Total Testosterone

Main male sex hormone

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Sex Hormones (Male)Category

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Reference Range

bone density

What is Total Testosterone?

Total testosterone measures the combined amount of free (unbound) and protein-bound testosterone in your blood. Testosterone is the primary male sex hormone, but it's critically important for both men and women. In men, it's produced primarily in the testes, while women produce smaller amounts in the ovaries and adrenal glands. Testosterone is essential for muscle mass, bone density, libido, energy, mood, cognitive function, and metabolic health.

Here's what many people don't understand:testosterone levels naturally decline with age—about 1-2% per year after age 30 in men. This gradual decline contributes to sarcopenia (muscle loss), increased body fat, reduced bone density, lower libido, fatigue, and cognitive decline. However, "age-appropriate"levels are often suboptimal for longevity and quality of life. Many functional medicine practitioners target higher levels within the normal range to optimize healthspan.

Total testosterone includes both free testosterone (2-3% of total, biologically active) and bound testosterone (bound to SHBG and albumin, less active). If total testosterone is low-normal but SHBG is high, free testosterone may be inadequate. This is why checking free testosterone or calculating the free androgen index is important alongside total testosterone.

Why Total Testosterone Matters for Longevity

Muscle mass and strength:Testosterone is THE primary driver of muscle protein synthesis. Low T accelerates age-related muscle loss.
Bone density:Testosterone (converted to estradiol in men) maintains bone mineral density. Low T increases fracture risk.
Metabolic health:Low testosterone is strongly associated with insulin resistance, type 2 diabetes, visceral fat accumulation, metabolic syndrome.
Cardiovascular health:Contrary to old beliefs, physiologic testosterone levels are protective. Low T increases CVD risk in men.
Cognitive function:Testosterone supports memory, spatial ability, and may protect against cognitive decline and Alzheimer's.
Quality of life:Libido, energy, motivation, mood, and sense of well-being are all testosterone-dependent.

Optimal vs Standard Ranges

Range Type	Level	Significance
Optimal (Men)	500-900 ng/dL	Optimal range for men. Higher end associated with better muscle mass, energy, libido. Functional medicine often targets 600-800 ng/dL.
Optimal (Women)	30-70 ng/dL	Optimal range for women. Too low causes fatigue, low libido, muscle loss. Too high can cause virilization (facial hair, acne, voice changes).
Low (Men)	<300 ng/dL	Hypogonadism in men. Requires treatment with testosterone replacement therapy (TRT). Causes fatigue, low libido, muscle loss, depression.
Low (Women)	<15 ng/dL	Low testosterone in women. Causes fatigue, low libido, difficulty building muscle. Consider DHEA supplementation or low-dose testosterone.

Standard lab range: bone density

How to Optimize Total Testosterone

1. High (Men)

>1000 ng/dL

2. Supraphysiologic levels. May indicate exogenous testosterone use or testicular/adrenal tumor. Increases hematocrit (blood thickness), cardiovascular risk.

High (Women)

3. >100 ng/dL

High testosterone in women. May indicate PCOS, adrenal hyperplasia, or tumor. Causes acne, hirsutism, irregular periods, infertility.

4. Testosterone Replacement Therapy (TRT) for Low T in Men

Testosterone cypionate or enanthate injections:100-200 mg every 7-10 days (most effective). Maintains stable levels.

Testosterone cream/gel:Daily application to shoulders/upper arms. Convenient but variable absorption. Risk of transfer to partners/children.

Testosterone pellets:Implanted subcutaneously every 3-6 months. Stable levels but requires minor surgery.

Goal:Bring total T to 600-900 ng/dL, free T to upper-normal range, and resolve symptoms. Monitor hematocrit, PSA, estradiol.

5. Lifestyle Optimization (Men and Women)

Resistance training:THE most powerful natural testosterone booster. Heavy compound lifts (squats, deadlifts, bench press) 3-4x/week.

Adequate sleep:7-9 hours nightly. Sleep deprivation drops testosterone by 10-15%.

Maintain healthy body fat:Obesity suppresses testosterone (fat tissue converts T to estrogen via aromatase). Target <20% body fat for men, <30% for women.

Reduce stress:Chronic stress elevates cortisol, which suppresses testosterone production.

Optimize micronutrients:Zinc (15-30 mg/day), magnesium (400 mg/day), vitamin D (>40 ng/mL) are critical cofactors for testosterone synthesis.

Symptoms of Abnormal Total Testosterone

Low Total Testosterone

Address Underlying Causes of Low T

High Total Testosterone

For Women:Address PCOS or Adrenal Issues if T is High

Causes of Abnormal Total Testosterone

Low Levels

Supplement Support (Evidence is Moderate)

High Levels

Zinc (if deficient):15-30 mg/day. Zinc deficiency suppresses testosterone.
Vitamin D:Optimize to >40 ng/mL. Vitamin D receptors are present in testes.
Ashwagandha:300-600 mg/day may increase T by 10-15% in stressed men.
Creatine:5 g/day may modestly support T levels via improved training performance.
Fenugreek, Tongkat Ali, Tribulus:Modest evidence;effects are small.

When to Retest

Fatigue, low energy despite adequate sleep
Decreased libido, erectile dysfunction (men)
Loss of muscle mass, difficulty building muscle
Increased body fat, especially abdominal
Reduced bone density, increased fracture risk
Depression, low mood, irritability
Cognitive decline, poor concentration
Loss of morning erections (men)
Gynecomastia (breast development in men) due to T→estrogen conversion
Hot flashes (women)
Irregular or absent periods (women)

Scientific Evidence

Low total testosterone in men <300 ng/dL=hypogonadism. In women, <15 ng/dL may cause fatigue and low libido.

Source:High testosterone in men >1000 ng/dL may indicate exogenous use or tumor. In women >100 ng/dL, evaluate for PCOS or adrenal disorder.

Primary hypogonadism (testicular failure):Klinefelter syndrome, chemotherapy, radiation, mumps orchitis, trauma, anabolic steroid abuse (suppresses natural production).|Secondary hypogonadism (pituitary/hypothalamic failure):Pituitary tumor, Kallmann syndrome, chronic opioid use, glucocorticoid excess, obesity.|Aging:Natural 1-2%/year decline after age 30.|Chronic illness:Chronic kidney disease, liver cirrhosis, HIV/AIDS, type 2 diabetes.|Medications:Opioids (most significant), glucocorticoids, ketoconazole, spironolactone, GnRH agonists.|Sleep apnea:Hypoxia suppresses testosterone production.|Obesity:Fat tissue converts testosterone to estrogen via aromatase enzyme.

Exogenous testosterone use (TRT, anabolic steroids).|Testicular tumors:Leydig cell tumors produce excess testosterone.|Adrenal tumors:Androgen-secreting adrenal carcinomas (rare).|PCOS in women:Insulin resistance drives ovarian androgen production.|Congenital adrenal hyperplasia:Enzyme deficiency causes androgen excess.|Ovarian tumors in women:Rare androgen-secreting tumors.

Source:If low T confirmed:Retest along with LH, FSH, prolactin, estradiol to determine if primary vs secondary hypogonadism.|If starting TRT:Retest total and free testosterone, hematocrit, PSA (men >40) after 6-8 weeks, then every 3-6 months.|If optimizing lifestyle:Retest 3-6 months after weight loss, exercise program, sleep improvement.|Routine screening:Consider checking testosterone in men >35 with fatigue, low libido, or difficulty building muscle. Women with similar symptoms may benefit from testing.|Morning collection:Testosterone peaks in the morning (7-10 AM). Always test in the morning for accurate baseline.

Testosterone Decline with Aging

Testosterone declines ~1-2%/year after age 30 in men. By age 70, 30-50% of men have total testosterone <300 ng/dL (hypogonadism range). This decline contributes to sarcopenia, osteoporosis, insulin resistance, and cognitive decline. Testosterone replacement can reverse many age-related changes.

Source:Travison TG, et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab. 2007;92(1):196-202.

Low Testosterone and Mortality

Multiple studies show low testosterone (<300 ng/dL) is associated with 35-40% increased all-cause mortality in men, independent of age and comorbidities. Low T is linked to increased cardiovascular disease, diabetes, and frailty.

Source:Shores MM, et al. Low serum testosterone and mortality in male veterans. Arch Intern Med. 2006;166(15):1660-1665.

Testosterone Replacement and Cardiovascular Safety

Recent large trials (TRAVERSE, 2023) show testosterone replacement in hypogonadal men does NOT increase cardiovascular events and may be protective when levels are optimized to physiologic range (400-800 ng/dL). Supraphysiologic doses (>1000 ng/dL) may increase risk.

Source:Lincoff AM, et al. Cardiovascular safety of testosterone-replacement therapy. N Engl J Med. 2023;389(2):107-117.

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Superpower	✓	$199	100+ (150 with ratios)
WHOOP Advanced Labs	—	$349	65
Labcorp OnDemand	—	$398	30+
Life Extension	✓	$486	40+
Everlywell	✓	$468	83
Mito Health	✓	$349	100+
InsideTracker	✓	$680	54
Function Health	✓	$365	100+
Marek Health Base	—	$250	65
Marek Health Comprehensive	✓	$495	70+
Marek Health Complete	✓	$895	100+
Marek Health Executive	✓	$1950	150+
Blueprint	—	$399	100+
Quest Health	—	$Varies	75+
Empirical Health	—	$190	100+
Oura Health Panels	—	$99	50
SiPhox Health	✓	$125	60
Hims Labs Base	✓	$199	50
Hims Labs Advanced	✓	$499	120+
Healthspan	✓	$4188	80+
Vitality Blueprint Standard	✓	$375	85
Vitality Blueprint Elite	✓	$700	129