We would like to extend our gratitude to a gracious and knowledgeable mentor, Aaron Johnson ARNP. His patience and willingness to share his insights and experience on this topic have been invaluable in advancing our knowledge.
Testosterone. That elusive, energy giving, libido-fueling, motivation wielding, mood lifting hormone. It is a complex topic that comes with varying opinions, definitions, and philosophies. Many men have questions about their testosterone, and for good reason! It is why this topic is worth a deep dive to better understand how it works and how men can affect their levels. Let’s start with the basics.
Most Commonly Asked Questions
1. What is Testosterone?
Testosterone is a sex hormone that in men is produced almost exclusively in the testes, and in very small amounts in the adrenal glands. It plays a vital role in many bodily functions including regulating sex drive, lean body mass, body hair growth, bone mineral density, sperm production, mood, energy, and motivation.
2. When is it highest?
Testosterone levels begin to significantly increase in males around puberty and typically peak around the age of 20. Levels decrease slightly through the 20’s and 30’s but usually hold pretty steady.
3. When does it start declining?
In general, testosterone levels start to steadily decline starting around the age of 40. Levels decline on average about 1-3% per year at a fairly consistent rate.
4. What is the normal range for testosterone levels?
While there is certainly some controversy on what qualifies as “normal” for a man, most labs recognize levels between 300-1000 ng/dL as within the normal range. There may be some slight variation from lab to lab.
Fun fact:
In general, men have about 15 times more testosterone in their bloodstream than women.
5. What is considered “low testosterone”?
In the medical world, male hypogonadism (AKA Low T) is diagnosed when there is both low testosterone levels on blood work AND correlating signs and symptoms of low testosterone.
6. What are the signs and symptoms of low testosterone?
The list of symptoms is quite long, and in many cases difficult to describe for men. They include:
- Fatigue and low energy
- Low motivation
- Loss of muscle
- Poor workout performance
- Low libido (sex drive)
- Weight gain
- Difficulty losing weight
- Depressed mood
- Erectile dysfunction
Understanding Lab Results for Testosterone Levels
Questioning the “normal range” and the controversy around it:
It is very important to note that the normal range as defined by the labs does not take age into account. As we just outlined above, testosterone levels start to decline around age 40 and continue to do so as we grow older. Knowing that, consider the following situation:
Take two men, one who is 90 years old and another who is 30 years old. Both of them have their testosterone measured at 301 ng/dL. Logic would say that the 30-year-old’s testosterone is on the low end for his age, but the 90-year old’s is probably pretty normal for his age. The way medicine is currently practiced, this would not be the case!
Both of these men would be considered in the “normal range”, even if the 30-year-old is dealing with fatigue, depression, weight gain, and erectile dysfunction. Despite these symptoms, he cannot technically be diagnosed with low T because his levels are “normal”. Seems a little odd, doesn’t it?
Think of it this way…
If a 30-year-old had an exam on his heart that showed he had the heart function of a 90-year-old, would that be considered normal? How about the bones of a 90-year-old? Kidneys? Lungs? Eyesight? Teeth, even? NO WAY!
No offense to 90-year-olds (we have met some pretty impressive ones over the years), but aging takes a toll on things. 30-year-olds and 90-year-olds should not be evaluated with the same measuring stick.
An unsettling trend:
The term “sub-optimal testosterone” has become a popular way to describe the 30-year-old above and situations just like his are becoming increasingly common. In fact, average testosterone levels in young men have seen a significant decrease over the last 20 years to the point that 20% of adolescent and young males now have true testosterone deficiency. If 20% of young men meet diagnostic criteria, imagine how many other men are right on the cusp. Spoiler…it’s a lot. It is becoming a big problem.
There are likely a lot of reasons for this trend, many of them attributable to the toxic world we live in. Endocrine disrupting chemicals, xenoestrogens, and worsening lifestyles all play a role, but these topics deserve a write-up all of their own.
We have met with countless gentleman with vague complaints and the general feeling that they “are not what they used to be”. Sure enough, many of these men have T levels right on the lower level of normal, and they have been denied treatment because this single lab result is technically “normal”.
Where should you start?
If you have the symptoms of low T or you are concerned about low T, get your labs done to see where your levels are at.
Tip: Ask to have your free and total testosterone drawn as well as your levels of luteinizing hormone (LH for short). More on LH later.
If your levels are pretty good, then that is excellent! We recommend skipping further down the page to our section on “lifestyle habits” to keep your testosterone levels up.
If you have confirmed Low T or you have found a provider who is willing to treat your suboptimal testosterone level (assuming you are having symptoms) there are a number of things that you need to know.
Important to note:
Even if you do have a low testosterone level outside of the normal range, insurance companies require multiple abnormal levels to be drawn on different days and all of those levels have to be out of range. Only then can you be considered to have “Low T” and insurance will pay for your treatment.
Why are many men denied treatment?
Being denied treatment can be a frustrating experience for many men who are experiencing daily symptoms, but it is difficult to blame the providers. Let us explain what we mean.
In the United States (and many other countries) testosterone is considered a controlled substance. This puts it in the same category as opioids (pain medications like Morphine or Percocet for example), benzodiazepines (anti-anxiety medications like Xanax or Ativan), and stimulant medications (like Adderall and Ritalin commonly prescribed for people with ADD or ADHD).
Prescriptions for controlled substances are quite scrutinized and are tracked by state prescribing databases. These databases are often overseen by the department of health in that state. For this reason, many providers are not willing to venture outside of the pre-defined practice guidelines and prescribe testosterone when testosterone levels are within the “normal range”.
To be fair, there is good reason for this scrutiny. Testosterone has a very high potential for abuse and there is a large market for testosterone often sold out of gyms or within body building circles. Improper use of testosterone can have detrimental and even fatal side effects, so it is important that testosterone be prescribed and managed by someone with training and a medical license.
All that to say, there are providers out there who will work with you and treat you even if you don’t meet the diagnostic criteria for “Low T”. There is certainly nothing illegal about it.
So, Your Testosterone is Low or Low Normal. What Are Your Options?
This is usually the most burning question on any man’s mind. Undoubtedly, most men want to raise their testosterone and want to do so in the safest and most efficient way.
Our approach to raising testosterone falls into four buckets, and they are as follows:
- Lifestyle interventions
- Supplements
- Pituitary stimulators
- Testosterone replacement therapy
Read on to learn about each in much more detail.
