If you get a lab test for testosterone, the hormone that gives men their distinctively male characteristics, your result will be accompanied by a “normal range” (or “normal values”, or “reference range”, all the same thing), which allow you and your doctor to see where your test result fits in relation to other healthy men. Normal laboratory values are very important for medical decision making, so anyone changing them should have good reasons for doing so. The biggest clinical laboratory in the U.S., LabCorp, recently changed its normal values for testosterone, which has implications for anyone getting tested. Hence this article on the normal values of testosterone and why they matter.
Labs are lowering the reference range for testosterone
LabCorp changed its reference range for testosterone from 348-1197 ng/dL to 264-916 ng/dL. Note that the entire range has been shifted lower. The company explains their reasoning and says the downward shift reflects two changes: 1) a new CDC standardization for the method used to assay testosterone (since different labs may use different methods, giving somewhat varying results), and 2) the new range “reflects a difference in average subjects with higher BMIs”. Reason number 2 is the most important for our purposes.
The new range comes directly from a recently published paper, “Harmonized Reference Ranges for Circulating Testosterone Levels in Men of Four Cohort Studies in the United States and Europe“.
Normal values are constructed such that 95% of apparently healthy people have values within that range, and the present paper is no different.
But it depends on what you mean by healthy. The paper uses values for men age 19 to 40 with a body mass index (BMI) of < 30, i.e. “healthy non-obese” men. Since it’s been found that obesity in men is associated with lower testosterone levels, they looked at only non-obese men.
However, it’s obvious that “non-obese” doesn’t mean “healthy”. Anyone with a BMI of ≥ 25 is considered overweight, and many men with a BMI less than that have high body fat, a more accurate measure of health risks. (A few, very muscular men may be normal at a BMI of 25 or more, but they’re a small fraction of the population.)
Basically, around 80% of the population has excessive body fat, which is a prime contributor to excessive aromatase activity, which lowers testosterone.
Normal lab values are constructed from the results of fat, sick people.
Do you want to compare yourself to them? I know I don’t.
Secular decline in testosterone and the obesity epidemic
Testosterone levels in men are declining. That means that men of a given age have lower testosterone levels than men of the same age a few decades ago. See chart below. From A Population-Level Decline in Serum Testosterone Levels in American Men.
We can only speculate on the causes of the decline. Obesity has been suspected, but much of the decline remains even when it’s been accounted for. Other causes might be environmental chemicals, less smoking (nicotine inhibits aromatase), processed garbage food (think soy and sugar), and others.
Whatever the cause, it’s clearly happening, and so much so that laboratories are lowering their normal ranges to account for it. Then, when you get tested, they compare you to a group that includes many overweight, unhealthy men who don’t exercise and eat bad food.
Men are getting fatter, which may or may not account for declining testosterone. But just because they’re getting fatter, that doesn’t mean it’s normal or that you should get fatter.
Since LabCorp is the largest clinical laboratory in the country, their decision reverberates to other labs, as well as to doctors and even insurance companies.
If you go to a doctor for evaluation of your testosterone levels, you may not get any treatment unless your test has a value less than 264 ng/dL, because that’s “normal”.
Insurance companies may refuse to pay, even when a doctor is willing, because you don’t technically have low testosterone.
Most unsuspecting men (for instance, those who don’t read this) will just accept their results at face value. If their testosterone comes in at, say, 300, they’ll consider the case closed and that whatever the symptoms they have must come from elsewhere.
Solution: get educated, and don’t compare yourself to fat, sick people.
Ultimately, for any test or for any treatment your doctor proposes, you simply must educate yourself enough to be able to evaluate them yourself.
To be uneducated in health matter is to leave yourself at the mercy of an increasingly impersonal, profit-oriented medical system that doesn’t care about you. The days of your kindly family doctor are over.
Don’t be fooled that being healthy just means being less sick than normal.
Because normal people are fat and sick, they don’t exercise, and are at high risk of diabetes, heart disease, cancer, and a host of other diseases.
Normality today means obesity, depression, SSRIs, statins, sugar, and soy. Not to mention no sense of purpose and 7 hours a day watching television.
The same study cited above found that 5% of men in from age 80 to 89 had testosterone levels above 897 ng/dL. These men are likely healthy and fit, and I call attention to this fact to show that decline isn’t necessary if you actively fight it.
Compare your health, your test results, and your progress only to truly healthy people and to your former condition.
33 Comments
“Insurance companies may refuse to pay, even when a doctor is willing, because you don’t technically have low testosterone”
The good news is that TRT is not very expensive even if you have to pay out of pocket. In fact the quarterly blood tests cost more than the medication and syringes.
Just had a basic Male Hormone test done, along with a thyroid and iron panel. Iron is now perfect. Hormones are non-existent. Serum testosterone is 35. I’m only 57. Saw a Dr yesterday, and am being referred to another hopefully this week. Since I pay out-of-pocket, am hoping to get testosterone up in the 800 range, unless there are more optimized numbers.
As an update, my testosterone was 35 on June 9th, and 91 on July 14th after being on 125 mgs of Levothyroxine for 4 weeks.
Did not like my thyroid numbers so switched to Thyro-Gold, an over-the-counter NDT. Also started a testosterone cream from Australia called AndroForte 5. Now on August 4th, my testosterone is all the way up to 1121. Need to lower the amount of cream used.
At least I’m finally in the ballpark.
Awesome!
Are there any other aromatase inhibitors available besides nicotine?
Yes, see here.
PD, You state ” The same study cited above found that 5% of men in from age 80 to 89 had testosterone levels above 897 ng/dL. These men are likely healthy and fit, and I call attention to this fact to show that decline isn’t necessary if you actively fight it.”.
Is there any way to validate this likelihood ? Can the data that this study is based on be accessed ?
Also I suspect that in other countries where there is better health care system, like the UK or here in Oz, testosterone is more readily available via a doctor’s prescription.
Hi Bill, the full study is available at the link, but it’s merely my interpretation that those older men with high T were fit. I base that on a paper that states
So, this study raises the question, just as I did recently, how much of aging is really aging and how much is poor health? The finding that healthy older men don’t have drops in T tells me that a drop isn’t inevitable.
Thanks for that reply PD Yes I will take a look at the sources.
Your assumption about the level of care being superior in AUS/UK to the US due to the fact the healthcare is socialist/and paid for via taxation is incorrect. The US is the most advanced and cutting edge country when it comes to TRT protocols. It’s not the easiest country to get T (those are the third world countries where T can be bought over the counter without prescription, such as in Mexico, Pakistan and Thailand) but it’s the easiest western country to get it.
I can’t really speak for AUS, but Europe is an absolute joke for testosterone, and the UK is no better. It’s extremely hard to get it here. There are not many men’s health clinics, and the NHS will probably not prescribe you testosterone unless you are beneath the range, which is the very issue Mangan is talking about here. In nanomoles, you’d need to get a measurement of around 8 to be prescribed TRT on the healthcare system here, which in nanograms per decilitre is somewhere in the 200s.
Not only that, assuming you do get prescribed, they will not give you HCG, nor an aromtase inhibitor. You will likely be put on testosterone gels, because it’s the most hassle free for the doctors, and needle fearing pussies (most people) want to do anything but actually inject themselves to get the test they really need, so instead of going straight to injections, which is agreed upon by clinicians and gym rats alike to be the best method of administration, they fuck around with gels or even try to get liver toxic testosterone pills (this is why test is not prescribed in pills, it’s toxic to the liver if taken orally, but perfectly non-toxic if directly injected into the muscle or subcutaneous fat tissue)
Assuming you can actually convince the NHS not to give you crappy gels, citing absorption issues, which they may force you to use anyway for months on end before running a blood test to confirm that it is in fact shit, when you get on injections it’ll be some shitty ester, like undecanoate (Nebido) or Sustanon 250 which is a blend of esters with various different release times so you won’t reach steady state blood serum testosterone levels. This means you’ll be around 1200-1500 when you first inject, then 800 at the end of the week and 400-500 the next week. Stupid rollercoaster nonsense due to infrequent injections which will have your mood and energy levels all over the place. A lot of them won’t even run a fucking blood panel to see where your estrogen is at. And if they do, and it’s high, they’ll just drop your test dose instead of giving you an aromtase inhibitor, so now you may fix your estrogen problem, but now your T isn’t high for you to feel optimal. There’s no point making yourself subfertile from exogenous testosterone usage if you’re not even going to get on an adequate protocol that makes you feel fucking awesome.
Honestly, it’s a joke. I don’t say this lightly, but if you live in the UK or anywhere in Europe for that matter, self-medication is the best route, because be it public or private healthcare, the expertise and infrastructure is just not there. You are on your own with this. You have to be your own doctor, take care of your own blood work, order your own T and do your own injections like a big boy. This is an area of men’s health that is grossly neglected, to the point the average dickhead in the gym hyped on his steroids is more informed in this area of endocrinology than both your general practioner or even actual endocrinologist. These idiots do not take the time to keep up to date on endocrinology and treat the numbers rather than the patient. They do a gross misservice to millions of people, when so many are told their blood work is fine when it’s not. Let that sink in for a second. The incompetence and the sheer lack of fucks given in the medical profession is rampant. And it’s not just testosterone that has this problem. The thyroid community has the same shit, with endos telling people with a TSH over 3 that they are absolutely fine when they’re not, and then even if they accept they are hypothyroid, prescribe them T4 instead of T3 so they don’t get any better. It’s the thyroid equivalent of a shit TRT protocol.
And before you think why am I ranting on about thyroid – it’s not only to highlight the medical profession’s negligence isn’t confined to male sex hormones, but also because your thyroid is linked to your testosterone. Men who are hypothyroid tend to produce less testosterone, if you fix their thyroid levels, their testosterone total and free increases. There is a link between the two, but most so-called endocrinlogists don’t even know this. Only top specialist doctors running private clinics in America have any sort of chance of knowing this.
So be your own doctor, these endos don’t give a fuck about your crappy blood work, they’ll see your 300ng/dL testosterone and tsh of 4.5 and tell you you have nothing to worry about, whilst you’re a depressed, anxious, and a lethargic fucking mess of a person who can’t even find the motivation to take a dump. Then after incorrectly telling you’re absolutely fine, they’ll magically and unscientifically pull out of their ass that you suffer from general depression, which is the catch all diagnosis for “your hormones are fucked, but we’re too retarded to realise that and actually do something about it, so take these sedatives and fuckoff) instead of actually fixing you. People trust doctors too fucking much and its unwarranted. At least in matters of endocrinology, the vast majority of them are extremely ignorant and unfit to practice medicine, because they’ll either ignore you, or give you shitty hormone protocols/SSRIs that’ll make you feel even worse than you did to begin with, giving you even greater health problems down the line. Fuck the endocrinology profession, they’re a god damn joke. Fuck them all, trust none of them, be your own doctor and reclaim your health.
/rant
Great rant, IM!
Old comment. But this rant was so awesome I had to give you a high 5!
Got my results yesterday. Age 52, 5’10” / 165#, not particularly hairy, hard-gainer, couple decades of following the low-fat nonsense to some extent….467. Not critically low, and I suspect it’s higher than it was a year ago when I started working to correct what’s wrong with how I fed myself and exercised. It’s a start.
Next challenge has to be learning to be content with 1 or 2 beers a day.
Ferritin: 120. Not as low as I’d hoped it might be, but also only a few blood donations away from 50, I hope.
more like evidence of the chemical castration of america
You might want to check this site out:
https://www.peaktestosterone.com/
I had no time yet for an in-depth reading, but at first glance it seems to be a rather good source of information.
Got a Labcorp full panel done six months ago, 715 ng/dl. At 33 I’m pretty happy with that, I’ll definitely keep up this low carb/high intensity weight training routine as I coast into middle age and beyond.
You wrote:
“If you go to a doctor for evaluation of your testosterone levels, you may not get any treatment unless your test has a value less than 264 ng/dL, because that’s “normal”.”
I think the key point here is that people who are actively involved in maximizing their health, presumably everyone reading this site, should not go near any doctor for a hormone related topic unless they know in advance that the doctor specializes in the area and most importantly, treats based on symptoms, not numbers.
I agree, but I’d give it a bit more nuance. Long ago a doctor told me that if you get near an endocrinologist, you’ll get even more messed up. Yet most doctors will want you to see an endocrinologist for hormonal issues; they beg off doing anything themselves. So probably the answer is seeing a doctor who is at least willing, and hopefully well-versed, in treating testosterone-related issues.
I’m still awaiting my results – nervously, I’ll admit – but with this post I finally feel like I at least know what the hell I should be looking for and what most of the jargon means. I think another point to make is knowing *when* you need to have tests run. I uhhm’d and aaahhh’d over this for months before finally doing a bit of digging and finding my symptoms matched the diagnosis pretty well (Dr Google, I know, but this list helped a lot https://www.genesysinstitute.com/low-testosterone/ ). Here’s hoping my results aren’t *too* low. Thanks again for the read!
Wkout Arthur Jones style , eat raw meat, Coconut oil, drink raw milk. These will raise T.
Jay Campbell has many excellent podcasts on testosterone and TRT. The podcasts he did a few years ago with Cernovich led me to get tested and as a 30 year old found 480ng/dl. Under the old labcorp values thats ~17%th percentile and what I’d expect if I was in my late 50’s or 60’s. That’s less than optimal for me. Urologist said, of course, that I was too young for TRT and my values were “fine”. The anti aging clinics near me in the north east cost around $3k a year but if you are enterprising and can figure out bitcoin you can devise your own course of treatment via online sources and it might only cost say $600/year. Do your own research, learn how to use a needle, and get your bloodwork done regularly. As Mangan always tells us, you are in charge of your own health, not your doctor, and if your hormones are out of whack you need to get that fixed!
Why pay some doctor I’ll rages fees to fix a problem you could really fix on your own through a little determination and hard work work out as if your life depended On it get a lot more sleep try to Lower your stress as much is possible stay away from pseudo-estrogens , Eat as many raw eggs, Brazil nuts, coconut Oil, raw meat. And raw milk as you can stand. Stay away from all pharmaceutical drugs
I usually take soy in my coffee, think I’ll go back to normal milk. Do you have a list of other foods that reduce testosterone?
Sugar.
Need to workout and HIIT.
question: A blood lab test for testosterone is good to verify or do I need a special test ?
If you don’t have any symptoms, you don’t necessarily need a test, although lots of men (lime me) like to test just so they know where they stand.
Exactly. Thats the reason why I want to test. Just to know.
Here again, the Individual is left to “roll their own”, if a out of shape man finds comfort in comparing themselves to other out of shape, fat men, their cause is mostly lost.
To take that a bit further, this is where Science! fails the individual and total reliance on studies lack fine grain texture that can be implemented personally
I’m 45. I went to my own lab and had total T of 330 and TSH of 4.169. So I went to the doctor. The doctor agreed my T was too low for my age. Doctor did more lab work at different lab which came back with total T of 379 and TSH of 4.1. Doctor prescribed thyroid medication. I’m supposed to take for 30 days and then go back. If I’m not feeling any better may start testosterone injections. Anybody have any advice based on my numbers?
Justin, I couldn’t comment on individual lab results, but high TSH is indicative of hypothyroidism, which in turn affects virtually every cell in the body.
So what should be the range? The older standards or were those also based on unhealthy men? Is there a study that counters this study that could be given to the doctor to convince them to reconsider the CDC guidelines?
The older standards are better and come from when the obesity epidemic wasn’t so bad.
I have been to the doctor twice this week for low T symptoms. One test was at 11am and the other was 2 days later at 7:30am. The first test came back with total at 184 (264-916). The second test came back with total at 348 (274-916) and free at 8.2 (8.7-25.1).
I had a test done two years ago and it came back with total at 190 (don’t have ranges). That doctor said my symptoms (same as above) are not related.
It’s very frustrating having blood test for two years showing low t, with low t symptoms and not being able to get treatment.
I’m 40, six foot, 160 lbs and overall healthy.