Free Androgen Index (FAI)

CPT: 84270; 84403
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Test Details

Synonyms

  • Testosterone:SHBG Ratio

Test Includes

Testosterone; sex hormone-binding globulin (SHBG)

Use

The free androgen index can be used to estimate physiologically active testosterone.

Methodology

Electrochemiluminescence immunoassay (ECLIA)

Reference Interval

• Male:

− 20 to 29 years: 30.0−128.0

− 30 to 39 years: 24.0−122.0

− 40 to 49 years: 14.0−126.0

− Older than 49 years: 18.0−82.0

• Female:

− 20 to 49 years: 0.4−8.4

− Older than 49 years: 0.4−6.6

Additional Information

In most men and women, >50% of total circulating testosterone is bound to sex hormone-binding globulin, SHBG, and most of the rest is bound to albumin.1-3 SHBG-bound testosterone is not readily available for intracellular complex formation because of SHBG's high binding affinity for testosterone.2 Thus, testosterone-bound SHBG is considered to be biologically inactive. Albumin has a much lower binding affinity for testosterone but binds a significant portion of the total testosterone because albumin is present at much higher plasma concentrations than SHBG.2,4 The rapid dissociation of “weakly bound” testosterone from albumin, together with a relatively long transit time of albumin through target tissue capillary beds, result in the availability of essentially all albumin-bound testosterone for steroid-receptor interaction.4 The sum of the free- and albumin-bound testosterone is often referred to as bioavailable testosterone. The concentration of testosterone in the various free and bound forms is essentially a function of total testosterone concentration and the relative concentrations of SHBG and albumin. It can be predicted that increased SHBG will decrease the concentration of both free and bioavailable testosterone for a given total testosterone concentration. The free androgen index can be used to estimate physiologically active testosterone.2,3 This index is calculated as the ratio of total testosterone divided by SHBG (both expressed in the same units) and multiplied by 100 to yield numerical results comparable in free testosterone concentration.2,5-7

Specimen Requirements

Specimen

Serum

Volume

1 mL

Minimum Volume

0.6 mL (Note: This volume does not allow for repeat testing.)

Container

Red-top tube or gel-barrier tube

Collection

If a red-top tube is used, transfer separated serum to a plastic transport tube.

Storage Instructions

Room temperature

Causes for Rejection

Plasma specimen

Clinical Information

Special Instructions

State the patient's age and sex on the test request form.

This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.

Footnotes

1. Klee GG, Heser DW. Techniques to measure testosterone in the elderly. Mayo Clin Proc. 2000; 75(Suppl):S19-S25. 10959211
2. Wheeler MJ. The determination of bioavailable testosterone. Ann Clin Biochem. 1995; 32(Pt 4):345-357.7486793
3. Gronowski AM, Landau-Levine M. Reproductive Endocrine Function. In: Burtis CA, Ashwood ER, eds. Tietz Textbook of Clinical Chemistry. 3rd ed. Philadelphia, Pa: WB Saunders Co;1999:1601-1641.
4. Manni A, Pardridge WM, Cefalu W, et al. Bioavailability of albumin-bound testosterone. J Clin Endocrinol Metab. 1985; 61(4):705-710. 4040924
5. Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999; 84(10):3666-3672. 10523012
6. Blight LF, Judd SJ, White GH. Relative diagnostic value of serum non-SHBG-bound testosterone, free androgen index and free testosterone in the assessment of mild to moderate hirsutism. Ann Clin Biochem. 1989; (Pt 4):311-316. 2764484
7. Wilke TJ, Utley DJ, Total testosterone, free-androgen index, calculated free testosterone, and free testosterone by analog RIA compared in hirsute women and in otherwise-normal women with altered binding of sex-hormone-binding globulin. Clin Chem. 1987; 33(8):1372-1375.3608155

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
146688 Free Androgen Index (FAI) 004227 Testosterone, Serum ng/dL 2986-8
146688 Free Androgen Index (FAI) 082016 Sex Horm Binding Glob, Serum nmol/L 13967-5
146688 Free Androgen Index (FAI) 146690 Free Androgen Index 24125-7

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