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JU INSIGHT: What Is a Normal Testosterone Level for Young Men? Rethinking the 300 ng/dL Cutoff for Testosterone Deficiency in Men 20-44 Years Old
By: Alex Zhu, DO; Juan Andino, MD, MBA; Stephanie Daignault-Newton, MS; Zoey Chopra, BA; Aruna Sarma, PhD; James M. Dupree, MD, MPH | Posted on: 01 Dec 2022
Zhu A, Andino J, Daignault-Newton S, Chopra Z, Sarma A, Dupree JM. What is a normal testosterone level for young men? Rethinking the 300 ng/dL cutoff for testosterone deficiency in men 20-44 years old. J Urol. 2022;208(6):1295-1302.
Study Need and Importance
Testosterone reference ranges for older men are long established in the urological literature. However, few studies have examined testosterone levels in young men. As a result, clinicians have struggled to counsel and evaluate young men presenting with concerns about testosterone deficiency. Contributing to this struggle is the fact that testosterone levels decline with age, yet we use the same age-independent cutoffs to evaluate young men for testosterone deficiency as we do for older men. In response, we performed the first study evaluating population-based testosterone levels for younger men in the United States. We also used the 2018 American Urological Association guideline for testosterone deficiency definition of a “normal testosterone” as the middle tertile of the population, to provide age-specific cutoffs for low testosterone levels in younger men.
What We Found
The mean total testosterone of men 20-44 years old was 466 ng/dL. Middle tertile, “normal” testosterone levels were 409-558 ng/dL (20-24 years old), 413-575 ng/dL (25-29 years old), 359-498 ng/dL (30-34 years old), 352-478 ng/dL (35-39 years old), and 350-473 ng/dL (40-44 years old). Age-specific cutoffs for low testosterone levels were 409, 413, 359, 352, and 350 ng/dL, respectively (see Figure).
Limitations
Our age-specific cutoffs for testosterone are modeled on the AUA guideline definition that a normal testosterone level is within the middle tertile. However, no randomized controlled trials have been performed to select the middle tertile as a cutoff value. Additionally, our study is limited by some shortcomings of the National Health and Nutrition Examination Survey database. Namely, the National Health and Nutrition Examination Survey does not specifically query men for hypogonadal signs and symptoms, and only 1 serum testosterone value was obtained from each subject.
Interpretation for Patient Care
Clinicians should integrate age-specific cutoffs into the evaluation of younger men presenting with testosterone deficiency. Age-specific cutoffs will be useful in evaluating younger patients with hypogonadal symptoms who have historically been disqualified from treatment based on age-independent cutoffs.
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