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What are “normal” testosterone levels?

First its important to understand what is being measured when your testosterone levels are checked at Alpha Medical. The 2 measurements of importance are your total testosterone and free testosterone. The total testosterone in your body is just that, the total amount that is both free and bound to proteins. 

About 2/3rd’s of testosterone is bound to the protein called Sex Hormone-Binding Globulin (SHBG) and the other 1/3rd to the protein albumin. The testosterone bound to SHBG is not utilized by our bodies. The testosterone bound to albumin on the other hand is loosely bound and is used in addition to our free testosterone, this is called our bio-available testosterone and is important to take into consideration when beginning Testosterone Optimization Therapy (TOT). 

I always tell patients to think about it as gas in your car. The gas in your fuel tank is being used by your vehicle. But lets say you have a full gas tank that is sitting in your trunk, its essentially useless until you put it in your tank. Sure, you might have 20 gallons of fuel total (total testosterone) but only 5 gallons is in your fuel tank being used (bio-available testosterone). This is why just using total testosterone as the decision maker to start TOT, like most of the standard medical community does, is a poor marker to beginning a treatment regimen that could potentially improve your life dramatically.

The levels of “normal” testosterone have a very broad range. These reference ranges differ from lab to lab but for simplicity purposes the average total testosterone level is between 300-1100 ng/dl and bio-available testosterone is 60-220 ng/dl. These levels typically decline as we age from the upper limits of normal when we are around 18-20 years old to about 400 (total) by the time your 80. 

So with that in mind, if you are a 35 year old who has symptoms of low testosterone and your level is 350 ng/dl, you are still considered to be in “normal” range and a majority of medical providers would not treat you even though its the level of a 80 year old man. Instead you could just be diagnosed with depression when in reality the underlying issue is low T. 

These ranges are important references, but the decision should not be black and white based off a number. The lab values and an individuals specific presentation should be used together when determining if TOT would be a beneficial treatment option. I personally do not weigh my decision to start a patient on TOT solely on the total testosterone. Instead I take into account the total testosterone, bio-available testosterone, other lab findings, and your symptoms/concerns to make a mutual decision to see if TOT would benefit your well-being. 

Justin Montgomery, NP

Clinical Director, Alpha Medical