Is 52 nmol/L testosterone too high for TRT? What the data says

What did @coach.neek actually say?

The short version: a viewer asked whether a testosterone reading of 52 was high or low, and @coach.neek assumed the unit was nmol/L, then said 52 nmol/L is too high for TRT. He set his personal upper ceiling at "35, 40 at an absolute push" and said he prefers his own levels between 25 and 30 nmol/L. He also framed anything above 35 nmol/L as "sports TRT" rather than therapeutic use.

To his credit, he flagged the missing units immediately. That is genuinely good practice. A reading of 52 ng/dL versus 52 nmol/L are not remotely the same thing, and the fact that he named that problem before answering is more than most TikTok coaches do. He also shared personal side effects from higher levels, including water retention, facial swelling, and elevated blood pressure, which grounds the advice in real physiology rather than just arbitrary numbers.

Does the science back this up?

Partially, yes. Clinical guidelines do support keeping TRT levels within the mid-to-upper normal male reference range, and 52 nmol/L is above most laboratory reference ranges for total testosterone. However, the specific ceilings he names are narrower than what most endocrinology bodies actually recommend.

The Endocrine Society's 2018 clinical practice guidelines (Bhasin et al., 2018, Journal of Clinical Endocrinology and Metabolism) recommend targeting total testosterone levels in the mid-normal range of the reference interval, which most labs place between roughly 10 and 35 nmol/L. The British Society for Sexual Medicine guidelines similarly advise keeping trough levels below 35 nmol/L to reduce risk of erythrocytosis and cardiovascular strain. So his upper ceiling of 35 nmol/L is actually consistent with UK clinical guidance, which matters given the UK hashtag on this video. The "sports TRT" framing for levels above 35 nmol/L is an opinion, not a clinical classification, but it reflects a real pattern in how supraphysiologic dosing is sometimes discussed in harm reduction circles.

What did they get wrong (or right)?

The biggest problem here is the delivery, not the numbers. Telling someone their level is "too high" and to "lower your dose" without knowing the individual's symptoms, haematocrit, SHBG, free testosterone, or comorbidities is incomplete advice at best. Total testosterone alone is a weak standalone marker for dose decisions.

He got the reference range boundary roughly right. The 35 nmol/L ceiling aligns with British clinical guidance. His personal anecdote about side effects at higher levels, specifically blood pressure and water retention, reflects what the literature says about supraphysiologic testosterone and fluid retention (Testosterone and the cardiovascular system: Oskui et al., 2013, Journal of the American Heart Association). What he got wrong, or at least glossed over, is that some individuals with low SHBG may have high total testosterone but normal or even low free testosterone. A blanket "52 is too high, lower your dose" misses that entirely. Free testosterone is where the clinical picture actually lives for many TRT patients.

• Correct: 52 nmol/L exceeds most UK and EU laboratory upper reference limits for total testosterone
• Correct: His 35 nmol/L ceiling matches BSSM trough guidance
• Oversimplified: No mention of SHBG, free testosterone, or symptom correlation
• Incomplete: Dose reduction advice given without any clinical context

What should you actually know?

Total testosterone is one number in a panel, not the whole story. If you are on TRT and your total testosterone reads 52 nmol/L, that may or may not be a problem depending on when the blood was drawn relative to your injection, your SHBG level, your haematocrit, and whether you are actually experiencing symptoms. The number alone does not tell your prescriber what to do.

In the UK, NHS and private TRT clinics typically monitor total testosterone, free testosterone, SHBG, haematocrit, PSA, and blood pressure together. Bhasin et al. (2018) explicitly state that dose adjustments should be based on a combination of serum testosterone levels and clinical response, not serum levels alone. If your level is 52 nmol/L and you feel fine, have normal blood pressure, normal haematocrit, and no androgenic side effects, the clinical calculus is different than if you are symptomatic. A regulated prescriber, not a TikTok coach, is the right person to make that call.

Finally, the "sports TRT" framing he uses is worth naming honestly. Levels above 35 nmol/L are not clinically indicated for hypogonadism treatment under UK guidelines. If someone is deliberately running levels that high, that is a performance enhancement conversation, not a therapeutic one, and it carries real cardiovascular and haematological risks that should be monitored by a clinician.