Elevated Testosterone Levels in Men
Causes of Elevated Testosterone
- The American College of Physicians recommends considering anabolic steroid use, testosterone replacement therapy, congenital adrenal hyperplasia, and rare testicular tumors as potential causes of elevated testosterone levels in men, with excessive dosing or improper monitoring during testosterone replacement therapy leading to elevated levels 1
- Congenital adrenal hyperplasia, a group of inherited disorders affecting the adrenal glands, can cause increased androgen production, including elevated testosterone levels 2
Diagnosis and Evaluation
- The Endocrine Society suggests confirming elevated testosterone levels with accurate testing, including morning total testosterone levels measured using reliable assays, and repeat testing to account for natural fluctuations, with additional testing for free testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) to determine the cause 1
- When evaluating high testosterone, it is essential to rule out laboratory error, review medications, evaluate for medical conditions, and assess the timing of the sample, with the highest testosterone levels typically occurring in the morning 1
Complications and Risks
- The American Heart Association notes that exogenous testosterone can cause erythrocytosis, one of the most common complications, particularly with injectable testosterone, as well as potential cardiovascular effects, although evidence is mixed regarding endogenous high testosterone and cardiovascular risk 1
- Exogenous testosterone can also suppress the hypothalamic-pituitary-testicular axis, leading to testicular atrophy and infertility, with suppression of spermatogenesis 1
Treatment and Management
- The American Urological Association recommends treating the underlying cause of elevated testosterone, addressing any medical conditions, and adjusting medication dosing as needed, with monitoring for complications, including hematocrit, liver function, and lipid profile 1
- It is crucial to avoid misinterpreting single measurements, overlooking medication use, ignoring laboratory variability, and focusing only on total testosterone, as free testosterone levels may provide additional diagnostic information 1