Morning Testosterone and SHBG Testing in Women

Guideline-Based Recommendation

• The Infectious Diseases Society of America explicitly states that obtaining testosterone levels in women in nonresearch settings is not recommended (strong recommendation, low quality evidence) 1, 2
• The Infectious Diseases Society of America recommends morning serum testosterone levels only for adult men with symptoms such as decreased libido, erectile dysfunction, reduced bone mass, or low trauma fractures 1, 2

Measurement and Interpretation

• SHBG should be measured alongside testosterone to calculate the free testosterone index (ratio of total testosterone/SHBG), as this provides better assessment of androgen status than total testosterone alone 3
• A free testosterone index <0.3 indicates hypogonadism 3
• Clinical diagnosis must correlate laboratory values with symptoms, not rely on laboratory values alone 3