question from a user
Let’s say a 45yo guy has all the symptoms of low testosterone but 2 tests 2 months apart show total t at 930ng/dl and free t at 16ng/dl naturally. SHBG is above normal at 62 and FSH at 10. Everything else is in normal range. Would you look elsewhere for the cause of the symptoms or try to adjust any of the values above? I got tested 12 years ago with total t at 1300 and felt great. Can my symptoms stem from a drop in t even though I’ve been sitting a very high levels both then and now?
AlphaMD's Answer
Yes, you could absolutely have symptoms just from the drop in testosterone, despite being within the upper range of normal. If what is normal for you is 1300, and you are now at 930, that drop alone can mean hypogonadism. This is a classic case of what is known as relative hypogonadism.
Because I just answered another question regarding relative hypogonadism, I will copy and paste what I wrote just in case you have not heard of relative hypogonadism before:
----- Relative hypogonadism is a term for men who have symptoms of hypogonadism, despite having lab tests that fall within the normal range based on lab values.
So, since the normal lab value range for total testosterone is so wide (350-1200 ng/dL), and normal values were obtained from creating a bell curve of the average based on testing tens of thousands of men, that means there are men out there who naturally produce 1200 ng/dL as their normal peak production.
Now, lets say his normal production at age 18 is 1200, but then 5 years later, his levels have dropped to 550 and he start to get symptoms of low testosterone. He goes to his doctor and his doctor says "Nope, your lab values are in the normal range, so you are fine."
Wrong.
He is not fine, because his body is producing half of what HIS normal T level is, so only half of his androgen receptors (which are attuned to a high level of testosterone) are being activated. He is technically hypogonadal, despite having a "normal" testosterone level based on the lab value cut offs.
Because we do not screen men's testosterone level UNTIL THEY HAVE SYMPTOMS, we can never typically know what any men's baselines are. If we tested every 18 year old man's testosterone even when they feel fine, then we could know what every man's peak testosterone level was and use that as a personal baseline for that patient. -----
Because we actually have a baseline in your case (Your level was 1300 and you "felt great"), we can say that your symptoms could very well be from relative hypogonadism.
You will know for sure that you have relative hypogonadism if the symptoms you are having resolve when your levels get back up to, or above 1300.
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