There are many factors that can contribute to the manifestation of low T symptoms, such as stress, poor sleep quality, nutritional deficiencies, or other hormonal imbalances. These factors may not be captured by a testosterone blood test alone.

Another possibility is that the blood test itself may not be entirely accurate. While testosterone blood tests are generally reliable, there can be instances of false negatives or false positives. Factors such as improper sample collection, lab errors, or variations in testosterone levels throughout the day can impact the accuracy of the test results.

It’s also important to note that testosterone levels can fluctuate naturally, with levels typically being highest in the morning and decreasing throughout the day. This means that a single blood test may not reflect an individual’s overall testosterone levels accurately.

Would low testosterone levels show up on a blood test?

Low testosterone levels can indeed be detected through a blood test. If you suspect you have low testosterone, absolutely get a testosterone test done. But don’t just test total testosterone, but also:

• SHBG
• DHEA-S
• Cortisol
• Estradiol
• Prolactin
• CRP
• Homocysteine
• And a thyroid panel (TSH, total and free T4, T3 and rT3)

Women generally have 10 times less testosterone than a man, and tests pick up their testosterone.

Is it fine to have a high testosterone serum level of more than 1500?

Having a high testosterone serum level above 1500 is not necessarily a cause for concern. Testosterone levels can vary greatly among individuals, and what may be considered high for one person may be within normal range for another.

Some men have a testosterone of 1500ng/dl naturally without even trying. But these guys are definitely outliers.

It’s important to interpret testosterone test results in conjunction with other symptoms and medical history. A single high reading on a testosterone test may not necessarily indicate a problem. If a high testosterone level is persistent and accompanied by symptoms such as increased aggression, acne, or even low testosterone symptoms, further investigation may be warranted.