There actually are no specific thresholds for treatment with TRT based on the Endocrine Society’s Treatment Guidelines. They make no indication as far as what number of TT or FT is needed to diagnose hypogonadism.

Also, testosterone tests vary rather significantly in their accuracy, so for that reason several other medical societies (like the American Urological Society) are also considering removing treatment thresholds as part of their diagnostic criteria.

The problem with using numbers to diagnose low T is that it is not a simple positive or negative test.

What matters most is that you have symptoms of low T. We do lab tests to help us determine THE LIKELIHOOD that your symptoms are from low T. If your levels below the “normal” range, then it’s a simple diagnosis. If your T levels are still in the normal range, but on the lower side, then it is more likely than not that your symptoms are from low T. If your T levels are mid range, then the likelihood that your symptoms are from hypogonadism is much lower. If your T levels are above 650 and/or your FT is above mid-range, then the likelihood of your symptoms being from hypogonadism is very low.

Also, people forget that your T levels drop by 15-20% in a 24 hour period. That is why insurance companies demand you get your T test first thing in the morning. If your T is 400 (“normal” range) the morning, then it is 320 (below “normal”) by the evening.

Any doctor that says “your T is in the normal range, you don’t need TRT” is a bad doctor. It is not a simple yes/no, positive/negative diagnosis.

That’s a long winded answer to basically say “it depends”.