How much free testosterone is too low?

Free testosterone refers to the amount of testosterone in the body that is available to the cells and tissues. Testosterone that is bound to sex hormone binding globulin (SHBG) is not free and bioavailable. As men age, both total and free testosterone levels tend to decline. But at what point is free testosterone considered too low?
Normal ranges

There is no universal consensus on specific cut-off levels that define low free testosterone. However, experts generally agree on the following normal reference ranges as a starting point when evaluating testosterone levels in men:

• Total testosterone: 300-1,000 ng/dL (To convert to nmol/L, divide by 28.8)


• Free testosterone: 50-210 pg/mL

*Bioavailable testosterone: 110-575 ng/dL

The Endocrine Society defines low testosterone or hypogonadism in men as:

• Total testosterone below 300 ng/dL


• Free testosterone below 50 pg/mL

Symptoms

Low free testosterone, even within the normal range, can cause various symptoms including:

• Low sex drive and erectile dysfunction


• Decreased muscle mass and strength


• Increased body fat, especially abdominal fat


• Fatigue, low motivation and depression


• Poor concentration and memory


• Reduced bone mineral density (osteoporosis risk)

The presence of multiple hypogonadal symptoms together with a low free testosterone level confirms androgen deficiency that may require testosterone replacement therapy.

Health risks

Over time, critically low testosterone can lead to various adverse health outcomes:

• Cardiovascular disease


• Metabolic syndrome


• Type 2 diabetes


• Obesity


• Osteoporosis


• Dementia


• Premature death

Restoring testosterone levels to a sufficient range can help mitigate these risks.

Evaluation and treatment

If your free testosterone levels are persistently low and you have clinical symptoms of low testosterone, make an appointment with a hormone specialist, endocrinologist or urologist for further evaluation.

• They will check your total and free testosterone along with other androgen hormones.


• Repeat testing may be needed because hormone levels fluctuate.


• They will consider your symptoms, medical history and rule out other underlying conditions.

Treatment usually involves testosterone replacement therapy to restore levels. Options include:

• Testosterone injections/shots


• Testosterone gels/creams


• Testosterone pellets


• Oral testosterone (less commonly used)

The goal is to increase your testosterone into a sufficient range until symptoms resolve. Therapy is customized and monitored to avoid adverse side effects.

At Hormone Harmony Clinic, we specialize in precision testosterone therapy to help men optimize strength, vitality and health. Contact us today for a consultation.