Dr. Conner,
I went to my doctor so he could check my testosterone level. His nurse took blood and the results came back at 400. He said this is normal but I don’t think that is right. Is a saliva test more accurate?
Tim
To answer the question, yes. A saliva test is much more accurate than blood for testing all your hormones because it gives the level of active hormone. There’s really no accurate way to determine what your active hormone saliva level would be based on that blood total testosterone level.
When testing hormones in the blood, the blood taken will be blood from your vein. This is the blood that has already gone through the body, “dropped off” the hormones that the tissues need, and is returning to the heart to be pumped back through the body. So, when one collects this blood, it has already given up a certain percentage of its carried hormones. Are the tissues saturated? Are the receptor sites blocked? Is there resistance to dispersion along the way? There is no way to answer these questions when testing blood.
Also, our bodies have a system of checks and balances in regards to these hormones. Our liver makes what is called sex hormone binding globulin, or SHBG. This is a protein that attaches to your hormones, making them unusable to the body. Under certain situations, you will produce more SHBG that will bind-up your hormones. Also, certain situations call for a lowering of SHBG. Testing total blood testosterone does not factor in your SHBG. If your SHBG is high, your testosterone level could be at the high end of normal and you’ll have symptoms of low testosterone. There is probably a 99% chance that your general family practitioner will have no concept of this and accept total testosterone as your hormone level.
I’ve had many male patients come to me saying their doctor told them their testosterone level is fine and normal. We check their saliva and find it to be low. When you test saliva, you are testing the free and active portion of the hormone. This is the amount of hormone that your body “drops off” into tissue, including the salivary glands. Saliva will not contain, nor will any other tissue in your body, the hormones that are bound to SHBG.
Back to your question, Tim…
The generally accepted “normal” blood testosterone level for a male is between 350-1200ng/dL. So, technically, a level of 400 is normal. Normal for who? Setting aside the inaccuracy of blood, a testosterone level of 400 puts you in the 75-80 year old male range. So great, your normal for your grandfather. This is ridiculous.
Maybe your individual level is supposed to be 800? That would still be considered normal. Maybe you’ll feel great with a level of 1000, that’s still considered normal and would be two and a half times your level now. I have no issue with supplementing your hormone level, bringing it up, still within the normal range, and seeing how you feel.
My opinion on your issue is to purchase your own saliva test. I sell them on the website or you can get one another way. Take your saliva testosterone level and see for yourself. Again, there is a range of normal but being in the normal range doesn’t necessarily mean that particular level is normal for you. Supplementing any hormone while keeping the patient in the normal range is not bad medicine.
If you feel you need testosterone therapy, I’d be happy to help you in that area. If you purchased the test from me, we can use those results for six months before we have to check them again.
My testosterone is 194. My doc tells me that is good. He gives me a shot once a month for replacement therapy but after about 2 weeks I feel bad again. He said it’s better to have the ups and downs of dosing this way. Am I right not to agree with him.
Hi Dr. Conner,
I am finding that I myself am in the same position. I went to the doctors two weeks ago for a physical and blood panel to find out that in my early 20’s I have a total testosterone count in the low 400’s. I workout daily and cut out fatty red meats 3 years ago, but nothing seems to help with my energy levels or gaining muscle mass. On top of that, I have had gynecomastia which the doctors just said were normal for my family history.
I spoke with my new physician about the tests, keep in mind I graduated Pre-Med and have a Masters in Biology, and he seemed to know absolutely nothing. All he knew is that because I fell in the lower range he could not/would not prescribe any treatment. I’m finding it quite concerning and discouraging that no one seems to think that my lacking energy levels, insomnia and weight gain, in spite of regular exercise, is a problem. So I was wondering how I would go about obtaining testosterone therapy if my normal family physician is ignoring the issue?