Do you feel like your testosterone is "low" but were told it was "Normal?"
Let’s discuss this…
SO WHAT IS THE REFERENCE RANGE?
Most lab values fall within a relatively normal bell curve distribution like the one in this image. When thousands of patients have their T levels checked, the highest number fall near the mean. If you look at a normal distribution, you see that 95% of men have T levels within 2 standard deviations from the mean. This is the reference range that many equate with the “normal range”. This is a VERY broad range. For instance, for free testosterone the range is from around 4 to around 24ng/dL meaning there is a six-fold difference between the lower and upper parts of the curve. If you are going to consider this a “normal” range, you have to consider 4 and 24 both normal. In fact, you would have to be in the bottom 2.5% of men to be considered abnormal, meaning 97.5% of your peers have higher free testosterone. This is why I have never cared for the premise that reference range = normal range.
Ultimately it is hard to argue that for most men a free testosterone of 6 is optimal, especially when his free T was 16 when he was younger. He is very likely feeling some effects of declining T, including decreased energy, decreased sex drive, decreased muscle mass, depressed mood, and maybe even cognitive decline. We don’t subscribe to the dogma that just because your T is within 2 standard deviations of the mean, your levels are optimized. Many people within the lower part reference range benefit greatly from optimization which in most cases just means a target within a higher part of the reference range.
Most importantly, we should treat people, not numbers. One man’s optimal T level (that which safely optimizes your lifestyle and health) is not the same as his neighbor’s. In fact, if a patient with a free T of 4 tells me his lifestyle (mood, libido, energy, muscle mass, etc) is great, I would feel no urgency to treat it at all. Conversely, if a man with a free T of 8 tells me his sex drive is in the tank, he has increasing fatigue, or declining mood, we would have a detailed discussion about the benefits and risks of testosterone optimization therapy (TOT).
Lastly, it is important to note that there are a lot of reasons sex drive can decline (stress, marital strife etc) or that a man can be tired or depressed. I’ve been tired for about 8 years. This correlates tightly to the birth of my first kid…It’s not always easy to establish causality between T levels and onset of these symptoms. Some men really put their eggs in the T basket and are disappointed when TOT does not improve symptoms. However, this is the minority of patients in our experience. Most symptomatic guys really do improve on TOT.
Many of the concerns about the risks of TOT have been debunked, but as with any treatment there is always some risk. That is why it is critical that TOT be monitored by a qualified physician. It should not be “set it and forget it.”
AND ANOTHER REASON TO LOOK AT THE TESTOSTERONE REFERENCE RANGE IN A THOUGHTFUL CONTEXT…
Here is another big curveball that a man should consider when he has low T symptoms but is told he has normal T:
Over the past 25 years or so, the average age-adjusted testosterone level has declined by about 1% per year. That means that an average 50 year-old has a testosterone level that is 25% lower than an average 50 year-old in the 1990s. Testosterone levels have declined across the board over time. There are a lot of theories to explain this, including sedentary lifestyle, increased obesity and metabolic syndromes, stress, environmental factors, and/or diet.
This is one potential reason why a man with a testosterone level within the 2023 reference range may not feel “normal.” Again, medicine should be about treating the human being, not the numbers, as long as it is done as safely as possible.
If you think you may have symptoms from suboptimal testosterone, feel free to drop in to The Men’s Center and see what we are all about or give us a call at 843-625-4273!