Introduction: The most widely used method for measuring free testosterone (FT) is by analog immunoassay (aFT); however, this assay has been criticized as unreliable based on laboratory studies in small groups of men. Calculated FT (cFT), derived from total testosterone (TT) and sex-hormone binding globulin (SHBG) values has been recommended in its place. There are limited data comparing aFT and cFT in clinical populations.
Aim: The purpose of this study was to compare aFT with cFT in a population of ambulatory men in a clinical setting.
Methods: Medical records were reviewed for 100 randomly selected men in a urology practice, yielding 140 test results complete for TT, aFT, and SHBG. Calculated FT was determined via an online calculator. Comparisons were made with Pearson rank coefficients.
Main outcome measures: Pearson rank correlation between aFT and cFT.
Results: Mean patient age was 52.3 +/- 14.3 years (range 24-80). Mean TT was 443.0 +/- 208.3 ng/dL (range 110-1276). Mean aFT was 1.22 +/- 0.54 ng/dL (range 0.24-3.8) and mean cFT 9.4 +/- 4.5 ng/dL (range 1.8-27.8). Mean SHBG was 34.2 +/- 19.5 nmol/L (range 9-127). A strong correlation was observed for aFT and cFT (r = 0.88, P < 0.0001), particularly at low concentrations. Significant correlations were also noted between aFT and TT (r = 0.73, P < 0.0001), and between cFT and TT (r = 0.82, P < 0.0001). Numerical values for aFT were approximately one-eighth of the values obtained for cFT. Neither aFT nor cFT correlated with SHBG.
Conclusions: A strong correlation was observed between aFT and cFT in this clinical population of ambulatory men. Different sets of reference values must be applied for each of these tests.