Can lower 'normal' testosterone levels still actually be considered 'low', and treatable?

Question

Dr. Frascino,

I am a 34 y/o HIV+ man who has recently had labs drawn to check my androgen levels, and the results of these tests has me confused. According to these, my free testosterone was 2.45 (sc: 1-2.7) and total testosterone was 290 (sc: 241-827 the low side of normal). I had these drawn due to a longtime battle with chronic fatigue, no libido and significant body composition changes over the past 6 mos. (a +20 lb. bodyfat gain measured by bioelectric impedance), this despite a very healthy diet and active lifestyle with exercise.

My question: is there any research to support the possibility that despite these 'normal 'levels, I might still be experiencing some form of hypogonadism? My doctor attributes these symptoms to normal aging, citing my normal levels of hormone and thus defers androgen therapy, but I don't think "aging" means essentially going from my 30s to what feels and seems more like an old 60. I would appreciate any help or information that you can offer. Thx LS

Answer

Hello L.S.,

Hypogonadism or low testosterone is extremely common in those of us with HIV. True, your level is in the normal range, but just barely. For a happy, healthy, horny 34-year-old, I'd expect you'd be 500+. (And if you were Italian, you should be 800+++.) Your doctor might want to check age-matched controls or perhaps old lab values to see if your testosterone levels are heading south. Would testosterone supplementation help? Probably - especially because your libido is "down," so to speak.

I'm assuming the other causes of fatigue have been thoroughly evaluated. Anemia? Depression? Low thyroid? Medication side effects? Watching Pat Robertson on TV?

Keep up the healthy diet and make sure that "active lifestyle" includes a regular exercise program. Would I personally recommend testosterone supplementation? Sure, I'd give it a try. Hopefully both you and Mr. Happy will get a lift! I'd recommend the gel formulation, AndroGel, for convenience. Under no circumstances would I recommend going directly from your 30s to your 60s. I'm having a wonderful time in my 40s!

Good luck. Write back if supplementation doesn't do the trick.

Dr. Bob