From the Guidelines
A total testosterone level of 4.40 ng/mL is generally considered low and may require further evaluation and potential treatment, especially if accompanied by symptoms of hypogonadism, as testosterone therapy may provide small improvements in sexual functioning and quality of life in older men with low testosterone levels 1.
Normal Testosterone Ranges
Normal testosterone ranges typically fall between 300-1000 ng/mL (10.4-34.7 nmol/L) for adult men. A level of 4.40 ng/mL is below this range, suggesting potential hypogonadism. However, it's essential to consider symptoms and other factors, as the definition of low testosterone and study entry criteria can vary 1.
Evaluation and Treatment
If you're experiencing symptoms like fatigue, decreased libido, erectile dysfunction, or mood changes, consult with your healthcare provider for further evaluation. Other factors such as free testosterone, sex hormone-binding globulin (SHBG), and estradiol levels may need to be checked to get a complete picture of your hormonal health. Testosterone treatment is approved by the U.S. Food and Drug Administration (FDA) for replacement therapy in men with primary or secondary hypogonadism caused by disorders of the hypothalamus, pituitary gland, or testes 1.
Lifestyle Factors
Lifestyle factors, including regular exercise, adequate sleep, stress management, maintaining a healthy weight, and a balanced diet, can help optimize your natural testosterone production. Testosterone levels fluctuate throughout the day, with highest levels typically in the morning, so timing of the test can affect results. Annual monitoring may be recommended if you have risk factors or symptoms, even with normal levels.
Key Considerations
- Testosterone therapy may provide small improvements in sexual functioning and quality of life in older men with low testosterone levels 1.
- Long-term efficacy and safety of testosterone therapy are unknown 1.
- Substantial proportions of U.S. men who receive testosterone therapy do not have testosterone levels tested before initiation of therapy 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Testosterone Levels and Hypogonadism
- A total testosterone level of 4.40 ng/mL is considered low, as most studies suggest that normal levels are above 300 ng/dL 2.
- Hypogonadism is a clinical syndrome complex that comprises symptoms with or without signs, as well as biochemical evidence of testosterone deficiency 3.
- The diagnosis of hypogonadism includes both clinical history and examination, as well as biochemical assessment of serum testosterone levels 3.
Symptoms and Treatment
- Symptoms of hypogonadism depend on the age at onset, severity of the deficiency, its duration, and sensitivity to androgen action 3.
- Testosterone replacement therapy (TRT) may improve sexual function, depressive symptoms, bone density, and lean body mass 4.
- TRT should be considered for men with testosterone deficiency to correct selected symptoms and induce and maintain secondary sex characteristics 4.
Guidelines and Recommendations
- The Society for Endocrinology recommends a multidisciplinary approach to treating patients with male hypogonadism 5.
- Clinicians should monitor men receiving TRT for symptom improvement, potential adverse effects, and adherence 4.
- Serum testosterone, hematocrit, and prostate-specific antigen levels should be measured at baseline and at least annually in men 40 years or older receiving TRT 4.