From the Guidelines
Your calculated free testosterone level of 11 pmol/L is within the normal reference range of 2-30 pmol/L, indicating that your free testosterone levels are currently normal, and no specific treatment or intervention is needed at this time. This measurement is often more clinically relevant than total testosterone because it reflects the hormone actually available for use by your body 1. While your level is in the normal range, it's in the lower half of that range. If you're experiencing symptoms that might be related to testosterone levels (such as fatigue, decreased libido, or mood changes), it would be worth discussing these with your healthcare provider even though your numbers are technically normal.
According to the American College of Physicians, testosterone treatment is not recommended for men with age-related low testosterone to improve energy, vitality, physical function, or cognition 1. The role of testosterone treatment in managing age-related low testosterone is controversial, and the benefits and harms of treatment are still being studied 1. Regular monitoring of your hormone levels may be recommended if you have ongoing concerns or risk factors for hormonal imbalances.
Some key points to consider:
- The incidence of low testosterone in the United States is reported to be approximately 20% in men older than 60,30% in those older than 70, and 50% in those older than 80 years 1.
- The prevalence of syndromic low testosterone (defined as at least 3 sexual symptoms with a total testosterone level <11.1 nmol/L [320 ng/dL]) is lower 1.
- Testosterone treatment may provide small improvements in sexual functioning and quality of life but little to no benefit for other common symptoms of aging 1.
- Long-term efficacy and safety of testosterone treatment are unknown 1.
It's essential to discuss your symptoms and concerns with your healthcare provider to determine the best course of action for your individual situation. Clinicians should reevaluate symptoms within 12 months and periodically thereafter, and discontinue testosterone treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function 1.
From the Research
Testosterone Levels
- The patient's free testosterone level is 11 pmol/L, which is below the reference range of 2-30 pmol/L.
- According to the study by 2, the reference intervals for free testosterone in healthy nonobese men are 66-309 pg/ml (229-1072 pmol/L) for all men and 120-368 pg/ml (415-1274 pmol/L) for men aged 19-39 years.
Relationship Between Testosterone and Erectile Function
- The study by 3 suggests that testosterone modulates nearly every component involved in erectile function, and that testosterone replacement therapy (TRT) may be beneficial for men with erectile dysfunction (ED) and hypogonadism.
- However, the study by 4 notes that the role of testosterone in sexual functioning is less evident in epidemiologic studies, and that TRT can only ameliorate certain aspects of sexual functioning, such as libido and erectile function, in the presence of a hypogonadal status.
Testosterone Replacement Therapy
- The study by 5 found that TRT improved sexual activity, hypogonadal symptoms, and sexual desire in middle-aged and older men with hypogonadism and low libido.
- The study by 6 suggests that TRT may be useful in restoring serum testosterone levels to the normal range in hypogonadal males, but that well-designed studies are limited with respect to the specific evaluation of the role of TRT as monotherapy in improving erectile function.
- The study by 4 notes that TRT alone can be effective in restoring only milder forms of erectile dysfunction, and that combined therapy with other drugs may be required for more severe vascular damage.