No Treatment Indicated for Normal Testosterone Levels
With a total testosterone of 675 ng/dL and free testosterone of 25.3 pg/mL, both values are well within the normal range and testosterone replacement therapy is not indicated. 1, 2
Why Treatment Is Not Needed
Your testosterone levels are clearly normal:
Total testosterone of 675 ng/dL exceeds the diagnostic threshold for hypogonadism (300 ng/dL), and falls well above the treatment target range of 450-600 ng/dL recommended by the American Urological Association 1, 2
Free testosterone of 25.3 pg/mL is normal, indicating adequate bioavailable hormone for physiological function 3, 4
Testosterone replacement therapy should only be initiated when morning testosterone levels are frankly low on at least 2 separate assessments (typically below 300 ng/dL), combined with clinical symptoms of hypogonadism 1, 2
What You Should Do Instead
If You Have Symptoms Concerning for Hypogonadism
Even with normal lab values, if you experience symptoms such as:
- Decreased libido or erectile dysfunction 1
- Reduced energy or depressed mood 5
- Loss of muscle mass or bone density 5
- Hot flashes, gynecomastia, or infertility 3
Repeat morning testosterone measurements are warranted, as testosterone levels can vary due to biological and measurement factors 6. If symptoms persist with repeatedly normal testosterone, the symptoms are likely unrelated to testosterone deficiency and alternative diagnoses should be pursued 1, 2.
Lifestyle Optimization
All men should be counseled regarding lifestyle modifications regardless of testosterone levels 1:
- Weight loss or maintaining weight within recommended range can increase endogenous testosterone levels 1, 2
- Increased physical activity has potential to reduce symptoms associated with metabolic dysfunction 1, 2
Critical Pitfall to Avoid
Do not initiate testosterone therapy with normal testosterone levels. Exogenous testosterone will suppress your natural production through negative feedback on the hypothalamic-pituitary-gonadal axis, potentially causing infertility (azoospermia or severe oligospermia) and testicular atrophy 1. The goal of testosterone therapy is to normalize levels to 450-600 ng/dL—you are already above this target 1, 2.
When to Recheck
If new symptoms develop or if you have conditions that alter sex hormone-binding globulin (SHBG) levels, measuring LH and FSH can help distinguish primary from secondary hypogonadism if testosterone levels subsequently become subnormal 1, 3.