Peter Attia· MD
so a free testosterone is low and I define low as somewhere between one and two standard deviations below the mean of our reference range in the lab and symptomatic so you have to have these two things in my opinion
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The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
so a free testosterone is low and I define low as somewhere between one and two standard deviations below the mean of our reference range in the lab and symptomatic so you have to have these two things in my opinion
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i would say from a clinical standpoint i find that symptoms track more with free testosterone than bioavailable
why are we so fixated on the numbers it's not about the numbers it's about how he feels right if a guy comes in with a level of 250 200 total te very low and he says I feel fantastic one could say why are you treating him conversely if he has a level of 500 feels great I mean it has all the symptoms we don't treat so if he comes in and he has symptoms then I will treat
I think it it totally depends on the symptoms would be my take.
Why symptoms of low testosterone are often more important than the actual levels when deciding whether or not to go on TRT
you hear a lot about um uh low te yeah low te and there's like this controversy around it like what defines low te is it a levels is it a combination of levels and symptoms um so how are like we're looking at menopause and women we're talking about an average age of about 51 or something like that right men let's take the same period of of life for men okay 50s do they start to experience like a decrease in testosterone around yeah but it's more gradual and it starts frankly in your 20s and 30s um so so male testosterone probably peaks in the 20s and it's just a slow steady decline it's not um it's not like in the case of women where they you know they go through puberty they have these hormones that are cyclical and then fall off a cliff with men it sort of you go through puberty you kind of peak and then you're on a slow uh decline down so um you're right low te is really a combination of levels and symptoms and it's really important to remember that symptoms matter because levels are really well how can I put it delicately I mean just not as helpful as we'd like to believe they are
It should be a combination of symptoms as well as uh blood values. But often times too, the blood values should be superseded by symptoms in some cases too.