What is the Meaning of Free Testosterone Calculation?

Free Testosterone Calculation is an analytical method used in clinical practice to estimate the concentration of biologically active, unbound testosterone in the circulation, often referred to as calculated free testosterone (cFT). This calculation uses measured total testosterone, sex hormone-binding globulin (SHBG), and sometimes albumin levels, along with established equilibrium constants, to provide a more accurate assessment of androgen status than total testosterone alone. It is a crucial diagnostic tool for evaluating symptoms of androgen deficiency or excess in both sexes.

What is the Origin of Free Testosterone Calculation?

The calculation method stems from the physiological understanding that only the fraction of testosterone not bound to SHBG or albumin is readily available to interact with target tissues. As direct measurement of free testosterone is technically challenging and prone to error, computational models like the Vermeulen method were developed in the late 20th century. These models offer a reliable, standardized clinical alternative to direct assay.

What is the Mechanism of Free Testosterone Calculation?

The calculation relies on the law of mass action, modeling the binding equilibria between testosterone and its primary transport proteins, SHBG and albumin. By inputting the measured total hormone and protein concentrations, the equation solves for the amount of testosterone that remains unbound. This estimated free fraction directly correlates with the hormone's biological effect at the cellular level, providing a functional measure of androgen activity for clinical interpretation.

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