Is Your Testosterone Normal or Optimal? Here's the Difference

In July 2026, Secretary of Defense Pete Hegseth announced that all active-duty service members aged 30 and older would be screened annually for testosterone deficiency as part of routine health assessments. The stated goal was to restore the biological foundation for strength, resilience, and long-term health, rather than waiting until symptoms had advanced into disease.

That decision from the military raises a reasonable question for the rest of us: if it makes sense to proactively screen every service member over 30, should we be doing the same for the general population?

At Valley Vital Medicine in Fargo, ND, the answer is yes. And the conversation around testosterone, what it actually does in the body, why levels are declining across the population, and what genuine optimization looks like, is one Trevor Hausauer, FNP-C, has been having with patients for years.

Why Testosterone Matters Beyond Libido

Most people associate testosterone with sex drive and athletic performance. Those are real effects, but they represent a fraction of what testosterone actually does.

Testosterone supports focus, motivation, confidence, and mood stability. It is directly involved in maintaining lean muscle mass, which in turn supports metabolism and the ability to stay strong and independent as we age. It plays a major role in bone density. Many cases of osteopenia and osteoporosis that get treated with pharmaceutical interventions are actually rooted in hormone deficiency, and replacing those hormones, combined with adequate nutrition, can actively rebuild bone.

Testosterone also has meaningful cardiovascular effects. It supports healthy body composition, helps control blood pressure, and is associated with improved insulin sensitivity. People with low testosterone carry a higher risk of prediabetes and type 2 diabetes. It supports red blood cell production, which means chronically low testosterone can contribute to anemia that goes unresolved. And there is a growing body of research linking testosterone levels to brain health, including a study of over 5,200 older men that found low testosterone was associated with a 48% higher risk of developing Alzheimer's disease. Women carry a disproportionately high risk of Alzheimer's, and research links age-related testosterone decline to worsened cognitive performance in women as well.

Sarcopenia, the gradual loss of muscle mass with age, is directly tied to declining hormone levels. The people who end up frail, unable to care for themselves, and at high risk of falls are overwhelmingly people who have lost the muscle and hormonal foundation that keeps the body strong and functional. Testosterone is a meaningful lever in preventing that outcome.

Testosterone Is Declining Across the Population

This is not just about individual aging. Population-level data show roughly a 50% decline in average testosterone levels over recent decades, along with significant reductions in fertility. This is not explained by age alone.

Chronic stress is a direct suppressor of testosterone production. Poor sleep compounds the problem. Sedentary lifestyle, excess body weight, certain medications, and head injuries all contribute. And then there is toxicity.

BPA, found in plastics, food packaging, beverage can linings, and receipt paper, has been detected in approximately 90% of Americans tested. It binds to androgen receptors and interferes with normal testosterone signaling. Phthalates, found in many personal care products that soften plastics, have similar hormone-disrupting effects. The burden of these environmental exposures is real, measurable, and one of the reasons that lifestyle and supplementation alone often fall short of getting people to optimal levels.

Normal Versus Optimal: Why the Standard Lab Range Misleads

Lab reference ranges are built by taking large volumes of population data and identifying where most results cluster. That creates a range that reflects what is statistically common, not what is biologically optimal.

For men, a total testosterone reference range might run from 350 to 1,200 ng/dL. That range is enormous. A 25-year-old man living a healthy lifestyle might naturally sit at 1,200. Calling 350 acceptable simply because it falls within the range is not the same as calling it healthy or sufficient. Most men feel and function best, and carry lower long-term disease risk, with total testosterone in the range of 900 to 1,100 ng/dL and free testosterone in the low-to-mid 20s range.

Free testosterone matters as much as total testosterone and is rarely measured in conventional settings. Sex hormone binding globulin (SHBG) binds a portion of total testosterone, leaving only the free fraction available to have biological effects. A man with a total testosterone of 700 but high SHBG might have very little free testosterone available. Evaluating only total testosterone misses that entirely.

For women, testosterone is frequently not measured at all until a patient is well into her 40s. Some women presenting with fatigue, anxiety, brain fog, low libido, and difficulty recovering from exercise have testosterone levels that are completely undetectable. One study in which women were given testosterone until their symptoms resolved found the average level at the point of symptom relief was 350 ng/dL, a level that would read as high on most standard female reference ranges. Research has not identified a clear upper safety threshold for testosterone in women, and clinical experience shows that many women feel and function well at levels that exceed conventional reference ranges, without significant adverse effects.

What the Research Actually Shows

For years, testosterone therapy carried a black box warning for cardiovascular risk, a designation based on early, methodologically limited studies. The TRAVERSE trial, published in the New England Journal of Medicine in 2023, was the largest randomized controlled trial of testosterone ever conducted, involving 5,246 men aged 45 to 80. It found that testosterone therapy was not associated with an increased risk of major adverse cardiac events including heart attack, stroke, or cardiovascular death. In April 2025, the FDA removed the cardiovascular risk language from the black box warning on all approved testosterone products, citing the TRAVERSE trial and subsequent evidence reviews.

The Testosterone Trials, a landmark NIH-funded study in men 65 and older, demonstrated improvements in sexual function, mood, walking capacity, bone density, and anemia.

On the question of prostate cancer, emerging research suggests testosterone therapy is not a cause of prostate cancer and may actually be protective when used in men without an existing diagnosis.

For women, the Global Consensus position statement from 11 medical societies confirms there is no signal for increased breast cancer risk when testosterone is used within physiologic dosing ranges.

Lifestyle and Supplements: Useful, but Often Insufficient

There are real things lifestyle and supplementation can do to support testosterone levels. Getting adequate sleep, managing stress, doing regular resistance training, reducing refined carbohydrates and alcohol (particularly beer, which contains estrogen-promoting hops), maintaining a healthy body composition, and reducing BPA and phthalate exposure all have documented effects on hormone production.

Supplements including zinc, vitamin D, ashwagandha, and magnesium have reasonable evidence for modest testosterone support. Other commonly marketed ingredients, including tongkat ali, shilajit, and fenugreek, have less consistent data.

The honest clinical reality is that lifestyle and supplements can produce meaningful improvement, but often fall short of optimal. A man who does everything right over a two to three month period might see his total testosterone rise from 400 to 550. That is an improvement, but it is not optimization, and for most men, it will not fully resolve the symptoms or meaningfully reduce long-term disease risk.

Treatment Options at Valley Vital Medicine

For the right candidate, testosterone therapy produces predictable, meaningful results that supplements and lifestyle cannot consistently replicate.

For men, the primary options are subcutaneous or intramuscular injections (done twice weekly to maintain steady levels rather than the peaks and drops associated with weekly or biweekly dosing), compounded topical testosterone cream applied to the scrotal skin for optimal absorption, or testosterone pellets.

For women, compounded topical cream applied to the labial skin absorbs well and produces excellent results in most cases. Testosterone pellets are also a strong option for women who prefer a less frequent routine.

At Valley Vital Medicine, testosterone pellets are sourced through Evexias, a company with rigorous pharmaceutical standards and a patented pellet compression process that produces consistent, sustained release. Evexias pellets are coated with a light anti-inflammatory compound to reduce scarring risk and improve absorption consistency. The result is a smooth onset, stable levels across the treatment window, and a gradual offset, without the sharp peaks and rapid drops that can occur with lower-quality pellet products. For men, pellets are typically reinserted approximately every five months. For women, the interval is approximately every three months. Both procedures are brief in-office appointments.

Dosing is calculated using the Evexias protocol, which accounts for height, weight, activity level, lab values, health history, and risk factors to project a starting dose that hits close to the target on the first insertion.

What to Expect and When

Within three to six weeks of starting testosterone therapy, most patients begin to notice improvements in mood, energy, libido, and mental clarity. Brain-related benefits tend to come first.

At around three months, sleep quality typically improves, body composition begins to shift, and workout recovery improves.

At six to twelve months, changes in lean muscle mass, fat reduction, cholesterol markers, and measurable bone density gains become more apparent. Sustained risk reduction for the chronic conditions discussed throughout this post builds over time with consistent therapy and monitoring.

Testosterone therapy is a long-term commitment, not a short experiment. Pellet patients are encouraged to complete at least three full rounds before assessing full outcomes.

Who Is and Is Not a Good Candidate

Good candidates typically have documented low or low-normal testosterone with related symptoms, are motivated to combine therapy with lifestyle changes, do not have active hormone-sensitive cancer, and are committed to the monitoring that responsible testosterone therapy requires. Lab work is rechecked at five weeks after a pellet insertion to assess levels and symptom response, and comprehensive panels are recommended annually.

Testosterone therapy warrants a careful, individualized conversation for people with a personal history of breast or prostate cancer, untreated sleep apnea, significantly elevated hematocrit, current efforts to conceive, or pregnancy and breastfeeding.

Potential side effects include increases in red blood cell counts (which require monitoring but are not inherently dangerous in most cases), estrogen conversion in men (manageable with targeted support), mild acne or oily skin, and in some women, minor changes in body hair. These are manageable with appropriate oversight and rarely outweigh the benefits for patients who are good candidates.

Getting Started

If you are a current Valley Vital Medicine patient, this conversation is one Trevor or Kali Boyer, FNP-C, can have with you directly. If you are not yet a patient, the free discovery call with Lori, our certified health coach, is the right first step. She will take the time to understand your history and goals and help determine whether a wellness experience and hormone evaluation makes sense for you.

Call 701-532-1926 or visit www.valleyvitalmedicine.com to schedule your free discovery call and find out where you actually stand.

Medical Disclaimer: The information in this article is for educational purposes only and does not constitute medical advice. Testosterone therapy decisions should be made in partnership with a qualified healthcare provider based on your individual health history, symptoms, and lab work.

References:

1. Lincoff AM, et al. Cardiovascular Safety of Testosterone-Replacement Therapy (TRAVERSE Trial). N Engl J Med. 2023;389:107-117.
2. Androgen Society Position Paper on Cardiovascular Risk with Testosterone Therapy. Mayo Clinic Proceedings. October 2024.
3. FDA. Labeling changes for testosterone replacement therapy products. April 2025.
4. Testosterone Trials Research Group. Effects of testosterone treatment in older men. N Engl J Med. 2016.
5. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019.
6. Cai Z, et al. Low testosterone and risk of Alzheimer's disease in older men: a systematic review. Andrology. 2023.