Estimation of Free Testosterone in routine clinical practice is not recommended.

Kindly raise your hands those who insist on  equilibrium dialysis method of estimating Free Testosterone  which has been declared unanimously as the  gold standard for measuring free testosterone?? God morning, Let us be frank about estimation of kind of testosterone (Free or Total ) testosterone in your practice? How many of us Kin

We should understand that the methods of estimations of hormones in general & also its accuracy, cost, sensitivity and above all clinical utility and applications in clinical medicine , If a report is not helpful for treating a Pt then it is no point for asking such tets even it is low coast. . My dear members please do remember that  although equilibrium dialysis is the gold standard for measuring free testosterone, it is expensive, complex, and usually limited to research settings, in a clinical setting; free testosterone levels can be estimated by assessment of testosterone binding to albumin and SHBG.

How best to asses of Hyperandrogenemia by Laboratory methods( i.e. method of confirmation &  documentation i hyperandrogenaemia.

In hyperandrogenic states, increases in testosterone production are not proportionately reflected in increased total testosterone levels because of the depression of SHBG levels that occurs concomitant with increasing androgen effects on the liver. What is free Androgen index?

Testosterone that is nonspecifically bound to albumin (AT), is linearly related to free testosterone (FT) by the equation:

AT=K_a [A] x FT,

Where AT is the albumin-bound testosterone, K_a is the association constant of albumin for testosterone, and [A] is the albumin concentration.

Then what os the role of albumin level while assessing testosterone? Understandably, the bioavailable testosterone level is based on the relationship of albumin and free testosterone. Free T4 is  incorporated the  with  albumin-à gives rise to the total testosterone .

This combination of total testosterone, SHBG( which is not bound to any sex hormones) , and albumin level measurements can be applied to derive a more accurate estimate of available bioactive testosterone and thus the androgen effects derived from testosterone. Bioactive testosterone determined in this manner provides a superior estimate of the effective androgen effect derived from testosterone

In hirsutism many  may opt for assessing serum T4: . Point 1:- When Total Testerone may be enough for clinical purpose?

In practical clinical evaluation of the hyperandrogenic patient, determination of the total testosterone level in correlation  with clinical assessment is frequently sufficient for diagnosis and management. Therefore, when moderate hyperandrogenism, characteristic of many functional hyperandrogenic states, occurs, elevations in total testosterone levels may remain within the normal range, and only free testosterone levels will reveal the hyperandrogenism. Severe hyperandrogenism, as occurs in virilization and those results from neoplastic production of testosterone, is reliably detected by measures of total testosterone. When physiologic albumin levels are present, the free testosterone level can be estimated by measuring the total testosterone and SHBG. In individuals with normal albumin levels, this method has reliable results compared with those of equilibrium dialysis. It provides a rapid, simple, and accurate determination of the total and calculated free testosterone level and the concentration of SHBG.::  In many cases of hirsutism, albumin levels are within a narrow physiologic range and thus do not significantly affect the free testosterone concentration. But the question is how best to assess  the free i.e. bioactive testosterone ?? 

Point 2:-When Free T will be desired?

Therefore, in practical clinical evaluation of the hyperandrogenic patient, determination of the total testosterone level in correlation with clinical assessment is frequently sufficient for diagnosis and management. When more precise delineation of the degree of hyperandrogenism is desired, measurement or estimation of free testosterone levels can be undertaken and will more reliably reflect increases in testosterone production.

   Is free T4 measurement essential?? Ans:-Such These measurements are not necessary in evaluating the majority of patients, but they are common in clinical research studies and may be useful in some clinical settings. Because many practitioners measure some form of testosterone level, they should understand the methods used and their accuracy. Although equilibrium dialysis is the gold standard for measuring free testosterone, it is expensive, complex, and usually limited to research settings, in a clinical setting; free testosterone levels can be estimated by assessment of testosterone binding to albumin and SHBG.