Is a total testosterone level of 22 ng/dL considered elevated?

Testosterone Level Assessment

A total testosterone level of 22 ng/dL is significantly low, not elevated, and indicates severe hypogonadism requiring further evaluation and potential treatment. 1, 2

Normal Testosterone Ranges

According to current clinical guidelines:

• The American Urological Association (AUA) defines testosterone deficiency as a total testosterone level below 300 ng/dL 1
• The Endocrine Society similarly recommends using a threshold of 300 ng/dL for diagnosing low testosterone 2
• Normal testosterone ranges for adult men are typically 300-950 ng/dL for total testosterone 2

Interpretation of 22 ng/dL

A total testosterone level of 22 ng/dL is:

• Severely below the lower limit of normal (300 ng/dL)
• Indicative of profound hypogonadism
• Concerning enough to warrant immediate further evaluation

Diagnostic Approach

When encountering a testosterone level this low:

1. Confirm the result with a repeat measurement

   • The diagnosis of testosterone deficiency requires at least two separate morning total testosterone measurements 1, 2
   • Both measurements should be taken in early morning (8-10 AM) 2
   • Use the same laboratory and testing method for consistency 2

2. Determine the etiology through additional testing:

   • Measure luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to distinguish between primary and secondary hypogonadism 2
   • Check serum prolactin to screen for hyperprolactinemia 2
   • Consider pituitary MRI if total testosterone remains <150 ng/dL with low/normal LH 2

Clinical Implications

A testosterone level this low (22 ng/dL) has significant clinical implications:

• Increased risk of osteoporosis and fractures
• Potential for decreased muscle mass and strength
• Possible cognitive and mood disturbances
• Reduced sexual function and libido
• Metabolic consequences including insulin resistance

Important Considerations

• Extremely low testosterone levels (<150 ng/dL) with low/normal LH warrant evaluation for pituitary pathology 2
• This level (22 ng/dL) is well below even the age-adjusted thresholds for men in their 70s (156 ng/dL) 3
• The measurement method (LC/MS) is considered the gold standard for testosterone measurement, making this result particularly reliable

Common Pitfalls to Avoid

• Failing to repeat the test on a separate day can lead to misdiagnosis 2
• Not considering secondary causes of severe hypogonadism such as hemochromatosis, pituitary tumors, or medications 2
• Overlooking the need for comprehensive hormonal evaluation in cases of severe testosterone deficiency

In conclusion, a total testosterone level of 22 ng/dL represents severe hypogonadism requiring prompt evaluation and appropriate management, not an elevated testosterone level.