Here is some great information on interpretation of hormone results from your labs pertaining to anti-aging and longevity medicine. This information will help you optimize your treatment plan with your doctor so that you will get maximum benefit from your health protocol.
It can be easily determined if you need testosterone replacement or estrogen suppression by utilizing the following guidelines.
Free Testosterone. Free testosterone blood levels should be at the high-normal of the reference range. We define high-normal range as the upper one-third of the reference range. Under no circumstances should free or total testosterone be above the high-end of the normal range.
What can happen is that a standard laboratory “reference range” can deceive a physician into believing that proper hormone balance exists because the results of a free testosterone test fall within the “normal” range. The following charts show a wide range of so-called “normal” ranges of testosterone for men of various ages. While these normal ranges may reflect population “averages,” the objective for most men over age 40 is to be in the upper one-third testosterone range of the 21- to 29 year-old’s. Based on the following reference range chart from LabCorp, this means that optimal free testosterone levels should be between 21-26.5 nanogram/dL in aging men.
Reference Intervals for Free Testosterone from LabCorp
- 20-29 years 9.3-26.5 picogram/mL
- 30-39 years 8.7-25.1 picogram/mL
- 40-49 years 6.8-21.5 picogram/mL
- 50-59 years 7.2-24.0 picogram/mL
- 60+ years 6.6-18.1 picogram/mL
An example of how this chart can be deceptive would be if a 50-year-old man presented symptoms of testosterone deficiency (depression, low energy, abdominal obesity, angina, etc.), but his blood test revealed his free testosterone to be 9 picogram/mL. His doctor might tell him he is fine because he falls within the normal “reference range”. The reality may be that to achieve optimal benefits, testosterone levels should be between 21-26.5 picogram/mL. That means a man could have less than half the amount of testosterone needed to overcome symptoms of a testosterone deficiency, but his doctor will not prescribe testosterone replacement because the man falls within the “average” parameters. That is why it is so important to differentiate between “average” and “optimal.” Average 50-year-old men often have the symptoms of having too little testosterone. Yet so many 50-year-old men have lower than desired testosterone levels, this is considered to be “normal” when it comes to standard laboratory reference ranges.
The reference values for measuring free testosterone from Quest Diagnostics:
Adult Male (20-60+ years): 1.0-2.7% 50-210 pg/mL
Optimal Range: 150-210 pg/mL for aging men without prostate cancer.
From what I have seen clinically, direct testing for free testosterone is the best way to access testosterone activity, as free testosterone is active testosterone and consists of only 1-2% of total testosterone. Total testosterone values should only be used for general testing. Regardless of methods used to determine your free testosterone status, the optimal level in the upper third of normal for a 20-29 year old male.
Estrogen (measured as estradiol) should be in the mid to lower-normal range. If estradiol levels are in the upper one-third of the normal reference range, or above the normal reference range, this excessive level of estrogen should be reduced. For optimal health, estradiol should be in the range of 10-30 picogram/mL for a man of any age.
It is not uncommon for most aging men to have elevated estrogen, but that does not mean it is acceptable for a man to have estrogen that is too low. Estrogen is used by men to maintain bone density, and low estrogen levels may increase the risk for prostate cancer and other diseases like osteoporosis. It is best to achieve hormone balance, not to create excessively high levels of testosterone without enough estrogen. The problem is, if we do nothing, most men will have too much estrogen and not nearly enough testosterone. Testosterone is extremely important for the health of the prostate. We want to do as much to help prevent males from getting prostate cancer as we do to prevent females from getting breast cancer.
Some men have their total testosterone measured. Reference ranges are between 241-827 nanograms/dL for most laboratories. Many older men are below 241. Optimal levels of total testosterone for males are between 500-827 nanograms/dL. If your levels are lower than 500 nanograms/dL or even a little higher and you still have symptoms, you should check your free testosterone. I prefer using the method of testing the total testosterone and sex hormone binding globulin and doing the conversion on a special graph that gives the results of free testosterone. As we have said, free testosterone is the free bioavailable (money in the bank as it were) hormone available for active use by the body.
For other hormone tests, the following are considered to be optimal:
PSA Under 2.6 ng/mL – (optimal range) Standard reference range is up to 4, but if your level is persistently 2.6 or above, have a blood test to measure the percentage of free vs. bound PSA and a digital rectal exam to help rule out prostate cancer. Do not rely on this result alone. Please seek other advice before beginning aggressive treatment on the prostate. There are many effective non-invasive methods in which to treat prostate issues. Please also don’t wait for symptoms to become present before you make choice for the health of your prostate. T here is something that I recommend over and over and that is Wobenzym. It is extremely effective to remove the inflammation that cause prostatitis, inflammation of the prostate gland. This can cause many issues like difficult urinating, getting up several times during the night to urinate, etc. Please contact me or a knowledgeable integrative physician that can help you manage this issue. I am available to help if you have any questions!
DHEA 400-560 mcg/dL – (optimal range) For older men, standard DHEA ranges are very low. It is important for men without prostate cancer to restore them to the youthful range (400-560).
DHT 20-50 nanogram/dL – (optimal range) Reference range is 30-85. DHT is 10 times more androgenic than testosterone and has been implicated in prostate problems and hair loss. This is a result that we monitor for hormone conversion. For example if this is elevated then it is possible that your extra testosterone is converting to another hormone, like estrogen.
Luteinizing hormone (LH) Age 20-70: 1.5-9.3 mIU/mL 70+: 3.1-34.6 mIU/mL (reference ranges) – Under 9.3 mIU/mL- (optimal range) If these levels are high, it is an indication of testicular testosterone production deficiency. LH tells the testes to produce testosterone. I f there is too little testosterone present, the pituitary gland secretes more LH in a futile effort to stimulate the testicles to produce testosterone. Testosterone replacement therapy should suppress excess LH levels. Low LH can also be a sign of estrogen overload, since too much estrogen can suppress LH activity. This could mean using an estrogen blocker like Arimidex or other aromatse inhibitors to help solve a testosterone deficiency problem.
Sex Hormone Binding Globulin (SHBG) – Under 30 nanomoles/L – (optimal range) Reference range is 13-71 nanomole/L. Excessive binding inactivates testosterone.
There are several possible explanations as to why free testosterone levels may be low-normal:
- Too much testosterone is being converted to estradiol by excess aromatase enzyme and/or the liver is failing to adequately detoxify surplus estrogen. Excess aromatase enzyme and/or liver dysfunction is likely the cause if estradiol levels are over 30.
Don’t forget, aromatase converts testosterone into estradiol, which can cause an estrogen overload and subsequently a testosterone deficiency.
Too much free testosterone is being bound up by the SHBG (sex hormone binding globulin). This would be obvious if total testosterone levels were in the high normal range, while free testosterone was below the optimal range.
The pituitary gland may be failing to secrete adequate amounts of luteinizing hormone (LH) to stimulate testicular production of testosterone. Total testosterone in manner would be in the bottom one-third to one-half range. (If we were looking at results from LabCorp’s ranges, the results would be below 241-500 ng/dL.)
The testes have lost their ability to produce testosterone, despite adequate amounts of the testicular-stimulating luteinizing hormone. Here, LH would be above normal, and total testosterone would in very low normal or below normal ranges.
Inadequate amounts of DHEA are being produced in the body. (DHEA is a precursor hormone to testosterone and estrogen).
I realize that is a tremendous amount of information in relation to hormones. My whole purpose for including this information here is so that you are armed with enough information to make an educated choice in regards to your health and health care. There are so many issues that can easily be corrected with proper hormone supplementation.
If you are a male or female experiencing any symptoms related to hormone imbalances, please don’t hesitate to contact me. This symptoms can range from hot flashes, night sweats, anxiety, decreased sex drive, erectile dysfunction, cardiovascular disease…the list goes on and on. We are here for you!!