The Dilemma of Low T: Should you worry about not having enough testosterone?

Friday Feb 27 | BY |
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Testosterone therapy was pioneered, and sometimes abused, by body builders wanting to bulk up. But, looking like the Incredible Hulk wasn’t just for gym enthusiasts. Professional athletes were not strangers to the performance enhancing effects of steroid hormones, including testosterone. And, doctors practicing anti-aging medicine were quick to recognize the mood improving and sexual stimulating benefits of testosterone for men and women.

By the late 1990’s, the hormone replacement market was thriving. Eventually, pharmaceutical companies joined in with television advertisements for “low T.” Doctors prescribed testosterone capsules, gels and creams, injections, and inserted pellets into their patient’s buttocks. Herbal testosterone products like maca and tribulus gained market share.

The argument went like this: Women had menopause, why couldn’t men and andropause? But andropause wasn’t a recognized medical condition, nor was it a word in the dictionary. What was a doc to do? Use existing medical codes like hypogonadism for abnormally low testosterone levels. That worked, and the market boomed.

Trouble started when two research studies were published in November 2013 and January 2014. Both reported significantly increased risk for cardiovascular disease in men receiving testosterone therapy. The media ran with it and conservative medical societies declared testosterone dangerous. Were doctors too quick to condemn?

Our office was flooded with phone calls from anxious male patients. However, not a single male or female patient treated in our office for testosterone deficiency over a ten-year period of time developed any type of cardiovascular condition. Based on our experience, the testosterone scare didn’t make sense.

Symptoms Associated With Low T:

    • Fatigue
    • Low mood (sad and grumpy “old man” syndrome)
    • Lower enthusiasm
    • Reduced exercise tolerance
    • Less muscle tone
    • Increased belly fat
    • Decreased bone mass
    • Body and facial hair loss
    • Low sex drive and difficulty getting and maintaining an erection
    • Interrupted sleep
    • Poor concentration

In March 2014, Life Extension Foundation published a detailed response to media reports associating testosterone treatment with greater risk for heart attack and stroke. But, it wasn’t just anti-aging advocates that disagreed with the cardiovascular risk worriers. Professional backlash against the studies was just as intense. More than twenty professional medical societies called for the retraction of the original negative study published in JAMA.

By the summer of 2014, the response was furious. In July 2014, WebMD reported on a new study involving 25,000 older men that found no link between testosterone therapy and heart attacks. By fall, the European Medicines Agency found no consistent evidence linking heart problems with testosterone.

The February 2015 issue of the Mayo Clinic Proceedings, the clinical journal published by the prestigious Mayo Clinic, not only published an extensive review on all studies proving testosterone replacement not only was not harmful but was helpful, and also published a thoughtful editorial.

Testosterone therapy not only doesn’t cause heart attacks or strokes, low testosterone levels are associated with increased death rates from all causes, including cardiovascular disease. The weight of evidence from all over the world indicates that normal levels of testosterone improve health in men and decrease the risk for cardiovascular disease.

What’s Your Testosterone Level?

Previously, testosterone levels between 300 and 890 ng/dL (nanograms per deciliter) were considered normal. Using these values, low T would be less than 299. However, many endocrinologists considered these measurements an inadequate picture of male hormone health. Normal levels are now considered adequate between 348 and 1,197 ng/dL. Anti-aging doctors suggest the threshold level for testosterone replacement therapy should be 500 ng/dL.

You can check your testosterone levels from a blood test. The first time you get tested, or you order your own, include a metabolic panel so you can measure albumin levels. Also test for Sex Hormone Binding Globulin (SHBG).

Basic Tests For Low T:

      • Total Testosterone
      • Free Testosterone
      • Albumin
      • SHBC

Use the bioavailable testosterone calculator from the International Society for the Study of the Aging Male (ISSAM) to calculate your bioavailable testosterone. Some clinical laboratories will calculate your bioavailable testosterone as part of a comprehensive male hormone panel.

Testosterone Levels:

Low Testosterone Table

Free testosterone levels more closely reflect bioactive testosterone. Low free testosterone, even if total testosterone is in the normal range suggests low T function. Bioavailable testosterone is a mathematical calculation used as another way of assessing the biological activity of testosterone. Low bioavailable testosterone indicates low T function.

What’s The Optimal T Level?

No one knows for sure the best testosterone level. However, the general clinical consensus of anti-aging doctors is that men with low, or borderline low total testosterone levels, or low free testosterone and bioavailable testosterone should consider restoring testosterone to youthful levels.

Maintaining higher testosterone levels has benefits. Several studies suggest that the threshold level for testosterone replacement should be greater that 500 ng/dL. Anti-aging doctors typically go a little higher using a threshold level of at least 600 ng/dL. For men between 40 and 65 years, the upper level varies depending on symptoms with an average between 750-900 ng/dL.

Benefits of Testosterone Therapy:

      • Improves cardiovascular function
      • Reduces body fat mass
      • Improves body muscle composition
      • Lowers glucose and Hemoglobin A1c
      • Lowers LDL cholesterol
      • Lowers triglycerides
      • Lowers inflammation markers like C-reactive protein
      • Improves exercise capacity
      • Boosts sex drive
      • Improves mood

Testosterone therapy is easy, but the science is complicated. Though you can order your own hormone tests, you have to educate yourself on what they mean and what additional tests you’ll need to evaluate how testosterone replacement is working in your body.

Remember that headline news is not the best place to get your science. Though sometimes even your doctor may be misinformed, a doctor knowledgeable in the clinical use of steroid hormones is invaluable in analyzing your benefits, progress, and monitoring the safe use of testosterone. If your testosterone level is below 500 ng/dL and you have symptoms of low T, talk with your doctor about testosterone replacement therapy.

Dr. J. E. Williams


Dr. Williams is a pioneer in integrative and functional medicine, the author of six books, and a practicing clinician with over 100,000 patient visits. His areas of interest include longevity and viral immunity. Formerly from San Diego, he now resides in Sarasota, Florida and practices at the Florida Integrative Medical Center. He teaches at NOVA Southeastern University and Emperor’s College of Oriental Medicine.

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  1. June Hanson says:

    Testosterone is just as important to a man, as bio-identical hormones are to a woman. I, am so thankful, that you, Dr Williams monitor mine closely. What a difference it has made in quality of life and my health.

    My testosterone was always a little high, was concerned that would make me a little masculine. Then, learned the benefits of it.

    Hormones are so important in our body. It is dangerous to take them on our own, without blood tests ordered by an Integrated Doctor, customized for your body.

    For Doctors to say they cause cardiovascular or cancer is ludicrous. Urologist was upset at 500, gave shot in abdomen, when seeing prostate cancer. Horrible results of depression, crying. Told Dr. no more, has to be a better way, and there was.

    Men, need to be educated on the importance of regular blood tests. Not just say, oh, I am feeling fine. Follow through and get on preventive plans. Importance of regular exercise, not just week-end warriors. Aware of food they eat either produces longevity or disease for the future. Leaning toward plant based diet, with smaller portion of protein. Know its not the American way, but then look at the health of Americans.

    Learning that taking all their time to build a career, does not work. Good health, disease free body, does not wait to a more convenient time. Our bodies are intricately and beautifully made, and need constant fine tuning. They do have to last longer than our cars. Replacement parts, never match the original that God placed in your body. Take care of life, it is precious. Testosterone needs to be monitored, just like any other part of your body. It is what helps to keep a man healthy and youthful.

    We woman, are tired of outliving our men.

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