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The total testosterone consists of two forms of testosterone; one is bound to SHBG and the other is free-circulating testosterone unattached to serum proteins. The opposite is true where SHBG is decreased and the free testosterone levels are high. This situation is seen in men with obesity and hypothyroidism; these men have normal amounts of testosterone available for use by the body but the serum testosterone level is decreased. If testosterone is low, a full hormonal evaluation consisting of LH (luteinizing hormone), prolactin, FSH and TSH may be recommended.
A low testosterone level may indicate an elevated prolactin level as well - a condition known as a hyperprolactinoma. Average levels of blood testosterone for males should range between 300-1,000ng/dl, which is too wide a spectrum when considering athletes. Unfortunately, the average drug-free athlete is probably somewhere around 500ng/dl, which is too low.
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