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Weird Medicine with Doctor Steve » Blog Archive » THE TRUTH ABOUT “LOW NORMAL TESTOSTERONE”


I’ve been asked so many times about this, that I am past-due for posting on this subject. This is one of the articles I reference, when discussing the treatment of “low normal” testosterone:

Aging Male. 2012 Dec;15(4):198-207. doi: 10.3109/13685538.2012.699562. Epub 2012 Jul 26.

A randomized, double-blind, placebo-controlled trial of testosterone gel on body composition and health-related quality-of-life in men with hypogonadal to low-normal levels of serum testosterone and symptoms of androgen deficiency over 6 months with 12 months open-label follow-up.

Behre HM1, et al

Center for Reproductive Medicine and Andrology of the University, Halle, Germany. hermann.behre@medizin.uni-halle.de



The clinical significance of low to low-normal testosterone (T) levels in men remains debated.


To analyze the effects of raising serum T on lean body mass (LBM), fat mass (FM), total body mass, and health-related quality-of-life (HRQoL).


Randomized, double-blind, placebo-controlled study. Men, aged 50-80 years, with serum total T<15 nmol/L and bioavailable T < 6.68 nmol/L, and a Aging Males’ Symptoms (AMS) total score >36, received 6 months treatment with transdermal 1% T gel (5-7.5?mg/day; n =183) or placebo gel (n =179), followed by 12 months open-label with T in all.


After 6 months, LBM increased in T- treated patients by 1.28?±?0.15?kg (mean ± SE) and FM decreased by 1.16?±?0.16?kg, with minor changes with placebo (LBM +0.02?±?0.10?kg and FM -0.14?±?0.12?kg; all p < 0.001, T group vs. placebo). Changes were largely similar across subgroups of age, baseline total testosterone, and baseline BMI. Total HRQoL improved compared with placebo (p < 0.05, T group vs. placebo).


Six months 1% T gel improved body composition and HRQoL in symptomatic men with low to low-normal T, with further improvements over the following 12 months.


In other words, in SYMPTOMATIC men (those with symptoms consistent with androgen deficiency, i.e., fatigue, erectile dysfunction, loss of libido, weakness) with “LOW NORMAL” testosterone (i.e., in the low range of “normal” (more on this later)), there is improved QUALITY OF LIFE when these patients are TREATED.

So you may ask, “if they’re in the ‘normal’ range, how can they be also ‘abnormal’?”   The answer is in the way “normal” levels are determined.  Basically take 1000 men and draw testosterone levels on them.  Exclude men with diagnosed hypogonadism (low testosterone), of course.  Then average the results and do a mathematical process to determine 2 “standard deviations from the mean.”   This sets your low and high normal levels.  The real process is a bit more complicated, but that’s the gist of it.

Well, what happens when your pool of “normal” candidates, from whom the normal range is derived, contains a SHIT LOAD of people with undiagnosed hypogonadism?  It is estimated that the vast majority of men with low T go undiagnosed (it may be as high as 95%!).   It follows that these undiagnosed men with hypogonadism will drag the average down, thus creating a normal range that also includes people who have symptomatic disease.

So, if you have symptoms of low T, and they’ve ruled out anemia, sleep apnea, depression and low thyroid, a savvy provider who understands the above may opt to treat (at least for awhile to see if it helps) you even if you’re in the “low normal” range.

Remember, testosterone replacement is real medicine, by prescription only, and should be done under the supervision of a licensed medical provider only.  There are downsides to this as well, and make sure your prescriber discusses the risks, benefits, and alternatives to treatment before embarking on any new regimen.

yr obt svt,


Dr Steve



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