From the Guidelines
The testosterone level of 11 pmol/L is within the normal reference range for women (2-30 pmol/L), so no specific intervention is needed. This represents the calculated free testosterone, which is the biologically active portion of testosterone that is not bound to proteins in the blood. Free testosterone levels in this normal range indicate appropriate hormonal balance for a female patient. While total testosterone measures all testosterone in the blood, free testosterone provides a more accurate assessment of the hormone available to act on tissues. Normal free testosterone in women is important for maintaining bone density, muscle mass, energy levels, and sexual function. If a woman had symptoms suggesting hormonal imbalance despite normal levels, further evaluation of other hormones or clinical factors might be warranted, but based solely on this result, no medication or treatment is indicated as the value falls well within normal parameters, as supported by the most recent study on evaluating the diagnostic accuracy of androgen measurement in polycystic ovary syndrome 1.
Some key points to consider in the evaluation of testosterone levels in women include:
- The reference range for testosterone can vary between laboratories, but a level of 11 pmol/L is well within the normal range for women.
- Free testosterone is a more accurate measure of the biologically active hormone than total testosterone.
- Normal free testosterone levels are important for maintaining overall health and well-being in women.
- Further evaluation may be necessary if symptoms of hormonal imbalance are present, despite normal testosterone levels, as suggested by studies on reproductive dysfunction in women with epilepsy 1.
It's also important to note that the diagnosis of conditions such as polycystic ovary syndrome (PCOS) requires a combination of clinical and biochemical evaluations, including the measurement of testosterone levels, as well as other hormones and clinical factors, as outlined in the evaluation and management of testosterone deficiency guidelines 1.
From the Research
Testosterone Levels
- The given testosterone level is 11 pmol/L, which is below the reference range of 2-30 pmol/L for women 2.
- According to a study published in 2011, the reference range for free testosterone in premenopausal women is 4.16-22.2 pmol/L 3.
- The calculated free testosterone level of 11 pmol/L is within the lower end of this range.
Clinical Utility
- Measurement of free testosterone is important in the diagnosis of many diseases, including disorders of androgen deficiency in men and androgen excess in women 2.
- Free testosterone levels can be measured using various methods, including equilibrium dialysis, ultrafiltration, and calculated free testosterone based on measurement of total testosterone, SHBG, and albumin 2.
- A study published in 2023 established reference intervals for free testosterone in adult men measured using a standardized equilibrium dialysis procedure, with a normative range of 229-1072 pmol/L 4.
Health Implications
- Testosterone plays a crucial role in maintaining bone health, and hypogonadism is a major secondary cause of osteoporosis in men 5.
- Testosterone replacement therapy can be used to treat hypogonadism, but it may suppress spermatogenesis and is contraindicated in men trying to conceive 6.
- The effects of testosterone on bone health and spermatogenesis highlight the importance of monitoring testosterone levels in both men and women 2, 3, 6, 5.