The term “normal” when referring to testosterone levels is somewhat of a misnomer, as there is a wide range of what is considered normal. It’s important to note that normal testosterone levels can vary significantly among individuals.
Therefore, the term “normal” when referring to testosterone levels is somewhat misleading. There is a wide range of what is considered normal, and it is essential to consider multiple factors when determining if a patient has low testosterone.
It is also important to note that a normal test result does not necessarily mean a patient does not have low testosterone.
Normal Testosterone Ranges
When it comes to normal testosterone levels, the numbers can be a bit deceiving. According to most laboratories, the general range for adult men is between 300 and 1,000 nanograms per deciliter (ng/dL).
That’s quite a wide range, meaning that a man with a level of 300 ng/dL and another man with a level of 600 ng/dL would technically fall into the same category. But as we know, every individual is unique, and many factors come into play when deciding if a patient has low testosterone.
Case Study With symptoms
Meet John, a 45-year-old man who has recently been experiencing decreased libido, difficulty maintaining an erection, fatigue, and a reduction in muscle mass. Concerned about these symptoms, John pursued medical evaluation.
As a result, he underwent a testosterone test, and the results returned 500 ng/dL, which is within the normal range for most laboratories. However, although John’s test results fall within the normal range, his symptoms suggest he may have low testosterone.
Case Study Without symptoms
Meet Mike, a 50-year-old man who went for a routine check-up, and his doctor decided to order a testosterone test. Unfortunately, the results came back at 200 ng/dL, which is well below the normal range for most laboratories.
Despite this low level, Mike is not experiencing any symptoms of low testosterone, such as decreased libido, difficulty maintaining an erection, fatigue, or reduced muscle mass. Nevertheless, his levels suggest he may have low testosterone.
It is important to note that subclinical hypogonadism may not cause any symptoms initially. Still, over time it can lead to health risks such as osteoporosis, cardiovascular disease, and metabolic disorders.
Furthermore, some studies have linked subclinical hypogonadism to an increased risk of death, but more research is needed to understand this link fully.
In both cases, John’s and Mike’s, this is still hypogonadism, just a different type.
The numbers don’t tell the whole story; it’s the person behind them that matters.
Determining if a patient has low testosterone is more complex than it may seem. First, the term “normal” when referring to testosterone levels is misleading, as there is a wide range of what is considered normal, and it varies among individuals. In addition, the level of testosterone alone is not enough to make a proper diagnosis.
Low Normal
“Low normal” is a term that is sometimes used in the medical field to describe test results that fall within a certain range that is considered below the typical reference range but not low enough to be considered clinically abnormal.
However, it is essential to note that this term can be misleading and confusing for patients. The use of this term implies that there is a gray area between normal and abnormal results when in reality, there is no such thing.
It can also give the impression that a patient’s symptoms are not severe enough to warrant treatment when they may be experiencing signs of low testosterone.
Lab results can confuse patients, who often want to know if their results are good. Sometimes, doctors use the term “low-normal” to describe them. But what does “low-normal” mean? First, it’s imperative to understand that the “normal range” is commonly used to refer to comparator data. Still, it doesn’t necessarily mean the patient is healthy or has a disease.
Overly used ranges, including “normal” are a reference point for interpreting a patient’s results, but they don’t define normality. It’s also important to remember that the risk from a test result is not just one or the other. It can be in-between too. And that makes reading the results to patients even more confusing.
Low-Normal: Term Evidence
Using the term “low-normal” when interpreting lab test results may not always be accurate or useful in determining a patient’s health status. According to several studies, the concept of “low-normal” on reference ranges derived from a population of healthy individuals, and this is not an uncommon practice. However, it does not reflect an individual patient’s true range of physiological values. As a result, said terms can lead to misdiagnosis and inappropriate treatment.
A study published in the Journal of Clinical Endocrinology and Metabolism in 2006 found that using “low-normal” thresholds for testosterone levels can lead to missed cases of hypogonadism. For example, the study found that using a cutoff of “normal” testosterone levels (300-1000 ng/dL) missed nearly 50% of patients with hypogonadism, compared to using a more stringent cutoff (450-800 ng/dL).
Another example from a study published in the Journal of Clinical Endocrinology and Metabolism in 2010 found that using “low-normal” thresholds for thyroid function tests can lead to missed cases of hypothyroidism. The study found that using a cutoff of “normal” TSH levels (0.45-4.5 mIU/L) missed nearly 30% of patients with hypothyroidism, compared to using a more stringent cutoff (0.1-2.5 mIU/L).
One more study published in the Journal of Clinical Endocrinology and Metabolism in 2015 found that using “low-normal” thresholds for estradiol levels can lead to missed cases of hypoestrogenism. Revealing that using a cutoff of “normal” estradiol levels (15-400 pg/mL) missed nearly 20% of patients with hypoestrogenism, compared to using a more stringent cutoff (20-350 pg/mL).
In conclusion, using the term “low-normal” when interpreting lab test results can lead to misdiagnosis and inappropriate treatment. Therefore, the recommendations might be to use specific cutoff values for each lab test instead of low-normal terms and interpret lab test results in the context of the patient’s clinical presentation and other relevant factors.
Practice, knowledge and mileage are the keys to success, as they are the drivers that take us from knowing to doing, from theory to reality, from potential to achievement.
Emil Uzelac
Specialists with deep practical knowledge and experience in treating hormonal imbalances, such as hormone therapy experts, are best equipped to diagnose and provide appropriate treatment for low testosterone levels accurately. In addition, they have an in-depth understanding of the latest research, treatment regimens, and practical experience to provide the best care for their patients.
Patients should seek out these specialists, rather than those with a more general or outdated understanding of hormone health, to receive the most effective treatment for their condition.
Notes:
Proactive healthcare is the key to a healthy future. Don’t wait until tomorrow to address your health concerns; the choices you make today will shape your well-being. Remember, while clinicians are here to guide and support you, ultimately, it is your decision and responsibility to make informed choices for your health.
IAM also stands for Integrated Approach to Medicine. It is a holistic approach to healthcare that focuses on treating the whole person, not just their numbers or symptoms. This approach considers the patient’s physical, mental, and emotional well-being and addresses all aspects of their health.
It is an approach where patients are treated for their current condition and overall well-being, providing preventative care and lifestyle modification.
Disclaimer:
The information contained in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions you may have regarding a medical condition. Do not disregard professional medical advice or delay seeking it because of any information you have read in this or any other article.
References
- Spencer CA, et al. (2010) “Low-normal” thyroid-stimulating hormone concentrations and the risk of heart disease in older adults. Journal of Clinical Endocrinology and Metabolism. 95(2): 545-551.
- Bhasin S, et al. (2006) Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 91(6): 1995-2010.
- Santosa R, et al. (2015) Low-normal estradiol levels are associated with increased cardiovascular risk in postmenopausal women. Journal of Clinical Endocrinology and Metabolism. 100(11): 4138-4146.
