Free testosterone is the portion of testosterone not bound to proteins in the blood. A free testosterone test measures that result, while several options also report total testosterone, sex hormone binding globulin (SHBG), albumin, or bioavailable testosterone. Those added measurements help distinguish a free result from the amount of testosterone circulating overall and from protein-binding patterns. Start by deciding whether you need free testosterone alone, free and total testosterone together, or a panel that also reports SHBG, albumin, and bioavailable testosterone.
Why free, total, SHBG, and albumin are compared
Free testosterone refers to testosterone that is not bound to proteins. Total testosterone reports the overall amount measured in the sample, so it answers a different question from the free result. SHBG is a binding protein that helps explain how testosterone is carried in blood, and albumin is another protein reported in the Testosterone, Free, Bioavailable and Total, LC/MS/MS panel. That panel also reports bioavailable testosterone. Seeing these values together is useful when a free result and a total result do not appear to tell the same story. A clinician can assess the pattern alongside symptoms, health history, and other relevant findings.
What separates the available test formats
Testosterone, Free, LC/MS/MS reports free testosterone only. Testosterone, Free and Total, LC/MS/MS adds total testosterone measured by MS, allowing both reported values to be reviewed together. Testosterone, Free, Bioavailable and Total, LC/MS/MS adds SHBG, albumin, and bioavailable testosterone to free and total testosterone. Testosterone, Free (Dialysis), Total (MS) and Sex Hormone Binding Globulin combines free testosterone by dialysis with total testosterone measured by MS and SHBG. Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis is another option explicitly named for free testosterone with mass spectrometry/equilibrium dialysis. The choice turns on which reported measurements you need for the question being evaluated.