From the Guidelines
Elevated testosterone levels can be caused by several conditions, including polycystic ovary syndrome (PCOS) in women, congenital adrenal hyperplasia, androgen-secreting tumors, anabolic steroid use, and certain medications, and management depends on the underlying cause, typically involving lifestyle modifications and medical treatments. The most common cause in women is PCOS, which is a form of hyperandrogenic chronic anovulation, characterized by hypersecretion of luteinising hormone, ovarian theca stromal cell hyperactivity, and hypofunction of the follicle stimulating hormone (FSH)–granulosa cell axis, resulting in hyperandrogenism, hirsutism, follicular arrest, and ovarian acyclicity 1.
Some key points to consider in the management of elevated testosterone levels include:
- Weight loss through diet and exercise, which can help reduce testosterone production in women with PCOS
- Combined oral contraceptives, such as ethinyl estradiol with drospirenone or cyproterone acetate, which can help regulate menstrual cycles and reduce androgen levels
- Anti-androgen medications, such as spironolactone (50-200 mg daily) or finasteride (2.5-5 mg daily), which can help block the effects of testosterone
- Surgical removal of tumors, if present
- Discontinuing offending medications or supplements, if applicable
- Regular monitoring of testosterone levels and related symptoms to assess treatment effectiveness and adjust therapy as needed
It's also important to note that excess body fat can increase testosterone production, while certain medications can directly block testosterone effects or production 1. Early treatment is crucial to prevent long-term complications like infertility, metabolic disorders, and cardiovascular disease.
In terms of diagnosis, guidelines recommend measuring fasting morning concentrations of total testosterone on 2 occasions to diagnose hypogonadism, but vary in their recommendations regarding the threshold at which to categorize a total testosterone level as low 1. The American College of Physicians recommends that clinicians measure fasting morning concentrations of total testosterone on 2 occasions to diagnose hypogonadism, but notes that the level of baseline testosterone that prompts initiation of therapy varies widely 1.
Overall, management of elevated testosterone levels requires a comprehensive approach that takes into account the underlying cause, lifestyle modifications, and medical treatments, with regular monitoring and adjustment of therapy as needed to prevent long-term complications.
From the Research
Causes of Elevated Testosterone
- Congenital adrenal hyperplasia (CAH) is a condition that can lead to elevated testosterone levels, as it affects the production of hormones in the adrenal glands 2, 3, 4, 5.
- Testicular adrenal rest tumors (TARTs) are a common complication in males with CAH, and can produce adrenal-specific steroids, including testosterone 2, 3.
- Human chorionic gonadotropin (hCG)-producing tumors can also lead to elevated testosterone levels, as hCG stimulates the production of testosterone in the testes 6.
- Other factors, such as advanced bone age and higher fludrocortisone dose, may also contribute to elevated testosterone levels in individuals with CAH 2.
Management of Elevated Testosterone
- Glucocorticoid therapy may be used to manage elevated testosterone levels in individuals with CAH, as it can help to reduce the production of androgens 2, 4.
- Testis-sparing surgery may be performed to remove TARTs and reduce testosterone production 3.
- Chemotherapy may be used to treat hCG-producing tumors and reduce testosterone production 6.
- Testosterone replacement therapy may be necessary in some cases, such as in individuals with hypogonadism due to TARTs or other conditions 4.