What causes hyperandrogenism (elevated testosterone levels) in males?

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From the Guidelines

High testosterone in men can be caused by several factors, including certain medical conditions, medications, and lifestyle choices, with the most significant factor being the use of anabolic steroids or testosterone replacement therapy, as evidenced by the substantial increase in testosterone use in the United States 1. When considering the causes of high testosterone in men, it's essential to evaluate the potential risks and benefits associated with testosterone replacement therapy. According to a study published in the New England Journal of Medicine, the risks of testosterone-replacement therapy include potential stimulation of prostate cancer by testosterone 1. Some medical conditions that can lead to elevated testosterone levels include:

  • Congenital adrenal hyperplasia
  • Androgen resistance
  • Testicular or adrenal tumors Medications that may increase testosterone include:
  • Anabolic steroids
  • Testosterone replacement therapy
  • Certain supplements marketed for bodybuilding or sexual enhancement Lifestyle factors that can influence testosterone levels include:
  • Intense resistance training
  • Adequate sleep
  • Maintaining a healthy body weight
  • Consuming sufficient protein and healthy fats
  • Stress reduction Symptoms of high testosterone might include:
  • Excessive body hair growth
  • Acne
  • Increased muscle mass
  • Aggression
  • Mood swings If you suspect high testosterone levels, it's crucial to consult with a healthcare provider who can order appropriate blood tests and determine if treatment is necessary, as recommended by a study published in Gastroenterology 1. Treatment approaches depend on the underlying cause and may include medication adjustments, lifestyle modifications, or addressing any underlying medical conditions, with the goal of maintaining healthy hormone levels and preventing potential complications associated with high testosterone levels 1.

From the Research

Causes of High Testosterone in Men

  • Organic disease involving the hypothalamus, pituitary, or testes may interfere with endogenous testosterone production, leading to high testosterone levels in men 2
  • Congenital adrenal hyperplasia (CAH) can cause elevated secretion of androgens, including testosterone, due to the accumulation of precursors like 17-hydroxypregnenolone and 17-hydroxyprogesterone (17OHP) 3, 4, 5
  • Testicular adrenal rest tumors (TARTs) associated with CAH can produce adrenal-specific steroids, including testosterone, and express adrenal-specific enzymes and ACTH and AII receptors 3, 4, 6
  • High adrenocorticotropic hormone (ACTH) levels (>200 pg/mL) can predict the presence of TARTs and correlate with their volume, as well as influence testosterone levels 6
  • The three-year average of serum testosterone levels can also correlate with the volume of TARTs 6

Underlying Conditions

  • Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency can lead to elevated androgen levels, including testosterone 5
  • Testicular tumors, such as interstitial cell tumors, can produce testosterone and cause high levels in men 3
  • Adrenal rest tumors in the testes can produce adrenal-specific steroids, including testosterone, and contribute to high testosterone levels 4, 6

Hormonal Influences

  • ACTH levels can influence the production of testosterone and the growth of TARTs 6
  • The hypothalamic-pituitary-gonadal axis can be affected by elevated androgen levels, including testosterone, leading to chronic anovulation and infertility 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Androgens in Congenital Adrenal Hyperplasia.

Frontiers of hormone research, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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