#1

This might be interesting to anyone personally dealing with or wanting to avoid dealing with these problems…Dr Kyle Gillett is a great resource on hormones. He also gets into some details on the finasteride vs. dutasteride question. Oh, and he says TRT does not have to be an irreversible decision…we can choose to do TRT short-term to escape a hormonal / mood / metabolic downward spiral. I found this talk very interesting, and personally useful.

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#2

I like him. Anything in here for women? If so, I’ll listen. If not, I’ll have the husband listen.

THX

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#3

It’s for the men. There is a little bit for the women. Maybe a lot for the woman who wants to help her man…? Dr Gillett is great.

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#4

Loved your self depreciating humor at the opening. You seem like a great guy to spend an afternoon with… outdoors… cooking out… hiking.

Fantastic information… thanks for the shout out on… "you know a significantly older guy with his hair and a prostate of a 20 year old… :grinning:. Only wish Kyle had said something about research on finasteride helping with cholesterol and preventing arthrocleurosis.

Really enjoyed making TRT… which is replacement testosterone in normal range… not a big deal.

Many men (and some women) would benefit from this program.

Excellent program.

With my TRT… finasteride (started at age 33)… tadalafil and of course rapamycin protocols
. . would say I am proof you can slow… fix and prevent the whammies.

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#5

@Agetron Thanks! I WAS thinking of you! It has been a longish road for me on the question of TRT. Your example has been helpful to highlight the positive long-term effects.

And, I am completely open to hanging out if you ever get close to the Asheville NC area.

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#6

I didn’t know that is where you live. What a spectacularly gorgeous area. We almost moved there, but the neighborhood we were buying into looked like it could potentially go bankrupt… fast forward… it did … we dodged that bullet

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#7

It is very nice, thanks. I am in Waynesville in the mountains outside of Asheville. Even prettier but further from city things, if you need that. I don’t so it is just what I need for now.

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#8

Owner of Marek Health and the person that Attia has been consulting with for years.

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#9

Nice episode.

I believe TRT is such a no brainer for men if they are unable to get their total testosterone level above 400 and don’t plan to have any more kids (the fertility thing is a real side effect, though it can be restored in most cases).

All the scaremongering over the years is strictly when you take supra-physiological levels that improve muscle mass. Even then, I know people who have done that for decades and are still kicking, though it’s not pro longevity, nor would I ever suggest it is. The increased red blood cell production has never been linked to any sort of increased risk in the absence of high platelets and genetic clotting factors, among other things.

There are some people who never bothered to look into the subject saying all kinds of nonsense on X about it, unfortunately (I won’t name names but I’m thinking of the guy who discovered NAD, hint hint). They really do this whole topic a great disservice when they can’t stay in their lanes.

I strongly believe TRT is pro longevity IF and only IF it is to fix a testosterone deficiency. It would make absolutely no sense for it to be harmful compared to being hypogonadal, especially given how much data we have on it in the year 2025. Not to mention an enormously large number of anecdotes.

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#10

Based on what evidence? Testosterone is such a loaded word and most people attribute magic properties to it, but if you look at it objectively from an alien 3rd person perspective, what evidence is there?

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#11

We can start with all the evidence of the harms of low testosterone.

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#12

I hope this doesn’t take the attention away from @约瑟夫_拉维尔 ’s episode with Dr. Gillett but this recent optispan episode was pretty insightful.

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#13

There are beneficial effects without negative effects on CVD, treating from testosterone <300 ng/dL, 400 ng/dL total testosterone is not used in the literature.

It’s highly unlikely someone is under <300 ng/dL, so it is not a neglected problem at that level.

Now will someone finds effects outside of treating hypogonadism? Dose-effect curve?

#14

The <400 ng/dl range I mentioned isn’t in the literature but it’s something I’ve observed talking to and looking at a lot of guy’s labs. It seems to be the consensus among most who work closely with this cohort that most guys don’t feel their best below 500 ng/dl. Most people who work closely with this agree that the lab range should not start at >300 ng/dl. If you want to stick to just the literature, then I suppose I can’t make a compelling argument for the low end of the lab range but that’s only because it hasn’t been studied from what I’ve seen.

On a separate note that I think people may find interesting, there are factors that could make the level fluctuate quite a bit before a blood draw though. For instance, I work with a 35 year old guy who showed me a testosterone level of I think 300ish but he had the labs drawn after a bachelor party week where he was essentially on an alcohol bender with very little sleep. He retested a month later after not drinking for a few weeks and sleeping well and the result was just around 500. Acute lifestyle habits can really make it fluctuate, but this isn’t always the case. Because he’s on the younger side, he was able to get it up.

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#15

Evidence > consensus.

500 ng/dl is the 50th percentile.

If we go by what people feel without citing any proper trials, which are confounded and subject to placebo, then we can believe whatever we want basically. There’s anecdotes for everything.

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#16

It has been a popular video topic lately.

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#17

Here is a good explanation of how this lab range was created to begin with. There was no good evidence to even establish this range. Posted by a provider on Reddit.

Why the Testosterone Range Is Flawed (and What It Means for TRT)

If you’ve ever looked at your testosterone labs, you’ve likely seen a reference range like 250–1,000 ng/dL (or something similar). Doctors often use this range to decide if you need treatment, but it’s important to understand where this range comes from—and why it might not be the best way to determine if you’re a candidate for TRT.

# 1. Where Does the Range Come From?

The “normal” testosterone range is based on population averages, not on what’s optimal for health. These numbers are pulled from large groups of men—many of whom are older, overweight, and unhealthy. Over time, as testosterone levels in the general population have declined, so have the “normal” ranges.

*** For example, a man with a Total T of 350 ng/dL in 2023 might be told he’s “in range,” but 30 years ago, the same level might have been considered low.**

# 2. Why the Range Is Misleading

*** Symptoms Don’t Follow the Range: Some men with Total T of 400 ng/dL feel terrible (fatigue, low libido, poor recovery), while others at 300 ng/dL might feel fine. The range doesn’t account for individual variability.**
*** No Age Adjustment: A 25-year-old and a 65-year-old are held to the same reference range. While 350 ng/dL might be “acceptable” for an older man, it’s far from optimal for someone in their 20s or 30s.**
*** Free T Is Ignored: Total T includes both bound (inactive) and Free T (active testosterone). You can have “normal” Total T but still feel symptomatic if your Free T is low.**

# Why It’s Inaccurate for Deciding on TRT

Doctors who rely solely on the reference range often miss the bigger picture:

1. Symptoms Matter More: Low libido, fatigue, brain fog, and poor recovery are clear signs of low testosterone, even if you’re “in range.”
2. What’s Optimal, Not Just Normal: Being in the bottom third of the range (e.g., 300–400 ng/dL) might technically be normal, but it’s far from optimal for energy, strength, and mental clarity.
3. Individual Variability: Some men need levels closer to 800 ng/dL to feel good, while others might thrive at 500 ng/dL. The range doesn’t account for this.

# What to Focus on Instead

If the range isn’t helpful, what should you look at?

*** Free Testosterone: This is the active testosterone your body can actually use. Low Free T often explains why symptoms persist despite “normal” Total T.**
*** Symptoms First: If you have classic low-T symptoms, they should guide treatment decisions more than the numbers alone.**
*** Age and Context: A 30-year-old with Total T of 350 ng/dL likely needs TRT, while it might be more acceptable for someone in their 70s.**

# The Bottom Line

The testosterone range isn’t a gold standard for deciding if you need TRT. It’s based on outdated averages, ignores key markers like Free T, and doesn’t reflect what’s truly optimal for health and quality of life. If you’re symptomatic, advocate for yourself and work with a provider who looks beyond the numbers to treat you, not just your labs.

Thankfully, there are many clinics who specialize in this ignore this range and focus on symptoms when someone falls into the lower end of it.

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#18

There was no evidence provided that 800 ng/dl would be superior to 300 ng/dl or 400 ng/dl, so it’s not true until proven otherwise. There was neither no evidence provided that a specific number was needed for subjective scores.

Anecdotes can’t replace studies.

So I basically repeated what I already said.

#19

I know you’re just going to dispute every point I make but I find it amusing and don’t mind it at all. So for the sake of entertainment, I will keep going:

I think we first need focus on why lab ranges were established to begin with and not just apply them as the gospel until proven otherwise. Therefore, I don’t think the burden of proof is on me to establish why 800 ng/dl is superior to 300 ng/dl (nor is it on you to say the opposite).

Until then, I am going to believe what my eyes (and most professionals) have seen over and over.

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#20

I do wonder if testosterone is becoming the defacto first tool whenever a man is complaining of fatigue, brain fog, depression, anxiety, poor sleep. Most men don’t know what poor recovery means because they’re untrained anyways, or not training at a level that’s relevant. Hopping straight on testosterone without investigation into other possible causes seems ill-advised IMO, especially because testosterone will raise neurotransmitters acutely, which causes people to feel better independent of the higher testosterone. IMO, a psychiatric evaluation and possibly a trial of medications to rule out a pure neurotransmitter deficiency/excess phenotype would be a better course of action. Even libido can be deceiving because it’s possible that it’s due to depression (that is not related to testosterone). I say all this with the caveat that I’m speaking about the people at 400-500 ng/dl. If you’re clearly near or below the reference range, that increases the probability that it’s testosterone related.

Anecdotally, I feel no different at ~450 vs ~1000. I lose libido around 250-300. I also can’t maintain muscle mass on a weight loss phase at 250. It seems ok at 450 and possibly better at 1000. At least, now that I’ve treated the borderline low T, I barely lose muscle on a weight loss phase. Concretely, I’m like 60% muscle, 40% fat per lb (sometimes even worse) once my testosterone tanks on a weight loss phase, at 1000 I’m somewhere in the range of 20% muscle/80% fat or better.

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