PSA (Total + Free + % Free)MALE
A protein produced by the prostate. Total, free and %-free together improve specificity for distinguishing benign enlargement from something requiring investigation.
Baseline and monitoring PSA is standard of care before and during testosterone therapy. Testosterone doesn't appear to cause prostate cancer, but can accelerate growth of an existing undetected cancer — so you establish a baseline first.
The plan of attack
In this order. Most people start at step four, which is why they change five things at once and learn nothing.
- Confirm the number is real
Ejaculation, cycling or a digital rectal exam. Ejaculation within 48 hours, a long ride, or an examination before the draw all raise PSA — sometimes enough to move a man across a biopsy threshold on a number that was never his baseline. Abstain 48 hours, avoid cycling for 48 hours, and draw PSA BEFORE any examination, not after. - Read it with its partner
A rising PSA velocity on TRT warrants urology referral — that's the signal, not a single value. Draw it alongside: Total Testosterone, Total & Free DHT. - Work out which direction is yours
If it's high — Requires urological evaluation — but rule out the benign causes above first, since they're far more common.
If it's low — Reassuring. Note finasteride/dutasteride roughly halve PSA — you must double the reported value to interpret it correctly. This is a consequential and frequently missed detail. - Fix it in this order
Nutrition. Cooked tomatoes/lycopene, cruciferous vegetables, and reduced saturated fat have modest observational support for prostate health.
Lifestyle. Maintain a healthy weight and exercise; both associate with lower BPH and prostate cancer risk.
Supplements. Saw palmetto for BPH symptoms (mixed evidence). Avoid high-dose supplemental selenium and vitamin E — the SELECT trial found no benefit and possible harm.
Hormones. 5-alpha-reductase inhibitors reduce prostate volume and PSA. Manage TRT with periodic PSA monitoring per your physician.
Compounds. Get a baseline before starting TRT, then monitor (commonly at 3–12 months, then annually). Abstain from ejaculation and cycling for 48h before the draw to avoid a false alarm.
Work down the list, not across it. Adding a compound on top of an unfixed diet is why generic protocols fail. - Retest
Baseline, 3–12 months after starting TRT, then annually. Change one thing at a time, or the retest can't tell you which thing worked.
How to fix it
📚 Endocrine Society Testosterone Therapy CPG — prostate monitoring. Thompson IM et al., NEJM 2004 — PSA and finasteride.
🩸 Test your PSA (Total + Free + % Free)
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includes this + 6 more markers · built for men — Over 45, or over 40 with a family history. Also anyone with urinary changes — weak stream, frequency, waking at night to urinate.
includes this + 10 more markers · built for men — You've decided to start testosterone therapy. Draw this before your first injection.
What moves your PSA (Total + Free + % Free)
2 supplements in the Vault have a documented effect on this marker, or are a reason to have measured it first:
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Would you feel it? Symptoms PSA (Total + Free + % Free) helps explain
People rarely search for a marker — they search for how they feel. These are the complaints where this marker is worth checking, and whether it is a first-line test or a follow-up once the obvious causes are ruled out.
Why your PSA (Total + Free + % Free) might be wrong
Most abnormal results are interference, not disease. These are the things that measurably move this specific marker — check them before you change anything. Each one says whether the number is wrong and should be repeated, badly timed and should be redrawn, or real with a cause worth explaining.
Finasteride and dutasteride roughly HALVE PSA within six to twelve months. An untreated-looking PSA on one of these drugs is therefore about double what it appears.
On a 5-ARI, double the result before comparing it to any reference range, and tell whoever reads it.
Ejaculation within 48 hours, a long ride, or an examination before the draw all raise PSA — sometimes enough to move a man across a biopsy threshold on a number that was never his baseline.
Abstain 48 hours, avoid cycling for 48 hours, and draw PSA BEFORE any examination, not after.
Ejaculation raises PSA for up to 48 hours; a long bike ride and a digital rectal exam do the same. These are common causes of an alarming result.
Abstain 48 hours, no cycling for 48 hours, and draw before any examination.
Roughly halve PSA. A PSA of 1.5 on finasteride corresponds to about 3.0 untreated, and failing to double it has caused missed cancers.
Double your PSA if you have been on a 5-alpha-reductase inhibitor for over six months, and tell whoever reads it.
Prostatitis and urinary infection can raise PSA dramatically — several times baseline — and it stays elevated for weeks after symptoms settle.
Wait 6–8 weeks after any urinary infection before retesting, and never act on a PSA drawn during one.
What PSA (Total + Free + % Free) means in combination
A single marker tells you a little. Combinations tell you the story — these are the named patterns this marker takes part in, and what each one points at.
Both effects are the drug working. The one that matters clinically is PSA: these drugs roughly halve it, so a PSA of 1.5 on finasteride corresponds to about 3.0 untreated. Failing to double the value has caused missed cancers.
Double your PSA if you have been on a 5-ARI for more than six months, and tell whoever reads it. Track the trend rather than the absolute.
A single raised PSA causes more panic than almost any other number, and most of the common causes are benign and several are temporary. Ejaculation within 48 hours, a long bike ride, prostatitis, a recent catheter or digital examination, and simple benign enlargement all raise it. So does age, steadily. The free fraction is the number that adds information, and it is the one people skip. PSA circulates bound and unbound; a HIGHER percentage free points toward benign enlargement, a LOWER percentage is the one that raises concern. Measuring total PSA without the free fraction throws away the part that discriminates. The opposite trap also exists: finasteride and dutasteride roughly halve PSA, so a 'normal' reading on a 5-alpha-reductase inhibitor may not be normal at all.
Before anything else, repeat it under clean conditions — no ejaculation, cycling or heavy lifting for 48 hours beforehand. A meaningful share of raised readings resolve on the repeat, and acting on the first one is how people end up in an unnecessary pathway. Ask for the % free PSA on the repeat, not just total. Velocity matters more than any single value — a number rising steadily across draws is more informative than one reading above a threshold, which is the argument for having a baseline before you need one. If you take finasteride or dutasteride, tell whoever reads it, because the correction is not automatic.
What to test next
Markers rarely answer alone. These are the ones that put PSA (Total + Free + % Free) in context — each with its own full breakdown.
Frequently asked questions
Total PSA <4.0 ng/mL traditionally; age-specific ranges are more useful. %Free >25% reassuring, <10% concerning. Ranges vary by laboratory and assay — always compare to the range printed on your own report.
Low and — most importantly — stable over time. The velocity of change matters more than any single value.
Requires urological evaluation — but rule out the benign causes above first, since they're far more common.
Reassuring. Note finasteride/dutasteride roughly halve PSA — you must double the reported value to interpret it correctly. This is a consequential and frequently missed detail.
You can order PSA (Total + Free + % Free) directly through Marek Diagnostics without a doctor's visit — drawn at any Quest Diagnostics location in the US. Code CAMERON applies 10% off automatically.