From the Guidelines
If a patient has taken too much testosterone, immediate medical attention is necessary to prevent serious complications such as cardiovascular problems, liver damage, and polycythemia. Treatment involves discontinuing testosterone administration and providing supportive care based on symptoms. For mild cases, monitoring vital signs and hydration may be sufficient. More severe cases may require medications to address specific symptoms: beta-blockers like propranolol for tachycardia or hypertension, diuretics such as furosemide for fluid retention, and anticoagulants like enoxaparin if there's concern for thrombosis 1. Laboratory tests should be performed to assess testosterone levels, complete blood count, liver function, and lipid profile. Long-term management includes gradually tapering testosterone if it's being used therapeutically, rather than stopping abruptly. The approach to treatment depends on whether the overdose was acute or represents chronic excessive use, with the goal of safely returning hormone levels to normal range while preventing withdrawal symptoms. Key considerations in management include the potential for cardiovascular events, as noted in guidelines that suggest delaying testosterone therapy for three to six months after a cardiovascular event 1. Given the low-certainty evidence regarding the benefits and harms of testosterone treatment, as discussed in the American College of Physicians guideline 1, a cautious approach to management is warranted, prioritizing the prevention of morbidity, mortality, and preservation of quality of life. Some important points to consider in the management of testosterone overdose include:
- Discontinuation of testosterone administration
- Supportive care based on symptoms
- Monitoring for potential complications such as cardiovascular problems and polycythemia
- Gradual tapering of testosterone in therapeutic use
- Consideration of the patient's history of cardiovascular events in management decisions 1.
From the FDA Drug Label
10 OVERDOSAGE There were no reports of overdose in the testosterone gel clinical trials. There is a single report in the literature of acute overdosage after injection of testosterone enanthate. This subject had serum testosterone concentrations of up to 11,400 ng/dL, which were implicated in a cerebrovascular accident. Treatment of overdosage would consist of discontinuation of testosterone gel, washing the application site with soap and water, and appropriate symptomatic and supportive care.
- Discontinuation of testosterone is the first step in managing an overdose.
- The patient should wash the application site with soap and water.
- Symptomatic and supportive care should be provided as needed. 2
From the Research
Management of Testosterone Overdose
- There is limited information available on the specific management of patients who have taken too much testosterone 3.
- However, it is known that the chronic use of high doses of anabolic androgenic steroids (AAS) is associated with adverse effects in several organ systems, including cardiovascular, metabolic, endocrine, neurological, psychiatric, and liver disorders 3, 4.
- Healthcare professionals play a crucial role in combating the public health problem of androgen abuse and should be aware of the potential risks and consequences of testosterone overdose 3, 4.
Adverse Effects of Testosterone Overdose
- The adverse effects of testosterone overdose can be severe and potentially life-threatening, including cardiovascular diseases, metabolic disorders, and liver damage 3, 5, 6.
- Testosterone replacement therapy has been linked to an increased risk of cardiovascular disease, although the evidence is not conclusive 5, 6.
- The use of high doses of AAS has also been associated with an increased risk of thromboembolic events 7.
Approach to Patients with Testosterone Overdose
- Physicians should be aware of the potential risks and consequences of testosterone overdose and take a proactive approach to managing patients who have taken too much testosterone 3, 4.
- This may involve monitoring for adverse effects, providing guidance on safe use, and addressing any underlying issues that may have contributed to the overdose 3, 4.
- Further research is needed to fully understand the effects of testosterone overdose and to develop evidence-based guidelines for management 3, 5, 6, 7.