Verbatim response from ChatGPT
Short answer
- In adult men the commonly used threshold is a total testosterone consistently below about 300 ng/dL (≈10.4 nmol/L) PLUS compatible symptoms — that combination is generally what prompts consideration of treatment. Very low values (for example <200 ng/dL) with symptoms make the indication stronger.
What clinicians actually do
- Diagnosis requires both: 1) signs/symptoms of hypogonadism (low libido, erectile dysfunction, low energy, loss of muscle mass, reduced bone density, etc.) and 2) unequivocally low morning total testosterone on at least two separate tests. Most guidelines (Endocrine Society and others) use ≈300 ng/dL as a practical cutoff.
- If total testosterone is borderline, measurement of free testosterone (or calculation adjusted for SHBG) is useful, because SHBG levels can make total testosterone misleading.
Testing practicalities
- Test early morning (usually 7–10 AM), fasting if possible, and repeat on a different day.
- Ask your clinician to also check LH and FSH (to distinguish primary vs central hypogonadism), prolactin, CBC, PSA (if appropriate), fasting glucose/lipids, and SHBG. If central causes are suspected, pituitary imaging may be needed.
When treatment is considered
- Consider treatment when you have consistent symptoms and confirmatory low testosterone on repeat testing.
- For borderline cases, treat reversible causes first (weight loss, treat sleep apnea, adjust meds, control chronic illness) and re-check levels.
- Be aware of contraindications and risks (e.g., known prostate cancer, elevated hematocrit, concerns about fertility, possible cardiovascular risks). Monitoring is required if treatment is started (PSA, hematocrit, symptoms, testosterone level).
Women and people assigned female at birth
- Normal testosterone levels are much lower; “low” in women is handled differently and treatment is only for specific indications (for example, postmenopausal hypoactive sexual desire) and usually at much lower doses — discuss with a specialist.
Common treatment options (for discussion with your clinician)
- Topical gels: AndroGel, Testim — convenient daily dosing, steady levels, risk of transfer to others.
- Topical patch: Androderm — daily, skin‑site reactions possible.
- Intramuscular injections: Depo-Testosterone (testosterone cypionate), or long‑acting undecanoate formulations (Aveed in the US; Nebido in some countries) — less frequent dosing, variable peaks/troughs.
- Buccal: Striant — twice daily application. (Your clinician will pick the form based on goals, comorbidities, fertility plans, convenience and monitoring needs.)
Where to get tested or care
- Reliable labs: Quest Diagnostics, LabCorp (or your hospital lab). Home kits (LetsGetChecked, Everlywell) are available for screening but confirm abnormal results with a clinical lab and clinician before starting therapy.
- For treatment and complex evaluation see your primary care clinician, a urologist experienced in male sexual health, or an endocrinologist. Large centers (e.g., Mayo Clinic, Cleveland Clinic) or board‑certified endocrinologists/urologists are good options if you want specialized care.
Next steps
- If you have symptoms, book an appointment with your primary care provider and request a morning total testosterone measurement (and the additional labs noted above). If you already have a result, tell your clinician the value and whether it was measured in the morning and repeated.
If you want, tell me your age, symptoms, and any recent lab result (with units and time collected) and I can help interpret it and suggest what to discuss with your clinician.