From the Guidelines
Elevated testosterone levels in males can be caused by various conditions, including testicular tumors, adrenal disorders, anabolic steroid use, and genetic conditions, and management depends on the underlying cause. The most common causes of elevated testosterone levels in males include testicular tumors, adrenal disorders, anabolic steroid use, and certain genetic conditions like congenital adrenal hyperplasia 1. Management of elevated testosterone levels typically involves treating the primary condition, and may include surgical removal of testicular tumors, medications like ketoconazole (200-400mg twice daily) or mitotane to reduce hormone production in adrenal disorders, and discontinuation of anabolic steroids 1. Genetic conditions often require lifelong hormone replacement therapy to balance levels, and symptomatic treatment may include anti-androgens such as spironolactone (50-200mg daily) or finasteride (5mg daily) to block testosterone's effects 1. Regular monitoring of hormone levels through blood tests is crucial during treatment, typically every 3-6 months initially, then annually once stabilized, and lifestyle modifications including maintaining healthy weight, regular exercise, and avoiding excessive alcohol can help support treatment 1. It is also important to note that there is no compelling evidence to suggest that testosterone replacement therapy increases the risk of prostate cancer, and proper monitoring with measurement of PSA and digital rectal examination can promote the early diagnosis and potential cure of most "unmasked" prostate cancers identified during testosterone treatment 1. Some key points to consider in the management of elevated testosterone levels include:
- Identifying and treating the underlying cause of elevated testosterone levels
- Monitoring hormone levels regularly to adjust treatment as needed
- Using anti-androgens or other medications to block the effects of excess testosterone
- Making lifestyle modifications to support treatment and overall health
- Being aware of the potential risks and benefits of testosterone replacement therapy, particularly in relation to prostate cancer.
From the Research
Causes of Elevated Testosterone in Males
- Congenital Adrenal Hyperplasia (CAH) is a genetic disease that can cause elevated secretion of androgens, including testosterone, due to a deficiency in 21-hydroxylase 2.
- Testicular adrenal rest tumors (TARTs) are a common finding in male patients with CAH and can produce adrenal-specific steroids, including testosterone 3.
- TARTs can interfere with gonadal function and are a significant cause of infertility in adult male CAH patients 4.
- Elevated androgens levels, including testosterone, can affect the hypothalamic-pituitary-gonadal axis, leading to chronic anovulation and infertility 2.
Management of Elevated Testosterone
- Intensified glucocorticoid treatment is recommended as a first-step treatment for TARTs in stages 2 and 3 4.
- Sparing surgical approach is preferred for tumors of stage 4 and steroid unresponsive masses 4.
- Magnetic resonance imaging is recommended before surgery to assess the size and location of the tumors 4.
- Replacement therapy using a sufficient amount of dexamethasone can help combat TARTs and reduce hyperplastic adrenal nodules and testicular tumors 5.
- Testicular biopsy specimens can be obtained after at least 6 months of evidence of compliance with ACTH suppressive medication and failure of the nodules to regress 6.
Testicular Tumors and CAH
- Testicular tumors are a rare presenting symptom of CAH, but can be a significant cause of infertility in adult male CAH patients 5.
- TARTs can be distinguished from Leydig cell tumors based on clinical, histopathologic, immunohistochemical, and endocrine features 4.
- Fertility preservation is a key management goal in testicular tumor of adrenogenital syndrome 4.