What is a Normal Blood Level of Testosterone? What Do Guidelines Say?

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Nelson Vergel

Founder, ExcelMale.com
Normal values may vary from lab to lab depending on what reference range they use. Depending on the country, ranges are in nanograms per deciliter (usually in the United States) or nanomoles per liter (Europe and other countries). The conversion factor is:

Click here: What’s a “Normal” Testosterone Level and How to Measure Your T

Hormone Ranges

Many doctors treat men who have under 350 ng/dL of total testosterone and who present with most of the symptoms listed by the ADAM questionnaire.

How do you know you need a testosterone blood test?

Testosterone Level: How Low is Too Low? Health Consequences of Low Testosterone


 
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Nelson Vergel

Founder, ExcelMale.com
Testosterone Fractions in the Blood

1- Total testosterone (total amount produced by the body. For a healthy male this production ranges from 5-7 mg per day)

2- Free testosterone (testosterone fraction not bound to any proteins. This is the active fraction)

3- Albumin-bound testosterone (this is testosterone's "savings account". They body draws from it when it needs more testosterone to become free testosterone)

4- Sex hormone binding globulin bound testosterone. This bound testosterone cannot be released into the blood stream. It is the body's "breaks" for avoiding excessive testosterone. Inflammation, aging, medications, and other factors can increase sex hormone binding globulin.

When we add free testosterone plus albumin bound testosterone we come up with bioavailable testosterone (the testosterone available to the body).

These are metabolites of bioavailable testosterone:

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Nelson Vergel

Founder, ExcelMale.com
These values are the testosterone blood levels used for diagnosis of low testosterone in several guidelines:

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Nelson Vergel

Founder, ExcelMale.com
Comparison of testosterone blood test levels that guidelines use to recommend starting TRT (TTh) for testosterone deficiency.

Guidelines from the Canadian Medical Association Journal, American Urological Association, European Association of Urology, Endocrine Society, International Society for Sexual Medicine, and British Society for Sexual Medicine were included for review. Recommendations were generally consistent across guidelines. Key differences include the biochemical cutoff for low T, and recommendations for patients with low to normal T, prostate cancer, or cardiovascular disease.


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Nelson Vergel

Founder, ExcelMale.com
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Most of the guidelines in Table 1 share the context in regard to cardiovascular risk, development of prostate cancer, and infertility. The safety of testosterone therapy in patients with treated prostate cancer has been on the rise in recent decades. The relationship between testosterone treatment and the development of prostate cancer is conclusive in 5 studies in Table 1. In terms of saturation theory [10], prostate cancer (and benign prostate hyperplasia) is suppressed in only the castrated level of testosterone; vice versa, testosterone therapy in TD may neither aggravate prostate cancer (and prostate-related lower urinary tract symptoms) nor cause prostate cancer. For the same reason, the EAU and ISSM guidelines clarified the possibility of testosterone therapy in patients with treated prostate cancer. Most researchers in urology agreed with this concept because all patients scheduled in prostatectomy should undergo bilateral orchiectomies if testosterone is responsible for developing prostate cancer.

Reference: Efficacy and Safety of Testosterone Therapy Based on Guideline Recommendations; Re: Clinical Practice Guideline by the American College of Physicians
 
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