How Should Total Testosterone Be Measured in Women?

Abstract

The report by Heijboer et al. (1) reports that "first-generation testosterone immunoassays are influenced by SHBG (sex hormone-binding globulin) concentrations that lead to inaccurate results in samples from subjects with high or low SHBG concentrations." This conclusion is based on their finding that some testosterone immunoassays display "a statistically significant inverse relationship between SHBG concentrations and deviations in testosterone from the ID (isotope dilution) LC-MS/MS results." Other testosterone immunoassays did not display SHBG concentrationdependent biases and were deemed to be analytically satisfactory. An issue that is not addressed by this report is: "Should immunoassays be used (at all) to measure total testosterone in women?" To address this question, a PubMed search was performed under the terms "guidelines" and "testosterone" and "women" and "measurement." This search yielded 6 references. PubMed citation number 1 is the American Association for Clinical Endocrinologists' clinical review on polycystic ovarian syndrome and recommends that testosterone be measured by "LC/MS assays or by RIA with purification" (2). I am not aware of any commercially available testosterone immunoassays on automated platforms that include a routine extraction step. I suspect that the authors of the guideline refer to an "RIA" method