Testosterone Levels: The Normal Range Fallacy
By Jay Campbell
July 12th, 2018
Are you asking yourself if it’s time for you to optimize your testosterone levels? The three essential life criteria necessary to determine whether you should optimize your testosterone levels are as follows:
- Age 30 or older
- testosterone levels lower than 600 ng/dL on a verifiable blood test
- experiencing low testosterone symptoms as recognized by your clinician
However, the REAL question is: Who defines the ‘normal’ range of testosterone levels? There is an infinite amount of hormonal diversity across the male population, and there is no real way to compress all men into a rigid ‘standard patient’ model where the normal range is universally defined. The following chart shows the variance in scales between the primary blood lab measurement companies: In July of 2017, a world-leading healthcare diagnostics company, LabCorp, changed its reference range for total testosterone levels. Why? According to LabCorp, the change was “driven by the consensus effort for accurate testosterone testing, which was endorsed by a group of professional associations, government agencies, and commercial entities in 2010.” They lowered their average values of testosterone by roughly 100 ng/dL. The previous reference range was based on a 2011 study of lean, healthy males. It effectively means that they have arbitrarily lowered their range of what is “normal.” They cite a 2017 study as a primary factor for their new reference range: “In early 2017, Travison, et al. demonstrated that obesity is directly associated with lower testosterone levels in male patients. The lower numeric range in the newly standardized reference interval reflects a difference in average subjects with higher BMI as well as harmonization with the CDC reference method.” LabCorp’s physician panel had to accommodate a growing population that is now more obese and has lower testosterone levels on average. Remember, there is only a 6-year difference between the studies. In other words, they’re lowering their range of ‘normal’ total testosterone levels to reflect the epidemic of obese men with lower testosterone levels. Most people have noticed that the lower end of LabCorp testosterone reference range is now 264 ng/dL, whereas the previous lower end of the ‘normal range’ was 348 ng/dL. Are You “Normal”? According to LabCorp, if you’re 30 and have the testosterone levels of a geriatric – congratulations, you’re “normal”! What’s even more disconcerting, however, is the fact they’ve also lowered the top end of the reference range. It was initially 1197 ng/dL, and now it is 916 ng/dL. That’s almost a 300 ng/dL difference! This is HUGE. Therefore, according to LabCorp, if you’re above 916 ng/dL, you have supraphysiological (i.e., above average) testosterone levels. The biggest issue with these measurement companies is the variance of their assessment between total and free testosterone levels in healthy young men. While variation between laboratories for the same testosterone assay is negligible, the reference ranges for testosterone levels [as well as luteinizing hormone (LH) and follicle-stimulating hormone (FSH)] differ widely and significantly. In other words, the labs will all give you similarly accurate results, but they will each define whether those results are “normal” differently. Can Physicians Rely on Blood Levels Alone? A physician can’t rely entirely on blood levels alone as an indicator of whether somebody qualifies for Testosterone Optimization Therapy (TOT). It presents a problem for doctors who might assume that there is a specific testosterone level below which the symptoms appear and go on to believe that this threshold is the same for everybody. The reality is that there is too much variance from one to another. In other words, your body is different from mine and is also different from someone else’s. Therefore, you need to work closely with your doctor to look at the whole picture of your health, rather than rely on a generalized standard. Physicians should ALWAYS treat the patient’s symptoms first before anything else. If you have blood testosterone levels in the normal to high range (usually above 600 ng/dL), then you’re likely not a candidate for TOT. There are always exceptions to the rule, but under normal circumstances, it is not enough for a patient to merely possess low to low normal blood testosterone levels. They must also demonstrate 4-5 of the accepted low testosterone symptoms before obtaining a prescription for TOT. To find out how you can reverse the effects of declining testosterone levels with the right therapy, purchase The TOT Bible.