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Can I Get Testosterone Therapy even if my Testosterone Level is Normal? TRT for Normal Testosterone.

In the following article, we help you answer the following questions about normal testosterone levels:

  • Can I get TRT if my levels are normal?

  • How do I know if I need testosterone?

  • What is a normal free and total testosterone level for men?

  • How do you qualify for testosterone replacement therapy?

What is a normal testosterone level?  Can I get testosterone therapy (TRT) with a normal testosterone level?

In this article, we’re going to take a look at how testosterone replacement therapy (TRT) is used for men whose testosterone levels aren't clearly low or high, but somewhere in the middle. Whether you're thinking about TRT for yourself, you're in the healthcare field, or you just want to know more about how these medical decisions are made, read on to find out more.

What is Free Testosterone compared to Total Testosterone?

In discussing TRT, it's essential to understand two key terms: total testosterone (T) levels and calculated free testosterone (cFT) levels. Total testosterone is the overall amount of testosterone in your blood, including both bound and free testosterone; however, not all of this testosterone is readily available for your body's use. That's where cFT comes in. cFT represents the fraction of your total testosterone that isn't bound to proteins in your blood and is available to your tissues. It's typically a much smaller number than your total testosterone.

Now, why is cFT so important for you to know about? cFT is often considered a more accurate indicator of testosterone activity in your body. While the normal range for total testosterone in men can be anywhere from 300 to 1,000 ng/dL (nanograms per deciliter), the calculated free testosterone levels are usually a fraction of this—often calculated in pmol/L (picomoles per liter). Experts suggest that a cFT level lower than 225 pmol/L may indicate testosterone deficiency, even if your total testosterone level appears normal. [1] More so, symptoms often follow free testosterone levels and not total testosterone. 

Can I have low T symptoms with a normal testosterone level?

Yes, you can experience symptoms of low testosterone (low T) even if your testosterone levels are within the normal range. Common signs of low T include fatigue, reduced libido, erectile dysfunction, weight gain, difficulty maintaining and building muscle mass, mood changes, and trouble with concentration. [2]

Can I get TRT if my levels are normal?

Imagine you're experiencing any of the symptoms above, yet your routine blood tests show that your total T levels are within the normal range, say around 400 ng/dL. Normal testosterone levels vary depending on the testing laboratory ( Quest vs LabCorp) but on average, range between 300ng/dL to 850ng/dL for all ages. This is a common scenario where the complexity of testosterone levels comes into play. You might think everything should be fine since your levels are "normal," but there's more to the story with cFT.

Let's say, upon further testing, your cFT levels are found to be around 200 pmol/L, which is below the threshold of 225 pmol/L, often cited as the lower limit of normal. This low level of cFT could be the hidden culprit behind your symptoms. Despite your total T levels being normal, the amount of testosterone freely circulating and available for your body to use is actually low. [1] 

In addition, it is also important to extrapolate that the value of a “normal” testosterone range is for all men of all ages, and your normal range may need to be age-adjusted. For instance, an 80-year-old male may have a tested serum testosterone of 400ng/dL, yet a 35-year-old male with a serum testosterone value of 400ng/dL, while within the normal range, should have a higher age-adjusted normal testosterone value. 

TRT in men with normal testosterone levels might be a game-changer in this case. The idea is that by taking TRT, you are not only raising total testosterone levels, but you are also increasing free testosterone, which your body can conveniently use. It's similar to having a bank account with a good balance (total T) but very little cash in your wallet (low cFT). If you're symptomatic, raising your cFT with TRT can help your body operate better, just like having extra cash on hand can make everyday transactions simpler. It's important to treat you according to your unique symptoms and hormone levels while following guidelines. 

Is there a benefit to TRT if my testosterone levels are normal?

Now that you understand how low T manifests, you may be wondering if you can take TRT even if you don't need it. To allay your fears, we must first comprehend the subtleties of your hormone profile and general health.

We now know that if your cFT is less than 225 pmol/L, using TRT might help with symptoms like exhaustion, diminished libido, or muscular weakness. However, these potential advantages must be balanced against the hazards and adverse effects of TRT, which include increased red blood cell count, sleep apnea, and changes in cholesterol levels. It is at this point that other therapeutic interventions are considered.

It may seem simplistic, but your testosterone levels and general well-being can actually be greatly impacted by lifestyle modifications, especially in your diet and amount of physical exercise. Weight reduction, for example, has been shown in studies to raise testosterone levels; for every five kg lost, testosterone levels increased by one nmol/L on average. Regular exercise, particularly strength and high-intensity interval training, has also been found to increase testosterone levels naturally. [3] [4]

“So, can I do TRT if my levels are normal?” Yes, but it's best to start with lifestyle changes first, which can naturally raise your total T and cFT levels.

How do you qualify for testosterone replacement therapy?

"How do I know if I need TRT?" you may now be wondering. Doctors utilize particular criteria and techniques to assess if you qualify for TRT.

The Androgen Deficiency in Aging Males (ADAM) Questionnaire, in addition to testosterone blood testing and the existence of symptoms, is a simple yet useful tool for determining the need for TRT. It contains questions concerning sexual desire, your level of energy, strength, and mood changes. The qADAM questionnaire, its expanded version, uses a Likert scale (1–5) for responses, where 1 indicates maximal symptoms and 5 represents the absence of symptoms. Your total qADAM score can range from 10 (most symptomatic) to 50 (least symptomatic). A lower score on this scale might indicate that TRT could benefit you. [5]

TRT can be given in many ways, like gels, injections, or patches, each with its own advantages, along with complementary treatments such as PDE5 inhibitors (Viagra and Cialis). It's important to ensure there are no contraindications to the type of TRT that’s prescribed for you; as such, you might also be tested for conditions where TRT might be unsafe, such as uncontrolled heart disease, untreated sleep apnea, or a history of certain cancers like prostate cancer. [6]

Remember, the decision to start TRT should be made after a thorough evaluation of your specific symptoms, testosterone levels, and general health, often in consultation with a healthcare professional.

Explore how testosterone replacement therapy can benefit you at REGENX Health, where personalized care meets cutting-edge hormonal health expertise.




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