A recent thread, which I replied in, had me thinking about ‘normal’ variations in T levels. Rather than sidetrack that thread, I thought I’d start a new one. So I’m going to try to succinctly go though my thought process and ask a lot questions along the way. (I’m hoping the questions give more of an idea of my thoughts than an expectation of getting answers to all of them.)
A number people are most likely reading this forum and wondering if they should start TRT (or even get their T levels checked). I wonder what people’s opinions are of the process by which someone decides whether to start TRT? For many it is very obvious because either their levels are very low, or symptoms are bad. ED and libido and obvious symptoms (although I had the latter for years without going to the doc or even thinking about low T). But what about people in-between? I mean many symptoms could just be short-term stress, or other factors (although some doctors seem to like to use this even when T levels are really low and the symptoms have been going on for years).
Some questions that come to mind;
Is one blood test showing low T enough? How many tests over what sort of time period did you wave before starting TRT? What do you now think is reasonable?
Can a someone’s T levels increase enough (say from 200-300 to 400+) over a period of time to justify them not going on TRT? 400 may be low, but if someone’s symptoms are not too bad should they still seriously consider TRT (or always consider it).
Is TRT so beneficial for long term health and/or quality of life, that someone with levels 350-450 and 30-40 years old start TRT independent of symptoms?
How much below ‘normal’ do doctors with good knowledge of TRT consider administering TRT? Is that totally dependent on the symptoms?
Looking at these data:
http://www.natural-hrt.com/andropause04.html
which are considered the ‘normal’ levels, should everyone below 1 standard deviation get TRT, or be considered for TRT? What about ½ a sd from the mean or median? What is someone is close to the mean and suffering low test symptoms? 1 sd below would be ~15% of the 'normal' population. Or should it be the lowest 10% or 30%? If we look at the population distribution is there a jump from normal to low, or is it normally distributed? I don't know, but I'm not sure looking at the tables and saying 'I'm X sd from the mean, I'd better get TRT' is the best way to go.
In fact, looking at the tables, is there a statistically significant variation with age? The drop in median values from 25-55 on that last table is only 1/2 of the standard deviation. If each age class is truly normally distributed, I'd guess there was a statistically significant decrease. The first study looks more conclusive, but one might be able to argue that there is no decrease with age until about 65 year old.
I’m not a statistician, and I haven’t read the whole trail of articles and sited references. Unfortunately I know enough to know that statistics can be grossly mis-represented. While I presume from the combined knowledge of people here that the age drop is real, the definition of ‘low T’, however is not so obvious. As I eluded to earlier, I guess there is more of a continuum than a sharp definition, so the question remains;
What in you opinion are reasonable criteria for someone to seriously consider TRT, especially if thier T levels are low-normal?
What are reasonable criteria for TRT? 
Linear Mode
