My total testosterone is 750 ng/dl and my free testosterone is 22 pg/ml on a reference range of 8-25 pg/ml. Even though my numbers are considered optimal my sex drive and motivation are still low. I definitely don’t feel like I have high testosterone levels! Please advise 

Being in the reference range even the high end of the reference range doesn’t always signify optimal testosterone levels. This is why legitimate hormone optimization experts focus on symptoms rather than waste time chasing numbers. At the end of the day it doesn’t matter if you’re levels appear ideal if you don’t feel optimal. There are several possibilities that could explain why you’re feeling off. 

One, while unlikely unless you’re on an estrogen blocker, your estradiol levels may be too low. Depleted estradiol levels often lead to a dramatic decline in sex drive as well as function. If your estrogen levels are too low you won’t be able to get an erection if your life depended on it regardless of what your testosterone levels are and let’s face it not being able to get an erection is very depressing. No man feels great with a low sex drive and poor function! While estrogen levels being too low is definitely problematic, it’s rare and men with excessive estrogen levels are certainly more common. This is visibly evident by how many overweight men you see these days who store body fat like overweight women in the chest, glutes, and legs. Many overweight couples look like twins but that is a story for another day. In addition to the physical attributes of excessive estrogen levels, if levels are too high you may find yourself being overly emotional and crying while watching commercials. This may explain why some men become highly emotional after several drinks as alcohol rapidly converts testosterone to estrogen in men but I digress. The mistake many make is viewing testosterone as a male hormone and estrogen as a female hormone. Both genders produce both hormones and both testosterone and estrogen are very important for men and women.  The notion that men should get testosterone as high as possible and estrogen as low as possible is antiquated and perilous. You need both in the optimal ranges to feel your best. Ideal estrogen levels are not only important for sex drive and function but also for growth hormone production, bone health, joint health, brain health, and mood. Thus, make sure to have your estradiol levels checked to ensure they are not too high or too low. 

Two, hormone optimization encompasses much more than just ideal testosterone levels as testosterone is one of many crucial hormones that must be dialed in for the most desired outcome. if you have been on TRT (testosterone replacement therapy) for several months make sure to check your DHEA and Pregnenolone levels. Top hormone optimization expert Dr. Mark Gordon states that just taking TRT alone for too long will down-regulate both upstream hormones DHEA and Pregnenolone. This is why many feel great on TRT for the first several months and then have a big drop off in the benefits. If you’re going to go on TRT make sure to supplement DHEA and Pregnenolone as well for maximum advantage. Also, make sure to check your thyroid hormone levels. If you have any thyroid issues you’re definitely not going to get the most out of having ideal testosterone levels as thyroid hormone production is crucial for real energy production, unlike the fake energy that caffeine provides. 

Three, you may need to be at a much higher testosterone level to feel your best.  This is especially true if you’re on TRT according to expert Dr. Keith Nichols. Dr. Nichols conveys that being at a testosterone level of 800 ng/dl on TRT is not the same as producing a testosterone level of 800 ng/dl naturally. He states that many men need to be at 1200 ng/dl or higher on TRT to actualize the same benefits. Therefore, if you’re on TRT talk to your doctor about increasing your dosage as an experiment to see if that leads to improvements. As a side note, one of the benefits of my testosterone booster ASTB is that it ramps up your own production of testosterone as well as the important neurohormone dopamine which plays a big role in sex drive and motivation in general. I have several customers who take ASTB with TRT to keep their natural production firing while they enjoy the benefits of a large augmentation in testosterone via TRT. The higher you keep your own production the lower the dosage of TRT you require which is another big plus. 

Finally, you didn’t state your age but some experts believe that as men get older they become more desensitized to testosterone. This makes sense when you think about it. When you’re 18 you have only been producing testosterone at a high level for a few years so it will feel like taking a drug for the first time. It is new and novel and an exciting feeling. However, with regular use over many years, you become desensitized and need more to induce the same feeling. Testosterone could be the same way. It may even in fact turn out that contrary to mainstream advice, men need higher testosterone levels as they age to feel the same vitality they felt in their youth. Unfortunately, the opposite happens with aging. Instead of just maintaining testosterone levels from your youth as you age, they decline and for some, it is a rapid decline for a variety of reasons such as excessive stress, exposure to environmental toxins, and an unhealthy lifestyle just to name a few major factors. Declining levels may turn out to be even more perilous than we realize if we need higher levels as we age to be our best selves for as long as possible. At the very least men should take measures to counter the decline in testosterone such as using ASTB and when needed TRT. 

In conclusion, it doesn’t matter what the reference range states. Many men get overly fixated on what their testosterone levels are. I have had some customers take ASTB and get excited about having blood work completed. They feel amazing and can’t wait to see where their levels are only to be disappointed when the results come back at a 580 ng/dl total testosterone and a 105 pg/ml free testosterone (Quest Diagnostics scale of 55-155 pg/ml). Testosterone levels are kind of like the new bench press, men can’t wait to be asked how much they can bench so they can proudly exclaim their number. What really matters is how you feel. If you have what many consider to be optimal testosterone levels but you’re not experiencing the many benefits of having optimal testosterone levels then you need to explore all the factors I mentioned and get back to your best self. On the other hand, if you have levels that are considered modest and mid-range but you feel fantastic then so what? Enjoy the benefits.