Testosterone, Free and Weakly Bound, With Total Testosterone, LC/MS-MS

CPT: 84410
Updated on 12/2/2018
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Test Details

Use

Free and weakly bound testosterone (FWBT), also referred to as bioavailable testosterone, is thought to reflect an individual's biologically active, circulating testosterone. FWBT includes free testosterone and testosterone that is bound to albumin. FWBT does not include sex hormone-binding globulin-bound testosterone. The SHBG-bound fraction is biologically inactive because of the high binding affinity of SHBG for testosterone. The rapid dissociation of "weakly bound" testosterone from albumin results in the availability of essentially all albumin-bound testosterone for steroid-receptor interaction.1

Methodology

Ammonium sulfate precipitation; liquid chromatography/tandem mass spectrometry (LC/MS-MS)

Additional Information

Free and weakly bound (bioavailable) testosterone measurement involves the selective precipitation of SHBG with ammonium sulfate. Tritiated testosterone is added to serum, which is then allowed to come to equilibrium at physiologic temperature. Testosterone bound to SHBG is then selectively precipitated with 50% ammonium sulfate, leaving free and albumin-bound testosterone in solution. The percentage of tritiated label not bound to SHBG is multiplied by the total testosterone to produce the bioavailable testosterone.

Elevated levels of FWBT are observed in female hirsutism.2 The measurement of free and weakly bound testosterone in women, when used in conjunction with the assay of the DHEA-S and SHBG, can be used to establish etiology of hirsutism. In males, decreased serum concentrations are associated with hypogonadism. FWBT levels tend to increase during pregnancy but have been found to remain below the upper limit of the reference interval.3 Total testosterone levels in women decrease by approximately 30% after menopause.4 Administration of exogenous estrogens has the physiologic effect of increasing SHBG concentrations and suppressing the production of androgens by the ovary.4 This results in a net decrease in FWBT. Decreased FWBT levels have been associated with diminished libido4 and loss of bone density.5 FWBT levels in males fall with age6 at a rate that exceeds that of total testosterone and parallels the drop in DHEA sulfate. This decrease is thought to be caused by diminished testicular production and not due to hypothalamic/pituitary insufficiency.7 Decreased FWBT was not, however, found to correlate with diminished potency.8 Since SHBG has been found to increase with age, the FWBT level may be a more reliable indicator of testosterone production than total testosterone.

Specimen Requirements

Specimen

Serum

Volume

2 mL

Minimum Volume

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

Container

Red-top tube or gel-barrier tube

Collection

Serum should be transferred from cells within one hour of collection and transferred to a plastic transport tube.

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

Serum should be transferred from cells within one hour of collection and transferred to a plastic transport tube.

Storage Instructions

Refrigerate

Stability Requirements

Temperature

Period

Room temperature

7 days

Refrigerated

7 days

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Temperature

Period

Room temperature

7 days

Refrigerated

7 days

Causes for Rejection

Improper labeling

Improper labeling

Clinical Information

Footnotes

1. Pardridge WM. Transport of protein-bound hormones into tissues in vivo. Endocr Rev. 1981; 2(1):103-123 (review). 7028469
2. Cumming DC, Wall SR. Nonsex hormone-binding globulin-bound testosterone as a marker for hyperandrogenism. J Clin Metabol. 1985; 61(5):873-876. 4044776
3. Kerlan V, Nahoul K, Le Martelot MT, et al. Longitudinal study of maternal plasma bioavailable testosterone and androstanediol glucuronide levels during pregnancy. Clin Endocrinol (Oxf). 1994; 40(2):263-267. 8137527
4. Davis SR, Burger HG. Use of androgens in postmenopausal women. Curr Opin Obstet Gynecol. 1997; 9(3):177-180 (review). 9263701
5. Jassal SK, Barret-Connor E, Edelstein SL. Low bioavailable testosterone levels predict future height loss in postmenopausal women. J Bone Miner Res. 1995; 10(4):650-654. 7610937
6. Morley JE, Kaiser F, Raum WJ, et al. Potentially predictive and manipulable blood serum correlates of aging in the healthy male: Progressive decreases in bioavailable testosterone, dehydroepiandrosterone sulfate, and the ratio of insulin-like growth factor 1 to growth hormone. Proc Natl Acad Sci USA. 1997; 94(14):7537-7542. 9207127
7. Nahoul K, Roger M. Age-related decline of plasma bioavailable testosterone in adult men. J Steroid Biochem Mol Biol. 1990; 35(2):293-299. 2106599
8. Korenman SG, Morley JE, Mooradian AD, et al. Secondary hypogonadism in older men: Its relation to impotence. J Clin Endocrinol Metab. 1990; 71(4):963-969.2205629

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
070282 Testosterone,F/WklyBd+T LC/MS 070036 Testosterone, Total, LC/MS ng/dL 2986-8
070282 Testosterone,F/WklyBd+T LC/MS 143257 Testost., % Free+Weakly Bound % 6891-6
070282 Testosterone,F/WklyBd+T LC/MS 070281 Testost., F+W Bound ng/dL 2990-0

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