When measuring testosterone levels, it is critical to determine the levels of both free and total testosterone to understand the cause of any observed symptoms of deficiency (Khosla et al 2008).
Because of difficulties with equipment standardization and inter-laboratory variability, it is recommended that physicians consistently use the same local laboratories and gain familiarity with the accuracy, precision and definition of normal values for the assays offered in their communities (Morales et al 2010).
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Currently, the SHBG test is not performed frequently or routinely. In many cases, health practitioners feel that the total testosterone , and perhaps free testosterone (as measured by a method called equilibrium dialysis), provides sufficient information. SHBG is ordered primarily when the total testosterone results do not seem to be consistent with clinical signs and symptoms , such as infertility, decreased sex drive, and erectile dysfunction in men or infertility , irregular menstrual periods, and excess facial and body hair in women.