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January 17, 2012

Testosterone Level, Part 1: What’s Normal?

Testosterone and Male and Female SymbolsTestosterone is found in both men and women, the question, what is normal for your body to function optimally? We know that in both males and females testosterone drops as we age and with our life expectancy as long as it is today how low can it go.  In males every year after thirty there is on average a 1.5% drop in the total testosterone and that usually corresponds with a drop in free testosterone as well.

By the time we are in our mid to late forties there has been a significant drop and that has an effect on our physiology. Leading to increase incidence of lipid problems, hypertension and diabetes, not to mention heart disease, stoke and erectile dysfunction.

Free Testosterone versus Total Testosterone

When testosterone is measured we must look at total and free. Total is just that – it is all the forms of testosterone in your blood stream. The free testosterone  reflects the amount of bio-available testosterone. This free testosterone is what really matters to us, it’s like gross verse net. Bottom line your body only responds to free testosterone.

A substance called sexual hormone binding globulin(SHBG) binds to testosterone to make it inactive. The bad part about SHBG is as we grow older and are naturally making less testosterone the SHBG production goes up.

This works like a double edge sword. I have seen men with total testosterone levels in the 800s but their free levels are far from optimal due to high levels of SHBG. One other cause for increase SHBG is liver disease (even too much alcohol). When evaluating individuals for sub-optimal testosterone it is important to always check their free levels of testosterone.

Optimal versus Normal Testosterone Level

Many a man has gone to the doctor with complaints of feeling sluggish, increased weight, poor sleep, loss of muscle mass and strength and decreased libido, only to have their testosterone checked and told they were normal.

What is normal ?

If you look at the standard normal levels used by average doctors you will be shocked. The normal range for total is 250 to 900, now that is quite a spread. This level incorporates all men of all ages and then calculates where 95% will fall and “Wha-La” that is normal.

It is similar to comparing a new tire with all it’s tread and old tire with no tread and coming up with an average tread. This will tell nothing about the safety of the tread only what is normal for 95% of the tires. I don’t know about you but I want optimal tread not just enough to get around.

Our testosterone is like that as well, optimal is associated with a decrease in % body fat, increase in muscle mass, increase in bone density, sharper thinking , better sleep, better functioning insulin, decrease in cholesterol and improved libido. Now I ask you do you want to be optimal or normal?

Risks of Optimal Testosterone Level

There was always a concern that by increasing one’s testosterone we were increasing the risk of prostate cancer. It turns out that when we optimize testosterone in our later years we improve our health and decrease the incidence of prostate cancer. When used in optimal physiologic doses testosterone decreases your incidence of heart disease, stroke, hypertension, diabetes and dementia. Risks when used correctly and monitored are slim to none. It’s your choice you can be normal or optimal you pick.

See Related articles:

“Part 11 testosterone and Erectile Dysfunction”

“What is Andropause”




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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

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