What’s relative hypogonadism?

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.