From the Guidelines
The testosterone levels of 492 ng/dL (total) and 16.5 pg/mL (free) for an 18-year-old male are within normal reference ranges, and according to the AUA guideline, a total testosterone level below 300 ng/dL is considered low 1. Given this information, no medical intervention is necessary at this time. Total testosterone reference ranges for adult males typically fall between 300-1000 ng/dL, while free testosterone typically ranges from 5-21 pg/mL, though exact ranges may vary slightly between laboratories. These values indicate normal testicular function and appropriate hormone production for a young adult male. Testosterone is essential for male development, muscle mass maintenance, bone density, libido, and overall energy levels. If the patient is experiencing symptoms that prompted testosterone testing (such as fatigue, decreased libido, or mood changes), other causes should be investigated since hormone levels appear normal. Some key points to consider in the evaluation of testosterone deficiency include:
- The diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions with both conducted in an early morning fashion 1.
- The clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms and/or signs 1.
- Clinicians should consider measuring total testosterone in patients with a history of unexplained anemia, bone density loss, diabetes, exposure to chemotherapy, exposure to testicular radiation, HIV/AIDS, chronic narcotic use, male infertility, pituitary dysfunction, and chronic corticosteroid use even in the absence of symptoms or signs associated with testosterone deficiency 1. Regular health maintenance including adequate sleep, proper nutrition, regular exercise, and stress management will help maintain healthy testosterone levels. Annual check-ups can monitor for any changes if there are ongoing concerns. It is also important to note that the use of validated questionnaires is not currently recommended to either define which patients are candidates for testosterone therapy or monitor symptom response in patients on testosterone therapy 1.
From the Research
Testosterone Levels and Hypogonadism
- The patient's free testosterone level is 16.5 and total testosterone level is 492, which may indicate hypogonadism 2, 3, 4, 5, 6.
- Hypogonadism is a condition characterized by low testosterone levels, which can be treated with testosterone replacement therapy (TRT) or alternative treatments such as clomiphene citrate 2, 3, 4, 5, 6.
Treatment Options
- Testosterone replacement therapy (TRT) is a common treatment for hypogonadism, but it may have disadvantages such as suppressing the hypothalamic-pituitary-gonadal axis and affecting fertility 2, 4.
- Clomiphene citrate is an alternative treatment for hypogonadism that can increase endogenous testosterone production and has been shown to be effective in improving biochemical and clinical symptoms of hypogonadism 3, 5, 6.
- Clomiphene citrate has been reported to have few side effects and good safety aspects, making it a potential treatment option for men with hypogonadism who wish to preserve fertility or have concerns about TRT 5.
Comparison of Treatment Options
- A study comparing testosterone supplementation versus clomiphene citrate for hypogonadism found that both treatments were effective in improving serum total testosterone levels, but men on clomiphene citrate reported similar satisfaction to those on testosterone gels despite lower serum total testosterone levels 6.
- Another study found that clomiphene citrate increased total testosterone, free testosterone, luteinizing hormone, follicle-stimulating hormone, sex hormone-binding globulin, and estradiol, and improved symptoms of hypogonadism with few reported side effects 5.