Is 22 ng/dL Total Testosterone Elevated in a Female?
No, a total testosterone level of 22 ng/dL is not elevated in a female patient, as it falls within the normal reference range for women. According to research evidence, the normal range for total testosterone in reproductive-age women without signs of hyperandrogenism is approximately 14.1 ± 0.9 ng/dL, with an upper limit (mean + 2 standard deviations) of 28 ng/dL 1.
Normal Testosterone Ranges in Women
- The reference range for total testosterone in women is significantly lower than in men
- Normal female total testosterone levels typically fall below 28 ng/dL when measured using accurate methods 1
- A level of 22 ng/dL is within the expected normal range for women
Interpretation Considerations
Testing Method Importance
The method used to measure testosterone is critically important when interpreting results:
- Liquid Chromatography-Tandem Mass Spectrometry (LC/MS) provides the most accurate measurements for female testosterone levels 2
- Commercial immunoassay kits show significant between-kit variability (57%-115%) for female samples 3
- This variability is particularly problematic when attempting to diagnose hyperandrogenemia in women
Menstrual Cycle Variations
Total testosterone levels in women fluctuate throughout the menstrual cycle:
- Levels increase across the follicular phase
- Peak at midcycle (average 43.6 ± 16.2 ng/dL) 4
- Gradually decline during the luteal phase
Therefore, the timing of measurement within the menstrual cycle should be considered when interpreting results.
Diagnostic Thresholds for Pathology
For context, significantly higher testosterone levels would be needed to suspect pathology:
- For androgen-producing tumors, total testosterone ≥5.1 nmol/L (approximately 147 ng/dL) measured by LC-MS/MS is the diagnostic threshold 2
- In postmenopausal women, pathologic hyperandrogenism is suspected with total testosterone ≥2.2 nmol/L (approximately 63 ng/dL) 2
Common Pitfalls in Testosterone Measurement
- Using laboratory reference ranges that are too high (some commercial labs use upper limits of 95 ng/dL) 1
- Not considering the testing method's accuracy (immunoassays vs. LC/MS)
- Failing to account for menstrual cycle variations
- Not correlating laboratory values with clinical presentation (presence or absence of hyperandrogenic symptoms)
Clinical Correlation
When evaluating testosterone levels in women:
- Always correlate with clinical signs and symptoms
- Women with hyperandrogenism typically present with hirsutism, acne, or menstrual irregularities
- Women with moderate to severe hirsutism have mean testosterone levels of approximately 49.0 ± 2.3 ng/dL 1
- The absence of clinical signs with a testosterone level of 22 ng/dL further supports that this is a normal finding
In conclusion, a total testosterone level of 22 ng/dL in a female patient is within normal limits and does not represent an elevated value requiring further investigation, assuming the measurement was performed using an accurate method.