The Other Sweet Spot
In our last blog, we discussed male estrogen/estradiol levels. I explained how my approach has evolved, how I no longer routinely block estrogen/estradiol in men, the benefits the hormone provides, and the 40ng/dl “sweet spot” that seems to work for so many of my patients.
Over the years, I and many other doctors practicing hormonal and metabolic optimization have found that there is a similar “sweet spot” for male testosterone. This is the serum direct free testosterone range at which energy levels are robust, inflammatory joint and muscle pain are reduced, recovery time between workouts is improved, libido as well as erectile functions feel well-supported, well-executed resistance training programs yield increases in lean body mass, well-planned nutrition plans yield reductions in body fat, and long term health benefits of testosterone are most likely to manifest.
By LabCorp’s scale, the male direct free testosterone “sweet spot” that helps to create the above scenarios is actually a range, and it sits at 25-35 pg/dl (twenty-five to thirty-five picograms per deciliter).
Read those numbers again. 25-35 pg/dl for male direct free T.
These numbers put men into the 100th-130th percentile by LabCorp’s range for men age 20-29. If you’re reading this, I assume you are NOT 20-29? Already, this sweet spot is sounding a bit suspicious. After all, aging means breaking down, getting old, and dying, right? This notion of being at or above the young man’s hundredth percentile at age 50 plus seems…..unnatural?
I understand. But keep in mind two important points. Point One: testosterone levels for almost all men have dropped 25-30 percent over the past 50 years, likely as the result of the unavoidable chemical endocrine disruptors we’ve placed into our environment. Once we factor this not-so- minor catastrophe into the equation, 25-35 pg/dl starts to make a bit more sense, doesn’t it? The second point: while I can’t read your mind, I’ve been doing this long enough to know that if you are interested in BHRT, you want something more for yourself than what you see happening to other men your age, and in exchange, you are willing to assume greater agency and personal responsibility. Therefore, the “normal” range has less relevance.
The science of bioidentical hormone replacement therapy (BHRT) is relatively new, so I constantly scour medical and allied scientific literature for the pros and cons of treatment as well as for ways I can adjust my approach to safely maximize vitality and longevity for my patients. Whether probing the internet for relevant content or attending BHRT lectures, I try to maintain a degree of skepticism without allowing it to freeze me in place. It’s a tricky balancing act, but every rapidly evolving branch of medicine demands it. “First, do no harm” cuts both ways. These words, wise as they are, were written before the eras of scientific methodology and information sharing. Today’s world is different, and in many ways, much more challenging. Nowhere is this more evident than in anti-aging and vitality medicine. Once one knows the possibilities hormonal and metabolic optimization have to offer, from preventing disease and disability to extending vibrant athleticism into old age, the comfortable fallback of doing nothing becomes inexcusable. Besides, men and women coming to us have already decided against inaction.
For the sake of questing, thoughtful inquiry and providing the best possible patient care, my next blog will examine the downsides of the direct free T sweet spot. Spoiler alert: there don’t seem to be many! In the meantime, for those of you interested in reading some of the literature supporting male testosterone optimization, I recommend:
“Sex, Energy, Well-Being, and Low Testosterone: An Exploratory Survey of U.S. Men’s Experiences on Prescription Testosterone” by Straftis and Gray
“The Anti-inflammatory Effects of Testosterone” by V. E. Bianchi
“Percent body fat negatively correlated with testosterone levels in males” by Hailu Ma and Juan Sun
All three can be accessed online by title and/or by author.