Can hypogonadal symptoms be present even if the testosterone level is in the normal range or above?
Yes, this is possible, for instance, if there is a testosterone receptor defect. This means that there is enough testosterone in the blood but it does not reach its proper site of action. In such cases, administering exogenous testosterone may be ineffective. A complete receptor defect is however a very rare finding. A normal total testosterone level with low levels of the biologically active hormone (free testosterone), is in contrast a very common finding in elderly men. In particular, SHBG levels tend to increase with age so that quite a portion of the testosterone is bound to this protein which prevents the hormone from reaching the receptor. If these or other causes are present, the patient with borderline testosterone levels may benefit from treatment. The doctor may decide together with the patient to prescribe individualized treatment to investigate whether short-term use of testosterone treatment can alleviate the symptoms.
