Testost., % Free+Weakly Bound (female)

Elevated levels of FWBT are observed in female hirsutism.

FWBT levels tend to increase during pregnancy but have been found to remain below the upper limit of the reference interval.

In females:

- Total testosterone levels in women decrease by approximately 30% after menopause.

- Decreased FWBT levels have been associated with diminished libido and loss of bone density.

- Administration of exogenous estrogens has the physiologic effect of increasing SHBG concentrations and suppressing the production of androgens by the ovary. This results in a net decrease in FWBT.

In males:

In males, decreased serum concentrations are associated with hypogonadism.

FWBT levels in males fall with age 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.

Decreased FWBT was not, however, found to correlate with diminished potency. Since SHBG has been found to increase with age, the FWBT level may be a more reliable indicator of testosterone production than total testosterone.

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.

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.