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Blood tests for low testosterone What to check, and why one test isn’t enough

Low testosterone is real and treatable, but it’s easy to misread. Levels fall through the day and dip when you’re ill, so one low number isn’t a diagnosis.1,2 Here’s what to test, how to read the results and what else can cause the same symptoms.

6 tests $59.60 Most results in 2 to 3 days

The short answer

If your sex drive has dropped, your erections aren’t what they were or you’re low on energy, four blood tests show whether low testosterone is behind it and, if so, why. Two more cover the checks clinicians make before any treatment.1,2 Ask for total and free testosterone, SHBG, LH, FSH, TSH, a complete blood count and PSA.

Before you go
Have your blood drawn before 10 a.m., before you’ve eaten. Testosterone is highest in the early morning,1,2,3 and food can lower it.2,3 If you take biotin, stop it 3 days before.
If it’s low
One low result isn’t a diagnosis. About 30% of men with one low result are normal on a second,2 so guidelines want two low morning results and symptoms to match.1,2
See someone sooner
If you have new headaches or changes in your vision, or a lump in a testicle. All the signs
What it costs
$59.60 for all six, from one blood draw. That’s the whole cost, and it’s HSA and FSA eligible.
The low testosterone tests
$59.60 · 6 tests, one draw
Order

What the six tests look for

Testosterone alone can’t tell you why a number is low, or how much of it your body can use. The next three help fill that in, or point to another cause.1,2 The last two are the checks clinicians make before any treatment.1 All six come from one blood draw.

  1. Total testosterone is the main test. Free testosterone, the small share not held by proteins, helps most when the total is borderline.1,2 This test measures it by equilibrium ultrafiltration, not by the “direct” immunoassay guidelines advise against.2,3

    The symptoms that go with low testosterone most closely are sexual: low sex drive, fewer morning erections and erection problems.2

  2. 02

    How much your body can use

    SHBG test

    SHBG is the protein that holds testosterone most tightly. When it’s high or low, total testosterone can mislead: a low SHBG can pull the total below the range while free testosterone stays normal.2

    More likely to be off if you carry extra weight or are older, or have diabetes, liver disease, a thyroid problem or HIV.2

  3. 03

    Where the problem starts

    LH and FSH test

    LH is the signal your pituitary gland sends to tell the testes to make testosterone. With a low testosterone, a high LH points to the testes, and a low or normal one to the pituitary gland or the part of the brain that controls it.1,2

    It matters most if your testosterone is low, and for your options if you want children.1,5

  4. 04

    An underactive thyroid

    Thyroid cascade test

    An underactive thyroid can leave you tired and gaining weight,4 symptoms that overlap with low testosterone.1 Thyroid problems also shift SHBG, which changes how your testosterone reads.2 This test checks TSH first and adds free T4 only if TSH is out of range.

    More likely if you also feel cold or have dry skin or constipation.4

  5. Your hematocrit is the share of your blood made of red cells. Testosterone treatment can push it too high, so clinicians check it before starting.1,2 Low testosterone can also come with mild anemia.2

  6. 06

    A starting point for your prostate

    PSA test, with free PSA if needed

    Testosterone treatment can raise PSA, so clinicians check it before starting if you’re over 40, and again once you’re on treatment.1 A result now gives you a number to compare against.

What else could it be?

Low sex drive, erection problems, tiredness and low mood all have causes besides testosterone, and some of them lower testosterone too.1,2 They’re worth a look whatever your result.

Erection problems

They can be a sign of narrowed arteries, whatever your testosterone.3

Ask a clinician to check your heart risk, including blood pressure, cholesterol and blood sugar.3 See the Heart Health panel

Sleep

Sleep problems, including sleep apnea, go with lower testosterone, and poor sleep wears you down on its own.2

If you snore, stop breathing in your sleep or wake up unrefreshed, ask a clinician about a sleep test.

Weight

Extra weight lowers SHBG and testosterone, so your total can read low even when free testosterone is normal.2

If you carry extra weight, losing some is the usual first step. Expect a modest rise, about 30 to 60 ng/dL.3

Medicines and alcohol

Opioids, steroid medicines such as prednisone and anabolic steroids lower testosterone, and so can heavy drinking and marijuana.2

Tell your clinician everything you take, including anabolic steroids. Don’t stop a prescribed medicine on your own.

Stress and mood

Stress and depression can feel just like low testosterone.1

Tell a clinician how you’ve been feeling. It’s a real cause, and it can be treated.

Illness and dieting

Being ill, recovering from an illness or eating far too little can lower testosterone, and so can a short course of opioids.2

Test once you’re well and eating normally, so the result shows your usual level.2

See a doctor rather than just retesting if you have

  • New headaches2,3
  • Changes in your vision2,3
  • A lump or swelling in a testicle7
  • Breast swelling or soreness2,7
  • Loss of armpit or pubic hair2
  • A testosterone result under 150 ng/dL1,2

These need an exam, and sometimes a scan of the pituitary gland, not just another blood test. See your doctor right away about a lump in a testicle.7 Go to an emergency room or call 911 for a sudden, severe headache, sudden loss of vision or sudden, severe pain in a testicle.8,9 If you’re thinking about harming yourself, call or text 988.

How to get tested, and what it costs

Order the six tests on their own, or get them inside a full yearly checkup. Either way it’s one morning blood draw, and the checkup adds a urine sample.

The low testosterone tests
$59.60

The six tests on this page, from one blood draw. Have your blood drawn before 10 a.m., before you’ve eaten.

Best if testosterone is the question you want answered.

Order the six tests
Base Core Annual
$204.25

Total and free testosterone, SHBG, LH, FSH, thyroid, a blood count and PSA, plus heart, blood sugar and vitamin tests: a full yearly checkup. 22 tests. Fast for 12 hours first, and have your blood drawn before 10 a.m.

Best if you’re weighing treatment, or it’s been a while since a checkup.

Order the checkup
  1. 01

    Order online

    Pick the six tests or the full checkup. The price is the whole cost, and you can pay with an HSA or FSA card.

  2. 02

    Blood draw

    Have your blood drawn before 10 a.m., before you’ve eaten; water is fine. For the full checkup, fast for 12 hours. If you take biotin, stop it 3 days before. Go to any Labcorp location for free, or have blood drawn at home for $75.

  3. 03

    Get your results

    Most arrive in the Picardo app in 2 to 3 days, with an explanation of each one; free testosterone can take up to 6 days. Ask Picardo what they mean, and book a physician follow-up if you want one.

Already have results?

My testosterone was low once

Don’t act on one result. About 30% of men with one low result are normal the second time.2 Repeat it before 10 a.m., fasting, on another day when you’re well.2,3

Check your testosterone number

My total is normal, but free is low

That usually means a high SHBG. It rises with age, and with liver disease, an overactive thyroid, HIV and some seizure medicines.2 Check how free was measured: if your report says “direct”, the number isn’t reliable, so go by your total and SHBG.2,3

Check your free testosterone number

My total is low, but free is normal

That often means a low SHBG, which goes with extra weight and diabetes. In one European study, men like this didn’t have the symptoms of low testosterone.2

Check your SHBG number

My LH is high

With a low testosterone, it means the testes aren’t responding to the signal from the pituitary. Causes include injury, some cancer treatments and Klinefelter syndrome, a chromosome difference some men are born with.2 If you want children, ask about a semen analysis, and don’t start testosterone.5

Check your LH number

My LH is low or normal

With a low testosterone, it points to the pituitary gland or the brain. Causes include severe obesity, opioids, steroid medicines and pituitary problems.2 US urologists strongly recommend checking prolactin next, which takes a separate blood test.1 If your testosterone is under 150 ng/dL, guidelines advise a pituitary scan too.1,2 Ask whether you also need free T4, since a normal TSH can miss a pituitary cause.2

Check your LH number

I’m already on testosterone

Time your test to your dose: midway between weekly or every-other-week shots, or 2 to 8 hours after a gel.2 The AUA aims for 450 to 600 ng/dL on treatment.1 A low LH is expected, and your blood count needs checking, because testosterone raises red blood cells.1,2

Check your number on treatment

Ask Picardo about your results. The app explains what each one means, and a physician can follow up if you want.

Questions people ask

What blood tests should I get for low testosterone?

Start with total testosterone before 10 a.m., and repeat it on another morning if it’s low.1,2 Add LH and FSH to find the cause, and SHBG and free testosterone to show how much is available, which matters most when the total is borderline.1,2,3 TSH checks your thyroid, which can cause similar tiredness.4 A blood count and PSA are the checks clinicians make before any treatment.1

What time of day should I get my testosterone tested?

Before 10 a.m.3 Testosterone peaks in the early morning. In men aged 30 to 40, a 4 p.m. result ran 20% to 25% lower than an 8 a.m. one.1 If you work nights, test after your main sleep.3

Do I need to fast for a testosterone test?

Ideally, yes. The Endocrine Society and European urologists ask for a fasting sample, because food lowers testosterone.2,3 The AUA doesn’t insist on it.1 Water is fine. If a result taken after eating comes back low, repeat it fasting. If you take biotin, stop it 3 days before: it can throw off the SHBG, LH and thyroid results.

What testosterone level is considered low?

US urologists use under 300 ng/dL on two early-morning tests, with symptoms to match.1 European urologists draw the line at about 350 ng/dL (12 nmol/L).3 The number alone isn’t enough: guidelines diagnose low testosterone only with symptoms too.1,2

Can I get these tests without seeing a doctor first?

Yes. Order them online, get a blood draw at a Labcorp location or at home, and most results arrive in the Picardo app in 2 to 3 days. You can book a physician follow-up if you want to talk them through.

What happens if a result is off?

The app explains what it means and what usually comes next. Often that’s a repeat test on another morning, since one low result can be a dip.2 If it’s confirmed, the cause decides the treatment: losing weight, changing a medicine or, for proven low testosterone, testosterone treatment.1,2,3 A physician can follow up if you want one.

Will testosterone treatment affect my fertility?

Yes. It lowers sperm production, often to zero. Recovery after stopping can take up to two years, and some men don’t recover.1,2 If you want children, don’t start it.5 If your LH is low or normal, drugs such as clomiphene, used off label, can raise your own testosterone and help keep your fertility.1

Is testosterone treatment safe?

In the largest trial, of men aged 45 to 80 with confirmed low testosterone and heart disease or a high risk of it, heart attacks, strokes and heart deaths were no more common on testosterone than on a placebo: 7.0% against 7.3%.6 Atrial fibrillation, kidney injury and blood clots in the lungs were more common, though.6 It also raises your red blood cell count, so clinicians check your blood during treatment.1,2 And guidelines offer it only to men with symptoms and confirmed low results.1,2

Sources

  1. 1 Mulhall JP, Trost LW, Brannigan RE, et al. Evaluation and management of testosterone deficiency: AUA guideline. J Urol. 2018;200(2):423–432. doi.org/10.1016/j.juro.2018.03.115
  2. 2 Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–1744. doi.org/10.1210/jc.2018-00229
  3. 3 Salonia A, Minhas S, Boeri L, et al. EAU guidelines on sexual and reproductive health: male hypogonadism. Edn. presented at the EAU Annual Congress, London 2026. Arnhem: EAU Guidelines Office; 2026. uroweb.org/guidelines/sexual-and-reproductive-health/chapter/male-hypogonadism
  4. 4 Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200–1235. doi.org/10.1089/thy.2012.0205
  5. 5 Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline (2020; amended 2024). Linthicum, MD: American Urological Association; 2024. www.auanet.org/documents/Guidelines/PDF/2024%20Guidelines/Male%20Infertility%20Unabridged%20Final.pdf
  6. 6 Lincoff AM, Bhasin S, Flevaris P, et al. Cardiovascular safety of testosterone-replacement therapy. N Engl J Med. 2023;389(2):107–117. doi.org/10.1056/NEJMoa2215025
  7. 7 American Cancer Society. Signs and symptoms of testicular cancer. Revised August 10, 2025. Accessed October 28, 2026. www.cancer.org/cancer/types/testicular-cancer/detection-diagnosis-staging/signs-and-symptoms.html
  8. 8 MedlinePlus. Pituitary apoplexy. US National Library of Medicine. Accessed October 29, 2026. medlineplus.gov/ency/article/001167.htm
  9. 9 MedlinePlus. Testicular torsion. US National Library of Medicine. Accessed October 29, 2026. medlineplus.gov/ency/article/000517.htm

Updated 4 Nov 2026.

This is general health information, not medical advice: talk to your clinician about your results and before changing any treatment.