In a recently published article, “Testosterone Therapy: Pros and Cons,” physicians and other faculty at the Pritikin Longevity Center focused on the conclusions of the T Trials, a series of nationwide studies designed to clarify the benefits and risks of testosterone supplementation.
In this article, we will focus on testosterone levels: What is a normal testosterone level? What is a low level? When might testosterone therapy be a good idea? When is it not?
But for starters, it’s important to know that while testosterone levels do decline with age, a surprisingly low percentage of older men have clinically significant low testosterone levels.
In a recent article in the physicians’ online newsletter MEDPAGE TODAY, author Sanjai Sinha, MD, of Weill Cornell Medicine in New York cited research1 showing that only 20% of men over 60, 30% over 70, and 50% over 80 were testosterone deficient. He also cited data2 showing that up to 25% of aging men with low libido and sexual disfunction—symptoms typically associated with low T—actually had normal testosterone levels.
What Is a Normal Testosterone Level? What Is Deficient?
In 2017, a study3 of more than 9,000 men from the United States and Europe defined a normal range for total testosterone in non-obese men aged 19 to 39 as 264 to 916 ng/dL.
For men of all ages, cutoffs for the definition of low testosterone vary somewhat. Generally accepted values are less than 200 or less than 300 ng/dL of total testosterone.4
Guidelines from the Endocrine Society, the world’s largest and most prestigious organization devoted to research on hormones and the practice of endocrinology, state that testosterone deficiency exists when total testosterone levels in the blood are below 300 ng/dL.5
When Testosterone Therapy May Not Be Warranted
If you have levels below 300, your doctor should check to see if there are causes other than age for your low testosterone, such as pituitary or testicular failure.
Other causes of your low T could be:
- Overweight, especially belly fat
- Metabolic syndrome, and/or
- Type 2 diabetes
If any of the above four are what’s driving down your testosterone levels, healthy lifestyle changes – not testosterone supplements – may be the recommended treatment. There is good evidence that healthy eating, physical activity, and weight loss improve testosterone levels.6
Also, men with clinically low testosterone levels may not have any of the symptoms of low T. If you do not have low libido, sexual dysfunction, osteoporosis, anemia, depressed mood, or low energy, even though you have low T levels, testosterone supplements are likely not necessary.
Should You Try Testosterone Therapy?
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In other words, not everyone with symptoms has low T, and not everyone with low testosterone has symptoms. In either case, testosterone therapy may not be warranted.
“As physicians, our goal should be: Treat the patient, not the lab result. And there’s no reason to test unless clinical symptoms warrant it,” sums up Tom Rifai, MD, FACP, Regional Medical Director of Metabolic Health & Weight Management at Henry Ford Health System in Michigan, and member of the Pritikin Scientific Advisory Board. “Testing a man largely because he’s curious to know his testosterone level is something I would discourage.”
Low T + Symptoms
“Only when you have one or more related symptoms and T levels below 300 should physicians be diagnosing their patients with primary late-onset hypogonadism and considering testosterone therapy,” states Norman Blum, MD, physician and educator on men’s health at the Pritikin Longevity Center.
As summarized in our previous article “Testosterone Therapy Pros and Cons,” the decision to start testosterone therapy is not an easy one. Therapy may have benefits, but it also has risks.
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The conclusions of the T Trials found that testosterone treatment improved sexual function and mood, increased bone density and strength, and corrected mild anemia. But at the same time, participants in the T Trials showed plaque build-up in the arteries that might, over time, pose cardiovascular risk.
All Benefits, No Risks: A Healthy Lifestyle Like Pritikin
“A healthy lifestyle like Pritikin has no negative side effects. The only side effects are good ones,” sums up Dr. Blum.
“When you exercise daily and eat well, filling your day with outstanding foods like fruits, vegetables, whole grains, and beans, you feel outstanding. It’s that simple. We see it happening every day here at the Pritikin Longevity Center.”
Bottom Line: Testosterone Therapy
More research is needed on the long-term risks and benefits of this hormone therapy, especially on the risks of cancer and heart disease.
Meanwhile, you and your doctor can carefully evaluate your symptoms and, if symptoms exist, test your testosterone levels. You can consider causes other than age for low T — for example, excess weight – and treat accordingly. If warranted, you can use testosterone supplements with caution.
But always, as you go through this process, remember that a healthy lifestyle may, without risk, reduce your symptoms as it improves your overall health and well being, and it may even raise your testosterone levels.
- 1 Harman SM, Metter EJ, Tobin JD, et al; Baltimore Longitudinal Study of Aging. Longitudinal effects of aging on serum total and free testosterone levels in healthy men. Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab. 2001;86:724-731.
- 2 Wu FC, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363:123-135.
- 3 Travison TG, Vesper HW, Orwoll E, et a. Harmonized Reference Ranges for Circulating Testosterone Levels in Men of Four Cohort Studies in the United States and Europe. Journal of Clin Endo & Met. 2017; 102: 1161-1173.
- 4 Araujo AB, Esche GR, Kupelian V, et al. Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab. 2007;92:4241-4247.
- 5 Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2010; 95:2536–2559.
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