The 2026 Levels Guide to male hormone testing

Take a deep dive into the chemical messengers that underpin men’s sexual functioning, bone and muscle health, and more (spoiler: there’s more than testosterone).

WRITTEN BY

Dan Wagener

REVIEWED BY

Jesse Mills, MD

Updated: 02/12/2026|12 min read

If you don't feel rested despite a full night's sleep, struggle to build muscle no matter how much time you spend lifting weights, or are having issues in the bedroom, your hormones may be imbalanced. These chemical messengers play a starring role in men's sexual functioning, metabolic health, and quality of life. Yet hormonal problems often go undiagnosed until symptoms such as erectile dysfunction or brain fog become too difficult to ignore.

Hormone testing provides a window into underlying issues that may affect energy, body composition, mood, and sexual health. This blood work looks at not only testosterone but also other essential hormones that keep a man's body running smoothly. Here's what you should know about male hormones, tests to measure yours, and how to interpret the results.

This information does not constitute medical advice. This is compiled expert opinion for educational purposes. Your doctor knows you best. Talk to your doctor for specific questions about your personal lab results.

Why do male hormone levels matter for health?

Hormones are indispensable for sexual development and health. Levels that rise too high or fall too low can lead to problems throughout the body.

In men, hormones are responsible for sperm production and help maintain sex drive and erectile function. These hormones are also vital for metabolic health. They influence insulin sensitivity and regulate muscle mass, bone density, and fat distribution. They also help produce red blood cells.

Moreover, hormones like testosterone are involved in mood and cognitive function, with possible roles in memory, focus, and spatial reasoning.

When should you consider a blood test for male hormones?

Endocrine Society guidelines don't recommend routine screening for low testosterone. However, your doctor may recommend a test for testosterone or another hormone if:

• You have symptoms of low testosterone or another hormone deficiency
• You had a previous out-of-range result
• You're taking medication that can lower testosterone or other hormone levels, such as opioids
• You're undergoing hormone therapy

Symptoms that may suggest abnormal hormone levels include:

• Unexplained fatigue or energy loss: Feeling tired despite adequate sleep, lack of motivation, or needing more rest than usual to function normally
• Changes in body composition: Increased abdominal fat, decreased muscle mass, gynecomastia (enlarged male breasts), or difficulty building muscle even though you're consistently working out and eating healthy
• Sexual health concerns: Reduced libido, erectile dysfunction, or difficulty conceiving
• Mood changes: New or worsening depression, anxiety, irritability, or brain fog
• Sleep disturbances: Insomnia, sleep apnea, or poor sleep quality

How to get tested

If you think you might have a hormone imbalance, there are several ways to check your levels. No matter which route you take, it's best to discuss the results with your healthcare provider.

1. Your doctor can order these tests.
2. You can directly order your own tests through some commercial labs. You'll need to schedule an appointment to complete the test at a lab location. Then the lab will send your results via email or a patient portal.
3. You can buy a test from an at-home testing company. You'll need to collect the sample yourself (usually through a finger prick), then use a prepaid shipping label to send it to the company for analysis. While mail-in testing is validated, the sample could degrade.) if it is delayed in the mail or exposed to extreme temperatures in transit. There's also more risk for error when you collect the sample yourself.

If you choose home testing, look for companies that:

• Use CLIA-certified labs, which meet federal testing standards for diagnosing, treating, or preventing disease
• Employ healthcare professionals to review and discuss results
• Provide clear information about their testing methodology

When should you test?

Most male hormones, especially testosterone, reach their highest levels in the morning. For accuracy, test your reproductive hormone levels between 8 and 10 a.m. If you do repeat tests, be consistent with timing.

Fasting will not affect the results of most hormone tests.

How often should you check your hormones?

The frequency of male hormone testing depends on your situation.

• If you're healthy, there are no official guidelines on how often to check your hormone levels. Some doctors may recommend testing your testosterone when you get your first adult physical, and then re-checking your levels annually, says Jesse N. Mills, MD, health science clinical professor and director of the Men's Clinic at UCLA.
• If you're testing to monitor a health condition, your doctor will discuss how often to test.
• If you use testosterone replacement therapy (TRT), follow your provider's recommended schedule. This typically means testing every three to six months.

What are the male hormone tests, and what do they tell you?

Below are the most common male hormone tests, though your doctor may test others as well. These tests can provide insight into what may be causing any symptoms and alert you to potential red flags that could develop into health complications.

Testosterone

Testosterone is the principal male sex hormone. It governs sexual development and is responsible for male secondary sex characteristics such as the growth of facial hair and deepening of the voice.

But testosterone's role in health is much more extensive.

• It promotes muscle growth by stimulating muscle protein synthesis and preventing the breakdown of muscle proteins.
• It increases bone density by stimulating the creation of osteoblasts (cells that form new bones and repair existing ones) and reducing the activity of osteoclasts (cells that break down bone tissue.
• It may reduce fat by increasing the number of beta-adrenergic receptors, which promote the breakdown of fats for energy use (lipolysis).
• It boosts red blood cell creation in bone marrow by triggering the release of erythropoietin (a hormone that stimulates red blood cell production) and increasing iron absorption. 
• Testosterone's effects on fat and muscle mass, its ability to limit inflammation, and its activation of insulin cells in skeletal muscle may increase insulin sensitivity in men.
• Healthy amounts of testosterone help maintain cholesterol levels by producing greater levels of high-density lipoprotein (HDL) cholesterol and lower levels of low-density lipoprotein (LDL) cholesterol and triglycerides. Testosterone may do this by acting on proteins involved in the production of cholesterol and its removal from white blood cells.
• Testosterone crosses the blood-brain barrier and may influence brain regions involved in learning, memory, and mood regulation. Low levels are linked to higher rates of depressive symptoms, and some evidence shows mood improvement with replacement therapy. It may also affect serotonin transmission between nerve cells in the brain, which may explain the mood changes associated with testosterone deficiency.

How is testosterone produced?

Testosterone production begins in the brain. The hypothalamus sends out gonadotropin-releasing hormone (GnRH), which signals the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH stimulates specialized Leydig cells in the testes to produce testosterone, while FSH stimulates sperm production.

Once released into the bloodstream, testosterone travels throughout the body in two forms: bound to proteins (primarily sex hormone-binding globulin [SHBG] and albumin) or unbound ("free" testosterone). Only free testosterone and the portion loosely bound to albumin (together called "bioavailable testosterone") can enter cells and activate receptors.

LH, FSH, thyroid-stimulating hormone, and prolactin (a hormone involved in sexual function and reproduction) may be tested with total testosterone. They can help identify pituitary gland problems that may affect testosterone levels.

Test ranges and causes of abnormal results

Normal ranges for total testosterone vary by lab and by age, but are generally in these ranges:

• Ages 20 to 39: 300 to 1000 nanograms per deciliter (ng/dL) or 10.4 to 34.7 nanomoles per liter (nmol/L)
• Ages 40 to 59: 250 to 900 ng/dL (8.7 to 31.2 nmol/L)
• Ages 60+: 200 to 800 ng/dL (6.9 to 27.7 nmol/L)

Low testosterone is categorized as primary or secondary. Primary is diagnosed when someone has low testosterone but above-normal LH. It's caused by a problem with the testicles, usually driven by things like a physical injury, cancer treatment, inflammation, genetic conditions such as Klinefelter syndrome, or age-related decline.

Secondary is diagnosed when someone has low testosterone and normal or low LH. It's caused by a problem with the pituitary gland or hypothalamus, typically driven by factors such as pituitary disorders, obesity, trauma, HIV, stress, and Kallmann syndrome (a genetic disorder that causes delayed or absent puberty).

Symptoms of low testosterone can include fatigue, low libido, reduced muscle mass, decreased bone density, and sexual dysfunction. Low levels are associated with increased risk of Type 2 diabetes; testosterone supports muscle glucose uptake and insulin signaling, though TRT is not recommended solely to improve glycemic control.

High testosterone is typically seen with testosterone replacement therapy, anabolic steroid use, Cushing syndrome, certain testicular tumors, or congenital adrenal hyperplasia (a genetic disorder that affects the adrenal glands). High testosterone levels may improve bone density and decrease body fat. However, they may also increase the risk of hair loss and high blood pressure. High levels may also increase the production of oil in the skin (sebum), which can cause acne.

Free testosterone

Free testosterone isn't bound to proteins, making it easier for your body to use. About 1 to 2 percent of total testosterone circulates as free testosterone, and this fraction is responsible for the hormone's biological effects. Free testosterone testing provides the most accurate measure of testosterone available for tissue uptake and cellular action. Free testosterone can be measured directly or estimated based on levels of total testosterone as well as SHBG and albumin.

Normal ranges of free testosterone are:

• 18-69 Years: 35.0-155.0 pg/mL
• 70-89 Years: 30.0-135.0 pg/mL

Low free testosterone may cause testosterone deficiency symptoms even with normal total testosterone. It's often seen with elevated SHBG levels, since SHBG binds to testosterone. Aging, liver disease, hyperthyroidism, and the use of anticonvulsants can increase SHBG.

High free testosterone has similar causes and implications as elevated total testosterone, and is seen with decreased SHBG levels.

What's next if your male hormone levels are out of range?

If your testosterone test results are abnormal, your doctor will likely perform additional testing and examine other factors before making a diagnosis or treatment recommendations. This may include:

• Repeat testing, usually within two to three weeks. There are a couple of reasons for this. According to Mills, testosterone levels can vary anywhere from 50 ng/dL to 150 ng/dL in healthy men during the day (which is why it's essential to check them in the early morning, when they peak). In addition, out-of-range results return to normal in 30 percent of people. Re-testing can ensure that an atypical result wasn't just a random fluctuation.
• Ruling out temporary influences like stress, sleep disruption, medications, or recent illness, which can skew results.
• Comprehensive testing of related hormones, such as those below, then evaluating symptoms in the context of those lab results. For example, reduced sex drive, erectile dysfunction, and gynecomastia could stem from an issue with several different hormones.

Additional hormones your doctor may test

To narrow down the cause of high or low testosterone, your provider may order one or more of these tests.

Sex hormone-binding globulin

Sex hormone-binding globulin (SHBG) is a protein produced by the liver that binds to testosterone and carries it through your blood. High SHBG levels mean more testosterone is bound and therefore less is bioavailable in your body. Low levels increase the availability of free testosterone.

If your total testosterone levels are normal but you have symptoms of testosterone deficiency,  you may have low free testosterone. To check, your provider may order an SHBG test. (Less commonly, they may order an SHBG test when they test your total testosterone.)

SHBG is also influenced by metabolic health. High insulin levels may prevent the liver from producing SHBG by increasing hepatic fat, which limits the expression of a gene involved in SHBG production. Lower SHBG levels could lead to higher levels of free testosterone.

The reference range for SHBG for adult males is:

• 18-55 Years: 10-50 nmol/L
• 55+ Years: 22-77 nmol/L

Low SHBG is common with insulin resistance, metabolic syndrome, obesity, inflammation, hypothyroidism, Type 2 diabetes, or steroid use.

High SHBG is often seen with aging, liver disease, or hyperthyroidism.

Estradiol 

Estradiol plays essential roles in male sexual health, including sperm production, sex drive, and erectile function. It's the prime driver of bone density and affects cardiovascular function. It may even help with fat regulation and insulin sensitivity.

The reference range for estradiol for adult males is:

• ≤39 pg/mL

Low estradiol may cause joint pain and bone density loss, and lead to low sex drive. It can be caused by low testosterone, since there is less testosterone to be converted into estradiol.

Conversely, a high level of estradiol can be a sign of high testosterone. High estradiol may cause gynecomastia, infertility, and erectile dysfunction. It's often seen with obesity, aging, stress, liver disease, and excessive alcohol use.  

Follicle-stimulating hormone

The pituitary gland produces follicle-stimulating hormone (FSH) in response to gonadotropin-releasing hormone from the hypothalamus. It stimulates sperm production in the testes by binding to receptors in the Sertoli cells, and it works with luteinizing hormone (LH) to support reproductive function and fertility.

Emerging research suggests FSH's effects may extend beyond the reproductive system to bone metabolism, fat breakdown, and cardiovascular health.

FSH is often tested with testosterone and LH to help pinpoint the cause of infertility, and on its own to distinguish the cause of testicular dysfunction. For example, if a man's testicle size is normal but he has low or no sperm count, FSH levels can help reveal whether the problem is related to sperm production or an obstruction in the reproductive tract.

The reference range for FSH in men is:

• 1.4-12.8 international units per liter (IU/L)

Low FSH may lower sperm count and quality. It's often seen with disorders that affect the pituitary gland or hypothalamus.

High FSH often indicates impaired sperm production or testicular damage. It's associated with primary testicular failure (due to cancer treatment or alcohol abuse), Klinefelter syndrome, hormone treatment, and pituitary tumors.

Luteinizing hormone 

Like FSH, luteinizing hormone (LH) is released by the pituitary in response to gonadotropin-releasing hormone. LH stimulates testosterone production by binding to Leydig cells in the testes.

LH levels can help identify problems with fertility as well as pituitary tumors. LH deficiency almost always occurs with FSH deficiency since both are secreted by the pituitary gland. LH is frequently tested with testosterone because of its key role in testosterone production.

The reference range for LH in men is:

• 18-59 Years: 1.5-9.3 mIU/mL
• ≥60 Years: 1.6-15.2 mIU/mL

Low LH is likely due to pituitary/hypothalamic dysfunction. Causes include testosterone use, Kallmann syndrome, prolactinoma (from a pituitary tumor), or congenital conditions.

High LH may be caused by testicular dysfunction, Klinefelter syndrome, mumps, a germ cell tumor (which starts in the cells that become sperm), or cancer treatment. It often indicates damage to the testicles. 

How do doctors treat abnormal male hormone levels?

If any of your male hormone levels are out of range, the recommended treatment depends on the specific hormone and your particular situation.

For low testosterone:

• Lifestyle modifications are often the first step. These include maintaining a healthy weight, building muscle, sleeping seven to nine hours a night, eating zinc-rich foods, and getting enough vitamin D. Cutting alcohol intake can also help, as it can be a driver of both a primary and secondary failure. 
• If your symptoms are significant and your levels are consistently low, your doctor may suggest testosterone replacement therapy. TRT involves taking prescribed gels, patches, injections, or tablets of testosterone.

For high testosterone, treatment depends on the cause. You may need to:

• Stop taking medications that can increase testosterone (such as anabolic steroids).
• Treat conditions that are elevating levels (such as tumors).
• Start medication, such as antiandrogens, that inhibit testosterone production.

For other hormone irregularities, treatment might include:

• In the case of estradiol, increasing testosterone levels may increase estradiol; losing weight, limiting stress, and drinking less alcohol may help lower estradiol levels.
• Treatment for high or low FSH levels can include lifestyle changes, hormone replacement therapy, or treating underlying conditions.
• Low LH levels can be treated with TRT, gonadotropin-releasing hormone therapy, or, in the case of a pituitary disorder, medications or surgery. High levels may require treating the underlying condition.

Whatever the treatment, addressing hormone imbalances requires ongoing monitoring under medical supervision. The goal is to relieve symptoms while minimizing potential side effects and maintaining overall health.

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