Testosterone, Total

Synonym/acronym: N/A

Common use

To evaluate testosterone to assist in identification of disorders related to early puberty, late puberty, and infertility while assessing gonadal and adrenal function.

Specimen

Serum (1 mL) collected in a red- or red/gray-top tube. Plasma (1 mL) collected in green-top (heparin) tube is also acceptable.

Normal findings

(Method: Immunochemiluminometric assay [ICMA])

Age	Conventional Units	SI Units (Conventional Units × 0.0347)
Cord blood
Male	17–61 ng/dL	0.59–2.12 nmol/L
Female	16–44 ng/dL	0.56–1.53 nmol/L
1–5 mo
Male	1–177 ng/dL	0.03–6.14 nmol/L
Female	1–5 ng/dL	0.03–0.17 nmol/L
6–11 mo
Male	2–7 ng/dL	0.07–0.24 nmol/L
Female	2–5 ng/dL	0.07–0.17 nmol/L
1–5 yr
Male and female	0–10 ng/dL	0.00–0.35 nmol/L
6–7 yr
Male	0–20 ng/dL	0.00–0.69 nmol/L
Female	0–10 ng/dL	0.00–0.35 nmol/L
8–10 yr
Male	0–25 ng/dL	0.00–0.87 nmol/L
Female	0–30 ng/dL	0–1 nmol/L
11–12 yr
Male	0–350 ng/dL	0.00–12.1 nmol/L
Female	0–50 ng/dL	0.00–1.74 nmol/L
13–15 yr
Male	15–500 ng/dL	0.52–17.35 nmol/L
Female	0–50 ng/dL	0.00–1.74 nmol/L
Adult–older adult
Male	241–827 ng/dL	8.36–28.7 nmol/L
Female	15–70 ng/dL	0.52–2.43 nmol/L

Tanner Stage
	Male	Female
I	2–23 ng/dL	2–10 ng/dL
II	5–70 ng/dL	5–30 ng/dL
III	15–280 ng/dL	10–30 ng/dL
IV	105–545 ng/dL	15–40 ng/dL
V	265–800 ng/dL	10–40 ng/dL

Description

Testosterone is the major androgen responsible for sexual differentiation. In males, testosterone is made by the Leydig cells in the testicles and is responsible for spermatogenesis and the development of secondary sex characteristics. In females, the ovary and adrenal gland secrete small amounts of this hormone; however, most of the testosterone in females comes from the metabolism of androstenedione. In males, a testicular, adrenal, or pituitary tumor can cause an overabundance of testosterone, triggering precocious puberty. In females, adrenal tumors, hyperplasia, and medications can cause an overabundance of this hormone, resulting in masculinization or hirsutism.

This procedure is contraindicated for

N/A

Indications

Assist in the diagnosis of hypergonadism
Assist in the diagnosis of male sexual precocity before age 10
Distinguish between primary and secondary hypogonadism
Evaluate hirsutism
Evaluate male infertility

Potential diagnosis

Increased in

Adrenal hyperplasia (oversecretion of the androgen precursor dehydroepiandrosterone [DHEA])
Adrenocortical tumors (oversecretion of the androgen precursor DHEA)
Hirsutism (any condition that results in increased production of testosterone or its precursors)
Hyperthyroidism (high thyroxine levels increase the production of sex hormone–binding protein, which increases measured levels of total testosterone)
Idiopathic sexual precocity (related to stimulation of testosterone production by elevated levels of luteinizing hormone [LH])
Polycystic ovaries (high estrogen levels increase the production of sex hormone–binding protein, which increases measured levels of total testosterone)
Syndrome of androgen resistance
Testicular or extragonadal tumors (related to excessive secretion of testosterone)
Trophoblastic tumors during pregnancy
Virilizing ovarian tumors

Decreased in

(related to dysfunctional testes)

(related to diminished or dysfunctional testes)

(alcohol inhibits secretion of testosterone)

(related to decreased binding protein and reflects decreased measured levels of total testosterone)

(decreased testosterone levels can result in impotence)

(chromosome abnormality XXY associated with testicular failure)

(related to testicular atrophy)

(testosterone production occurs in the testes)

Critical findings

N/A

Interfering factors

Drugs that may increase testosterone levels include barbiturates, bromocriptine, cimetidine, flutamide, gonadotropin, levonorgestrel, mifepristone, moclobemide, nafarelin (males), nilutamide, oral contraceptives, rifampin, and tamoxifen.
Drugs that may decrease testosterone levels include cyclophosphamide, cyproterone, danazol, dexamethasone, diethylstilbestrol, digoxin, D-Trp-6-LHRH, fenoldopam, goserelin, ketoconazole, leuprolide, magnesium sulfate, medroxyprogesterone, methylprednisone, nandrolone, oral contraceptives, pravastatin, prednisone, pyridoglutethimide, spironolactone, stanozolol, tetracycline, and thioridazine.

Nursing Implications and Procedure

Potential nursing problems

Problem	Signs & Symptoms	Interventions
Sexuality (Related to insufficient testosterone level)	Delayed puberty; poor development of muscle mass; minimal body hair; insufficient penile and testicle growth; gynecomastia (breast development); arms and legs grow faster than the body trunk; erectile dysfunction; infertility; osteoporosis	Explain the importance of testosterone replacement therapy; administer prescribed testosterone replacement medication
Body image (Related to altered male sexual development secondary to lack of testosterone)	Negative verbalization of physical appearance and lack of male attributes; preoccupation with lack of physical body changes; distress and refusal to talk about appearance; negative verbalization about physical appearance	Assess the patient’s perception of physical appearance; note the frequency of negative comments about lack of male attributes associated with physical appearance; assist in the identification of positive coping strategies to address inadequate male attribute physical appearance; provide reassurance that physical appearance may change with testosterone therapy; provide a referral to local support groups
Self-esteem (Related to altered body image; functional impairment [erectile dysfunction])	Negative self comments; comments regarding difficulty dealing with health situation; indecisive behavior	Assess feelings regarding patient’s sense of control over health management; provide an environment that will encourage the expression of feelings; assess the patient’s feeling of being accepted and loved by others; use active listening; provide guidance as necessary to decrease anxiety

Pretest

Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
Patient Teaching: Inform the patient this test can assist with evaluating hormone levels.
Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
Obtain a history of the patient’s endocrine and reproductive systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

Potential complications: N/A
Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
Recognize anxiety related to test results, and offer support, as appropriate. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services.
Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
Patient Education
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
- Answer any questions or address any concerns voiced by the patient or family.
Expected Patient Outcomes
- Knowledge
- States understanding that lack of development of male attributes is due to inadequate testosterone
- States understanding of the importance of testosterone replacement to supporting male characteristic development
- Skills
- Expresses the harmful effects of negative self-talk on self-esteem
- Reads provided referral information and agrees to attend an introductory meeting
- Attitude
- Refrains from making negative self-comments associated with physical appearance
- Agrees to counseling in relation to concerns related to erectile dysfunction and intimacy

Related Monographs

Related tests include angiography adrenal gland scan, ACE, antibodies antisperm, biopsy thyroid, chromosome analysis, CT renal, DHEAS, estradiol, FSH, LH, PTH, RAIU, semen analysis, thyroid scan, TSH, thyroxine, and US scrotal.
Refer to the Endocrine and Reproductive systems tables at the end of the book for related test by body system.

Testosterone, Total