From the Guidelines
Elevated testosterone levels in males should be evaluated by a healthcare provider promptly to prevent potential complications such as polycythemia, cardiovascular problems, and prostate issues. The normal range for adult males is typically 300-1000 ng/dL, with levels above this considered elevated 1. Treatment depends on the underlying cause, which may include testicular tumors, adrenal disorders, anabolic steroid use, or certain medications. According to a recent study published in the Annals of Internal Medicine, testosterone treatment in men without established conditions that cause permanent testicular or hypothalamic–pituitary dysfunction should be approached with caution 1.
Some key points to consider when evaluating elevated testosterone levels include:
- The potential risks of polycythemia, which can lead to increased blood viscosity and aggravate vascular disease in the coronary, cerebrovascular, or peripheral vascular circulation 1
- The importance of measuring fasting morning concentrations of total testosterone on 2 occasions to diagnose hypogonadism, as recommended by guidelines from the Endocrine Society and American Urological Association 1
- The need for additional tests, including luteinizing hormone (LH), follicle-stimulating hormone (FSH), and imaging studies, to determine the source of the elevated testosterone levels
- The potential treatment options, which may include surgery for tumors, medication adjustments, or specific treatments like ketoconazole (200-400mg twice daily) to reduce testosterone production in certain cases
While waiting for medical evaluation, it is essential to avoid supplements or medications that might further increase testosterone levels. The body normally regulates testosterone through a feedback loop involving the hypothalamus, pituitary gland, and testes, so persistent elevation suggests this regulatory system is being bypassed or overwhelmed, requiring medical intervention to identify and address the specific mechanism causing the elevation 1.
From the Research
Elevated Testosterone Levels in Males
- Very elevated testosterone levels in males can be a result of various factors, including the use of testosterone replacement therapies or aromatase inhibitors 2, 3.
- Aromatase inhibitors, such as anastrozole, work by lowering serum estradiol levels and increasing gonadotropin levels, which in turn increases testosterone levels 2.
- Studies have shown that the use of aromatase inhibitors can sustain therapeutic testosterone levels in hypogonadal men and increase the interval between testosterone pellet insertions 2.
- However, the use of aromatase inhibitors can also have potential cardiovascular risks, particularly in elderly men with low testosterone levels 3, 4.
- It is essential to monitor lipid profiles, inflammatory markers, and insulin sensitivity when using aromatase inhibitors to minimize the risk of cardiovascular disease 3, 5.
Treatment Options
- Testosterone replacement therapies, such as testosterone pellets, can be used to treat hypogonadism in men 2.
- Aromatase inhibitors, such as anastrozole, can be used off-label to treat male hypogonadism by increasing testosterone levels 2, 3.
- Androgen receptor inhibitors can also be used to treat non-metastatic prostate cancer, but their use may increase the risk of cardiovascular disease 4.
Cardiovascular Risks
- The use of aromatase inhibitors can increase the risk of cardiovascular disease, particularly in elderly men with low testosterone levels 3, 4.
- Studies have shown that anastrozole can reduce the risk of thromboembolic events compared to tamoxifen, but its long-term cardiovascular safety profile is still being evaluated 5.
- Letrozole and exemestane, other aromatase inhibitors, have also been shown to reduce the risk of thromboembolic events, but their long-term cardiovascular safety profiles are still being studied 5.