My free testosterone is low but total is normal — what should I do?
Low free testosterone with normal total often reflects elevated SHBG. Check SHBG, estradiol, thyroid, and insulin. Addressing SHBG drivers (thyroid excess, low insulin, hepatic factors) can restore free T; persistent symptomatic deficit is evaluated for Testosterone Optimization.
Full answer
Free testosterone is the bioactive fraction. Low free T with normal total testosterone usually means SHBG is elevated, binding most circulating testosterone. SHBG rises with hyperthyroidism, low insulin, hepatic disease, and certain medications. The workup includes SHBG, estradiol, TSH/free T4, fasting insulin, albumin, and a hepatic panel. Addressing reversible SHBG drivers can restore free T without exogenous therapy. Persistent symptomatic deficit is evaluated for Testosterone Optimization, with calculated free T tracked alongside total T at each recalibration window.
Educational. Not a substitute for individualized provider review.
- Methodology — Primary source · oMeds
- Reviewed by Dr. Laura Purdy, MD, MBA · Clinical Director, oMeds · Last reviewed 2026-06-03