What are “normal” testosterone levels and when do we treat?

First, It’s important to understand what is being measured when your testosterone levels are checked and what those numbers represent. Understanding this information is crucial to determining if testosterone replacement therapy would be beneficial or not. When analyzing testosterone, there are two key metrics that need to be assessed: total testosterone and free testosterone. Total testosterone encompasses all testosterone in your body, both the free (unbound), and the portion bound to proteins.

Approximately 2/3 of testosterone is attached to a protein called Sex Hormone-Binding Goblin (SHBG), the remaining 1/3 is bound to albumin. The testosterone bound to SHBG is not usable by the body. However, the testosterone bound to albumin is loosely attached and along with the free testosterone constitutes what is known as bio available testosterone. This bio available testosterone is vital to consider when starting testosterone replacement therapy for optimization of your testosterone levels.

To understand this concept, let’s use a vehicle analogy. Think of bioavailable testosterone as the fuel in your vehicle’s tank, it’s what powers your vehicle. Now, imagine you have a full gas tank in the bed of your truck but no gas in the fuel tank. Although you technically have the fuel (the total testosterone), it’s useless unless it’s in the tank and ready to be used (bioavailable testosterone). This is why relying solely on total testosterone levels, as many in traditional medicine tend to do, is not the best approach for deciding whether to begin TRT or not. Focusing only on the total testosterone could miss an opportunity to significantly improve your quality of life.

The “normal” range for testosterone levels is also quite broad. These ranges can vary slightly between different laboratories, but generally total testosterone levels range from 300 to 1100 ng/dl, while bioavailable testosterone is between 60 to 220 ng/dl. As people age, these levels naturally decline. Peak testosterone levels are usually found in late adolescence and will begin to drop every year to around 300 ng/dl total testosterone by age 80. 

With this in mind, this is where traditional medicine fails so many men. Imagine a 32-year-old experiencing symptoms of low testosterone who has his levels checked and has a level of 350 ng/dl of total testosterone. While this number is technically within the “normal” range, this is a level similar to what would be seen in the 80 year-old man. In cases like this, many healthcare providers might dismiss this as normal and not treat the patient, potentially leading to a misdiagnosis of depression when low testosterone is the real issue at hand.

While reference ranges are useful, treatment decisions shouldn’t be solely based on a number. It is essential to consider lab results in conjunction with a patient’s symptoms and overall health when determining if TRT could be beneficial. At True North Health & Wellness, we don’t base our decision to start a patient on TRT purely on total testosterone levels. Instead, we look at the big picture and consider the combination of total testosterone, bioavailable testosterone, other lab results and the patient’s symptoms and history to decide if TRT is a suitable option for improving their well-being.