Short answer: most guidelines use a total testosterone cutoff of about 300 ng/dL (≈10.4 nmol/L). Treatment is usually considered only if you have consistent low measurements plus symptoms of testosterone deficiency. Details and what that means for you Typical adult male total testosterone reference is roughly 300–1,000 ng/dL (10.4–34.7 nmol/L), though lab ranges vary. The Endocrine Society and American Urology Association commonly use a threshold of ~300 ng/dL. If total testosterone is below ~300 ng/dL on at least two morning (7–10 a.m.) measurements and you have symptoms (low libido, erectile problems, low energy/mood, loss of muscle mass, increased body fat, anemia, decreased bone density), treatment may be appropriate. Very low values (for example <200 ng/dL) are much more likely to cause symptoms and to prompt treatment or urgent evaluation. Important caveats Measure testosterone in the morning, while fasting if possible, and repeat the test because illness, stress, some meds, and acute medical problems can transiently lower levels. If total testosterone is borderline (250–350 ng/dL) or if you have conditions that change SHBG (obesity, diabetes, liver disease, thyroid disease), free testosterone or calculated bioavailable testosterone should be checked — labs report different reference ranges, so compare to your lab’s normal values. You also need further testing to find the cause: LH/FSH (to distinguish primary vs secondary hypogonadism), prolactin, and sometimes iron studies, sleep apnea screen, and metabolic testing. When NOT to give therapy and other concerns Don’t start exogenous testosterone if you have suspected or active breast or prostate cancer. Other contraindications/precautions include very high hematocrit, uncontrolled heart failure, and some recent cardiovascular events — these need individualized discussion with a clinician. Exogenous testosterone suppresses sperm production and can cause infertility. If you want to preserve or build fertility, alternatives include clomiphene citrate (commonly used off‑label) or hCG — discuss with a specialist. Common treatment options (examples and why) Topical gels: AndroGel, Testim — steady daily dosing, easy to use, but risk of transfer to others. Transdermal patch: Androderm — steady delivery, once-daily patch. Intramuscular injections: testosterone cypionate/enantate (often dispensed as Depo-Testosterone or generic testosterone cypionate) — less expensive, given every 1–3 weeks; can cause peaks and troughs. Long‑acting injections (testosterone undecanoate: Aveed/Nebido) provide more stable levels but require specific administration. Nasal: Natesto — multiple daily doses, lower systemic exposure between doses for some people. Fertility-preserving therapies: clomiphene citrate (Clomid, off‑label in men) or hCG (Ovidrel or prescribed hCG products) to raise endogenous testosterone without suppressing spermatogenesis as much. Monitoring if you start therapy Regular follow‑up with serum testosterone (to target mid‑normal range), hematocrit (risk of polycythemia), PSA, lipids, liver tests as indicated, and assessment of symptoms. Next step See your primary care doctor, urologist, or endocrinologist. Ask for a morning total testosterone test (and repeat it if low), plus LH/FSH and prolactin if the result is low. If you want, tell me your lab number(s) and symptoms and I can help interpret them and outline likely next steps.
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