Dr. Abraham Morgentaler

The reference ranges for laboratory tests for testosterone, for example, I mentioned earlier they're useless. They're useless because they all differ, their reference ranges, and they're not based on clinical symptoms. So there's been an effort with testosterone to use young, healthy men with no obesity, no medical problems whatsoever, and to say, this is our reference population.

The reference ranges for laboratory tests for testosterone, for example, I mentioned earlier they're useless. They're useless because they all differ, their reference ranges, and they're not based on clinical symptoms. So there's been an effort with testosterone to use young, healthy men with no obesity, no medical problems whatsoever, and to say, this is our reference population.

And then what's funny about that is it is a central tenet of laboratory medicine that if you had, let's say, 100 individuals in your reference population, that the central 95% of them are categorized as normal. That's how labs work. For any blood test you want, with a few exceptions, like where there's targets like cholesterol, PSA.

And then what's funny about that is it is a central tenet of laboratory medicine that if you had, let's say, 100 individuals in your reference population, that the central 95% of them are categorized as normal. That's how labs work. For any blood test you want, with a few exceptions, like where there's targets like cholesterol, PSA.

Otherwise, whatever it is, hemoglobin, hematocrit, liver tests, they have a reference population, and they say that the lowest 2.5% are low, By definition. And the highest 2.5% are high. So if you have a condition where the prevalence is, let's say testosterone, let's say low testosterone, let's say you had a perfect reference population, whatever that is.

Otherwise, whatever it is, hemoglobin, hematocrit, liver tests, they have a reference population, and they say that the lowest 2.5% are low, By definition. And the highest 2.5% are high. So if you have a condition where the prevalence is, let's say testosterone, let's say low testosterone, let's say you had a perfect reference population, whatever that is.

It would be fine if the lowest 2.5% of the population had that condition, if the prevalence was 2.5%. But what if the percentage is 5% or 10%, but only the lowest 2.5% are getting categorized as abnormally low? It means that you're missing and miscategorizing in the 10% prevalence, which I think is a conservative number for adult men.

It would be fine if the lowest 2.5% of the population had that condition, if the prevalence was 2.5%. But what if the percentage is 5% or 10%, but only the lowest 2.5% are getting categorized as abnormally low? It means that you're missing and miscategorizing in the 10% prevalence, which I think is a conservative number for adult men.

You're mischaracterizing 75% of them as normal when they're actually low.

You're mischaracterizing 75% of them as normal when they're actually low.

And so a lot of people don't understand what reference ranges are and how we use them. They're a guide, but they cannot be used as some rigid application of anything. So with women, the data on levels and symptoms have been harder to find correlations with than in men. So I know I have a lot of my colleagues in the testosterone world do treat women with testosterone.

And so a lot of people don't understand what reference ranges are and how we use them. They're a guide, but they cannot be used as some rigid application of anything. So with women, the data on levels and symptoms have been harder to find correlations with than in men. So I know I have a lot of my colleagues in the testosterone world do treat women with testosterone.

And they won't base it generally on a level. They say, well, we just base it on symptoms. And that's not necessarily wrong. But the world of, and those, I'm not an endocrinologist, but maybe I play one on TV. But I'm a frustrated one.

And they won't base it generally on a level. They say, well, we just base it on symptoms. And that's not necessarily wrong. But the world of, and those, I'm not an endocrinologist, but maybe I play one on TV. But I'm a frustrated one.

Thank you. Yeah, my wife is a clinical psychologist, Marianne Brandon is a clinical psychologist and sex therapist. We met at a sex therapy conference where I was lecturing. And so we have a lot to talk about. And so we talk about that in our show, The Sex Doctors. It's fun.

Thank you. Yeah, my wife is a clinical psychologist, Marianne Brandon is a clinical psychologist and sex therapist. We met at a sex therapy conference where I was lecturing. And so we have a lot to talk about. And so we talk about that in our show, The Sex Doctors. It's fun.

Yeah. So I've used, over the course of my career, every available form of testosterone for my patients. I always wanted to know what the story is with them because everybody wants to hear what I have to say about it and I want the experience. And I'm a firm believer that until you actually get some clinical experience with something, it's hard to know what's real and what isn't real.

Yeah. So I've used, over the course of my career, every available form of testosterone for my patients. I always wanted to know what the story is with them because everybody wants to hear what I have to say about it and I want the experience. And I'm a firm believer that until you actually get some clinical experience with something, it's hard to know what's real and what isn't real.

In terms of, all of these products work. If we can raise testosterone in men to adequate levels, they respond. And it doesn't matter whether they got it through a pill or an injection or a pellet or a cream. And the beauty of the orals is that most men are used to taking medicines by mouth. So the orals have been a great advance. That's just the last few years. We have three of them.

In terms of, all of these products work. If we can raise testosterone in men to adequate levels, they respond. And it doesn't matter whether they got it through a pill or an injection or a pellet or a cream. And the beauty of the orals is that most men are used to taking medicines by mouth. So the orals have been a great advance. That's just the last few years. We have three of them.