I'm a man over 50 and my testosterone is on the low side — should I take TRT?

It depends on whether you have consistent symptoms attributable to low testosterone, whether the low reading is confirmed on a second morning sample, whether your LH/FSH and prolactin are checked to look for the cause, and whether you have other medical conditions (prostate concerns, cardiovascular disease, sleep apnoea, obesity) that affect the decision. Many Indian endocrine guidelines recommend addressing modifiable factors (weight, diabetes, sleep apnoea, exercise) before considering TRT, and starting TRT only when symptoms are clearly attributable to confirmed low testosterone. The decision is individualised.

My testosterone is raised but I am a woman — does that mean PCOS?

Raised testosterone in women is most commonly seen in PCOS, but PCOS is a clinical diagnosis based on multiple criteria (irregular periods, signs of androgen excess, ovarian appearance on ultrasound — typically two of three). Mild testosterone elevation alongside irregular periods and signs of androgen excess fits PCOS. Very high testosterone, or rapid onset of symptoms, prompts evaluation for other causes — adrenal disorders, ovarian conditions, or Cushing's syndrome. Discuss with the doctor.

Are testosterone-boosting supplements safe?

Many over-the-counter 'testosterone boosters' sold in India and online have limited evidence for raising testosterone meaningfully. Some traditional or herbal preparations contain undeclared substances that can affect hormones and other body systems unpredictably. Anabolic steroids used outside medical supervision are a different category — they raise testosterone but carry well-documented cardiovascular, liver, fertility, and mood risks. Discuss any supplement use with the doctor, particularly when testing testosterone.

Why does my testosterone reading vary so much between tests?

Testosterone naturally varies — by time of day (highest in the morning), by recent illness, by sleep, and by season. The same person can show different readings on different days even without any underlying problem. Most Indian and international guidelines recommend morning samples and confirming low or high readings with at least one repeat on a separate day before acting on them. Biotin supplements can also produce misleading values.

Do I need to fast for a testosterone test?

Most labs do not strictly require fasting for testosterone alone, but morning sampling matters more than fasting. Since testosterone is often drawn with other tests, an overnight fast is commonly requested. Pause biotin supplements 48–72 hours before. Avoid the test soon after acute illness or hospitalisation — values are typically lower during and just after acute illness.

Testosterone Test: Normal Range & Meaning

Also seen on reports as: Total T, Serum Testosterone, S. Testosterone

What is Testosterone?

Testosterone is the main male sex hormone, produced largely in the testes in men and in smaller amounts in the ovaries and adrenal glands in women. It plays an essential role in male physical development, muscle and bone mass, sex drive, fertility, and energy. Women also produce testosterone in smaller amounts — it contributes to muscle and bone strength, libido, and overall well-being.

Most testosterone in blood is bound to proteins (sex hormone–binding globulin, or SHBG, and albumin), with only a small free portion biologically active. The standard test — Total Testosterone — measures both bound and free hormone together. Free Testosterone or 'bioavailable testosterone' (which excludes the SHBG-bound portion) is sometimes ordered when the picture is unclear or when SHBG is known to be abnormal.

The test is run on a small blood sample drawn from a vein. NABL-accredited Indian labs typically report Total Testosterone in nanograms per decilitre (ng/dL). Levels follow a daily rhythm — highest in the morning, lower later in the day — so morning samples (typically between 7:00 and 10:00 AM) are preferred for consistency.

Why doctors order it

In men, testosterone is most commonly ordered to investigate symptoms of male hypogonadism — low sex drive, erectile difficulties, reduced energy, loss of muscle mass, gynaecomastia (breast development), infertility, hot flushes, or unexplained low mood in middle-aged or older men. It is also part of the work-up for delayed puberty in adolescents.

In women, testosterone is most commonly ordered in the work-up of polycystic ovary syndrome (PCOS) — extremely common in India, with surveys placing prevalence around 8–22% of reproductive-age women depending on diagnostic criteria. Raised testosterone in women may also reflect adrenal disorders, certain ovarian conditions, or other endocrine causes. Symptoms — irregular periods, acne, excess facial or body hair (hirsutism), male-pattern hair loss — usually trigger the test.

Testosterone is also tracked in men receiving testosterone replacement therapy (TRT), in patients on certain medications that affect testosterone (long-term opioids, some chemotherapy, steroids), in suspected pituitary disorders, in male infertility evaluation, and in some chronic illnesses (chronic kidney disease, untreated diabetes, sleep apnoea, obesity) that can lower testosterone.

What the result means

Reference ranges differ markedly between men and women, and shift with age. In adult men, Total Testosterone is typically 300–1,000 ng/dL — though older men naturally have lower levels. In adult women, the range is much lower, typically 15–70 ng/dL. A 'low' result in either sex needs interpretation against the right reference range and against symptoms.

In men, low Total Testosterone (<300 ng/dL, lab-dependent) with consistent symptoms suggests male hypogonadism, which is typically classified as primary (testicular problem) or secondary (pituitary or hypothalamic problem) based on additional hormone tests (LH, FSH). Indian endocrine guidelines usually recommend confirming with at least two morning samples drawn on different days before starting treatment — single low readings are often non-specific.

In women, raised testosterone (above the upper limit of female range) is most commonly seen in PCOS. Other causes — adrenal hyperplasia, certain ovarian tumours, Cushing's syndrome — are less common but need exclusion when testosterone is very high or onset of symptoms is rapid. PCOS testosterone elevations are usually modest; very high levels (well above the normal female range) typically prompt further evaluation.

Reference range

Total Testosterone in ng/dL — morning sample preferred. Ranges differ markedly by sex and age.

Adult men — typical range: Roughly 300 – 1,000 ng/dL (varies by age and lab)
Adult women — typical range: Roughly 15 – 70 ng/dL
Male hypogonadism: Total Testosterone consistently <300 ng/dL with symptoms — confirm with second morning sample
Female PCOS pattern: Testosterone modestly raised above female upper limit — usually with clinical signs (irregular periods, hirsutism, acne)
Very high testosterone in women: Above ~150 ng/dL — usually warrants evaluation for adrenal or ovarian source
Free Testosterone (separately): Reported when total is borderline or when SHBG is abnormal; lab-dependent units

Testosterone follows a daily rhythm (higher in morning) and varies day-to-day. Indian endocrine guidelines recommend morning sampling and confirming low or high values with a repeat on a separate day before acting. Biotin supplements can interfere with some testosterone assays and should be paused 48–72 hours before testing.

Common factors that affect the result

Time of day matters substantially. Testosterone is highest in the early morning and falls by late afternoon by 20–30% in many men. Most Indian and international guidelines recommend morning samples (typically 7:00–10:00 AM) for diagnostic testing. Day-to-day variation is also significant — a single low reading is not enough to diagnose hypogonadism.

Several common medications and conditions affect testosterone. Long-term opioids (used for chronic pain), long-term steroids, antifungals like ketoconazole, certain antipsychotics, and some chemotherapy lower testosterone. Untreated obesity, type-2 diabetes, sleep apnoea, untreated hypothyroidism, and chronic kidney disease all lower it. Acute illness lowers testosterone temporarily — most guidelines recommend not testing during acute illness or hospitalisation.

In women, several medications and conditions raise testosterone. Anabolic steroid use (sometimes seen in fitness contexts), some seizure medications, and PCOS itself raise it. Pregnancy raises testosterone. Oral contraceptives raise SHBG and can lower Free Testosterone without changing the total much. Biotin (popular in Indian beauty supplements) interferes with many testosterone assays — pause for 48–72 hours before testing.

When to talk to your doctor

You are a man with symptoms suggestive of low testosterone — low sex drive, erectile difficulties, loss of energy, reduced muscle mass, hot flushes, mood changes — and Total Testosterone is below 300 ng/dL on a morning sample.
You are a woman with irregular periods, acne, excess facial or body hair, or male-pattern hair loss, and testosterone is raised — PCOS evaluation usually follows alongside other hormone tests.
You are on testosterone replacement therapy and the levels are being followed for safety and efficacy.
You are on long-term opioids, steroids, or other medications known to lower testosterone and have symptoms suggestive of hypogonadism.
Your child has delayed or precocious puberty and testosterone is one of the tests being done — paediatric endocrinology input usually applies.

Related tests

Hormones

Cortisol

Testosterone