There’s a lot of noise about testosterone right now. Social media is full of checklists, quizzes, and “Low T” warnings that promise answers in a few taps. But as Dr Dave, GP and men’s health expert at Numan, explains, the reality is far more nuanced than an online score.
“I think it’s fair to have some level of cynicism towards online questionnaires,” he says. “The symptoms are relatively vague, and you may score highly in the symptoms but have normal levels of testosterone. So the questionnaires are just an indicator or a pointer to encourage people to get a blood test.”
In other words, a quiz might nudge you in the right direction, but it shouldn’t be the thing that decides whether you start testosterone replacement therapy (TRT).
The problem with chasing a number
When someone comes in convinced they have low testosterone, Dr Dave’s first move isn’t to look at a lab report.
“The main symptoms I’m looking for are sexual dysfunction,” he explains. “A lack of morning erections, but also erectile dysfunction and lack of libido. Those would be the main symptoms.”
There are other signs too, but they’re less specific. “There are some general symptoms of fatigue and motivation and mood changes, but those are harder to specify as being testosterone-related,” he says.
This is where the idea of a “testosterone threshold” gets complicated, as it starts being less about a certain level and more about how that number fits with someone’s symptoms and quality of life.
Why blood tests are only half the story
“The blood test is within the context of symptoms,” Dr Dave says. “Some clinicians feel the blood test is the only factor that should decide whether people get treated. Others feel it should be symptom-related, and the blood test is just an accompaniment.”
“Personally, I think both are important,” he explains. “At Numan, we want to make sure we’re treating patients effectively and not over-treating.”
That balance has led to a subtle shift in how Numan approaches thresholds. “We’ve increased our threshold for when we will treat testosterone if patients are also struggling with sexual dysfunction symptoms,” he says.
Total vs free testosterone, and why it matters
Understanding testosterone levels requires more than a single number.
“We look at total testosterone and free testosterone,” says Dr Dave. “Some patients will have plenty of testosterone floating around their blood, but it’s bound to other hormones, which means it’s less available for the body to use. So we often look at free testosterone rather than just total testosterone.”
That binding is influenced by other markers. “There’s something called albumin and SHBG (sex hormone-binding globulin) which bind with testosterone and can cause your testosterone levels to be lower,” he explains.
And it isn’t just hormones that matter. “We’re also making sure the symptoms aren’t caused by thyroid issues, anaemia, diabetes, or other conditions,” he adds.
How Numan interprets the testosterone threshold
“Ultimately, we look at numbers,” Dr Dave says. “If somebody has a testosterone level of less than 12 and some symptoms, we would encourage treatment.”
But there’s a grey zone too. “If a patient has borderline low levels and sexual dysfunction symptoms (between 12nmol/l and 15nmol/l), then we have a discussion and will often trial a dose of testosterone to see if they respond.”
This shift came from a common pattern. “We were seeing a lot of men with significant symptoms where their levels were technically within the normal range,” he explains. “There’s some evidence suggesting that some patients can improve with a trial of testosterone.”
Why does the same number not feel the same?
One of the most challenging parts of interpreting testosterone is how differently men respond to the same level.
“You might have two men with the same testosterone result - one might feel fine, and the other might be symptomatic and improve with treatment.” This is why strict cut-offs rarely reflect real life. “It’s a balance between following guidance, of which there isn’t a great deal of strong evidence, and being patient-centred,” he says.
TRT isn’t a shortcut
Dr Dave is clear in his guidance towards anyone expecting TRT to solve everything quickly.
“I try to downplay TRT as something that may improve symptoms in combination with a big lifestyle change,” he says. “I encourage patients to use this as a trigger for getting their life on track, be it diet, exercise, sleep, alcohol, smoking, or stress, all of which are components of a healthy life.”
Often, TRT helps jump-start those changes. “Men tell me that once their levels are back to normal, they finally have the motivation to go to the gym or eat more healthily. It’s definitely a combination of the two.”
Who shouldn’t be on TRT
Not everyone who wants TRT should be on it.
“We often get men pushing for treatment when they don’t fulfil the guidance,” he says. “I usually tell them that TRT doesn’t really work if you have normal levels. It puts them at risk of side effects, and it’s unlikely to improve their symptoms.”
Before anyone starts treatment with Numan, safety comes first. “We make sure the patient is fully aware of the risks, including reduced sperm count and reduced natural testosterone production, and they understand the importance of safe monitoring.”
The myth that needs correcting
What do men get wrong most often about testosterone?
“That it’s a drug purely for vanity, and that this is something to be embarrassed about,” Dr Dave says. “If your testosterone levels are naturally low, that doesn’t make you less of a man. That’s a misconception I’d really like to correct.”
Testing, symptoms, and how you actually feel
For men unsure whether to get tested, Dr Dave’s advice is simple.
“If you have symptoms that are affecting your quality of life, even if they’ve crept up slowly, it is worth having a test to see where you are.”
What happens after that depends on you. “If your levels are normal, fantastic. If they’re low and you want to try lifestyle measures first, that’s completely fine. Or you may decide to start treatment and feel a lot better. All three paths are valid.”
The numan take
If you’re wondering about your testosterone, start with the basics: recognise the symptoms, get a proper blood test, and interpret the results in context, not in isolation. Questionnaires can guide you, but they aren’t a diagnosis. A “normal” number doesn’t always match how you feel. And TRT isn’t a quick fix - it’s part of a bigger health plan.
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