Medical Webinars:Hormone Q&A
Neal Rouzier, M.D.The Obesity Epidemic
Timothy McKnight, M.D.Estrogen Optimization
Neal Rouzier, M.D.
What is considered the normal range for testosterone levels in men? It may seem like an easy question to answer, as traditionally serum testosterone levels are observed to be anywhere between 300 to 1,200 ng/dL. Yet, the answer to this question is not as simple as it may seem.
Hypogonadism, or an androgen deficiency, affects an estimated four to five million men in the United States. More than 60% of men over 65 years old have low free testosterone levels. Even so, hypogonadism often goes undiagnosed and older men experience a rapid decline in their health. Low testosterone levels can be observed through serum tests, but what are normal testosterone levels? What are optimal testosterone levels? The answer to this question depends on who you ask and varies widely amongst healthcare practitioners. Hormone Doctor, Neal Rouzier. M.D. gave his expert opinion in a recent interview.
Dr. Rouzier’s Recommendation
“An important point is the difference between optimal and normal. Normal for one’s age is not optimal for one’s age. The medical literature supports replacement levels to that of a younger age, typically 20 to 30 years old. At these levels, optimal health is attained, as well as the feel-good effects. The problem is how one defines normal and optimal. Normal for a 70-year-old is not normal for a 20-year-old. If a 20- year-old man has the testosterone level of a 70-year-old man, he will not feel well. If a 70-year-old man has the level of a 70-year-old man, this is considered normal. No man should have the testosterone level of a 70-year-old as supported in our medical literature. In reality we are not trying to be 30; however our goal is to optimize levels to those we would see in a 20 to 30 year-old. A free testosterone lab value of 25 may be interpreted as optimal when in fact this level is quite low. A lab value of 40 would be interpreted as being too high when in reality it is a perfect level and our goal for a younger person. All the medical studies utilize hormone dosages resulting in levels on the upper end of the physiologic range. These are levels found in young adults.
In past years, various labs would list the testosterone ranges for all ages next to the lab results. Today, the labs publish only the normal levels based on a person’s age. This does not provide the appropriate indication of optimal levels as it is age specific. For example, normal free testosterone levels for a 60-year-old man range from 5 to 25. Optimal is therefore expected to be 25. A traditional medical doctor would interpret 25 as optimal. But remember, our goal is to replace free testosterone levels to that of a younger male. These free testosterone levels would be 30 to 40. A lab value of 40 would be interpreted by the lab as being too high, when in reality the level of 40 is perfect and is always our goal.
Optimal levels are conducive to optimal health. Having good testosterone in your system decreases incidents of heart attacks, strokes, Alzheimer’s, diabetes, high blood pressure. It has a beneficial effect in protecting against cardiovascular disease in every study. It decreases the instance of heart attacks because of its effect on blood vessels. It has a beneficial effect of improving your good cholesterol and lowering your bad cholesterol. It has a beneficial effect of improving all of the good lipoproteins and reducing all the bad lipoproteins.
Critics perhaps don’t understand that the more that you have, the better off you are, and every longevity study says the same thing: the higher level, the longer you’ll live, the less risk of heart disease that you’ll have. Where would you like your levels to be?”
Low Testosterone Symptoms
What are the signs of a deficiency?
Type 2 Diabetes
Restoring optimal testosterone levels can deter these health risks and improve bone mineral density, sexual function, muscle mass/strength, and mood. Furthermore, quality of life is improved overall.
If you are considering testosterone replacement, a healthcare provider who is trained in evidence-based Hormone Replacement can help you restore hormone levels to an optimal point that reduces or eliminates symptoms and improves quality of life without causing significant side effects. If you are a health practitioner, it is recommended that you understand the medical literature supporting optimal hormone levels before treating patients with testosterone replacement therapy.
- Akishita M, Hashimoto M, Ohike Y, Ogawa S, et al. Low testosterone level as a predictor of cardiovascular events in Japanese men with coronary risk factors. Atherosclerosis. 2010 May;210(1):232-236.
- Culley CC. Prevalence, Diagnosis and Treatment of Hypogonadism in Primary Care Practice. Boston University. Retrieved on October 26, 2011 from http://www.bumc.bu.edu/sexualmedicine/publications/prevalence-diagnosis-and-treatment-of-hypogonadism-in-primary-care-practice/
- Harman SM, Metter EJ, Tobin JD, Pearson J, Blackman MR. Longitudinal effects of aging on serum total and free testosterone levels in healthy men: Baltimore Longitudinal Study of Aging. J Clin Endocrinol Metab 2001;86:724-31.
- Morley JE, Kaiser FE, Perry HM III, et al. Longitudinal changes in testosterone, luteinizing hormone and follicle-stimulating hormone in healthy older men. Metabolism. 1997;46:410-3.
- Rabijewski M, Zgliczynski W. Testosterone deficiency in elderly men. Pol Merkur Lekarski. 2009 Dec; 27(162):517-523.
- Schubert M, Jockenhovel F. Testosterone and the metabolic syndrome. Urologe A. 2010 Jan;49(1):47-50.
- Srinivas-Shankar U, Roberts SA, Connolly MJ, O’Connell MD, et al. Effects of testosterone on muscle strength, physical function, body composition, and quality of life in intermediate-frail and frail elderly men: a randomized, double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2010 Feb;95(2):639-650.