Seeking Advice on What Testosterone Level is Appropriate for Body Type

I need some advice.

I am male, 53 years old, 6.0’ tall, 185 lbs, and approx. 20% body fat. I am considering going on TRT, but I am concerned about what target testosterone level to seek, based on my body type and probable historical testosterone levels.

I recently had my testosterone tested, and my levels came back at 365 ng/dL for serum testosterone, and 8.5 pg/mL free testosterone (direct). I have never had my testosterone tested previously, so I have no idea how my current level compares to when I was younger. However, now, I am clearly at the lower end of the normal range. This confirms and corresponds well with what I have been feeling for the past few years – tiredness, fatigue, low sex drive, etc. I have read a fair amount on TRT, and I do think I would most likely benefit from treatment.

I have read that many TRT programs seek a 900 ng/dl level for treatment. However, I have been doing some additional reading, and now I have questions about what my natural testosterone “setpoint” should be.

I have always been fairly athletic – I would say easily in the top 20% of the general male population. I have always tended more to endurance based activities – running, cycling, rowing, etc. But, I have decent musculature – despite never having lifted seriously, I was recently able to get to 270 bench and 160+ OHP within 5 months of lifting moderately. I have always had a normal to above-average sex drive.

However, I have traits that suggest that I could have a naturally lower testosterone baseline level. Very little body hair, a thinner, more wiry body (well, maybe not so much anymore :icon_roll), full head of hair, late physical development (very late teens). I do have a deep voice, however.

I am looking to get back to feeling similar to how I did 10 years ago, but I don’t wish to fundamentally change my body type or hormonal profile, if that makes sense? I have read some anecdotal accounts that suggests that certain body types (endurance-type athletes, for instance) may have naturally lower testosterone levels. I have read other anecdotal reports, and simple bell curve distribution would support, that some men have natural testosterone baselines of, say, 600 ng/dl testosterone, with normal physical and masculinity characteristics. Then, there might be others whose natural testosterone baseline is closer to 1300. I am not sure one type would do well at the other extreme, or at a middle-range 900 level.

I am seeking your advice on 1) is the concept of lower or higher testosterone “setpoints” a valid one?, 2) what is the best way to determine what new testosterone level to shoot for? If I am a natural “600” guy, and I get boosted to 900, will that in some way upset my body’s natural preferred equilibrium? I realize it is difficult to answer this question definitively, but I would appreciate anyone’s thoughts and advice.

Thank you.

General advice is to not use the Total T lab to make any decisions. It is only a screening lab, and a mediocre one at that. You need to have either Free T or Bioavailable T labs run. My experience is that two test methods parallel each other well. As we age, not only do we tend to produce less T, we also tend to increase our production of a protein call Sex Hormone Binding Globulin (SHBG) and this protein tightly binds with T and prevents it from passing through the blood-brain barrier where you need the T to feel normal. So, lower T production combined with higher SHBG production means much lower Free T.

You want to base your treatment decisions on Free T. However, the problem with this lab is that they provide you with age-adjusted "normal" ranges. I don't want to have the hormones of my typical out of shape and aging peers, so I interpret the labs differently and shoot for the 75th percentile of a 30-40 year old guy, which is about the 165th percentile of my 60+ age group. Using the LabCorp Free T test, this is about 21-26 pg/mL Free T.

Looking through my notes, I found this excerpt from a Life Extension Organization discussion on Free T. The link will take to a very informative full length article on their philosophy toward implementing TRT. This is just a small extract of that article focused on Free T.

Life Extension believes that comprehensive tests, along with a careful physical examination, are essential in detecting hormonal imbalances in aging men.

The so-called "normal" levels of testosterone in older men reflect population averages. Life Extension believes that most aging men would prefer not to accept the loss of youthful vigor as normal. Instead, we suggest that a more valid optimal level for all men would be in the upper one-third of the reference range used for men aged 21 to 49 years, and that any supplementation should aim to restore hormone levels to that range. The current Life Extension optimal level of free testosterone is 20‒25 pg/mL.

When measuring testosterone levels, it is critical to determine the levels of both free and total testosterone to understand the cause of any observed symptoms of deficiency.

Because of difficulties with equipment standardization and inter-laboratory variability, it is recommended that physicians consistently use the same local laboratories and gain familiarity with the accuracy, precision and definition of normal values for the assays offered in their communities.

It is also important to remember that blood levels of both free and total testosterone vary widely among individuals, making it difficult to establish a general baseline on which to prescribe a standardized treatment protocol. However, levels are quite consistent within individuals, and thus it is important that men have multiple tests over time to determine trends and individual thresholds for treatment.

Finally, during the initial testing, it is also imperative to test estrogen levels. Many of the unwanted effects of male hormone imbalance are actually caused by an elevated estrogen level relative to low testosterone levels (the estrogen/testosterone ratio). The Life Extension optimal level of estrogen (measured as estradiol) for aging men is 20‒30 pg/mL.

Estrogen Balance is Critical to Aging Men
A study published in the Journal of the American Medical Association (JAMA) measured blood estradiol in 501 men with chronic heart failure. Compared to men in the balanced estrogen quintile, men in the highest quintile (serum estradiol levels of 37.40 pg/mL or greater) were significantly (133%) more likely to die. Those in the lowest estradiol quintile (serum estradiol levels under 12.90 pg/mL) had a 317% increased death rate compared to the balanced group. The men in the balanced quintile—with the fewest deaths—had serum estradiol levels between 21.80 and 30.11 pg/mL.56 This is the ideal range that Life Extension has long recommended male customers strive for.

An epidemic problem we at Life Extension observe in aging male customers is insufficient free testosterone, that is less than 20‒25 pg/mL of serum. When accompanied by excess estradiol (over 30 pg/mL of serum), this can signal excess aromatase enzyme activity.

From

Thank you very much for your detailed reply. Much appreciated.

I did get my Free T tested, and I will make sure to use that as an important metric in analyzing post-treatment T levels.

I did not realize that T ranges are reported on a age-adjusted basis. Yes, I totally agree with you -- I do not want my final T to be based on "old" body levels, I want "original condition".


Ultimately, I think my question is best addressed by the paragraph in the excerpt you included:

"It is also important to remember that blood levels of both free and total testosterone vary widely among individuals, making it difficult to establish a general baseline on which to prescribe a standardized treatment protocol. However, levels are quite consistent within individuals, and thus it is important that men have multiple tests over time to determine trends and individual thresholds for treatment."

There just appears to be no way to know, unless one was lucky enough to have established a baseline of T levels when younger and healthy, what each person's normal, healthy testosterone level should be. I think that physical characteristics (perhaps general level of muscularity, body hair, libido, etc.) may give clues to whether one is/was normally (pre-aged and pre low-T symptoms) high, moderate, or low T, but there really is no way to know definitively. I guess I will have to start treatment, and rely on my body to tell me.

If, after starting TRT, my body should begin changing in ways that are uncharacteristic (developing body hair on back or chest where there wasn't any normally, moodiness, etc.), should this be a sign that I should seek to back off the level, even if I am in the targeted Free T range? Or, should I accept these new body changes as potentially being a new and improved body?

Has anyone had any experiences in having too high T, post treatment, based on body indicators? Experiences?

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Originally Posted by Maas

Thank you very much for your detailed reply. Much appreciated.

I did not realize that T ranges are reported on a age-adjusted basis. Yes, I totally agree with you -- I do not want my final T to be based on "old" body levels, I want "original condition".

Free-T is age adjusted (at least at LabCorp) Total T is not. For Total T they base the normal range on published values for men between the age of 19 and 39, but as I said it's only a screening lab and does not take SHBG into account.

If, after starting TRT, my body should begin changing in ways that are uncharacteristic (developing body hair on back or chest where there wasn't any normally, moodiness, etc.), should this be a sign that I should seek to back off the level, even if I am in the targeted Free T range? Or, should I accept these new body changes as potentially being a new and improved body?

You will only develop those characteristics if you are genetically programmed for them. By this stage of your life you would probably have a good idea of what your genetics are dictating. Raising T will only speed the process up and/or accentuate the end result (e.g., hair loss). One needs to make a personal decision whether you want or can tolerate the secondary sex characteristics cased by elevated T balanced by how you feel pre and post-treatment. Personally, I could never go back to the way I felt before TRT. Life was becoming intolerable.

Has anyone had any experiences in having too high T, post treatment, based on body indicators? Experiences?

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"Too high" is a relative term in this forum. I define it as being out of the normal range, others have differing opinions. There is no right or wrong, only opinions. The medical community would agree with my opinion, but then again, I have a rather low opinion of the medical community with regard to their collective knowledge of male hormones. For me, I did notice a very slight increase in body hair but it was so subtle that only I would notice it. The only other external feature that changed was hair loss. I knew going into this that I was genetically programmed for it, and it definitely occurred at a much greater rate after TRT. In retrospect, I would add DHT control to the list of things you should look into. There's a lot of bad press about using finasteride, but that's mostly from guys that are younger and not on TRT. When you increase you T levels, DHT will also go up. Mine went way out of range but I was hesitant to use finasteride to control it. I realize now that was a mistake. I now take small doses to keep my DHT within the normal range.