Free testosterone is usually a calculated value, not a separate substance measured in blood: the lab works it out from total testosterone, SHBG and albumin. Practitioners use it when high or low SHBG makes total testosterone misleading, and to read androgen status in women alongside the free androgen index (FAI). Method, contraception, pregnancy and time of day all affect the result.
| Test type | Calculated by the lab from other results |
|---|---|
| Measurements required | Total testosterone, SHBG and albumin. Labs usually calculate free testosterone and print it on the report. |
| Sample and collection | Blood draw at a collection centre |
| Preparation | Men: book your collection before 10am, ideally after an overnight fast (water only), as testosterone is highest in the morning. |
| Turnaround | About 3 to 5 business days |
| Available through | Hormone Studies. Available in: Full Body Health Check, Weight Management Test, Male Hormone Health Test, Testosterone Panel, Female Hormone Health Test, Perimenopause Test, Menopause Test. |
| Pricing | Price on sign-up |
| Results | Returned in the Vively practitioner platform, beside your client's other markers |
What are the Free testosterone reference and optimal ranges?
| Typical lab reference | Vively optimal | |
|---|---|---|
| Men up to 60 | 260 to 740 pmol/L | 350 to 740 pmol/L |
| Men over 60 | 91 to 579 pmol/L | 91 to 579 pmol/L (no narrower target) |
| Women, day 2 to 5 of cycle | Lab-specific: use the female range on the client's report | 10 to 31 pmol/L, read with FAI and SHBG |
Calculated and measured free testosterone differ by method and female ranges vary widely, so read the result against the range on the client's report (RCPA guidance).
Check a client's Free testosterone result
Your lab calculates Free testosterone for you. Enter the value printed on your client's report to see where it sits against the typical lab range and the Vively optimal range.
A guide only, not a diagnosis. One result is a starting point: read it with symptoms, history and a repeat test. Labs differ, so check the result against the range on your client's report. Nothing you enter is stored or sent.
How do you arrange Free testosterone testing through Vively?
- Get verified. Practitioners with a recognised qualification or membership (ATMS, NHAA, ANTA, Dietitians Australia, NSA, CMA or Ahpra registration) can request free practitioner access.
- Choose a panel. Log in to the practitioner platform and pick a panel that includes Free testosterone, or build your own. Add-on pricing shows when you sign up.
- Client collects. Your client collects at a partner collection centre, with their request on their phone or printed.
- Review results. Results come back to you in the practitioner platform, beside your client's other markers, ready for the follow-up consult.
Which Vively panels include Free testosterone?
Log in to the practitioner platform to view a panel in full, or build and save your own from 100+ tests and panels.
- Log in to view this panelTestosterone Panel5 markers · HormonesPrice on sign-up
- Log in to view this panelMale Hormone Health Test6 markers · HormonesPrice on sign-up
- Female Hormone Health Test17 markers · HormonesPrice on sign-up
Two blood tests timed to the cycle, to show how hormones shift across it.
Log in to view this panel
Why does the optimal range sit there?
For men up to 60, our 350 pmol/L floor sits above the 260 pmol/L lab limit because lower male reference values are contested.
An older man with high SHBG can have a normal total and a low free fraction, while a man with obesity and low SHBG can have a low total and adequate free testosterone.
Confirm borderline results on repeat morning samples before reading them as deficiency (Yeap et al., 2016). Most Australian labs use the Vermeulen formula, so any error in total testosterone or SHBG carries through.
For women, FAI and SHBG usually give the clearer read. Men over 60 have no narrower target than the 91 to 579 pmol/L lab range.
What should Free testosterone be read with?
- ContextNormal total, low free testosterone, high SHBG (men)
Often seen with ageing, hyperthyroidism, liver disease or low energy intake.
- LowLow total, normal free testosterone, low SHBG
Common with obesity and insulin resistance; the free fraction may be adequate.
- HighHigh free testosterone in a woman, low SHBG, high fasting insulin
Often seen in PCOS with insulin resistance.
- LowLow free testosterone in a woman on the combined pill
Expected: the pill raises SHBG and lowers free testosterone, so the result reflects the pill.
- LowLow free testosterone with high LH (men)
Points to a testicular cause; GP review.
What can affect a Free testosterone result?
- Time of day and recent food intake in men
- Combined pill (raises SHBG, lowers free testosterone); Implanon may lower androgens; hormonal IUDs usually have little effect
- Pregnancy and breastfeeding, when SHBG shifts and results are less reliable
- Low albumin or an unusual SHBG, which distort the calculation
- Direct (analogue) free testosterone immunoassays, which are not recommended
- Testosterone, DHEA or anabolic steroid use
When should you refer the client to their GP?
- Men: free testosterone below range on two morning samples, with symptoms
- Men: low free testosterone with headaches, visual change, testicular changes or infertility
- Women: rapid-onset hirsutism, acne or virilisation, or a result well above the lab range
- Women: irregular or absent periods with high free testosterone
How should a client prepare for a Free testosterone test?
Copy or print this to send to your client.
Preparing for your Free testosterone test
- Men: book your collection before 10am, ideally after an overnight fast (water only), as testosterone is highest in the morning.
- If your result comes back low, expect to confirm it with a second morning test.
- Women: if you have periods, book for day 2 to 5 of your cycle. Day 1 is the first day of full bleeding.
- Tell your practitioner if you use hormonal contraception, such as the pill or an implant, as it can change your result.
- Take your pathology request to any of 4,000+ collection centres. Bring it printed or on your phone.
- Keep taking prescribed medicines as usual unless your doctor tells you otherwise.
- Results usually take about 3 to 5 business days and come to your practitioner. Book your results appointment for after that.
How do practitioners use Free testosterone with clients?
In men, the changes that move free testosterone most are fat loss, resistance training, enough sleep and less alcohol; repeat total testosterone and SHBG after 3 to 6 months to see the effect. In women, read free testosterone together with FAI, SHBG, cycle history and insulin markers.
Free testosterone FAQs
Can a naturopath, nutritionist or dietitian order free testosterone through Vively?
Yes. Add it to any client panel on the Vively practitioner platform. It sits in Hormone Studies and is also in Full Body Health Check, Weight Management Test and Male Hormone Health Test. Add-on pricing shows when you sign up. No account yet? Request free access.
Should I use free testosterone or FAI for a female client?
Use both, and lean on FAI and SHBG. Female free testosterone values are small, so calculation and assay error matter more, while FAI is simple and widely reported. FAI loses reliability in pregnancy and when SHBG is very low or very high, which is when calculated free testosterone adds most.
Is a free testosterone of 300 pmol/L low for a 40-year-old man?
It sits inside the 260 to 740 pmol/L reference range but under the Vively optimal floor of 350. Confirm it with a second early morning sample, check SHBG, LH and FSH, and look at sleep, weight, alcohol and training load. A result below range on repeat, or with symptoms, needs GP review.
When is free testosterone more useful than total testosterone?
When SHBG is unusual or the total sits in the grey zone. A man with obesity and low SHBG can have a low total with adequate free testosterone, while an older man with high SHBG can have a normal total and a low free fraction. Free testosterone is calculated from total testosterone and SHBG, so errors in either carry through.
Should free testosterone be a direct assay or calculated?
Calculated is preferred. Most Australian labs derive it from total testosterone and SHBG using the Vermeulen formula, and direct analogue immunoassays are not recommended. If a report does not say how free testosterone was derived, ask the lab before relying on a borderline result.
References
- Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. Journal of Clinical Endocrinology and Metabolism. 1999. Source
- Rosner W, et al. Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. Journal of Clinical Endocrinology and Metabolism. 2007.
- Yeap BB, et al. Endocrine Society of Australia position statement on male hypogonadism (part 1): assessment and indications for testosterone therapy. Medical Journal of Australia. 2016.
- Royal College of Pathologists of Australasia. RCPA Manual: Testosterone. Source