Assessment of Normal Testosterone Levels
Your testosterone levels are normal and do not require treatment. With a total testosterone of 455 ng/dL and free testosterone of 89 pg/mL (assuming standard units), both values fall within the normal adult male range of 300-800 ng/dL for total testosterone 1.
Clinical Interpretation
No intervention is indicated for asymptomatic men with normal testosterone levels. The evidence-based approach to testosterone management requires BOTH biochemically confirmed low testosterone AND specific symptoms before considering treatment 2, 3, 4.
Key Diagnostic Criteria Not Met
- Total testosterone threshold: Your level of 455 ng/dL exceeds the diagnostic threshold of <300 ng/dL used to define hypogonadism 1
- Free testosterone status: Your free testosterone of 89 pg/mL is normal, which is the critical measurement when total testosterone is in the equivocal range 1
- Clinical context: Treatment guidelines specifically state testosterone should only be considered in men with unequivocally LOW levels on repeated morning measurements 3, 4
When Testosterone Treatment Would Be Appropriate
The American College of Physicians provides clear guidance that testosterone treatment should be reserved for specific circumstances 2:
- Sexual dysfunction only: Treatment may be considered exclusively for sexual dysfunction (not energy, vitality, physical function, or cognition) 2
- Confirmed biochemical deficiency: Requires documented low morning testosterone on at least two separate occasions 2, 3, 4
- Symptomatic presentation: Must have specific symptoms of hypogonadism including decreased libido, erectile dysfunction, reduced muscle mass, decreased energy, hot flashes, or gynecomastia 1
Important Caveats for Obesity
If you have obesity, be aware that low sex hormone-binding globulin can artificially lower total testosterone while free testosterone remains normal 1. This is why free testosterone measurement is essential in men with obesity - and your normal free testosterone confirms you do not have true hypogonadism 1.
What to Monitor Going Forward
- Repeat testing only if symptoms develop: No routine monitoring is needed with normal levels 3, 4
- Morning measurements: If future testing is needed, always measure between 8-10 AM using a reliable assay 1, 5
- Confirm abnormalities: Any low result requires confirmation with repeat testing before considering treatment 3, 4
Contraindications to Avoid
Even if levels were low, testosterone therapy would be contraindicated in men with prostate cancer, breast cancer, PSA >3-4 ng/mL without urologic evaluation, hematocrit >50%, untreated severe sleep apnea, severe urinary symptoms (IPSS >19), or uncontrolled heart failure 3, 4.