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Free Androgen Index (FAI) Testing

Free Androgen Index (FAI) Testing

January 21, 2026
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Do I need a Free Androgen Index (FAI) test?

Struggling with unexplained weight gain, thinning hair, irregular periods, or stubborn acne? Could your hormone balance be off, and might a Free Androgen Index test reveal what's happening?

The FAI measures the ratio of testosterone to the protein that binds it, showing how much active testosterone is actually available in your body. This matters because even normal total testosterone can mask an imbalance.

Testing your FAI gives you a quick snapshot of your androgen activity, helping pinpoint whether hormonal imbalances are driving your symptoms. It's the essential first step to personalizing your treatment plan and lifestyle adjustments so you can finally address those frustrating changes.

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Key benefits of Free Androgen Index (FAI) testing

  • Reveals how much testosterone is actually active and available in your body.
  • Spots androgen imbalances that explain acne, hair loss, or excess body hair.
  • Flags PCOS early, helping protect fertility and metabolic health long-term.
  • Guides treatment decisions for irregular periods, low libido, or mood changes.
  • Tracks whether hormone therapy or lifestyle changes are restoring balance effectively.
  • Clarifies symptoms when total testosterone levels alone don't explain what you're experiencing.
  • Best interpreted with total testosterone, SHBG, and your clinical symptoms together.

What is Free Androgen Index (FAI)?

The Free Androgen Index is a calculated ratio that estimates how much testosterone is biologically active in your bloodstream. It compares total testosterone to sex hormone-binding globulin (SHBG), the protein that binds and inactivates most circulating testosterone.

A window into hormone availability

Most testosterone travels bound to SHBG, making it unavailable to tissues. Only the small unbound fraction can enter cells and trigger effects like muscle growth, libido, and energy regulation. FAI approximates this free, active portion without requiring specialized lab techniques.

Why the ratio matters

When SHBG levels rise, more testosterone gets locked away, reducing what's available for use. When SHBG falls, more testosterone circulates freely. FAI captures this dynamic balance, offering insight into androgen activity that total testosterone alone can miss.

This makes FAI particularly useful in conditions where SHBG levels shift, such as polycystic ovary syndrome, metabolic syndrome, or thyroid disorders. It reflects the functional androgen status your body actually experiences.

Why is Free Androgen Index (FAI) important?

The Free Androgen Index estimates how much testosterone is biologically active rather than bound to carrier proteins in your blood. It matters because active testosterone drives energy, muscle tone, libido, mood stability, and metabolic health in both sexes, while imbalances ripple through reproductive, cardiovascular, and bone systems. FAI is calculated from total testosterone and sex hormone-binding globulin (SHBG), offering a window into androgen availability when direct free testosterone measurement isn't feasible.

When the signal is too quiet

When FAI falls below the typical range, your tissues may not receive enough androgen stimulation. In men, this can manifest as fatigue, reduced muscle mass, low libido, and mood changes. Women with low FAI may experience similar energy dips, though their baseline androgen levels are naturally much lower than men's.

When the signal is too loud

Elevated FAI suggests excess free testosterone, which in women often signals polycystic ovary syndrome (PCOS), triggering irregular periods, acne, excess hair growth, and insulin resistance. Men rarely see high FAI unless using exogenous androgens or facing certain tumors.

The metabolic and reproductive crossroads

FAI connects hormonal balance to insulin sensitivity, ovarian function, cardiovascular risk, and bone density. Persistent imbalances can accelerate metabolic syndrome, infertility, and long-term cardiovascular disease, making FAI a vital marker for understanding how androgens shape whole-body health across the lifespan.

What do my Free Androgen Index (FAI) results mean?

Low values

Low values usually reflect reduced androgen activity relative to binding protein levels. In men, this often signals low testosterone production or elevated sex hormone binding globulin, which can accompany aging, obesity, metabolic syndrome, or thyroid excess. The result may be reduced energy, libido, muscle maintenance, and mood stability. In women, low FAI is less commonly flagged but may occur with very high binding protein levels or androgen deficiency states.

Optimal values

Being in range suggests balanced androgen bioavailability for your sex and life stage. In men, this supports normal sexual function, muscle and bone health, and metabolic regulation. In women, optimal FAI typically sits in the lower portion of the reference range, reflecting physiologically lower androgen levels that support energy and tissue repair without virilizing effects.

High values

High values usually reflect increased free androgen activity. In women, this is the hallmark of polycystic ovary syndrome, where excess ovarian or adrenal androgen production combines with low binding protein levels. It often accompanies irregular cycles, acne, hirsutism, and insulin resistance. In men, elevated FAI may indicate androgen excess from supplementation, tumors, or conditions that suppress binding proteins like obesity or hypothyroidism.

Notes

FAI is calculated from total testosterone and sex hormone binding globulin, so interpretation depends on both. Pregnancy, oral contraceptives, thyroid disorders, liver disease, and obesity all alter binding protein levels and shift the index independently of true androgen status.

Method: Derived from laboratory results. If any input is measured by a laboratory-developed test (LDT) validated under CLIA, that input is not cleared or approved by the FDA. This ratio/index itself is not FDA-cleared. Results support clinician interpretation and are not a stand-alone diagnosis. Inputs: total testosterone, SHBG.

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Frequently Asked Questions about Free Androgen Index (FAI) Testing

What is the Free Androgen Index (FAI) test and what does it measure?

Free Androgen Index (FAI) is a calculated ratio that estimates how much testosterone is biologically active (available to tissues) in your body. It’s not a hormone measured directly. Instead, FAI compares total testosterone with sex hormone-binding globulin (SHBG), the main protein that binds and inactivates testosterone in the bloodstream. A higher FAI generally indicates more bioavailable testosterone relative to binding capacity.

How is Free Androgen Index (FAI) calculated from total testosterone and SHBG?

FAI is calculated using your total testosterone result and your SHBG result to estimate the “free” or active fraction of testosterone. Because SHBG binds most circulating testosterone, the ratio helps show whether symptoms may reflect true androgen excess/deficiency or changes in binding proteins. For best interpretation, FAI should be reviewed alongside total testosterone, SHBG, and your clinical symptoms.

Why does SHBG affect Free Androgen Index (FAI) and testosterone activity?

SHBG acts like a carrier and buffer for testosterone, binding a large portion of circulating hormone. Bound testosterone is largely inactive, while unbound (“free”) testosterone can enter cells and drive effects on energy, muscle, libido, mood, metabolism, and reproductive function. When SHBG rises, FAI tends to fall; when SHBG drops, FAI often rises - even if total testosterone doesn’t change much.

What are the key benefits of Free Androgen Index (FAI) testing for women with symptoms?

FAI testing helps reveal how much active testosterone is available, which can clarify symptoms linked to androgen imbalance. It can help assess irregular periods, excess facial/body hair (hirsutism), acne, scalp hair thinning, and unexplained weight gain. FAI is also useful for flagging androgen excess patterns commonly associated with polycystic ovary syndrome (PCOS) and for tracking response to therapy over time.

How does a high Free Androgen Index (FAI) relate to PCOS and androgen excess?

A high FAI in women often suggests increased free testosterone availability, commonly seen with PCOS. Elevated androgen activity may contribute to irregular cycles, acne, unwanted hair growth, scalp thinning, and insulin resistance. High FAI can result from higher total testosterone, lower SHBG, or both. Because obesity and insulin resistance can lower SHBG, FAI can rise even without a large increase in testosterone production.

What does a low Free Androgen Index (FAI) mean in men and what symptoms can it cause?

Low FAI typically indicates reduced bioavailable testosterone relative to binding proteins, often due to high SHBG or low testosterone production. In men, this pattern may align with fatigue, reduced libido, difficulty building muscle, reduced muscle tone, mood changes, and slower recovery. Importantly, total testosterone can appear “normal” while FAI is low, which is why pairing FAI with symptoms and SHBG matters.

What does a low Free Androgen Index (FAI) mean in women, including after menopause?

In women, low FAI is less commonly flagged but may occur with very high SHBG states or ovarian insufficiency. Very low androgen availability may contribute to low energy, diminished vitality, and - over time - effects on bone density and well-being, particularly after menopause. Because women naturally have a smaller androgen pool, “optimal” results are often in the low-normal range rather than mid-to-high values.

What conditions and lifestyle factors can change SHBG and skew Free Androgen Index (FAI) results?

FAI can shift due to factors that alter SHBG. Obesity, insulin resistance, hypothyroidism, and liver disease tend to lower SHBG and raise FAI independent of true androgen excess. Pregnancy, oral estrogen, and hyperthyroidism often raise SHBG and lower FAI. Because FAI is a calculated ratio, changes in SHBG can meaningfully change results even when total testosterone changes only slightly.

How should Free Androgen Index (FAI) be interpreted alongside total testosterone and symptoms?

FAI is most useful when interpreted with total testosterone, SHBG, and your clinical picture. This helps distinguish whether symptoms are driven by true androgen excess/deficiency or by altered binding proteins. For example, someone may have normal total testosterone but low FAI due to high SHBG, or a high FAI driven mainly by low SHBG from metabolic factors. Symptom context improves accuracy and clinical relevance.

Is Free Androgen Index (FAI) a direct measurement of free testosterone, and what are common misconceptions?

FAI is not a direct measurement of free testosterone; it’s an estimate derived from total testosterone and SHBG. A common misconception is that FAI alone “diagnoses” conditions like PCOS - FAI can support assessment but should be paired with symptoms and related labs. Another misconception is that high FAI always means high testosterone production; low SHBG from metabolic issues can raise FAI even without major testosterone increases.

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