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Why “normal” testosterone does not always mean normal function
Why is it that testosterone looks normal but you still have symptoms consistent with low testosterone?
Low libido.
Reduced energy.
Blunted drive.
It is tempting to conclude: Testosterone is not the problem.
That is a conclusion too easy to arrive at.
This is one of the mismatches we often see in clinic, and it is not peculiar to testosterone.
Someone can be within the lab’s normal reference range, sometimes comfortably inside it, and still describe symptoms that are discordant with what the results are saying.
The evidence does not support diagnosing testosterone deficiency from symptoms alone. But it also does not support asserting that a normal total testosterone is the end of the conversation either.
Current guidelines require symptoms plus unequivocally low testosterone for diagnosis, while the physiology tells us that total testosterone is only one part of a wider system.
Furthermore, there is no consensus amongst specialist bodies as to what the lower threshold of total testosterone or free testosterone below which individuals will notice symptomatic improvements.