What is a normal testosterone level in men?
Is declining testosterone inevitable with age?
What are healthy testosterone levels?
These are all questions that I'll address in this ultimate guide.
You'll learn discover:
Let's do this.
Testosterone is not just one number.
When testosterone enters the blood stream, about 45% of it attaches to SHBG (sex hormone-binding globulin), 53% binds to albumin, while only ~2% of it is allowed to exist in a free, unbound state:
SHBG is a carrier protein that binds to and transports estrogens and androgens. Your body only uses a small amount of these sex hormones at any given moment and the purpose of SHBG is to safeguard them from being metabolized too quickly.
SHBG has a high binding affinity for testosterone and therefore SHBG-bound testosterone is considered biologically inactive, i.e. it is unable to exert an influence on your mind and body.
With all other factors being equal, SHBG and free testosterone hold an inverse relationship:
Higher SHBG translates to lower levels of free T and lower SHBG means higher free T.
This relationship is crucial because a man with normal total testosterone but high SHBG can still end up experiencing the symptoms of low testosterone.
The normal range for SHBG in men lies between 10 to 57 nmol/L.
High SHBG translates to less bioavailable testosterone.
Low SHBG, though, is not a good thing either and has been linked to increased rates of obesity and diabetes.
As with most things in life, balance is key.
For more, check out Androgen Hacker's ultimate guide to SHBG.
Albumin is the most abundant protein in the human body and it plays a number of key roles including (but not limited to):
Like SHBG, albumin is also a carrier protein for testosterone. Unlike SHBG it has a very low binding affinity, i.e. albumin-bound testosterone is biologically active.
Free testosterone is the amount of testosterone that is readily available for your body to use, but since it makes up such a minor percentage of total T, free T can be hard to measure accurately.
Whether you look online, refer to a lab’s reference range, or ask a medical professional, the normal range for total testosterone tends to lie between 250-1200 nano-grams per decilitre (ng/dL).
But the problem with this range is how wide it is.
If your level comes back at 300 ng/dL you are considered "normal" but you might still end up experiencing the symptoms of low T.
Take me for example - my total testosterone level came back at 564 ng/dL:
564 ng/dL is a level well within this so-called "normal range," yet it is also the level at which I was skinny-fat, depressed, and lacked a zest for life:
Since taking the steps to naturally increase my levels from 564 to 902 ng/dL...
...not only has my physique totally transformed but so has my mindset - I went from being a victim of external circumstances to becoming a man that takes responsibility for his health, happiness, and fulfillment:
When you get your testosterone levels checked at a lab, they provide you with a reference range.
You can see in my lab results above that the reference range is 348-1197 ng/dL. The problem with this range is that it includes ALL of the patients that have had their blood work run at the lab.
Whether it is a 20-year old athlete or an 80-year old diabetic doesn't matter - they're all given equal weight within this reference range.
The reference range does not break patients down by any factor other than gender, and this is why it is not an accurate measure with which to compare your results.
Labs and medical professionals don’t break down testosterone levels by age, but luckily we have access to a few studies that have done just that.
In 2014, a group of researchers extracted data from thirteen different studies to derive, validate, and publish - for the first time ever - an age-related normative model for total testosterone in healthy men. The entire scope of data spanned over 10,000 subjects in the age range of 3-88 years.
After analyzing this huge sample size, researchers proceeded to break down average values for the 1st to 99th percentile for each age from 3-88 years in nmol/L. For a detailed look at the results definitely check out the study in its entirety, but I've gone ahead and broken down the data in 10-year average age increments and converted nmol/L to ng/dL:
Notice how age fails to have a significant influence on testosterone levels.
Similar results were revealed in a 2017 study that looked at data spanning over 9,000 subjects aged between 19-99 across both the US and Europe. For a more detailed look at the data, definitely check out the study in its entirety, but the following table breaks down the highlights:
On average, the subjects in this second study had higher total testosterone than the subjects in the first study but the trends in both are similar:
Age fails to have a significant influence on testosterone (more on this in the next section).
What these studies above left out is a comparison of free testosterone levels.
There is currently no published research on an age-related model for free testosterone, but I did find some unpublished research in a textbook titled Androgens And the Aging Male. This textbook dates back to 1995 but it is the only resource I was able to find that breaks down both total and free testosterone levels by age:
Looking at this data you can observe that older age correlates with lower testosterone (both free and total) but that's because the researchers broke it down based on average levels rather than percentiles.
Either way, when comparing my April 2016 blood-work to the data above, my total T-level (564 ng/dL) was closer to the average for men more than twice my age.
But after taking the steps to naturally increase my total testosterone level to 902 ng/dL, I went from having sub-optimal T to having a level that, as it turns out, is exactly in the 97.5th percentile, i.e. higher than 97.5% of men.
I had my free testosterone level measured in March 2018 while travelling abroad (thus the different lab report and reference range). Here are my results:
Both free and total T levels lie in the upper limits, but what's alarming is my estrogen level - more than 300% higher since my last test. I don't feel any noticeable differences and I suspect that it might be an error, but this is definitely an area I'm looking in to before getting my next blood-work measurement.
Naturally increasing your testosterone can have vast implications on every aspect of your life from how your body looks to how your mind works to how well you are able to assert your values in the world.
At TripleYourT, I'm centred on providing you with the strategies, tactics, and frameworks to help you achieve and maintain optimal testosterone levels - regardless of how old you are.
What is optimal?
I define the optimal total testosterone level to be above 700 ng/dL and free testosterone levels to be above 12 ng/dL.
The relationship between aging and declining testosterone is a classic case of correlation versus causation:
Although older age is correlated with lower T, it is not age that is causing the decline.
This fact was made clear in the two robust studies cited above, but Australian researchers were the first to actually bring the issue of age and testosterone to the forefront in 2011.
"Age, in itself, has no effect on testosterone levels in healthy older men. It's more likely that lowering of testosterone is a consequence of illnesses men acquire as they get older, like cardiovascular disease and obesity." - Dr David Handelsman
Dr. David Handelsman - MD, PhD, professor and director of the ANZAC Research Institute at the University of Sydney - and his team of researchers recruited 325 men (40-97 years old, average age=60) who had self-reported excellent health and no symptoms to complain of. Blood samples were collected from these men nine times over a period of three months. When analyzing the data, results revealed that testosterone levels amongst these men did not differ, despite the large age range.
Critics of the study claimed that a sample size of 325 men was too small a segment to make inferences across the population. But the findings of this study have since been validated by the two studies cited above that looked at close to 20,000 men:
Notice how total testosterone peaks around age 20, after which it flatlines.
Maintaining optimal testosterone levels is simply a matter of making changes in how you eat, train, and sleep. It is what every man should strive for and age is not an excuse.
Developing the right diet and lifestyle habits right now will allow you to maintain optimal testosterone levels well into old age.
Now that you understand what testosterone range to shoot for, we move on to how to go about actually measuring your T-levels.
Clinicians are confused about the most accurate method for measuring T levels.
There are numerous schools of thought regarding which form of the hormone should be measured and which method of analysis provides the most accurate results.
The problem arises due to a lack of standardization in hormone testing.
Since there is no clear consensus in this area, it is important to understand the basis for the various methods available. I will provide a quick overview of each so that you know what test is best for you:
Most labs analyze total testosterone levels using automated immunoassay methods.
These methods do not require much work on the part of the technician and can be performed relatively quickly and cheaply. The drawback is about a +/- 20% loss in accuracy. This is why liquid chromatography-tandem mass spectrometry (LC-MSMS) remains the gold standard for measuring T levels amongst researchers and professionals.
LC-MSMS is more expensive and requires more work on the part of the technician, but the result is more accurate.
Given that free T makes up such a tiny percentage of the total testosterone in your blood, getting an accurate measurement of it is technically demanding.
Most labs use automated immunoassay methods to measure free T, but studies have shown that the results can sometimes be misleading.
Equilibrium dialysis and ultrafiltration are the most accurate methods for determining free T, but they require more time and work on the part of a well-trained technician. Most labs don't even offer these methods due to the complicated nature of testing.
The concentration of testosterone in its various forms essentially comes down to total testosterone and the relative concentrations of SHBG and albumin. Many clinicians use an androgen index calculation to estimate free testosterone levels.
Typically, the index is calculated as the ratio of total T divided by SHBG, multiplied by 100. The problem with this method is a lack of accuracy. Plus, you end up paying for three different tests, which can raise the price significantly.
If you want to save the hassle of having to go to a lab and want to save a few bucks, it is possible to measure your testosterone levels using a home test kit.
You can buy this kit on Amazon, spit in the cup, send it in the mail, and receive your total testosterone measurement a week later. If you want a measure of your free testosterone, check this kit out.
If you choose to order a home test kit, just know that salivary testosterone methods are not as accurate as blood tests.
The only times researchers use a subject's saliva to measure testosterone is when ease of sample collection is a priority or when testosterone levels are being compared across a large body of subjects.
I highly recommend that you order your own blood test instead of running it through a doctor.
In this way, not only is the price about 80% cheaper, but you are also able to track your progress and take charge of your own health. It will be the exact same test, the same lab, and usually even the same person who draws your blood.
If you have health insurance, the best option is to go to your primary health care physician and have them run a comprehensive blood and hormone panel. This will probably cost an extra $10-20.
If you don't have health insurance and if you’re in the US, (and not in the states of NY, NJ, MA, MD, or RI) then go through the following process:
Step 1 - Go to PrivateMDLabs.com
Private MD Labs lets you order a blood test without the need for a doctor's permission.
On their website you will have to search for the blood test you are looking for. The three best options for our purposes are:
Option #1: Hormone Panel for Females
At $66.99, this is the best option for guys on a budget.
The Hormone Panel for Females will give you your total testosterone measurement but not your free testosterone measurement.
The Hormone Panel for Females contains the following tests:
The method used for measuring testosterone is ECLIA. This is an automated immunoassay method, i.e. it is the fastest and most affordable method to measure total T in your blood.
Don’t worry about the details, we will go over exactly how to analyze your blood work in the next chapter.
Option #2: Hormone Panel with F&T Testosterone LC/MS
This option provides the same tests as the Hormone Panel for Females with the addition of free testosterone.
Also, the method used for testing total testosterone is LC/MS (liquid chromatography-mass spectrometry). This method requires more work on the part of the technician and is more expensive, but it outputs a more accurate result.
The addition of a free testosterone test and use of the LC/MS method for testing brings the price of this hormonal panel up to $103.99.
Option #3: Hormone Panel for Males
Compared to option #2, the Hormone Panel for Males comes with the addition of lipid and thyroid profiles, as well as a reading for IGF-I.
The cost is $176.49.
Free testosterone is measured using Equilibrium Ultrafiltration (EU) rather than RIA direct (like in option #2).
EU is the most accurate method for measuring free T.
Tests in the Hormone Panel for Males:
Each test varies in the results it delivers and the methods it uses to take the measurements.
Step 2 - Type Your Test of Choice Into the Search Bar
For example, type “Hormone Panel for Females” into the search bar and click “Go”.
Next, click “View Cart” and then click “Checkout”.
Step 3 - Find a Lab Near You
Enter your zip code to find the lab that is closest to you.
To get 12% off your order enter the coupon code HEALTHY12.
Enter your billing information and you’re all set.
Step 4 - Get Your Blood Drawn
It is best to go to the lab upon waking on an empty stomach.
T levels are highest in the morning and tend to drop through the day.
Step 5 - Wait for Your Results
You can get your results back the next day, but the standard is usually within 2-3 days.
You’ll get an email with a PDF of your results.
As an example, I’ll compare two results from a Female Hormone Panel.
One from a guy on testosterone replacement therapy (TRT) and one is a report of my own lab results.
This person is on testosterone replacement therapy.
How do we know this?
Total testosterone is very high and outside of the physiological range, while LH and FSH (the precursors of testosterone) are near zero. This makes it clear that the body is shut off its natural testosterone production mechanism and that an outside source of testosterone is coming in.
Also, estradiol (a form of estrogen) is very high. Naturally high testosterone usually means lower estrogen, but in this case there is too much T coming into the body and all the excess is being converted into estrogen.
T-levels lie within the upper limit of the reference range. LH and FSH are also high, which means that testosterone is being produced naturally.
Estrogen is on the lower end.
Given that testosterone has such a big impact on our lives as men, it is important to gain an understanding of it to the extent of knowing what levels to shoot for and how to go about doing so.
I hope you found this post useful, and if you have anything to add let me know in the comments below.
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